Psychotherapy and Behavior Change: Study Questions for Exam One
Part I: Professional Issues (Answer 1 of 2)
1. What kinds of "dual relationships" can occur in the context of "counseling" someone?
Problems with dual relationships may be explained by role theory. Social roles contain inherent
expectations about how a person in a particular role is to behave as well as the rights and obligations
which pertain to that role. Role conflicts arise when the expectations attached to one role call for
behavior which is incompatible with that of another role. A dual role relationship exists when an
individual simultaneously or sequentially participates in two role categories. It has been concluded that a
dual relationship exists when, in addition to the professional relationship, there is some other relationship
with the individual: friend, family member, student or business partner.
". . . it may not be feasible or reasonable for psychologists to
avoid social or other nonprofessional contact with persons such as
patients" (p. 1601). Nevertheless, it cautions against entering into such
relationships if, "it appears likely that such a relationship reasonably
might impair the psychologist's objectivity or otherwise interfere with the
psychologist's effectively performing his or her functions as a
psychologist, or might harm or exploit the other party" (APA 1992)
You are going to have to pass judgment sometimes about clients and decisions that may affect their
ability to create a climate of trust in which they can function ideally. Because this is unavoidable
sometimes it is important that you give careful thought to the complexities of multiple relationships
before embroiling yourself in ethically questionable situations. Consider if the potential benefit outweighs
the potential harm.
How would you rate different dual relationships on a continuum of extremely unethical to
within the confines of appropriate ethics? Sexual relationships go too far. In fact touching in
general, beyond a hand-shake is discouraged by most insurance carriers. But the reality is that nonerotic touching may have therapeutic benefits. Counseling rests on a foundation of trust when clients
initiate counseling they trust that their well being will be given primary consideration Counselors who
enter into a sexual alliance with clients violate this basic trust and clients may well say “look what
happened when I did trust.” Counselors loose their ability to be objective. Clients may feel used and
may discount anything positive that they learned. Counselors may start to just care about the feelings
the client has for them instead of therapy goals. Even sexual attraction and overtones can ruin therapy if
dealt with poorly.
Support your answer with examples from class discussion, your own experience, and
possibly a diagram to illustrate your view.
The model proposed by Herlihy and Corey differentiates between unavoidable and avoidable
relationships. In cases where a dual relationship is unavoidable the guidelines for minimizing risks
discussed in the previous section apply if the dual relationship is avoidable the counselor has a choice of
what course of action to take. If the potential benefits outweigh the risks, it is still sound practice to
follow all of the procedures listed earlier. If the risks outweigh the benefits, ethical practice demands
that we decline to enter in o a conflicting relationship.
2. What are the basic rights of clients and what are the limits to confidentiality? Consider
information from discussions and readings. In general, it is a counselor’s primary obligation to
protect the client’s disclosures as a vital part of the therapeutic relationship. When assuring clients that
what they reveal in sessions will generally be kept confidential counselors should also tell them of any
limitations on confidentiality. this practice does not necessarily inhibit successful counseling.
Limits:
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When clients pose danger to self or others
When client is under 16 and is believed to be a victim of rape, abuse or another crime
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When the therapist determines that the client needs hospitalization.
When information is made an issue of the court
When clients request information to be released to a third party.
Information obtained in therapeutic relationships should be discussed with others for professional
purposes only and with persons who are clearly related to the case. Identity should be protected at all
costs. Practitioners have a duty to protect the public too, from potentially dangerous clients and are
expected to use professional judgment and that they seek consultation when they are in doubt about a
given individual or situation. People should be notified if they are intended victims if the law allows or
their parents if the victim is a minor.
3. Name and describe difficult issues faced by beginning therapists and why are they so
important to consider in terms of the therapeutic relationship? In your opinion, what are
the most difficult issues? Support your view by using concepts from theories that we've
considered so far.
 Dealing with our anxieties- a willingness to recognize and deal with these anxieties as
opposed to denying them by pretenses is a mark of courage.
 Perfectionism- avoid it. Don’t put yourself under tremendous pressure. We don’t have to
be perfect. Share mistakes and what you perceive to be as errors.
 Knowing/understanding out limitations-we cannot expect to be successful with every
client. Push your self to explore which populations you can work well with.
 Understanding silence-when silence occurs, explore what it means. I could be an
evaluation of some insight gained or it could be boredom.
 Demanding clients-don’t let them manipulate you (i.e calling you at home). Make your
expectations clear during the initial counseling session or in the disclosure statement.
 Uncommitted clients-resistance is brought about by a counselor who omits preparation
and merely assumes that all clients are open and ready to benefit from therapy. What
appears to be a lack of commitment may be a failure to understand the nature of
counseling-so brief them well at the beginning about expectations, rules, limits.
