Comprehensive
Exam Review
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Helping
Relationships
Part 2
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Gestalt Therapy - Fritz Perls
A Gestalt means a whole, and Gestalt
therapy is based on the person feeling
whole or complete in his/her life.
Gestalt therapy is considered to be a “hereand-now” therapy focusing on awareness,
with the belief that when clients focus on
what they are and not what they wish to
become, they become self-actualized.
Thus, the client achieves self-actualization
through self-acceptance.
Gestaltists believe that the individual naturally
seeks to become an integrated whole, and thus
to live productively.
Gestaltists are antideterministic because they
believe that people have the ability to change
and become responsible.
Gestalt borrows heavily from existentialist,
experientialist, and phenomenologicalist
viewpoints, with the emphasis on the present
and awareness and the client's own inner world
of interpretation and assessment of the present
life situation.
Gestaltists believe that individuals emphasize
intellectual experience and diminish the
importance of emotions and senses, which
results in an inability to respond effectively to
situations or events in their lives.
Gestaltists believe that current thoughts,
feelings, and reactions to past events or
situations impede personal functioning and
prevent here-and-now awareness, a
phenomenon referred to as “unfinished
business.”
Awareness is considered to be on a continuum,
with the healthiest person being most aware of
his/her needs and dealing with them through
manipulation of the need and the
environment.
In the Gestalt perspective, people experience
difficulties through loss of contact with or
overinvolvement in their environment,
fragmentation, difficulties with life’s
dichotomies (e.g., love/hate or pleasure/pain),
conflicts between shoulds and wants, and
failure to resolve unfinished business.
The Gestalt counselor’s role is to help the
client explore his/her needs in order to grow,
focus on using energy to adapt positively,
and discern life patterns.
The counselor also helps the client to use
present tense verbs, address persons directly
rather than talk about them, use “I” instead of
referring to personal experiences in the second
(you) or third (it) person, focus on how and
what rather than why, and turn covert
questions into statements.
The goals of Gestalt Therapy include helping
the client to become aware in the here-andnow of the client's experience, make current
awareness choices, resolve past issues, become
congruent, reach intellectual maturity, and
shed neuroses.
Primary techniques in Gestalt therapy
usually manifest in one of two forms: either
an exercise or an experiment.
Typical exercises include activities such as
frustration actions, fantasy role playing,
fantasy, and psychodrama.
Experiments are unplanned, creative
interventions that grow out of the here-andnow interaction between the client and the
counselor.
Dream work in Gestalt therapy consists of
the client telling the dream and then
focusing his or her awareness on the
dream from the perspective of each
character or element in the dream.
The “Empty Chair” technique is a process
wherein the client addresses parts of his/her
personality, or that of another, as if it were an
entity sitting in an empty chair.
In confrontation, the counselor calls attention
to incongruities between the client's
verbalizations and observed emotions or
behaviors.
“Making the Rounds” is a group exercise in
which the client is instructed to say the same
sentence to each member of the group and then
to add something personal to each person.
Exaggeration is overdramatizing the client's
gestures and movements to help the client
gain insight into their meaning .
“May I Feed You?” is the question the
counselor asks before giving the client a more
specific expression of what the counselor
believes is the underlying message of the
client.
“I Take Responsibility” is a statement the
counselor has the client say after expression
of perceptions to help the client to integrate
internal perceptions and behaviors.
Rational Emotive BehaviorTherapy - Albert
Ellis
Rationale Emotive Behavior Therapy (REBT)
assumes the individual has the capacity to be
rational or irrational and sensible or crazy, which
Ellis believes is a biologically inherent capacity.
REBT is most concerned with irrational thinking,
especially that which creates upsetting thoughts
and related behaviors.
REBT views the individual as being easily disturbed because of gullibility and suggestibility.
Ellis is a proponent of the individual thinking
of behavior as separate from personhood (i.e.,
"I did a bad thing" rather than "I am a bad
person”).
Ellis believes that each individual has the
ability to control his/her thoughts, feelings
and actions, but in order to gain this control,
a person must first understand what s/he is
telling him/herself (self-talk) about the event
or situation.
Ellis believes that cognitions about events or
situations can be of four types: positive,
negative, neutral, or mixed, and that these
cognitions result in “like thoughts,” with
positive leading to positive, negative leading
to negative, etc.
Ellis listed the most common irrational beliefs
that clients find disturbing:
1. It is absolutely essential to be loved or
approved of by every significant
person in one's life.
2. To be worthwhile, a person must be
competent, adequate, and achieving
in everything attempted.
