INTRODUCTION TO COUNSELING AND PSYCHOTHERAPY BY: HARDIE GIEBEN M. CRUZ, MAED, LPT, RGC Theory Defined 2 A practical means or a framework in making systematic observations and explaining phenomena Attempts to explain & provide understanding of what happens in the counseling relationship Summarizes the information base of the philosophy and draws conclusions They explain behaviors Counseling 3 a process concerned with helping normally functioning or healthy people to achieve their goals or to function more appropriately tended to have an educational, situational, developmental, and problem-solving focus the helping professional concentrates on the present and what exists in the client’s conscious awareness may help people put into words why they are seeking help, encourage people to develop more options for their lives, and help them practice new ways of acting and being-in-the world Psychotherapy 4 Usually reconstructive, remedial, in-depth work with individuals who suffer from mental disorders or who evidence serious deficiencies A process of enabling a person to grow in the directions that he or she chooses More long-term, more intense process that assists individuals who have severe problems of living. 5 Counseling Rudimentary Skills 1. Attending 6 Attending involves actively paying attention to clients, and it is a vital aspect of avoiding the error of approach. accomplished through presence and focus be present or fully focused on clients means paying attention to what they say (the content) and how it is said (the process). 2. Active Listening 7 Active listening may entail nodding one’s head, verbal tracking (i.e., staying on the topic the client brings up), accurate summarization, and an ability to have the client feel heard (as evidenced by clients’ self-reports, “I feel like you are really listening to me when I talk”). 3. Reflection 8 One way to avoid making the error of interpretation, or the failure to accurately understand what another person is attempting to convey, is to use reflection. Reflection helps therapists attend to what is being communicated by conveying to clients a sense of what they are picking up from them. Counselors may choose to reflect the content (what is said) or process (how it is said) of clients. 4. Gathering Information 9 The skill of gathering information entails getting as much information as is necessary Counselors become more effective as they learn when to gather information and what type of information is relevant. To gather information a counselor needs to make a few basic inquiries 5. Questioning 10 Effective questioning is often accomplished when counselors are aware of the difference between content (what is said) and process (how it is said). By focusing on the client’s process rather than content, counselors move the focus from external to internal. 6. Empathizing 11 If we were to not only walk in another’s shoes, but live in another’s body, experiencing the other person’s cognitive functioning, affective range, every emotional experience, memory, and even only have access to that person’s psyche, we would have made every single decision that person has made 7. Self-Disclosure 12 If you want people to listen to what you are about to say, tell them it’s confidential. Self-disclosure means telling someone something about your life, something about you personally 8. Focusing 13 four steps to effective counseling: building rapport, establishing a contract, focusing the client, and funneling the session. the counselor’s job is to help the client focus on the issue at hand. 9. Providing Feedback 14 Two primary skills for counselors: to be able to accept feedback themselves, to be able to circumvent the error of language. People are much more likely to respect what they see as opposed to what they are told. Counselors must live out what they preach, and that begins with being able to accept feedback. 10. Confrontation 15 effective counseling relationships as antithetical rather than complementary. An antithetical relationship is one in which confrontation is essential. Antithetical literally means to “set in opposition”; this very definition is set in opposition to the literal meaning of the word complementary, which means “identical with” 11. Silence 16 Some clients process ideas and concepts in silence; Some have difficulty in silence and feel a need to fill what they perceive to be a void. Regardless of the reason, counselors have a responsibility to allow clients to own the silence The more counselors are comfortable with their own silence, the more they will allow clients to own the silence. 12. Goal Setting 17 Goal setting is contracting with clients about what they want. Short term and long term goals 13. Modeling 18 genuineness stems from congruence between the real or actual self (who we truly are) and the ideal self (either who we believe we are or who we strive to be Counselors are charged with the life- long pursuit of self-awareness. 14. Reframing 19 When people process events, they do so egocentrically at first, and usually only after time can they begin to develop a broader perspective on the event. To reframe what someone says, a counselor merely has to reflect what clients say in a different way from how the clients presented it. 15. Termination 20 Knowing the boundaries of professional relationships is important to preparing for the final or termination stage. Understanding when to terminate clients is a skill that takes experience, practice, and, most often, guidance from an outside entity, such as a supervisor. Components of Choosing a Theoretical Orientation to Therapy 21 Personal therapeutic belief systems Theoretical school affiliation-self-reported adherence to one or more theoretical schools Espoused theory- what the therapist says he or she does Theory-in-action- what is inferred by people observing the therapist’s behavior when working with clients 1 ETHICAL ISSUES IN COUNSELING PRACTICE Ethical Decisions 2 Mandatory ethics involves a level of ethical functioning at the minimum level of professional practice. Aspirational ethics focuses on doing what is in the best interests of clients. Positive ethics is an approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble (Knapp & VandeCreek, 2006). Some Steps in Making Ethical Decisions 3 Identify the problem or dilemma. Identify the potential issues. Look at the relevant ethics codes for general guidance on the matter. Consider the applicable laws and regulations, and determine how they may have a bearing on an ethical dilemma. Seek consultation from more than one source to obtain various perspectives on the dilemma, and document in the client’s record the suggestions you received from this consultation. Some Steps in Making Ethical Decisions 4 Brainstorm various possible courses of action. Enumerate the consequences of various decisions, and reflect on the implications of each course of action for your client. Decide on what appears to be the best possible course of action. The Right of Informed Consent 5 Informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it. Providing clients with information they need to make informed choices tends to promote the active cooperation of clients in their counseling plan. By educating your clients about their rights and responsibilities, you are both empowering them and building a trusting relationship with them. Seen in this light, informed consent is something far broader than simply making sure clients sign the appropriate forms. It is a positive approach that helps clients become active partners and true collaborators in their therapy. Dimensions of Confidentiality 6 Confidentiality is an ethical concept, and in most states it is the legal duty of therapists not to disclose information about a client. Privileged communication is a legal concept that protects clients from having their confidential communications revealed in court without their permission (Herlihy & Corey, 2015a). Ethical Issues in the Assessment Process 7 The Role of Assessment and Diagnosis in Counseling Assessment consists of evaluating the relevant factors in a client’s life to identify themes for further exploration in the counseling process. Diagnosis, which is sometimes part of the assessment process, consists of identifying a specific mental disorder based on a pattern of symptoms. Both assessment and diagnosis can be understood as providing direction for the treatment process Ethical Aspects of Evidence-Based Practice 8 Evidence-Based Practice (EBP): “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences”(APA Presidential Task Force on Evidence-based Practice, 2006, p. 273). Managing Multiple Relationships in Counseling Practice 9 Dual or multiple relationships, either sexual or nonsexual, occur when counselors assume two (or more) roles simultaneously or sequentially with a client. This may involve assuming more than one professional role or combining professional and nonprofessional roles. The term multiple relationship is more often used than the term dual relationship because of the complexities involved in these relationships, but both terms appear in various professional codes of ethics, and the