ETHICS ETHICAL PRINCIPLES OF COUNSELING AND HELPING - Fidelity – pertains to honoring the trust paced in the practitioner. - Autonomy – it relates to respect for the client’s right to be self-governing. - Beneficence – a commitment to promoting the client’s well-being based on professional assessment. - Non-maleficence – founded on the commitment of avoiding harm to clients. Justice – the principle of justice means the fair and impartial treatment of all clients and focuses on providing adequate services. Self-respect – counseling practitioners need to foster their self-knowledge and to care for themselves. - - ETHICAL CODES AND GUIDELINES The concept of ethics relates to moral consideration. The challenge lies in what is considered moral or ethical. Ethical guidelines or codes are used by groups and organizations to define what actions are morally right and wrong. CONFIDENTIALITY Before commencing their placements, trainees need to familiarize themselves with any limitations on confidentiality the agency or institution requires, so that they can communicate these limitations to clients in advance. - EXISTENTIAL THERAPY more a way of thinking, or an attitude about psychotherapy, than a particular style of practicing psychotherapy. existential psychotherapy is an attitude toward human suffering and has no manual. asks deep questions about the nature of the human being and the nature of anxiety, despair, grief, loneliness, isolation, and anomie. focuses on exploring themes such as mortality, meaning, freedom, responsibility, anxiety, and aloneness as these relate to a person’s current struggle. it emphasizes self-reflection, recognizing life choices, and making decisions based on the belief that we are free and responsible for our choices and actions. Freedom implies that we are responsible for our lives, for our actions, and for our failures to take action. Existential guilt is being aware of having evaded a commitment, or having chosen not to choose. Authenticity implies that we are living by being true to our own evaluation of what is a valuable existence for ourselves; it is the courage to be who we are. The basic dimensions of the human condition, according to the existential approach, include (1) the capacity for self-awareness; (2) freedom and responsibility; (3) creating one’s identity and establishing meaningful relationships with others; (4) the search for meaning, purpose, values, and goals; DUAL RELATIONS AND SEXUAL CONTACT (5) anxiety as a condition of living; and Dual relations are those where the participants engage in a relationship that has a different agenda from their professional relationship. (6) awareness of death and nonbeing. Two Main Types of Dual Relationship: 1. 2. Trainees on placement and client Supervisor and trainee ETHICS AND STAFF-TRAINEE RELATIONS On counselling courses, it is preferable if staff and trainees can develop a set of ethical group norms regarding how they treat one another and clients. Meaninglessness in life can lead to emptiness and hollowness, or a condition that Frankl calls the existential vacuum. Logotherapy is designed to help clients find meaning in life. The therapist’s function is not to tell clients what their particular meaning in life should be but to point out that they can create meaning even in suffering (Frankl, 1978). Existential anxiety is the unavoidable result of being confronted with the “givens of existence”—death, freedom, choice, isolation, and meaninglessness. Normal anxiety is an appropriate response to an event being faced. JAMES BUGENTAL (1915-2008) Failure to move through anxiety results in neurotic anxiety, which is anxiety about concrete things that is out of proportion to the situation. - ➢ - - - ➢ GOALS to assist clients in their exploration of the existential “givens of life,” how these are sometimes ignored or denied, and how addressing them can ultimately lead to a deeper, more reflective and meaningful existence. best considered as an invitation to clients to recognize the ways in which they are not living fully authentic lives and to make choices that will lead to their becoming what they are capable of being. aims at helping clients face anxiety and engage in action that is based on the authentic purpose of creating a worthy existence. Existential therapists are mainly concerned about helping people to reclaim and re-own their lives. - wrote about life-changing psychotherapy, which is the effort to help clients examine how they have answered life’s existential questions and to invite them to revise their answers so they can live more authentically coined the term “existential-humanistic” psychotherapy was a leading spokesman for this approach ➢ ROLE OF THERAPIST AND CLIENT - - KEY FIGURES IN CONTEMPORARY EXISTENTIAL PSYCHOTHERAPY - VIKTOR FRANKL (1905–1997) - born and educated in Vienna A psychiatrist and Holocaust survivor, his logotherapy is a form of existential therapy that focuses on finding meaning in life - ROLLO MAY (1909–1994) - emphasized the importance of anxiety as a fundamental aspect of human existence and explored the existential dimensions of various psychological issues. IRVIN YALOM (b. 1931) - contemporary psychiatrist and existential psychotherapist who has written extensively