3. Some people are wicked, bad, and
villainous, and therefore should be
blamed or punished.
4. It is terrible and atastrophic whenever events do not occur as one
hopes.
5. Unhappiness is the result of outside
events, and a person has no control
over such despair.
6. Something potentially dangerous or
harmful should be cause for great
concern and should always be kept
in mind.
7. Running away from difficulties and
responsibilities is easier than
facing them.
8. A person must depend on others and
must have someone stronger on
whom to rely.
9. The past determines one's present
behavior and thus cannot be changed.
10. A person should be upset by the
problems and difficulties of others.
11. There is always a right answer to every
problem, and a failure to find this
answer is a catastrophe.
The counselor’s role in REBT is direct and
active in teaching and correcting the client's
cognitions.
Ellis believes that a good REBT counselor
must be bright, knowledgeable, empathic,
persistent, scientific, interested in helping
others, and use REBT in his/her personal
life.
The primary goals of REBT are to help
people live rational and productive lives; see
that it is their thoughts and beliefs about
events that creates difficulties, not the events
or situations themselves; understand that
wishes and wants are not entitlements to be
demanded; stop catastrophizing; and
change self-defeating behaviors.
REBT stresses using the appropriate
emotional response to a situation or event,
and the acceptance and tolerance of self and
of others in order to achieve life goals.
Initial REBT-based counseling is devoted to
learning the “ABC Principle,” in which:
A = Activating event
B = Belief or thought process
C = emotional Consequence.
Cognitive disputation is a technique aimed
at asking the client questions that challenge
the logic of the client's response.
Imaginal disputation has the client use
imagery to examine a situation where the
client is likely to become upset.
Behavioral disputation involves having the
client behave in a way that is opposite to
the way the client would like to respond to
the event or situation.
The Emotional Control Card is an actual card
intended for the client to carry in his/her
wallet on which there is a list of inappropriate
or self-destructive feelings countered with
appropriate, non-self-defeating feelings.
Confrontation occurs when the counselor
challenges an illogical or irrational belief that
the client is expressing.
Encouragement involves explicitly urging
the client to use RET principles rather
than to continue self-defeating responses.
Transactional Analysis - Eric Berne
In the Transactional Analysis (TA) viewpoint,
people can change, and can change at any
point in life.
Four major methods are used in TA to
analyze and/or predict human behavior:
Structural Analysis
Transactional Analysis
Game Analysis
Script Analysis
Structural analysis looks at what is happening
within the individual and describes each person
in terms of three ego states:
1. The Parent ego state contains the
parental admonishments and values with
dos, shoulds, and oughts.
2. The Adult ego state contains the
objective, thinking, rational, and logical
ability to deal with reality.
3. The Child ego state is the source of
childlike behaviors and feelings.
Transactional analysis looks at what is
happening between two or more people and
describes interactions as three transactions:
1. Complementary transactions are
characterized by both people communicating
from the same ego state.
2. Crossed transactions are characterized by
both people coming from different ego states,
which results in a hurtful response.
3. Ulterior transactions are characterized by
people coming from different ego states, but
the responses appear to be from the same ego
state.
Game analysis looks at transactions between
individuals that lead to negative feelings and
involve three levels of games or ulterior
transactions that appear to be complementary:
First degree games are played in social situations
and lead to mild upsets.
Second degree games are played in more
intimate circles and lead to really bad feelings.
Third degree games are violent and usually end
in the jail, hospital, or morgue.
Script analysis looks at the life plan the
individual has chosen to follow and includes
life plans such as:
Never scripts result in a person who believes
he/she is a ne’er-do-well.
Until scripts result in the person who
continues to wait until he or she can deserve
the reward.
Always scripts result in a person continuing
without change.
After scripts results in anticipation of difficulty
after a certain event.
Open-ended scripts result in lack of direction
after a given time or event.
Ideal scripts are characterized by “I am ok and
you are ok .” (Less desirable scripts are
characterized by “I'm ok, you are not ok”; “I'm
not ok , You're ok”; and “I'm not ok, You are
not ok”)
The counselor’s role in TA is as a teacher of TA
and its unique language.
The counselor contracts with the client for the
changes that they desire.
The goal in TA is not only to learn to adjust to
life but also to attain health and autonomy.
Through gaining autonomy, the client becomes
more aware, intimate and spontaneous, living a
life free of games and self-defeating life scripts.
In addition to structural, transactional, game
and script analysis, TA counselors use other
techniques such as:
Treatment contract, in which an agreement is
reached between the counselor and client about
what is to be accomplished and agreed upon
responsibilities.