ACA (2014) uses the term nonprofessional relationships. Ways of Minimizing Risk 10 Set healthy boundaries early in the therapeutic relationship. Involve clients in ongoing discussions and in the decision-making process, and document your discussions. Consult with fellow professionals as a way to maintain objectivity and identify unanticipated difficulties. When multiple relationships are potentially problematic, or when the risk for harm is high, it is always wise to work under supervision. Self-monitoring is critical throughout the process. Establishing Personal and Professional Boundaries 11 A boundary crossing is a departure from a commonly accepted practice that could potentially benefit a client. For example, attending the wedding of a client may be extending a boundary, but it could be beneficial for the client A boundary violation is a serious breach that harms the client and is therefore unethical. A boundary violation is a boundary crossing that takes the practitioner out of the professional role, generally involves exploitation, and results in harm to a client Social Media and Boundaries 12 Limit what is shared online. Include clear and thorough social networking policies as part of the informed consent process. Regularly update protective settings because social media providers often change their privacy rules. Becoming an Ethical Counselor 13 Ethical decision making is an evolutionary process that requires you to be continually open and self-reflective. Becoming an ethical practitioner is not a final destination but a journey that will continue throughout your career 1 THE COUNSELOR: PERSON AND PROFESSIONAL The Counselor as a Therapeutic Person 2 Personal Characteristics of Effective Counselors Effective therapists have an identity. Effective therapists respect and appreciate themselves. Effective therapists are open to change Effective therapists make choices that are life oriented Effective therapists are authentic, sincere, and honest Effective therapists have a sense of humor Effective therapists make mistakes and are willing to admit them Effective therapists generally live in the present Effective therapists appreciate the influence of culture Effective therapists have a sincere interest in the welfare of others The Counselor as a Therapeutic Person 3 Personal Characteristics of Effective Counselors Effective therapists possess effective interpersonal skills Effective therapists become deeply involved in their work and derive meaning from it. Effective therapists are passionate Effective therapists are able to maintain healthy boundaries The Counselor’s Values and the Therapeutic Process 4 Value imposition Refers to counselors directly attempting to define a client’s values , attitudes, beliefs, and behaviors. It is unethical for counselors to impose their values in the therapeutic relationship. Acquiring Competencies in Multicultural Counseling 5 Beliefs and Attitudes Knowledge Skills and Intervention Strategies Issues Faced by Beginning Therapists 6 Dealing With Anxiety Being Yourself and Self-Disclosure Avoiding Perfectionism Being Honest About Your Limitations Understanding Silence Dealing With Demands From Clients Dealing With Clients Who Lack Commitment Tolerating Ambiguity Issues Faced by Beginning Therapists 7 Becoming Aware of Your Countertransference Developing a Sense of Humor Sharing Responsibility With the Client Declining to Give Advice Defining Your Role as a Counselor Learning to Use Techniques Appropriately Developing Your Own Counseling Style Maintaining Your Vitality as a Person and as a Professional 8 Countertransference, defined broadly, includes any of our projections that influence the way we perceive and react to a client. This phenomenon occurs when we are triggered into emotional reactivity, when we respond defensively, or when we lose our ability to be present in a relationship because our own issues become involved. 1 PSYCHOANALYTIC THERAPY (Freud) View of Human Nature 2 Deterministic Maintains that an individual’s personality is fixed largely by the age of 6. People do not have free will, their behavior is determined by innate drives that have to do with sex and aggression or love and death Levels of Consciousness 3 Conscious Level: All of our thought processes operate; Only 10%; everything we are aware of Preconscious Level Contains our memories and thoughts that are not at the conscious level but that may threaten to break into the conscious level at any moment Events, thoughts, and feelings are easily recalled About 10-15% of the mind Levels of Consciousness 4 Unconscious Level The lowest and deepest level of awareness, or unawareness Hold the bulk of our past experiences, including all the impulses and memories that threaten to debilitate or destabilize our minds. Constitutes 75-80% of the mind Structure of the Mind 5 Id Biological self; most basic of the three Contains instincts, needs and wishes Preoccupied with its own needs and desires; self-centered Functions on primary process thinking: preverbal and dreamlike original, irrational state of libido; sets into operation a means for forming an image of something that helps reduce a drive Governed by pleasure principle, illogical, amoral, and driven to satisfy its instinctual needs and desires Structure of the Mind 6 Ego Develops most clearly about 6-8 mos Lies within the realms of the conscious, preconscious, and unconscious Rational, capable of forming realistic plans, functions as a liaison between the id and superego Reality oriented seeks to protect the self Functions on secondary process thinking: thinking directed toward problem-solving and self-preservation Has the capacity for rational decision making and decides when not to satisfy the urgings of the id Structure of the Mind 7 Superego Represents parental values and societal standards Operates on morality principle Seeks perfection and is oriented toward the past rather than the present or the future Uses introjections: involves a process of the individual’s incorporating the norms and standards of a culture into his or her culture. It is aided by the individual’s identification with significant adults during childhood 8 Common Defense Mechanisms 9 Repression Rationalization Regression Identification Displacement Reaction Formation Psychosexual Stages of Development 10 Oral Birth to 18 mos. Source of gratification: feeding and body organs associated with this function-mouth, lips, and tongue, along with the infant’s feelings of security that occur as a result of his or her being held Oral Personality: pessimism/optimism, suspiciousness/gullibility, self-belittlement/cockiness, passivity/manipulativeness; dependency Psychosexual Stages of Development 11 Anal 18 mos to 3 years old Main source of pleasure: anal area Involves power struggle; children become fixated at the anal phase if their caretakers are too demanding or overindulgent Anal Personality: stinginess, constrictedness, stubbornness, messy, disorganized, reckless, careless Psychosexual Stages of Development 12 Phallic 3-5 or 6 years old Settling for the most sexual conflict Source of gratification: genital area Oedipus and electra complex Phallic personality: reckless, narcissistic, excessively vain and proud; afraid or incapable of close love ( could be a major cause of homosexuality) Psychosexual Stages of Development 13 Latency 6-12 or puberty Child’s sexual drive lies dormant; unparalleled repression of sexual desires Children repress their sexual energy and channel it into school, friends, sports, hobbies, and direct their attention to the larger world It is a time for ego development and for learning the rules of society Psychosexual Stages of Development 14 Genital 13-18; signals the onset of adolescence Focus their sexual energy toward opposite sex or same sex More altruistic and less selfish than others People unable to make psychological attachments during adolescence and young adulthood will manifest abnormal personality patterns. 