on existential therapy. His books, such as "Existential Psychotherapy" and "Love's Executioner," have been influential in introducing existential concepts to a broader audience. JEAN-PAUL SARTRE (1905–1980) - Existential philosopher whose ideas on human freedom and responsibility influenced existential therapy - - ROLE OF THERAPIST primarily concerned with understanding the subjective world of clients to help them come to new understandings and options. consistently invite clients to accept personal responsibility. When clients complain about the predicaments they are in and blame others, the therapist is likely to ask them how they contributed to their situation. Existential therapists encourage experimentation not only within the therapy office but also outside of the therapy setting, based on the belief that life outside therapy is what counts. - - - ROLE OF CLIENT encouraged to assume responsibility for how they are currently choosing to be in their world. must be active in the therapeutic process, for during the sessions they must decide what fears, guilt feelings, and anxieties they will explore. confront ultimate concerns rather than coping with immediate problems. PERSON-CENTERED THERAPY Carl Rogers stands out as one of the most influential figures in revolutionizing the direction of counseling theory and practice. Carl Rogers has become known as a “quiet revolutionary” who both contributed to theory development and whose influence continues to shape counseling practice. His basic assumptions are that people are essentially trustworthy, that they have a vast potential for understanding themselves and resolving their own problems without direct growth if they are involved in a specific kind of therapeutic relationship. ➢ EVOLUTION OF PERSON- CENTERED THERAPY Emotion- Focused Therapy ➢ - - emerged as a person-centered “approach informed by understanding the role of emotion in human functioning and psychotherapeutic change” - - designed to help the client increase their awareness of their emotions and make productive use of them. - - EFT strategies focus on two major tasks: (1) help clients too little emotion access their emotions, and (2) help clients who experience too much emotion contain their emotions. - A main goal of EFT is to help individuals’ access and process emotions to construct new ways of being. Existentialism and Humanism - The two viewpoints have much in common, yet there also are significant philosophical differences between them. They share a respect for the client’s subjective experience, the uniqueness and individuality of each client, and a trust in the capacity of the client to make positive and constructive conscious choices. GOALS to assist clients in achieving a greater degree of independence and integration so they can better cope with problems as they identify them. The cornerstone of person-centered theory is the view that clients in a relationship with a facilitating therapist have the capacity to define and clarify their own goals. Person-centered therapists are in agreement on the matter of not setting goals for what clients need to change, yet they differ on the matter of how to best help clients achieve their own goals and to find their own answers. Clients come to the counselor in a state of incongruence; that is, a discrepancy exists between their self-perception and their experience in reality. This humanistic approach is perhaps best characterized as a way of being and as a shared journey in which therapist and client reveal their humanness and participate in a growth experience. Congruence implies that therapists are real; that is, they are genuine, integrated, and authentic during the therapy hour. Unconditional positive regard can best be achieved through empathic identification with the client. Empathy is a deep and subjective understanding of the client with the client. - Existentialists tend to acknowledge the stark realities of human experience, and their writings often focus on death, anxiety, meaningless, and isolation. The humanists, in contrast, take the somewhat less anxiety- evoking and more optimistic view that each of us has a natural potential that we can actualize and through which we can find meaning. - THE STAGES OF CHANGE • precontemplation stage, there is no intention of changing a behavior pattern in the near future. Abraham Maslow was a pioneer in the development of humanistic psychology and was an influential in furthering the understanding of self-actualizing individuals. • He studied “self- actualizing people” and found that the differed in important ways from so- called normal individuals. contemplation stage, people are aware of a problem and are considering overcoming it, but they have not yet made a commitment to take action to bring about the change. • The core characteristics of self-actualizing people are self- awareness, freedom, basic honesty and caring, trust and autonomy. preparation stage, individuals’ intent to take action immediately and report some small behavior changes. • action stage, individuals are taking steps to modify their behavior to solve their problems. Abraham Maslow’s Contributions to Humanistic Psychology - Expressive arts therapy, extends the person-centered approach to