 Accepting slow results- you cannot cure clients in a few sessions. Clients may get worse
before better, going through pain, depression, etc.
 Avoiding self-deception- not necessarily conscious lying for it can be subtle and
unconscious. For both parties the motivation for deception may be the need to make the
relationship worthwhile and productive; both have invested in seeing positive results.
Our need to witness personal changes may blur reality and cause us to be less skeptical
than we should be.
 Avoiding losing ourselves in client- We need to learn how to let clients go and not carry
around their problems until we see them again. Avoid counter transference. Empathy
can become distorted and militate against a therapeutic intervention.
 Establishing goals- Both counselor and client need to establish realistic goals for
therapy.
 Declining to give advice- Counseling should not be confused with dispensing
information. Therapists should at times help clients discover their own solutions and
recognize their own freedom to act, not to deprive them of the opportunity to act freely.
Just because they may want you to prescribe all the time, doesn’t mean you should.
5. Consider the issue of therapist burnout. What is it and how does it develop? How can you
handle and prevent it?
In studies of many human service fields burnout is defined as "...a syndrome of emotional
exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals
who do people work' of some kind" (p. 2). The rehabilitation counselor's work can gratify and drain
simultaneously. To enjoy life professionally and personally, the rehabilitation counselor must become an
effective manager who can control rather than be controlled by responsibilities, risks, and rewards. Tired,
drained, and without enthusiasm, believing that what their doing doesn’t help are common feelings
associated with burnout. It can feed off of it self and make counselors feel isolated.
Causes:
 Doing same type of work without variation.
 Giving much personally and not getting much back in the way of appreciation or
positive response.
 Working with a difficult population.
 Unresolved personal conflicts
 Not having opportunities to express yourself.
 Lack of trust between you and supervisor.
Remedy: Counselors will have to become active and stop blaming the system for all they cannot do.
Instead as a place to being they can focus on what they can do to bring about some changes and to
create a climate in which they can do work that has meaning for them.
Prevention: Stay alive, be attune to subtle cues of burnout instead of waiting for the blowout. Don’t wait
for life to change.
 Recognize that you can be an active agent in your life.
 Find meaning through play, travel or new experiences.
 Try to bring variety into work
 Find hobbies, interests outside of work.
 Look for internal validation, self-confirmation, and for self rewards.
 Rearrange schedule to reduce stress
 Make time for spiritual growth
 Learn your limits.
 Stop to evaluate yourself. Consider counseling as a way for personal growth.
Part II: Psychoanalytic Approaches: Drive and Object-Relations (Answer 1 of 2)
6. What are the functions of and relationship between the id, ego, and superego in Freud's
model?
According to Freud, we are born with our Id. The id is an important part of our personality because as
newborns, it allows us to get our basic needs met. Freud believed that the id is based on our pleasure
principle. In other words, the id wants whatever feels good at the time, with no consideration for the
reality of the situation. The id doesn't care about reality, about the needs of anyone else, only its own
satisfaction. When the id wants something, nothing else is important. Autonomic arousal.
Within the next three years, as the child interacts more and more with the world, the second part of the
personality begins to develop. Freud called this part the Ego. The ego is based on the reality principle.
The ego understands that other people have needs and desires and that sometimes being impulsive or
selfish can hurt us in the long run. Its the ego's job to meet the needs of the id, while taking into
consideration the reality of the situation. The ego controls conscious processing , keeps people from
doing things counter to their survival. The ego grows as the ID is satisfied without the ID taking over.
Ego is a sense of ‘I.’
By the age of five, or the end of the phallic stage of development, the Superego develops. The
Superego is the moral part of us and develops due to the moral and ethical restraints placed on us by our
caregivers. Many equate the superego with the conscience as it dictates our belief of right and wrong.
What role do the defense mechanisms play (both health- and disorder-wise) in this system?
In a healthy person, according to Freud, the ego is the strongest so that it can satisfy the needs of the id,
not upset the superego, and still take into consideration the reality of every situation. Not an easy job by
any means, but if the id gets too strong, impulses and self gratification take over the person's life. If the
superego becomes to strong, the person would be driven by rigid morals, would be judgmental and
unbending in his or her interactions with the world.
Psychopathology can develop from repression. Over-use is the problem, it becoming second nature is
not good. Constant, conscious suppression becomes unconscious repression. You must process your
emotions, you will be hurt if you do not.
And, how does adult personality (and pathology) relate to his stages of development?
The ego defense mechanisms are ways of dealing with unconscious material that arises in
childhood. How and when these defense mechanisms arise depend on events occurring in the
psychosexual stages. Personality and the formation of the id, ego, and superego depend on the course
of psychosexual development in the first 5 years of life.