15 The Therapeutic Process 16 Begins with asking the person to lie down on a a couch, looking away from the therapist The person expresses whatever thoughts, feelings, or images that come to mind, without censoring, suppressing, or prejudging them The therapist sits behind the couch and listens in a nonjudgmental manner to the client The Therapeutic Process 17 Periodically, the therapist interrupts the client’s associations, helping him or her to reflect on the possible connections and significance of his or her associations. The therapist’s goal is to make the unconscious conscious, to interpret transferences, to work through and resolve such transferences, and to strengthen the client’s ego Childhood experiences are reconstructed, interpreted, and analyzed. Analytic therapy is directed toward achieving insight and self-understanding. Goals of Therapy 18 To bring about changes in an individual’s personality and character structure Helping those who are willing and able to participate in a lengthy and often painful process to achieve a resolution of some intrapsychic conflicts so that they might experience life in a mature manner. Goals of Therapy 19 To help clients achieve self-awareness, honesty , and more effective interpersonal relationships and gain better control over their irrational and id impulses. Ultimate goal: reorganization that promotes the integration of dissociated psychic material and results in a fundamentally changed, firmly established new structure of personality Role of the Therapist 20 Begins by evaluating whether the client is suitable for psychoanalysis People who do not dare regress from reality and those who cannot return readily to reality are poor risks for psychoanalysis Clients who have been diagnosed as schizophrenic, manic-depressive, schizoid, or borderline personalities are believed to be poor risks for psychoanalysis Role of the Therapist 21 Compassionate neutrality attitude should be maintained The therapist does not offer advice or extend sympathy The therapist is seen as very passive and detached. Focuses on intrapersonal conflicts The ideal client is one who is capable of pregenital fixations; genital personality is the ideal. Role of the Therapist 22 1. Opening Phase: Consists of therapist’s first contact with the client and lasts from 3-6 weeks Therapist notes everything that the client says and does for possible late ruse in treatment. Therapists assesses the nature of the client’s problems Introducing clients to the couch and techniques of psychoanalysis Focuses primarily on conflicts that are readily accessible to the client’s consciousness Role of the Therapist 23 2. Development of Transference The client was unconsciously reenacting forgotten childhood memories and repressed unconscious fantasies Transference prevents us from seeing others entirely objectively It is a form of memory in which the client repeats in therapy conflicts from his or her early childhood as if they currently existed. It helps clients distinguish fantasy from reality and the past from the present Role of the Therapist 24 3. Working-through phase Slow, gradual process of working again and again with the insights that have emanated from the therapist’s interpretations of resistance and transference. Entails clients’ gaining insights to their issues as a result of transference analysis Clients come to understand that they do not have to fear their impulses as they did when they were children, because in the transference relationship, they expressed those same impulses in intense words and were not castrated, rejected, or abandoned Role of the Therapist 25 4.Resolution of transference Both the therapist and client agree on a date to end the therapy. They must resolve any remaining attachments issues the client has with the therapist. Therapy Techniques 26 1. Free Association Cardinal technique which allows clients to say anything and everything that comes to mind regardless of how silly, painful, or meaningless it seems. One association leads to another that is deeper in the unconscious Permits clients to abandon their usual ways of censoring or editing thoughts. 27 Therapy Techniques 28 2. Dream analysis Pathway to the unconscious Manifest content: surface meaning of the dream Latent content: contains the deeper, hidden, and symbolic meaning Therapist’s task is to help the client uncover disguised meanings by studying the symbols in the manifest content of the dream 29 Therapy Techniques 30 3. Analysis of Resistance Resistance exists when client behaviors interfere with or hinder the analytic process It is an unconscious situation clients use to defend against anxiety Client resistance is an opportunity to gain insight into their client’s unconscious motivations or defensive mechanisms It is designed to help clients become aware of the reasons for resistance so that they can confront them. Therapy Techniques 31 4. Analysis of Transference Therapist interprets the distorted displacements of significant relationships clients experience during their transference onto the therapist Interpret client’s buried feelings, traumatic conflicts and unconscious fixations of early childhood Helps clients gain insights into the influence of their past on their present lives. Clients learn how to work through old conflicts that hindered their psychological growth. Libido Persona Consciousness Ego Introjections incorporated from outside the psyche Defense Mechanisms Subconscious Displacement Regression Denial Reaction Formation Confirmation Bias Projections from inside the psyche onto the outside world Unconscious Ebullition General Projections Anima/Animus Shadow True Self Complexes Archetypes Collective Unconscious Libido 32 1 ADLERIAN PSYCHOTHERAPY View of Human Nature 2 People are basically self-determined and that they forge their personalities from the meaning they give to their life experiences. People create their own lives by using their creative power It is the individual who must ultimately be responsible for making good use of his abilities People are motivated by their present perceptions and by their present expectations of the future. View of Human Nature 3 People do not determine meanings by situations, but they determine themselves by the meanings they give to situations. People create their own personalities, and they can change their personality by developing new attitudes His view is essentially optimistic, holistic, and phenomenological in orientation Theory of Personality 4 1. Social Interest Refers to the individual’s sense of being part of the human community and their attitudes toward others. An individual’s ability to empathize with others Social interest provides us with a basically positive outlook on life and an interest in developing the welfare of others Theory of Personality 5 2. Masculine Protest The desire to be a “real man”, a desire to be superior, to strive to be perfect. Men carefully hide their feminine traits through exaggerated masculine wishes and efforts Theory of Personality 6 3. Lifestyle Behaviors is lawfully organized and that each person develops a generalized pattern of responses to most situations Habitual pattern of behavior unique to each person Considered as the major key of our behavior Includes our goals, opinions of ourselves and the world, and he habitual behaviors we use for achieving desired outcomes Theory of Personality 7 4. Goal-directed and purposeful behavior All behavior is purposeful and goal directed As counselors we must first understand our client’s goals. When counselors help clients analyze their goals, they are taking important steps to helping them lead more productive lives Theory of Personality 8 5. Feelings of Inferiority All human beings begin their psychological life with feelings of inferiority It is the presentation of the person to himself and others that he is not strong enough to solve a given problem in a socially useful way It is more than a sense of inadequacy Its is inevitable, universal, and normal Theory of Personality 9 6. Striving for Superiority Used to explain our drive to master external obstacles, to gain power and status, and to arrive at a positive state Positive striving for perfection Theory of Personality 10 7. Fictional Finalism Can help us deal more effectively with reality, or they may block our attempts to accept reality. Fictional goals develop during early childhood, and they exist primarily at the unconscious level of awareness throughout one’s life. Our fictional goals influence the way we think, and act throughout our lives. Theory of Personality 11 8. Family Constellation Describes the composition of a family and one’s position within that system It is not what we are that determines our behavior, but rather, it is what we think we are that has the most impact on us. Theory of Personality 12 9. Birth Order First born: “reigning monarch”, given undivided attention Best understands the significance of power and the exercise of it Conservative in outlook, nostalgically look at the past, highly organized, responsible, conscientious One feels a sense of responsibility and takes care of others. Theory of Personality 13 Second Born Grows up knowing that he or she has to share parental time and attention Optimistic, competitive, and ambitious Strives in directions different from the first born Theory of Personality 14 Middle Child They are in a difficult and unfair position They are ambitious and develop a strong social interest Unfavorable outcomes they are rebellious and envious, they often experience difficulty being a follower Theory of Personality 15 Youngest Child Tends to be pampered within the family constellation May excel over all others o establish their place within the family Competitive orientation and become high achievers Theory of Personality 16 Only Child Not likely to develop a competitive spirit Develops exaggerated views of their own importance May develop rich imaginations Likely to be deficient in social interest 17 18 The Therapeutic Process 19 Usually time-limited, supportive therapy focused on specific problems Designed to bring about moderate insight, attitude change, and behavioral change May focus on parenting, marital relationships, and career choice and development Overall goal: to help a person develop from a partially functioning person into a person who lives life more cooperatively, more