spontaneous creative expression, which symbolizes deep and sometimes inaccessible feelings and emotional states. • maintenance stage, people work to consolidate their gains and prevent relapse. Deflection is the process of distraction or veering off, so that it is difficult to maintain a sustained sense of contact. ➢ ROLE OF THERAPIST AND CLIENT Confluence involves blurring the differentiation between the self and the environment. - - - - - - ROLE OF THERAPIST The role of person-centered therapists is rooted in their ways of being and attitudes, not in techniques designed to get the client to “do something.” therapists use themselves as an instrument of change by encountering clients on a personto-person level. It is the therapist’s attitude and belief in the inner resources of the client that creates the therapeutic climate for growth. - - - ROLE OF CLIENT Clients have the opportunity to explore the full range of their experience, which includes their feelings, beliefs, behavior, and worldview. Clients come to the counselor in a state of incongruence; that is, a discrepancy exists between their self-perception and their experience in reality. As counseling progresses, clients are able to explore a wider range of beliefs and feelings. GESTALT THERAPY an existential, phenomenological, and process-based approach created on the premise that individuals must be understood in the context of their ongoing relationship with the environment. The approach is phenomenological because it focuses on the client’s perceptions of reality and existential because it is grounded in the notion that people are always in the process of becoming, remaking, and rediscovering themselves. gives special attention to existence as individuals experience it and affirms the human capacity for growth and healing through interpersonal contact and insight. Phenomenological inquiry involves paying attention to what is occurring now. Unfinished business can be manifested in unexpressed feelings such as resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment. Impasse, or stuck point, occurs when external support is not available or the customary way of being does not work. The general orientation of Gestalt therapy is toward dialogue, an engagement between people who each bring their unique experiences to that meeting. As an existential brand of therapy, Gestalt practice involves a person-to-person relationship between therapist and client. Exercises are ready-made techniques that are sometimes used to make something happen in a therapy session or to achieve a goal. Experiments, in contrast, grow out of the interaction between client and therapist, and they emerge within this dialogic process. Confrontation is set up in a way that invites clients to examine their behaviors, attitudes, and thoughts. FRITZ PERLS was the main originator and developer of Gestalt therapy. - - Contact is made by seeing, hearing, smelling, touching, and moving. Introjection is the tendency to uncritically accept others’ beliefs and standards without assimilating them to make them congruent with who we are. - Projection is the reverse of introjection. In projection we disown certain aspects of ourselves by assigning them to the environment. Retroflection consists of turning back onto ourselves what we would like to do to someone else or doing to ourselves what we would like someone else to do to or for us. ➢ - Although Perls was influenced by psychoanalytic concepts, he took issue with Freud’s theory on a number of grounds. Whereas Freud’s view of human beings is basically mechanistic, Perls stressed a holistic approach to personality. Freud focused on repressed intrapsychic conflicts from early childhood, whereas Perls valued examining the present situation. The Gestalt approach focuses much more on process than on content. This process involves Gestalt therapists putting themselves as fully as possible into the experience of the client without judgment, analyzing, or interpreting, while concurrently holding a sense of one’s individual, independent presence. GOALS Gestalt therapy does not ascribe to a “goal-oriented” methodology per se, but therapists clearly attend to a basic goal—namely, assisting the client to attain greater awareness, and with it, greater choice. - The Gestalt approach helps clients note their own awareness process so that they can be responsible and can selectively and discriminatingly make choices. Through a creative involvement in Gestalt process, Zinker (1978) expects clients will do the following: • Move toward increased awareness of themselves • Gradually assume ownership of their experience (as opposed to making others responsible for what they are thinking, feeling, and doing) • Develop skills and acquire values that will allow them to satisfy their needs without violating the rights of others • Become more aware of all of their senses • Learn to accept responsibility for what they do, including accepting the consequences of their actions • Be able to ask for and get help from others and be able to give to others - ➢ - - - ROLE OF THERAPIST AND CLIENT ROLE OF THERAPIST The therapist’s job is to invite clients into an active partnership where they can learn about themselves by adopting an experimental attitude