Interrogation, in which the client is forced to
answer from the adult ego state through a
succession of confronttional questions.
Confrontation, in which the counselor points out
the client’s inconsistencies.
Explanation, in which the counselor teaches the
adult ego state of the client as a tenet of TA.
Illustration, in which a story or example is used
to portray a point.
Confirmation, in which the counselor directs
the client's attention to a previously modified
behavior that is reoccurring.
Interpretation, in which the counselor
explains to the (client’s) child ego state the
reasons behind the client's behavior.
Crystallization, in which the client realizes
that game playing can be given up and the
client can enjoy the freedom of choice in
behavior.
Specification, which is identifying the ego
state that is the source of the transition.
Behavioral Theories - B.F. Skinner
Behaviorists, with the exception of cognitive
behaviorists, concentrate on behavior that
can be observed, particularly with a hereand-now focus.
A basic tenet of Behavioral Counseling is
that all behavior is learned, whether the
behavior is maladaptive or adaptive, and
that adaptive behavior can be learned so as
to replace maladaptive behavior.
Behaviorists set well-defined, measurable, and
observable goals in therapy, reject the idea
that human personality is composed of traits,
and strive to obtain empirical evidence to
support the use of specific techniques.
Respondent learning is often referred to as
stimulus-response learning in which the
learner does not (necessarily) need to be an
active participant.
The outcome of Behavioral Therapy is the
counter-conditioning (i.e., unlearning) of
involuntary responses.
Operant conditioning requires that the
participant be actively involved and involves
rewarding desired behavior and/or punishing
undesired behavior until the person learns
the desired behavior that elicits the reward.
Operant conditioning differs from respondent
conditioning in that operant conditioning is
the conditioning of voluntary responses
through rewards or reinforcers.
Social modeling is the process in which new
behavior is learned from watching other
people and events without experiencing the
consequences from the behavior or engaging
in the behavior.
Roles of the behavioral counselor are varied
and include being a consultant, teacher,
advisor, reinforcer, and/or facilitator.
The counselor is active and may supervise other
people in the client's environment to achieve the
goals of therapy.
Counselors using social learning may model
the desired behavior, while respondent and
operant conditioning counselors are more
directive and prescriptive in their approach to
the therapy goals.
The goal of Behavioral counselors is to
improve the life of the client through better
adjustment and for the client to achieve
personal goals professionally and personally.
Four steps in developing therapeutic goals are:
Define the problem concretely, specifying
when, where, how, and with whom the
problem exists.
Take a developmental history of the
problem, eliciting conditions surrounding
the beginning of the problem, and what
solutions the client has tried in the past.
Establish specific subgoals in small,
incremental steps toward the final goal.
Determine the best behavioral method
to be used to help the client change.
Establishment and use of reinforcers are the
primary techniques used to increase desired
behaviors.
Positive reinforcers are things desired by the
client, while negative reinforcers are things to be
avoided.
Primary reinforcers are intrinsic while
secondary reinforcers are tokens that acquire
value by being associated with a primary
reinforcer.
Schedules of reinforcement include:
Fixed-ratio, wherein the reinforcer is
delivered after a set number of responses.
Fixed-interval, wherein the reinforcer is
delivered after a set time lapse.
Variable-ratio, wherein the reinforcer
is delivered after varying numbers of
responses.
Variable-interval, wherein the reinforcer is delivered at varying time
intervals.
Shaping is learning behavior in small steps
that are successive approximations toward
the final, desired behavior.
Chaining is the order of the desired sequence of
skills leading to the desired behavior.
Generalization is the transfer of learning from
behavioral therapy to the client’s world.
Extinction is the elimination of a behavior
through withholding a reinforcer.
Punishment is the delivery of aversive stimuli
resulting in suppression or elimination of a
behavior.
Systematic desensitization is a process
accomplished through successive
approximation to reduce anxiety toward an
anxiety provoking event or situation.
The steps needed to accomplish the behavior are
listed and prioritized.
The counselor helps the client to learn
relaxation techniques to reduce/overcome
anxiety.
Because a client cannot feel anxious and
relaxed at the same time, the phenomenon is
termed reciprocal inhibition.
Behavioral rehearsal is repeating and
improving a behavior until the client
accomplishes the behavior that is desired.
Environmental planning is a process in which
the client arranges the circumstances to
promote or inhibit particular behaviors.
Maintenance is the consistent continuation of
learned behaviors without support from
sources external to the client's self-control and
self-management.