courageously. And with a greater sense of contribution to his community. Goals of Therapy 20 Establishing and maintaining a good client-therapist relationship Uncovering the client’s dynamics, which include his lifestyle, goals, family constellation, childhood illnesses , basic mistakes included in his lifestyle Developing interpretations that culminate in client insight Reorienting the client Three entrance gates to an individual’s mental life: Birth order position in the family of origin First childhood memory Dreams Role of the Therapist 21 Establish friendly relationship between equals Encourage clients to use their talents to help others---to develop a social interest Counselors tend to be active and talkative in therapy Confront clients with their basic mistakes, misplaced goals, and self-defeating behaviors. Encourage clients to develop new alternatives for reaching their revised goals Take a non-pathological view of clients’ difficulties Avoid labeling clients with the traditional medical model’s diagnoses. Instead help clients better understand themselves and to modify their life’s stories. Phases of Therapy 22 1. Establishing the Therapeutic Relationship Use humor and small talk to establish therapeutic alliance Help the client become a more cooperative person Therapist offers genuine warmth, empathy, acceptance and understanding Remain neutral in order to discuss possible improvements in their situations Phases of Therapy 23 2. Uncovering the Client’s Dynamics a.Assessment and Diagnosis Assess the client’s lifestyle Assess and interpret the client’s early recollections b. Analysis of Client’s Basic Mistakes (5 basic mistakes) Overgeneralizations: “People are no good” False or impossible goals of security: “I must please everyone, if I am to be loved” Misperceptions of life and life’s demands: “I never get any breaks” Minimization or denial of one’s worth: “I’m stupid” Faulty values: “I must be first, regardless of who gets hurt in the process” Phases of Therapy 24 c. Early Recollections as an Assessment Technique We select memories that coincide with our basic beliefs about ourselves and the rest of the world Earliest memories provide the therapist with an understanding of our mistaken beliefs, social interests, and future actions Phases of Therapy 25 d. Analysis of Client’s Dreams Dreams were a way of dealing with our insecurities Help us try out strategies for overcoming our limitations Can serve as bridge to what we want More problems you have, the more dreams you are likely to have Adlerian dream work involves examining the parts of a dream and analyzing what problems or inferiorities they might represent Phases of Therapy 26 Dreaming is purposive. Dreams prepare clients to solve their current problems or to overcome their present circumstances by rehearsing them for potential future actions Common dream symbols: Flying (moving or striving from below to above) Falling (moving or striving from above to below) Being chased ( an expression of inferiority or weakness in relation to others) Being unclothed in public ( fear of disclosure or being found out) Phases of Therapy 27 e. Integration and Summary of Adlerian Uncovering and Assessment Client’s subjective experience and life story; family constellation and developmental data, early recollections, personal strengths, basic mistakes and coping strategies Phases of Therapy 28 3. Client Insight and Self-Understanding Insight: client’s understanding of the purposive nature of his behavior and the mistaken beliefs that sustained it. Self-understanding results when therapists help clients make conscious hidden lifestyles and goals Phases of Therapy 29 4. Reorientation To help the client gain or regain the courage to face life’s challenges-to put insight into action and to redirect goals Client is encouraged to develop more social interest in others Client has learned to feel and function better Therapy Techniques 30 Time limits must be set with clients Sessions with children usually last for 30 minutes Adults: 45 to 50 minutes Homework assignments are usually made near the end of the therapy session A. Offering Encouragement 31 It is both a principle and a technique that pervades all of Adlerian therapy Encouragement is necessary for children’s healthy development Used in working with clients when they express faith and belief in them Therapist does the following: Values the client as he or she is Demonstrates faith in the client Tries to build a positive self-concept within the client Gives the client recognition for his or her efforts Concentrates on the strengths and assets of the client B. Asking the Question (Miracle Question in Solution Focused) 32 “If I could magically eliminate your symptoms immediately, what would be different in your life?” “What would be different if you were well?” C. Asking “As If” 33 Clients who state that they would do thus and so if only they possessed certain qualities are encouraged to act for a short period of time as if they possessed the qualities they believe they lack. It is based on the belief that clients must change their behaviors to elicit different responses from others. D. Using the Push-Button 34 Would ask clients to imagine pushing a button then direct them to picture a pleasant experience in as much as detail and vividness as possible Request clients to make note of the pleasant memory that made them feel good as they engaged in the imaginary push-button exercise Give the same directions—only this time asking clients to imagine a negative experience in as much detail as possible Tell clients that they can exercise inner control regarding how they feel at any moment by controlling what they think about Push-button technique 35 E. Catching Oneself 36 Permits clients to become aware of their self- destructive behaviors or thoughts without feeling guilty about them Clients are told to “catch themselves” when they are just about ready to revert back to their old ways and to substitute the new behavior. The goal is to help clients change maladaptive old habits F. The Midas Technique 37 Entails exaggerating the client’s irrational demands Helps clients to see that their wishes, when taken to their logical extreme, can be absurd. Clients laugh at their own wishes and positions taken G. Pleasing Someone 38 Designed to increase clients’ social interest Therapist suggests that the client do something nice or someone else Therapist might recommend that a client volunteer his or her service and have no expectation of a reward other than that which comes from serving another person The technique of pleasing someone helps put the client back into society H. Socratic Questioning 39 Leading an individual to insight through a series of questions Makes the client responsible for his or her own conclusions I. Task Setting 40 Therapists give homework assignments to give clients practice with a behavior The client finds threatening situations less and less frightening J. Creating Images 41 Used to describe clients with a single phrase, such as the beggar as a king Adlerians use images to describe clients K. Brainstorming 42 Brainstorms with clients’ alternatives beliefs and convictions. E.g. in place :”I never get what I want”; “Sometimes I get what I want”. L. “Spitting the in the client’s soup” 43 The intent is to spit in the client’s soup of excuses and hidden goals When therapists reveal the hidden purpose of a client’s symptom or behavior, they deprive him or her of the secondary gains that the symptoms provide M. Paradoxical Intention 44 The therapist helps the client overcome his own opposition by encouraging him to do that which he is complaining about. E.g. “never do anything you don’t like”; “don’t stop worrying”. Can be used to encourage a client symptom or to give him permission to do something. Asking clients to exaggerate or to amplify the target behavior to show the client how ridiculous the behavior is. 1 EXISTENTIAL THERAPY (ROLLO MAY AND VIKTOR FRANKL) View of Human Nature 2 Main focus deals with human existence and what it means to be alive To be human means asking questions about our very existence Searching for meaning in life is a distinctly human characteristic Our validation must come form within rather than from others People create their own values. People are free when they choose freely and when they accept the consequences of their actions. Existential Therapy 3 Individuals define who they are by their choices even though there may be factors beyond one’s control that restrict one’s choices Ontological experience, the science of “being” Basic concept: “being in the world” Umwelt: physical; Mitwelt: Social Eigenwelt: Psychological or self-knowing Uberwelt: Spiritual Therapists may help clients recognize outmoded ways of life and become willing to take the responsibility to change, to expand, and to find meaning in their lives that is unique to them. View of Human Nature 4 Levels of Being the World: Umwelt (Biological/Physical World): living cycles of organisms such as sleep patterns, drives, instincts Milwelt (Social World): refers to existence as influenced by our social relationships Eigenwelt (Self-Knowing/Psychological