toward life in which they try out new behaviors and notice what happens. Gestalt therapists use active methods and personal engagement with clients to increase their awareness, freedom, and self-direction rather than directing them toward preset goals. the therapist functions as a guide and a catalyst, presents experiments, and shares observations, the basic work of therapy is done by the client. TECHNIQUES: The Internal Dialogue Exercise - - - One goal of Gestalt therapy is to bring about integrated functioning and acceptance of aspects of one’s personality that have been disowned and denied. Gestalt therapists pay close attention to splits in personality function. A main division is between the “top dog” and the “underdog,” and therapy often focuses on the war between the two. The top dog is righteous, authoritarian, moralistic, demanding, bossy, and manipulative. This is the “critical parent” that badgers with “shoulds” and “oughts” and manipulates with threats of catastrophe. The underdog manipulates by playing the role of victim: by being defensive, apologetic, helpless, and weak and by feigning powerlessness. The Empty-Chair Technique - - - ROLE OF CLIENT The general orientation of Gestalt therapy is toward dialogue, an engagement between people who each bring their unique experiences to that meeting. Clients in Gestalt therapy are active participants who make their own interpretations and meanings. It is they who increase awareness and decide what they will or will not do with their personal meaning. - This is a role-playing technique in which all the parts are played by the client. In this way the introjects can surface, and the client can experience the conflict more fully. Future Projection Technique - In future projection, an anticipated event is brought into the present moment and acted out. designed to help clients express and clarify concerns they have about the future. Making the Rounds - exercise that involves asking a person in a group to go up to others in the group and either speak to or do something with each person. The Reversal Exercise - Certain symptoms and behaviors often represent reversals of underlying or latent impulses. Thus, the therapist could ask a person who claims to suffer from severe inhibitions and excessive timidity to play the role of an exhibitionist. The Rehearsal Exercise • - CBT treatment also usually involves efforts to change BEHAVIORAL patterns. When clients share their rehearsals out loud with a therapist, they become more aware of the many preparatory means they use in bolstering their social roles. These strategies might include: • • The Exaggeration Exercise - In this exercise the person is asked to exaggerate the movement or gesture repeatedly, which usually intensifies the feeling attached to the behavior and makes the inner meaning clearer. Staying with the Feeling - At key moments when clients refer to a feeling or a mood that is unpleasant and from which they have a great desire to flee, the therapist may urge clients to stay with their feeling and encourage them to go deeper into the feeling or behavior they wish to avoid. The Gestalt Approach to Dream Work - The Gestalt approach does not interpret and analyze dreams. Instead, the intent is to bring dreams back to life and relive them as though they were happening now. COGNITIVE BEHAVIOR THERAPY a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. places an emphasis on helping individuals learn to be their own therapists. through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior. Learning to develop a greater sense of confidence in one’s own abilities. • Facing one’s fears instead of avoiding them. Using role playing to prepare for potentially problematic interactions with others. Learning to calm one’s mind and relax one’s body. ❖ RATIONAL EMOTIVE BEHAVIOR THERAPY people contribute to their own psychological problems, as well as to specific symptoms, by the rigid and extreme beliefs they hold about events and situations. based on the assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship. REBT is based on the premise that we learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime. ALBERT ELLIS (1913–2007) - Grandfather of Cognitive Behavior Therapy Early in 1955 he developed an approach to psychotherapy he called rational therapy and later rational emotive therapy, and which is now known as Rational Emotive Behavior Therapy (REBT). A-B-C Model - A-B-C framework is central to REBT theory and practice. provides a useful tool for understanding the client’s feelings, thoughts, events, and behavior. CBT treatment usually involves efforts to change THINKING patterns. A - activating event These strategies might include: B - persons belief about that activating event • C - consequence or the emotional reaction • • Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality. Gaining a better understanding of the behavior and motivation of others. Using problem-solving skills to cope with difficult situations. D - disputing (encompasses methods that help clients challenge their irrational beliefs.) 