Clinical Models
Week 14
Agenda
• Clinical models that turn
worry into action
• Clinical models that
strengthen self-evaluation
• Clinical models that
nurture self-respect
Clinical models that
strengthen self-evaluation
• Cognitive Behavioral
Therapy (Arnold A. Lazarus)
• Dialectical Behavior Therapy
(Marsha M. Linehan)
• Transactional Analysis (Eric
Berne)
Clinical models that
nurture self-respect
• Client Centered Therapy
(Carl Rogers)
• Narrative theory (Michael
White)
Cognitive Behavioral
Therapy (CBT)
• Modern adaptation by
Arnold Lazarus
Cognitive Behavioral
Therapy
•
Draws from
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cognitive therapies (Albert Ellis’ Rational Emotive
Therapy, Aaron Beck’s Cognitive Therapy) and
behavioral therapies (Pavlov, Wolpe, Skinner, Eysenk)
Here-and-now orientation
Briefer and time-limited (efficacy within <16 sessions)
highly instructive nature and the fact that it makes use
of homework assignments.
the goal of therapy is to help clients unlearn their
unwanted reactions and to learn a new way of
reacting.
Cognitive-behavioral therapy is based on the idea that
our thoughts cause our feelings and behaviors, not
external things, like people, situations, and events.
The benefit of this fact is that we can change the way
we think to feel / act better even if the situation does
not change.
CBT Techniques
• Techniques include:
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Validity testing.
Cognitive rehearsal.
Guided discovery.
Writing in a journal.
Homework.
Modeling.
Systematic positive
reinforcement.
– Aversive conditioning.
CBT Techniques (cont’d)
• Slow-talk/slow walk/slowing
down
• Stopping automatic negative
thinking (ANTs)
• The acceptance paradox: how
we keep the fires burning and
how to put them out
• Rational and helpful selfstatements that can become
permanent and "automatic”
CBT Techniques (cont’d)
• Continuing to move our selfstatements up
• Whose voice are you listening to,
anyhow? Do we have to listen and
believe all those old lies?
• The determination factor: becoming
more focused and gently determined
• Focusing: What are you paying
attention to?
• Later, it’s important we address:
– perfectionism, anger, frustration,
setbacks, and our view of the world
Dialectical Behavior
Therapy (DBT)
• Marsha Linehan
• Most noted for work with
clients with borderline
personality disorder
Dialectical Behavior
Therapy
• DBT combines
– standard cognitive-behavioral
techniques for emotion regulation
and reality-testing
• with concepts of
– mindful awareness,
– distress tolerance, and
– acceptance largely derived from
Buddhist meditative practice.
Teaching Interpersonal
Effectiveness within DBT
• The interpersonal effectiveness
module focuses on
– situations where the objective is to
change something (e.g., requesting that
someone do something) or
– to resist changes someone else is trying
to make (e.g., saying no).
• The skills taught are intended to
maximize the chances that a person’s
goals in a specific situation will be
met, while at the same time not
damaging either the relationship or
the person’s self-respect.
Teaching Emotion
Regulation within DBT
• Individuals with borderline
personality disorder and suicidal
individuals are frequently
emotionally intense and labile.
• They can be
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angry,
intensely frustrated,
depressed, or
anxious.
• This suggests that these clients
might benefit from help in learning
to regulate their emotions
Teaching Distress
Tolerance within DBT
• Distress tolerance skills
constitute a natural
development from mindfulness
skills.
• The goal is to become capable
of calmly recognizing negative
situations and their impact,
rather than becoming
overwhelmed or hiding from
them.
Transactional Analysis
• People are OK; thus each person has
validity, importance, equality of respect
• Most everyone has the capacity to think
• People decide their story and destiny, and
these decisions can be changed
• Freedom from historical maladaptations
embedded in the childhood script is
required
• The aim of change under TA is to move
toward autonomy (freedom from childhood
script), spontaneity, intimacy, problem
solving
Transactional Analysis
Client Centered Therapy
• Carl Rogers
• This technique uses a nondirective approach.
• This aids patients in finding
their own solutions to their
problems.
Client Centered Therapy
• Rogers stated that there are six
necessary and sufficient
conditions required for therapeutic
change:
– Therapist-Client Psychological
Contact
– Client incongruence, or Vulnerability
– Therapist Congruence, or
Genuineness
– Therapist Unconditional Positive
Regard
– Therapist Empathic understanding
– Client Perception
Narrative Therapy
• Michael White
• From the post-modern
branch of counseling
• Narrative therapy holds that
our identities are shaped by
the accounts of our lives
found in our stories or
narratives
Concepts of
Narrative Therapy
• The narrative therapist is a
collaborator with the client in
the process of discovering
richer ("thicker" or "richer")
narratives
• “The person is not the problem,
the problem is the problem.”
• Operationally, narrative therapy
involves a process of
deconstruction and "meaning
making”
Common Elements in
Narrative Therapy
• The assumption that narratives or stories
shape a person's identity
• An appreciation for the creation and use of
documents
• An "externalizing" emphasis
• A focus on "unique outcomes" or
exceptions to the problem
• A strong awareness of the impact of power
relations in therapeutic conversations, with
a commitment to checking back with the
client about the effects of therapeutic styles
• Responding to personal failure
conversations