experience): refers to our own individual world, represents an attempt to understand ourselves; consists of our awareness, introspection and self-knowing Uberwelt (Spiritual World): refers to the spiritual world of being; people relate to the unknown and create a sense of an ideal world, as well as philosophical outlook on that world. It often leads to people finding something for which they are willing to live or die. 5 Goals of Therapy 6 Finding personal meaning: the client is encouraged to find his or her own personal meanings and truths about life. Taking responsibility for one’s decisions about living. Living in the present so that the client experiences life more fully each moment. Increasing self-awareness and authentic living Role of the Therapist 7 Facilitate client’s encounters with themselves Focus on the issue of client responsibility Assist clients in learning how to embrace responsibility rather than avoid it Assists clients in making choices, removing the obstacles that block their decision-making ability, and understanding the methods they use in arriving at decisions. Therapy Techniques 8 Free to use techniques across the broad schools of thought, including diverse techniques such as desensitization and free association Primary guideline: address the uniqueness of each person Initial Phase: help clients identify and clarify their beliefs about their worlds. Clients are encouraged to explore the ways in which they make sense of their being Middle Phase: examines clients’ values and their sources Final Phase: focuses on helping clients take action regarding the kind of life they want. Logotherapy 9 3 Basic Assumptions: Life has meaning under all circumstances People have a will to meaning People have the freedom under all circumstances to activate the will to meaning and to find meaning in life Logotherapy 10 Techniques: Socratic Dialogue: Conversational method used to raise clients’ consciousness about their possibilities Therapist asks specific questions to raise into consciousness the possibility to find, and the freedom to fulfill, meaning in one’s life Paradoxical Intention Directs a client to do something contrary one’s actual intentions Labeled Dereflection People encounter problems because they put too much emphasis on themselves When people shift their attention to others, their own personal problems seem to lessen 11 BEHAVIOR THERAPY 1 John Watson, B.F. Skinner, Joseph Wolpe, Donald Meichenbaum View of Human Nature 2 People are basically neutral at birth; they are neither good nor bad People are influenced by what happens to them and by what they learn Learning can result in the development of any pattern of human behavior, provided that the person has a certain learning history and biological capability Includes both personal and environmental determinants of human behavior Theory of Personality 3 1. Classical Conditioning (Pavlov) 2. Operant Conditioning (Skinner and Thorndike) Consequences that follow behavior help learning Behavior is changed by systematically changing the consequences It occurs when a behavior is followed by a consequence, and the nature of the consequence changes a person’s or an organism’s tendency to repeat the behavior in the future. We are more likely to increase behavior that is rewarded and to decrease behavior that is either punished or not reinforced. Theory of Personality 4 3. Reinforcement To strengthen some behavior. It refers to any stimulus that strengthens or increases the likelihood of a specific response from a person. Positive Reinforcement: adding something to increase a response Negative Reinforcement: when a certain stimulus is removed after a specific behavior is exhibited. It involves taking something away to increase a response Punishment: adding something aversive for the purpose of decreasing a behavior; helps decrease a behavior Theory of Personality 5 4. Extinction Takes place when reinforcers are withdrawn or unavailable, and people stop demonstrating a behavior A process of removing an unwanted response by not reinforcing it. 5. Generalization When behavior is reinforced on a consistent basis, it may become generalized to other situations Theory of Personality 6 6. Discrimination Learning how to respond differently to stimuli, depending on the situation with which we are presented 7. Shaping Behavior that is learned gradually in steps by successive approximation Shaping takes place when a person actually practices a behavior. Theory of Personality 7 8. Counterconditioning E.g. desensitization Because anxiety can be learned through conditioning, it can be unlearned by a process of counterconditioning 9. Token Economies To shape client behavior when approval and other reinforcers do not work Provide a concrete measure of a person’s motivation to change specific behaviors Individuals can decide how to use their tokens, thereby giving them a sense of control over their lives The Therapeutic Process (Perspectives) 8 Counseling and psychotherapy should focus on client’s observable behavior and their life responses, not on their unresolved, unconscious conflicts. Learning is a central principle for understanding and changing a client’s behavior. Clients’ changes in behavior are governed by the law of effect: “behavior that is followed by satisfying consequences will be more likely to be repeated and behavior that is followed by unsatisfying consequences will be less likely to be repeated. The Therapeutic Process (Perspectives) 9 Learning is also governed by contingencies. Clients change their behaviors as they discover relationships between sequences of events and their behaviors— associate learning Behavior therapy is an individual-focused approach. It takes a non-pathological approach to what other schools of thoughts label as mental illness. The Therapeutic Process (Perspectives) 10 Most abnormal behavior is assumed to be acquired through learning and maintained in the same manner as normal behavior Instead of focusing on the past, behavioral assessment examines the current determinants of behavior. The therapist conducts a prior analysis of the problem into its components or subparts The Therapeutic Process (Perspectives) 11 Therapist develops treatment strategies that are individually tailored for each client, depending on the issue for which they request assistance It is not essential for a behavior therapist to understand the origins of a psychological problem in order to produce positive client behavioral change. Behavior therapists must commit to the scientific method in their work with clients The Therapeutic Relationship 12 Behaviorists establish a warm and empathic relationship with clients It is central in behavior therapy because the therapists must be able to get clients to trust them in such sensitive issues as dealing with their deepest fears. Goals of Therapy 13 The counselor informs the client about the need for goals, the role that they play in therapy, and the client’s involvement in the goal-setting process. The client indicates the positive changes he or she desires from therapy. Emphasis is placed on what the client wants rather than what he or she does not want. The therapist highlights that change can only come from the client and the fact that the client must accept responsibility for the desired change in behavior. Throughout the therapy process, the client and therapist work on identified goals, revising them as the need arises. A plan of action is developed to achieve the identified goals. Role of the Therapist 14 Function as consultants in producing behavioral change Active and directive during counseling Conduct a complete functional assessment to identify the variables that maintain the conditions about which the client complains Generate initial treatment goals and construct a treatment plan to achieve these goals Role of the Therapist 15 Teach concrete skills to the client by instruction, modeling, and performance feedback Use therapy techniques to promote maintenance of behavior change Measure the effectiveness of treatment procedures Complete follow-up assessments Role of the Client 16 Agreeing to perform homework assignments and by engaging in behavioral rehearsal until skills are learned. Clients who come to therapy are motivated to change Behavior Therapy Techniques 17 1. Relaxation Training Techniques: should be individualized for each client 2. Reciprocal Inhibition and Systematic Desensitization Reciprocal inhibition: based on the inhibition of responses by the occurrence of another response that is incompatible with it. E.g. relaxation training Systematic desensitization Training in deep muscle relaxation Construction of anxiety hierarchies Matching specific anxiety situations from the hierarchies with relaxation training Behavior Therapy Techniques 18 3. Stress Inoculation Training Designed to help inoculate people against collapse as they experienced stress. Goal: to change individual’s beliefs about the behaviors and statements they make to themselves regarding how they deal with stress Helps clients to induce a relaxation response, engage in cognitive restructuring, and perform effective problem-solving skills Exposure