3 components of this disputing process: - discriminating - Clients learn to discriminate irrational (self-defeating) beliefs from rational (self-helping) beliefs. - detecting - detect irrational belief (absolutistic “shoulds” and “musts,” “awfulizing,” and “self-downing”) help clients change their thinking and minimize their irrational ideas. encourages clients to identify the irrational beliefs they have unquestioningly accepted. strongly encourage clients to develop a rational philosophy of life so that in the future they can avoid hurting themselves again by believing other irrational beliefs. - debating - Once they can detect irrational beliefs, particularly clients debate dysfunctional beliefs by logically, empirically, and pragmatically questioning them. - clients review their progress, make plans, and identify strategies to prevent, or cope with, any new challenges as they arise. E - develop new effective philosophy TECHNIQUES: PURPOSE: Cognitive Methods REBT’s basic hypothesis is that emotions are mainly created from our beliefs, which influence the evaluations and interpretations we make and fuel the reactions we have to life situations. REBT relies heavily on thinking, disputing, debating, challenging, interpreting, explaining, and teaching. GOALS: The many roads taken in rational emotive behavior therapy lead toward the destination of clients minimizing their emotional disturbances and self-defeating behaviors by acquiring a more realistic, workable, and compassionate philosophy of life. ROLE OF THERAPIST AND CLIENT: - - THERAPIST show clients how they have incorporated many irrational absolute “shoulds,” “oughts,” and “musts” into their thinking. disputes clients’ irrational beliefs and encourages clients to engage in activities that will counter their self-defeating beliefs by replacing their rigid “musts” with preferences. - - CLIENT Clients are encouraged to actively work outside therapy sessions. By carrying out behavioral homework assignments, clients become increasingly proficient at minimizing irrational thinking and disturbances in feeling and behaving. continue to focus on learning effective ways to dispute selfdefeating thinking. - Disputing irrational beliefs Doing cognitive homework Bibliotherapy Changing one’s language Psychoeducational methods Emotive Techniques tend to be vivid and evocative in nature, and their purpose is to dispute clients’ irrational beliefs. These strategies are used both during the therapy sessions and as homework assignments in daily life. Their purpose is not simply to provide a cathartic experience but to help clients change some of their thoughts, emotions, and behaviors. Evocative and Emotive Therapeutic Techniques: - Rational emotive imagery Humor Roleplaying Shame-attacking exercises ADVANTAGE AND DISADVANTAGE: ADVANTAGE One of the strengths of REBT is the focus on teaching clients ways to carry on their own therapy without the direct intervention of a therapist. Generic Cognitive Model - DISADVANTAGE Another potential limitation involves the misuse of the therapist’s power by imposing ideas of what constitutes rational thinking. - ❖ COGNITIVE THERAPY It is set out to create an evidence-based therapy for depression, and he tested each of his theoretical constructs with empirical studies and conducted controlled outcome studies to determine how CT’s outcomes compared with existing psychotherapy and pharmacotherapy treatments for depression. - Beck believed this negative cognitive triad maintained depression, even when negative thoughts were not the original cause of an episode of depression. - CT is based on the theoretical rationale that the way people feel and behave is influenced by how they perceive and place meaning on their experience. Three theoretical assumptions of CT are: (1) that people’s thought processes are accessible to introspection, (2) that people’s beliefs have highly personal meanings, and (3) that people can discover these meanings themselves rather than being taught or having them interpreted by the therapist. AARON T. BECK (1921 - 2021) - Some of the principles on which this model is based. • • One of Beck’s early contributions was to recognize that regardless of the cause of depression, once people became depressed, their thinking reflected what Beck referred to as the Negative Cognitive Triad: negative views of the self (self-criticism), the world (pessimism), and the future (hopelessness). - Father of Cognitive Therapy Founder of cognitive therapy (CT), one of the most influential and empirically validated approaches to psychotherapy. Beck has proposed a generic cognitive model to describe principles that pertain to all CT applications from depression and anxiety treatments to therapies for a wide variety of other problems including psychosis and substance use. The generic cognitive model provides a comprehensive framework for understanding psychological distress, and some of its major principles are described here. Psychological distress can be thought of as an exaggeration of normal adaptive human functioning. Faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioral reactions. Common Cognitive Distortions: - Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Personalization Labeling and mislabeling Dichotomous thinking PURPOSE: The goal of CT is to help clients learn practical skills that they can use to make changes in their thoughts, behaviors, and