Assertiveness training is a technique in which
the client is taught to express appropriate
feelings without hostility, anxiety, or passivity.
Contingency contracts are written agreements
in which the desired behaviors are specifically
described, as are the reinforcers to be given
and the circumstances in which the reinforcers
will be administered.
Implosion is desensitizing the client by
having the client imagine an anxiety
provoking situation that may have a dire
consequence in a safe environment.
Time out is an aversive technique in which
the client is prevented, usually through some
form of isolation, from receiving a positive
reinforcer.
Overcorrection is an aversive technique in
which the client is required to restore the
environment and to improve it substantially.
Covert sensitization is an aversive technique
in which a behavior is eliminated through
pairing with an unpleasant thought.
Cognitive restructuring is helping clients
change how they think about an event or
situation by examining their thoughts and
challenging the irrational or self-defeating
thoughts.
Thought stopping is a series of procedures in
which the client replaces self-defeating
thoughts with assertive, positive, or neutral
thoughts.
The procedure is one in which the counselor
asks the client to think obsessively in a selfdefeating manner, then suddenly and
unexpectedly yells, "stop." If successful, the
client cannot continue the self-defeating
thoughts after this disruption.
Stress inoculation is a three step preventative
technique that includes:
The nature of stress and coping for the
client is defined.
Specific stress reduction and coping skills
are taught to expand those stress and
coping skills already used by the client.
The client practices the new skills in real
life situations.
Reality Therapy - William Glasser
Glasser maintains that people act on a
conscious level, that they are not driven by
instincts or the unconscious, and that there is a
force in every person that seeks both physical
and psychological health and growth.
Glasser separates the forces into the “old
brain,” or primitive physical needs, and the
“new brain,” or psychological needs.
Glasser believes that identity, or a healthy
sense of self, is crucial.
The old brain contents itself with
maintaining life, and the new brain seeks
belonging, power, freedom, and fun.
A success identity comes from being loved and
accepted, and a failure identity comes from
not having needs met for acceptance, love, and
worth.
Glasser espouses two critical periods in
children’s development.
Children ages 2 to 5 are socialized to deal
with frustrations and disappointments.
Children not getting support and love from
their parents during this critical time begin
to establish a failure identity.
Children ages 5 to 10 who already have
socialization or academic problems often
establish a failure identity.
Glasser suggests that human learning is a life
long process; therefore, identity can be
changed at any time by learning what needs
to be learned.
Glasser believes that humans are selfdetermined, that each person has within
him/herself a self-picture or perception, and
that the person behaves in a way that is
determined or controlled by this self-image.
Glasser’s Control Theory has three parts:
B is the behavior.
C is the control, in which comparison is
made between the desired image
and the image the behavior is
producing.
P is the perception or the development of
the image.
The role of the counselor in Reality Therapy is
as a teacher and a model to the client.
The counselor creates an atmosphere of
acceptance and warmth, helping the client
focus on the control of displayed thoughts and
actions.
The reality counselor uses "ing” verbs to help
the client describe thoughts and actions (e.g.,
angering, bullying, or excusing).
The focus of counseling is on the behavior
that the client needs or wants to change and
how to change that behavior in a positive
manner.
The primary goal of Reality Therapy is to
help the client become psychologically strong
and rational (i.e., a strong and rational
person who is autonomous and behaves
responsibly toward self and others).
Other goals include to help clients to
determine what they want in life, develop
practical plans to accomplish personal
needs and desires, put the past behind and
focus on present behaviors, and accept no
excuses and eliminate punishment from
life.
The three primary steps of Reality Therapy
are:
The counselor helps the client to see the
reality and understand how a behavior is
unrealistic.
The counselor separates the client from the
behavior and rejects the behavior without
rejecting the client.
The counselor teaches the client how to
fulfill needs realistically and positively.
Humor is used to point out absurdity without
being sarcastic.
Confrontation is used to help the client accept
responsibility for behavior.
Reality therapy uses WDEP: establishing
what the client wants, clarifying what they
have been doing, evaluating how helpful the
actions have been, and planning for how they
want to behave in the future.
The eight steps in Reality Therapy to accomplish
its goals are:
Establish a relationship.
Focus on present behavior.
Client evaluates his/her behavior.
Develop a contract or plan of action.
Get a commitment from the client.
Don’t accept excuses.
Allow reasonable consequences but
refuse to use punishment.
Refuse to give up on the client.
This concludes Part 2 of the
presentation on
Helping Relationships