Therapies 19 General category of behavior techniques that are designed to treat phobias and a wide range of other behaviors Therapists introduce clients to the situations that have contributed to their problems 1. Flooding: constitutes either an in vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time. The therapist exposes the client to a safe version of the fearsome stimulus at maximum intensity Exposure Therapies 20 2. In Vivo: refers to procedures that takes place in the client’s actual environment 3. Implosive Therapy: Client imagines all anxiety situations The imagined anxiety scene are exaggerated to elicit as much anxiety as possible The imagined scenes are based on hypothesized sources of anxiety, which are psychodynamic in nature 21 REBT (Albert Ellis) View of Human Nature 22 People are born with a potential for irrational or rational thinking Human beings have predispositions for selfpreservation, happiness, and growth actualization People are constructivists and have a great deal of resources for human growth. Theory of Personality 23 ABC Model of personality A: activating event or experiences, such as family problems or early childhood trauma, that trigger stress or worry B: belief system—the cognitive component in our reaction to events. Especially important are irrational, self-defeating beliefs that form the source of our unhappiness C: consequences (the neurotic symptoms and negative emotions, such as depression, anger, and rage) that come from our beliefs D: Disputing Irrational Thoughts and beliefs Detecting Debating discriminating E: Cognitive and Emotional effects of revised beliefs 24 The Therapeutic Process 25 Designed to help clients gain a more realistic, rational philosophy of life Therapist does not devote much time to examining the morbid details of the client’s life Challenges clients’ irrational beliefs in the first few sessions Intended to be a brief therapy (1-10 sessions) The Therapeutic Process 26 Clients with sever disturbances are encouraged to come to individual and/or group sessions for at least 6 months 2 techniques: Tape the entire session. Clients then listen to the recordings several times so they can ascertain their problems and the REBT way of handling them To give REBT Self-Help Form to teach clients how to use the method when they experience emotional problems between therapeutic sessions The Therapeutic Relationship 27 General REBT: similar to CBT Preferential REBT, which stresses a deep philosophical change in the client’s life and way of relating to people 3 powerful insights: Person’s self-defeating behavior usually stems from the interaction of A and B; such that A+B=C People have made themselves emotionally disturbed because they keep indoctrinating themselves with similar irrational beliefs Clients recognize that only hard work and practice will correct irrational beliefs. Clients must commit themselves to repeated challenging of irrational thoughts until they are fully extinguished. Role of the REBT Therapist 28 Must understand belief systems and how to distinguish rational and irrational beliefs. Primary role: focus on the main irrational ideas that lie behind the feelings clients have expressed in therapy, especially their ideas that is awful the way in which people have treated them Role of the REBT Therapist 29 3 phases: Cognitive Phase: therapist presents the cognitive rationale for REBT to the client. It is devoted to clients writing down their troublesome thoughts. Emotive Phase; clients are instructed that they can learn to control their emotions by becoming fully aware of the thoughts that support such emotions and by learning to substitute alternative thoughts Behavioristic Phase: clients are taught to change their behavior Role of the Client 30 Individuals who are out of contact with reality, in a highly manic state, seriously autistic or brain injured, and in lower ranges of mental deficiency are not good candidates for REBT More effective clients who have a single major symptom such as depression. Clients are instructed to focus on the present and not on the past Expected to participate actively in the therapeutic process and to complete assignments. Counseling Techniques 31 Uses a variety of therapeutic techniques: didactic discussion, bibliotherapy, role playing, assertion training, operant conditioning, activity-oriented homework assignments Changing one’s language Imprecise language contributes to distorted thinking Clients learn how to change their “musts” to “preferences” Humor: emotional disturbance comes from taking oneself too seriously Counseling Techniques 32 Shame-attacking exercises: to help clients reduce shame over how they behaved. Such exercises are designed for increasing client self-acceptance. Disputing Detailed examination sentence by sentence of any irrational belief that the client states during therapy Using three forms of disputation: Cognitive: attempts to persuade the client by asking direct questions; e.g. “Can u prove it?”; “How do u know”? Imaginal: ask client to imagine themselves in the situation about which they feel uncomfortable Behavioral: if clients continue practicing rational emotive imagery, they can reach the point where they no longer feel upset over negative events Counseling Techniques 33 Emotional Control Card Wallet sized and contains four emotionally debilitating categories: anger, self-criticism, anxiety and depression; a list of inappropriate feelings, and a parallel list of appropriate feelings The goal is to get clients to become aware of the feelings that they are using and to encourage them to rationally choose the emotions they display. 1 GESTALT THERAPY (PERLS) Contributions of Gestalt Psychology to Gestalt Therapy 2 An individual’s behavior is a Gestalt, a whole that is greater than the sum of its parts. An individual experiences the world according to the principles of a figure-ground relationship. An individual will seek closure of an incomplete gestalt. An incomplete gestalt draws an individual attention until it is unified and stabilized An individual will complete gestalts on the basis of his or her most prevalent need A person’s behavior can be most meaningfully understood only in its immediate context. Gestalt Counseling 3 A therapeutic approach in which the therapist assist the client toward self-integration and toward learning to utilize his energy in appropriate ways to grow, develop, and actualize Primary focus: here and now Major objective: integration of the person/ “getting it all together” Therapist seeks to increase the client’s awareness Client must also learn to take responsibility for themselves Framework for Gestalt 4 Individuals are composite wholes made up of interrelated parts Individuals are also part of their own environment and cannot be understood apart from it People choose how they respond to external and internal stimuli. They are actors, nor reactors People have the potential to be fully aware of all their sensations, thoughts, emotions, and perceptions Individuals are capable of making choices because they are aware Framework for Gestalt 5 Individuals have the capacity to govern their own lives effectively People cannot experience the past and the future. They can only experience themselves in the present People are neither basically good nor bad. Emphasis on the “NOW” 6 E.g “what are you doing now?” Avoids the why or cause questions Emphasize the Eigenwelt ( the relation to oneself) rather than the past. “lose your mind and come to your senses” The Therapeutic Process 7 Highly verbal and experiential Therapy focuses on what is happening in the moment-to-moment therapeutic process rather than on what is being discussed (the content). Therapist is highly intuitive and can be compared to an artist Clients become aware of what they are doing, how they are doing it, and what they need to do to bring about desired change Here-and-Now Principles 8 Live now; stay in the present. Live here; be with the present. Stop imagining; experience reality. Stop unnecessary thinking. Expressing rather than manipulating, explaining, justifying, or judging. Do not restrict your awareness; give in to your awareness of unpleasantness. Accept no “should” or “ought” other than your own. Take full responsibility for your own actions, feelings, and thoughts. Surrender to being who you are right now. Gestalt Rules for Therapists 9 1. The principle of Now: always use the present tense and deal with life in the present rather than in the past. 2. The use of I instead of It: helps clients substitute personal pronouns (take responsibility for feelings) for impersonal ones. 3. Focusing on how and what rather than why: gestalt therapists maintain that when clinicians ask why questions, they are requesting a rationale/excuse from clients. Gestalt Rules for Therapists 10 4. The conversion of questions to statements: People sometimes hide behind their questions. Gestalt clinicians ask clients to change their questions into statements 5. Paying attention to client’s language patterns: a client’s language can both describe and conceal. Eg. Perhaps, sort of, possibly, I can vs I won’t 6. Listening to clients metaphors: you