emotions and how to sustain these changes over time. ROLE OF THERAPIST AND CLIENT: - - - THERAPIST must combine empathy and sensitivity with technical competence. must have a cognitive conceptualization of cases, be creative and active, be able to engage clients through a process of Socratic questioning. identify specific, measurable goals and move directly into the areas that are causing the most difficulty for clients. ADVANTAGE AND DISADVANTAGE: - CLIENT expected to identify the distortions in their thinking, summarize important points in the session, and collaboratively devise homework assignments that they agree to carry out. - - TECHNIQUES: The therapeutic relationship is basic to the application of cognitive therapy. Through his writings, it is clear that Beck believes effective therapists must combine empathy and sensitivity with technical competence. 1. 2. A therapeutic alliance is a necessary first step in cognitive therapy, especially in counseling difficult-to-reach clients. Without a working alliance, techniques applied will not be effective. The cognitive therapist functions as a catalyst and a guide who helps clients understand how their beliefs and attitudes influence the way they feel and act. Homework is often used as a part of cognitive therapy because practicing cognitive behavioral skills in real life facilitates more rapid and enduring gains. ADVANTAGE Beck demonstrated that a structured therapy that is present centered and problem oriented can be very effective in treating depression and anxiety in a relatively short time. Beck developed specific cognitive procedures to help depressive clients evaluate their assumptions and beliefs and to create a new cognitive perspective that can lead to optimism and changed behavior. - - DISADVANTAGE Cognitive Therapy has been criticized for focusing too much on the power of positive thinking; being too superficial and simplistic; denying the importance of the client’s past; being too technique oriented; failing to use the therapeutic relationship; working only on eliminating symptoms, but failing to explore the underlying causes of difficulties; ignoring the role of unconscious factors; and neglecting the role of feelings. ❖ STRENGTH -BASED-COGNITIVE BEHAVIOR THERAPY As the name implies, one central addition of SB-CBT is an emphasis on identification and integration of client strengths at each phase of therapy. The main idea of SB - CBT is that active incorporation of client strengths encourages clients to engage more fully in therapy and often provides avenues for change that otherwise would be missed. CHRISTINE PADESKY & KATHLEEN MOONEY - Padesky and Mooney developed many innovations in the practice of cognitive therapy including the use of constructive questions, the importance of identifying client imagery and metaphors for change, and an emphasis on client strengths. PURPOSE: SB-CBT expands previous models of CBT to include methods that help people develop positive qualities. Their ideas developed in parallel with positive psychology, a research field that investigates happiness, resilience, altruism, and a host of positive emotions and behaviors (Lopez & Snyder, 2011). TECHNIQUES: DONALD MEICHENBAUM Like cognitive therapy, SB-CBT is empirically based. This means that - (1) therapists should be knowledgeable about evidence-based approaches pertaining to client issues discussed in therapy, (2) clients are asked to make observations and describe the details of their life experiences so what is developed in therapy is based in the real data of clients’ lives, and (3) therapists and clients collaborate in testing beliefs and experimenting with new behaviors to see if they help achieve desired goals. ADVANTAGE AND DISADVANTAGE: - ADVANTAGE This approach emphasizes empowerment and self-efficacy, encouraging clients to harness their capabilities rather than solely concentrating on weaknesses. It fosters a more holistic understanding of the person, enhancing motivation and resilience when facing challenges. - DISADVANTAGE It's crucial to balance this positivity with addressing underlying issues and ensuring that critical problems aren't overlooked. Therapists need expertise in navigating this approach effectively, acknowledging that while highlighting strengths is beneficial, it's essential to address the full spectrum of an individual's needs for comprehensive therapeutic outcomes. ❖ COGNITIVE BEHAVIOR MODIFICATION It focuses on changing the client’s self-talk. Meaning self-statements can affect a person's behavior is the same way as a statement that is being said to another person. The idea of Meichenbaum’s Cognitive Behavior Modification is that the client must observe how they feel, think and behave, and the impact they have on others. For change to happen, the client must break the nature or personality of their behavior so that they can evaluate their behavior in various ways. - Meichenbaum attributes the origin of CBT to his mother, who had a knack for telling stories about her daily activities that were peppered with her thoughts, feelings, and a running commentary. This childhood experience contributed to Meichenbaum’s psychotherapeutic approach of constructivist narrative therapy, in which clients tell their