learn about their internal and external struggles. The therapist translates the meaning of these metaphors into manifest content so that it can be dealt with in therapy 11 Techniques 12 1. The Hot Seat Designed to bring about greater self-awareness among clients who are usually in a group setting Members are told that anyone who wants to work may sit in a chair facing the leader The person who decides to sit in the chair is told to begin by stating a specific life problem 10-30 minutes or until the individual or the leader feel closure has been reached 13 Techniques 14 2. Now and How NOW refers to a person’s immediate awareness of experiencing. E.g. “Now I am feeling like a hopeless child, still clinging to my mother’s apron’s string”. HOW refers to a person’s description of the manner in which certain feelings are experienced. E.g. “What are the sensations you experience when you feel like a child, clinging to your mother’s apron’s string?” Techniques 15 3. Top dog and Underdog Introjections Refers to the process by which people take into themselves aspects of other people, especially their parents. There may be a split between what they want to do and what they feel they should do. “should” introjections is known as topdog, it is equivalent to superego. E.g “if you don’t act like a good girl, then you’ll be called cheap trash, and nobody will ever respect you.” Underdog attempts to control top dog by reacting defensively, apologizing and playing the role of “nobody likes me”. Clients who operate from the underdog position are usually passive aggressive, make excuses for behavior, and have countless reasons for delay. Those who play underdog have great resentment toward those whom they consider their top dog Techniques 16 4. Dreamwork ‘messages” that reflect a client’s place at a certain time. Clients present dreams and then the therapist directs them to experience what it is like to be each part of the dream The goal is to bring dreams back to life and to relive them as if they were happening now Clients with repetitive dreams are encouraged to understand that unfinished business is being brought into awareness and that there is a need to take care of the message the dream delivered. Techniques 17 5. Making the Rounds Used primarily in groups; confrontation is at its height E.g. ‘I hate everyone in this room”; therapist: “Make that statement to each person here, and in doing so, express your feelings about each person.” “Why are you in touch within this group?” Techniques 18 6. Role Reversal May be used in group or individual therapy Used to help clients understand that their overt behavior may represent the opposite of their latent impulses A client may be asked to role-play a specific feeling or behavior that seems the opposite of what he or she wants. Techniques 19 7. Homework Might entail having clients write dialogues between parts of themselves or between the parts of their bodies. Techniques 20 8. Rehearsal Clients can gain awareness of how much time they use preparing to play their social roles or the effort required when they are trying to be something other than what they are. Rehearsal permits practice and modeling of desirable behaviors, especially in situations that provoke in clients strong avoidance anxiety Techniques 21 9. Exaggeration Requires clients to accentuate behavior or gestures of which they may only be mildly aware Exaggeration of body language, including gestures, tone of voice, posture, and facial expressions, can promote clients’ awareness of incongruences between their verbal messages and their nonverbal communications. Techniques 22 10. Withdrawal Individual’s right to withdraw from contact and from therapy. It symbolizes the organismic regulation of the person; people decide for themselves whether they want to be left alone or in contact with other people Helps a participant withdraw psychologically from a group if that individual indicates he or she wants to do so. E.g. “try to relax and imagine that you are going to leave this group.” What are you experiencing now? Can you try to put yourself into what you are experiencing now?” 1 REALITY THERAPY View of Human Nature 2 Assumes that all behavior come from within People choose their behavior, and they choose the best behavior for their needs at any given time. View of Human Nature 3 5 genetic/basic needs that drive us: Survival: eating, drinking, sleeping, seeking shelter, avoiding illness Belonging and love: need to love and be loved, to share, and to cooperate; forming friends and involvement within our families and other people; it is the primary need in people Power: achieving and accomplishing our goals and by being recognized and respected within our families, at work, and within the general society Freedom: making daily choices in our lives Fun: our desire for pleasure and enjoyment View of Human Nature 4 Our basic needs provide the general motivation for everything we do in life Our brains continually monitor whether or not our needs are being met. As a result, people may experience a gap between their needs and what they are getting. They choose behavior to close the gap between their needs and wants Control: Key Component in RT 5 “The only person I can really control is myself” Trying to control others is a never-ending battle that alienates one from others and causes pain and frustration RT therapists teach clients to focus on what is in their control and to respect the right of other people to seek means to meet their needs 10 Axioms of RT 6 axiom is a claim that could be seen to be true without any need for proof 1. The only person whose behavior we can control is our own. 2. The best a therapist or another person can do is to give information to a person. 3. All long-lasting psychological disturbances are relationship problems. 4. A person’s relationship problem is always part of his or present life. 5. Although the past may affect what we are today, we can only satisfy our basic needs in the present and plan to continue satisfying them in the future. 10 Axioms of RT 7 6. We can only satisfy our needs by satisfying the pictures in our quality world. 7. All we do is behave. 8. All behavior is total behavior and is made up of four components: acting, thinking, feeling, and physiology. 9. All total behavior is chosen, but we only have direct control over the acting and thinking components. We control our feelings and physiology indirectly through how we choose to act and think. 10. All total behavior is named by verbs and named by the most recognizable part. 7 Deadly Habits 8 Deadly habits: Criticizing Blaming Complaining Nagging Threatening Punishing Bribing/rewarding to control 7 Caring Habits 9 Caring Habits: Supporting Encouraging Listening Accepting Trusting Respecting Negotiating differences The Therapeutic Process 10 Therapist is directed to establish a friendly personal counseling relationship Therapists are involved with clients from the beginning and create warm, supportive, and challenging relationships As the therapeutic relationship becomes deeper, the therapist becomes firmer Involvement and concern for clients are conveyed throughout the counseling process. RT therapist is friendly, warm, and optimistic The goal is to help clients meet their basic need of belonging Avoid criticizing clients, accepting their excuses, and giving up on them Goals of Therapy 11 Overarching: To meet their basic needs To help clients learn more effective ways of satisfying all basic needs Begin by asking clients what they want and what brings them to counseling Build a satisfying relationship with the client Role of the Therapist 12 1. Teacher and Collaborator Accept no excuses for irresponsible client behavior Does not stay in the past, unless it is related to the present or a source of strength Avoid punishing, criticizing, or arguing with clients 2. Encourager Does not give up on clients when they have failed to implement their plans Convey that there is always hope, no matter how bad things seem Seeks to teach clients how to fulfill their needs Role of the Therapist 13 3. Assessment Assess clients’ total behaviors Do not interpret the clients’ symptoms. Symptoms persist because they are needed to help a client deal with unsatisfying relationships or the inability to satisfy basic needs 4. Focus on the Present rather than the Past Therapist only goes back to the past to learn about needs and how they were satisfied previously The goal is to help clients satisfy their needs in the present. Reject transference because it allows both the therapist and client to avoid being who they really are. Role of the Therapist 14 5. Importance of Relationship in Client’s Life An unsatisfying relationship or the lack of a relationship causes problems in a client’s life Poor relationships are the heart of most unhappiness Therapist must guide the client to a satisfying relationship and teach the client to behave in more effective ways. Clients discover that their problems are the way they have chosen to behave. 15 Therapy Techniques (WDEP System, Wubbolding) 16 W: wants and needs Seek to help client discover what they want Assist clients to recognize, define, and redefine their basic needs and how they would like to meet them E.g. Does your behavior help you or hurt you? By doing what you are doing, are you getting what you want? Are you breaking the rules? Are your wants realistic and attainable? What would you be doing if you were living the life you would like to lead? Do you really want to change your life? What is it that you are not getting from life? What stops you from getting what you would like to get out of life? Therapy Techniques (WDEP System, Wubbolding) 17 D: Direction and Doing Raise clients awareness of their current total behaviors E.g. What are you doing? Where are you heading? What are your recent success? Recent challenges? What have you tried so far? Hold a mirror before the client and ask: How do you see yourself now and in the future? Encourage clients to change what they are doing and thinking Therapy Techniques (WDEP System, Wubbolding) 18 E: Evaluation Therapy is directed towards getting clients to evaluate their behavior Helping clients engage in an inner evaluation is at the core of RT Based on the belief that people do not voluntarily change their behavior until they evaluate that what they are doing is not working E.g. Does your current behavior help you get what you want now, and will take you in the direction that you desire? Is what you are doing helping you? Is your behavior working for you? Is what you are doing in your best interests or in the best interests of those you care about? If nothing outside you changes—such as at work or within your family---what will you do? Therapy Techniques (WDEP System, Wubbolding) 19 P: Planning Formulate an action plan that contains possible replacement behaviors for ineffective ones A plan helps clients focus their thoughts and behaviors Elements of a good plan: SAMIC (Wubbolding) Simple Attainable Measurable Immediate Controlled by the planner, consistently practiced, and committed to by the client. Therapy Techniques (WDEP System, Wubbolding) 20 Some qualities of a good change plan are as follows: Flexible and open to modification Stated positively in terms of what the client is willing to do (behave) Capable of being completed independently without the assistance of others Repetitive and performed daily 21 Person-Centered Therapy Learning Objectives determine the role of the therapist in the person centered therapy distinguish the therapeutic goals and techniques in the therapy Carl Rogers In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth? The good life is a process, not a state of being. I t is a direction, not a destination. Relationship to Existing Theory Based on concepts of humanistic psychology brought to the US by Jews fleeing the Nazis Was developed as non-directive counseling In reaction to the directiveness of psychoanalytic theory Falls into what has been termed the third force in therapy An alternative to both psychoanalysis and behaviorism Theory Development First Period -- 1940s Nondirective Counseling Developed in reaction to psychoanalytic approach Challenged the basic assumption that “counselor knows best” Second Period -- 1950s Client-Centered Therapy Reflects emphasis on the client rather than on nondirective methods Characterized by shift from clarification of feelings to a focus on the phenomenological world of the client Focused more actualizing as a motivational force Theory Development Third Period -- 1950s – 1970s Openness to experience Trust in one’s experience Internal Locus of Evaluation Willingness to be in process Encounter Groups, Applied in education as student-centered Existentialism & Humanism: Similarities Share a respect for the client’s subjective experience Trust in capacity of the client to make positive and constructive conscious choices Emphasize concepts such as freedom, choice, values, personal responsibility, autonomy, purpose and meaning Parallel concepts with regard to the client-therapist relationship at the core of therapy Both adopt a phenomenological stance Call for therapist to enter the subjective world Both emphasize client’s capacity for self-awareness Existentialism & Humanism: Differences Existentialists believe that, as humans, we are faced with the anxiety of choosing to create an identity in a world that lacks intrinsic meaning Humanists believe each person has a natural potential that we can actualize and through which we can find meaning Major Philosophical Assumptions Belief that people are resourceful, capable of self-direction and able to live effectively and successfully People will move in positive directions if the way is clear for them to do so When people are free to do so, they will find their own way Has little faith in the role of experts who direct others toward self-betterment Major Philosophical Assumption, cont… Humanistic philosophy is compared to the acorn, which, if provided the right nurturing conditions will automatically grow in positive ways, pushed naturally toward actualization as an oak tree. Major Philosophical Assumption, cont… Becoming increasingly actualized = An openness to experience A trust in oneself An internal source of evaluation A willingness to continue growing Central Constructs & Tenets Therapist can promote client growth by demonstrating: Congruence Unconditional positive regard Accurate empathy Self actualization These result in people being less defensive, letting go of rigid perceptions and being more open to self-actualization Congruence Genuineness & Caring Real without False Front Considered by Rogers as most important Trying too hard to be genuine can lead to incongruence Therapist does not have to be fully selfactualized in order to be effective: However, Congruence must be present in the counseling relationship Unconditional Positive Regard Refers to acceptance of the worth of the person; not acceptance or approval of all behaviors Accurate Empathy Able to grasp the subjective world of another Implies that the therapist will sense the client’s feelings without getting lost in them (losing own identity) Easier said than done, learning it sometimes feels silly (example of mirroring in counselor training) Self-Actualization Looked at the healthy rather than the sick side of clients and at the value of their moving toward self-actualization through which they experience Tolerance of uncertainty Acceptance of self and others Spontaneity and creativity Comfort with solitude Autonomy Capacity for deep personal relationships Sense of humor Genuine caring for others Inner-directedness Positive outlook on life Therapeutic Frame of Reference Present Past is important only as it contributes to current awareness Therapeutic Goals To achieve a greater degree of integration and independence To focus on the person rather than on the presenting problem. No preset goals Client with the help of a trusted, facilitating therapist will set own course View of Pathology Clients come to therapy in a state of incongruence (discrepancy between selfperception and their experience in reality) with resultant anxiety Feel sense of helplessness and powerlessness toward making appropriate decisions to direct their own life Since the drive toward higher levels of psychological maturity are deeply rooted, person-centered therapy can be effective with normal and maladjusted persons Therapeutic Objectives Congruence Increased trust in self Increased willingness to explore alternatives Increased personal resources Role of the Therapist To establish a therapeutic climate (i.e., congruence, empathy, unconditional positive regard) that facilitates growth and change. Clients should be able to: Feel understood and accepted without judgment Lower their defenses to self-exploration and feel more open to experience Discover hidden aspects of themselves Become more realistic Perceive others with greater accuracy Relationship of Counselor & Client Quality of relationship determines outcome of counseling 2 people are in psychological contact Client is in state of incongruence, being vulnerable or anxious Counselor is congruent or integrated in the relationship Counselor experiences unconditional positive regard for the client Counselor experiences an empathic understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client The communication to the client of the counselor’s empathic understanding and unconditional positive regard is to a minimal degree achieved Clients should be able to… Feel safer and less vulnerable Accept themselves more as they are Become truer to themselves and less affected by others’ expectations Become more self-directed Perceive the past as less deterministic Multicultural Contributions Significant contributions to cross-cultural communication Person-centered philosophy and practice is studied and practiced in many different cultures Emphasis on core conditions increases the utility of approach for understanding diverse worldviews Multicultural Limitations Some clients desire more structure Difficult to translate the core conditions into actual practice in some cultures Communication of conditions must be congruent with client’s cultural framework Internal Locus of Evaluation Some cultures value collectivism more than individualism