stories and describe what they did to “survive and cope.” PURPOSE: The behavior change that occurs through a sequence of mediating processes involving the interaction of inner speech, cognitive structures and behaviors and their resultant outcomes. TECHNIQUES: There are three phase process of change: Phase 1: Self-observation. This phase is the initial phase of the Cognitive Behavior Modification. The Client must learn to observe their internal thought processes, fostering self-awareness and laying the foundations of the therapeutic work aimed at the behavioral and cognitive restructuring. (In other words, the client is more passive on the idea of changing behavior) Phase 2: Starting a New Internal Dialogue. In this phase, the client is now taking a proactive approach from observing maladaptive behaviors to actively engaging in a new dialogue. The client now recognizes the opportunities for a positive change and learning how to alter their thoughts. Phase 3: Learning New Skills. The final phase involves a practical application of newly acquired skills in real-life situations. The client learns patterns of negative thoughts and behavior, adopt more adaptive coping mechanisms, and be more mindful of the consequences of their behavior. Self-talk is still important in ensuring the sustainability of positive changes. Meichenbaum developed the Stress Inoculation Training based on the assumption that we can affect our ability to cope with stress by modifying our beliefs and selfstatements about our performance in stressful situations. ADVANTAGE AND DISADVANTAGE: ADVANTAGE The CBM has a holistic approach, it considers the thoughts, feelings, and behavior of the client. It empowers the client by emphasizing their ability to change their thoughts and behaviors. The CBM follows a structured and goal-oriented format by providing a clear framework for therapy. - - - WILLIAM GLASSER (1925—2013) - - - DISADVANTAGE CBM is not suitable for all disorders because some of the disorders might require a more specialized approach. In focusing on cognitive patterns, there might be risks with the client’s thoughts particularly on self-blaming. CBM focuses on change but there might be some underlying factors that might be overseen in the therapy sessions. CHOICE THEORY/ REALITY THERAPY - Founder of Reality Therapy and Choice Theory. He emphasized personal responsibility, the importance of choice, and the idea that individuals have the power to control and change their behavior. ROBERT E. WUBBOLDING (b. 1936) - A psychologist and a prominent figure in the development and promotion of Reality Therapy. He has written extensively on the subject and has contributed to the application of Reality Therapy principles in various settings. - PURPOSE: - Primary goal of contemporary reality therapy is to help clients get connected or reconnected with the people they have chosen to put in their quality world. Help clients learn better ways of fulfilling all of their needs, including achievement, power or inner control, freedom or independence, and fun. - CHOICE THEORY posits that we are not born blank slates waiting to be externally motivated by forces in the world around us. GOALS: Five genetically encoded needs that drive us all our lives: - • • • • • - Survival or Self-Preservation; Love and Belonging; Power or Inner Control; Freedom or Independence; And Fun or Enjoyment. We store information inside our minds and build a file of wants, called our quality world, which is at the core of our life. In our quality world, we develop an inner picture album of specific wants as well as precise ways to satisfy these wants. REALITY THERAPY provides a delivery system for helping individuals take more effective control of their lives. If choice theory is the highway, reality therapy is the vehicle delivering the product consists mainly of helping and sometimes teaching clients to make more effective choices as they deal with the people they need in their lives. help clients get connected or reconnected with the people they have chosen to put in their quality world. help clients learn better ways of fulfilling all of their needs, including achievement, power or inner control, freedom or independence, and fun. ROLE OF THERAPIST AND CLIENT: - - - - THERAPIST teach clients how to engage in self-evaluation, which is done by raising the question, “Is what you are choosing to do getting you what you want and need?” not to make the evaluation for clients but to challenge clients to examine what they are doing. assist clients in evaluating their own behavioral direction, specific actions, wants, perceptions, level of commitment, possibilities for new directions, and action plans. convey the idea that no matter how bad things are there is hope. - - CLIENT not expected to backtrack into the past or get sidetracked into talking about symptoms. expect to experience some urgency in therapy. should be able to say to themselves, “I can begin to use what we talked about today in my life. I am able to bring my present experiences to therapy as my problems are in the present, and my therapist will not let me escape from that fact.” TECHNIQUES: ADVANTAGE AND DISADVANTAGE: The “WDEP” System - - The WDEP system can be used to help clients explore their wants, possible things they can do, opportunities for self-evaluation, and design plans for improvement. Wants - clients are given the opportunity to explore every facet of their lives, including what they want from their family, friends, and work. Furthermore, this exploration of wants, needs, and perceptions should continue throughout the counseling process as clients’ pictures change. Direction and Doing - even though problems may be rooted in the past, clients need to learn how to deal with them in the present by learning better ways of getting what they want. Problems must be solved either in the present or through a plan for the future. - Self-Evaluation - is the cornerstone of reality therapy procedures. This evaluation involves the client examining behavioral direction, specific actions, wants, perceptions, new directions, and plans. - Plans - the plan gives the client a starting point, a toehold on life, but plans can be modified as needed. Simple Attainable ADVANTAGE A key strength of reality therapy is that it provides clients with tools to make the changes they desire. Reality therapy is an open system that allows for flexibility in application based on the needs of culturally diverse individuals. - - DISADVANTAGE One of the shortcomings of reality therapy in working with clients from certain ethnic groups is that it may not take fully into account some very real environmental forces that operate against them in their everyday lives. Some clients are very reluctant to directly verbally express what they need. Their cultural values and norms may not reinforce them in assertively asking for what they want. FAMILY SYSTEMS THERAPY A family systems perspective holds that individuals are best understood through assessing the interactions between and among family members. The development and behavior of one family member is inextricably interconnected with others in the family. Family therapy perspectives call for a conceptual shift from evaluating individuals to focusing on system dynamics, or how individuals within a system react to one another. Attempts at change are best facilitated by working with and considering the family or set of relationships as a whole. MURRAY BOWEN (1913–1990) - Measurable Considered one of the pioneers of family systems therapy. He developed Bowen Family Systems Theory, which focuses on the interplay between individual family members and the emotional patterns that shape family dynamics. Involved VIRGINIA SATIR (1916–1988) Controlled by the planner, committed to and consistently done. - - Highly influential family therapist known for her Human Validation Process Model. Satir emphasized the importance of open communication, self-esteem, and personal growth within the family system. Her work focused on helping families improve their communication patterns and emotional dynamics. PURPOSE: - To help family members develop a rational, nonreactive approach to living (called a differentiation of self). To de-tangle family interactions that involved two people pulling a third person into the couple’s problems and arguments (or triangulation). TECHNIQUES: Structural-Strategic Approach - a theoretical framework and therapeutic approach within the field of family therapy. involves understanding the family's structure, hierarchies, and boundaries, which originated from the work of theorists and practitioners such as Salvador Minuchin and Jay Haley. Human Validation Process Model - The human validation process model directs focus on communication patterns, self-esteem, and self-worth of each individual member and family and the innate internal strengths in every human. The model is experiential in design and growth oriented. The family's experiences in therapy lead to change, and then they develop insight. This theory assumes that every human has eight universal internal resources: physical; intellectual; emotional; sensual; interactional; nutritional; contextual; and spirituality. Based on these eight internal resources, Satir found seven levels of experiences within the self: yearning, expectations, perceptions, feelings, feelings about feelings, coping, and behavior. Multi-Generational Family Therapy - an approach to family therapy that focuses on understanding and addressing issues within a family system over multiple generations. This therapeutic model was developed by Murray Bowen, and it is often referred to as Bowenian therapy. Genograms: - Therapists often use genograms, which are graphical representations of family relationships and medical history across multiple generations. Genograms help visualize family patterns and identify recurring themes. ADVANTAGE AND DISADVANTAGE: - - ADVANTAGE Explore the system for family process and rules, perhaps using a genogram. Focus on the family relationship. Concerned with Transgenerational meanings, rules, cultural, and gender perspectives within the system, and even the community and larger systems affecting the family. - - DISADVANTAGE Focus less on the causes, purposes, and cognitive, emotional, and behavioral processes involved in client’s and coping. Focuses on group dynamics than the individual therapy. Could ensue less privacy to the patient especially if parents or family members are involved.