7. Briefly describe Sullivan's model of personality. Where does his model fit among the
psychoanalytic approaches considered thus far (e.g., drive, object-relations, and ego
psychology)? Can you find Freud's model in Sullivan's theory? How does it differ from
Freud's drive model of personality? Support your answer.
Sullivan draws a lot from early childhood memories and experiences. There is a lot of tension at
the beginning of ones life—id. The Ego can develop from interactions from mother and develop into
good/bad me or a combination of both. ‘Not me’ comes from severe anxiety-disassociation can lead to
MPD and DID can come form mental/physical abuse. Sullivan holds that personality is the relatively
enduring pattern of recurrent interpersonal situations which characterize a human life. Emphasized social
life. Sullivan conceived of the human being as an energy system one of whose primary concerns is to
reduce the tensions created by needs. These tensions and the behaviors the organism uses to dispel
them, are experienced in three cognitive modes or ways of perceiving and thinking (id ego superego).
Sullivan's approach to psychiatry emphasized the social factors which contribute to the
development of personality. He differed from Sigmund Freud in viewing the significance of the early
parent-child relationship as being not primarily sexual but, rather, as an early quest for security by the
child. The dynamism is a specific and recurrent pattern of behavior that characterizes a particular
person. He objected to studying mental illness in people isolated from society. Personality characteristics
were, he felt, determined by the relationship between each individual and the people in his environment.
He avoided thinking of personality as a unique, individual, unchanging entity and preferred to define it as
a manifestation of the interaction between people.
For Sullivan speculations about people’s unconscious fantasies are at best inference which are
terribly hard to prove or at worst wild and potentially harmful guesses. Sullivan had a relational approach
while Freud had a drive approach. Most of what Freud did was working with things that Sullivan
considered truly unknowable, private.Sullivan emphasizes disassociation over repression. Both have
regression to earlier stages. If you are bad, it’s your fault, you wouldn’t have been treated badly if you
weren’t.
8. Consider psychodynamic constructs of neutrality, transference, interpretation, and
resistance. How are these related and how does the dynamic interaction of these factors
lead to setbacks and gains in therapy?
The process of therapy it self beings with interpretation that often links past events to current
behavior or conflicts. The analyst gives his or her interpretation. People are viewed as ‘objects.’
Insights lead to catharsis (an emotional release) which then leads to symptoms decreasing. Instead of
catharsis, upset can occur as a reaction from something that went wrong like no release of symptoms.
In general, the closer the material is to the preconscious the more likely the patient is to accept it.
Patients work through their early relationships, particularly with parents by responding to the analyst as
they may have with a parent. ( Analysis of Transference).
Neutrality (selective attention bias)-filtering by an analyst who maybe wrong. They only have so
much information/one side of the story. Affected as little as possible by aspects of the analyst that are
extraneous to the patient. Countertransference is the projection of an analysts own case concerns on to
the client. Irrational or neurotic reactions of therapists toward the paitent. Transference is a
phenomenon in psychology characterized by unconscious redirection of feelings for one person to
another. One definition of transference is "the inappropriate repetition in the present of a relationship
that was important in a person's childhood."[1] Another definition is "the redirection of feelings and
desires and especially of those unconsciously retained from childhood toward a new object."
Resistance can be encountered if timing of the interpretation is off or if the person isn’t ready or
if it’s the wrong issue. Resistance can occur by a number of different means such as being late for
appointments, forgetting appointments or losing interest in therapy. A frequent source of resistance is
known as transference resistance which is a means of managing the relationship with the therapist so
that a wished or feared interaction with the analyst can take place.
One must be neutral /empathic in order to have the patient be able to free associate to materials
that are affected as little as possible by aspects of the analyst that are extraneous to the patient.
Transference and countertransference hinder this.
9. What is the difference between "insight-oriented" and "supportive" therapy? How do
they handle clients and the therapeutic relationship differently? How do their goals differ?
What kinds of patients would each be best for? **
Insight oriented is about truth, breaking down barriers (access) and working with the negatives.
While supportive therapy provides more structure. Supportive therapy is encouraging and validating
while emphasizing strengths and building up the ego. Supportive therapy is any form of treatment
intended to relieve symptoms or help the patient live with them rather than attempt changes in character
structure.
Insight-Oriented Therapies
demonstrated effectiveness particularly for clients dealing with depression, relationship problems, and
other areas of difficulty. These therapies tend to be more long term than CBT and BT. The insight
oriented approach doesn’t work if the person had trouble accessing information and the patient is
resistant.
Supportive: use for those with psychopathies.
What can you expect from insight-oriented therapies?
Learn how past relationships (especially childhood) may influence how you feel about yourself
and how you relate to others in your life
Become more aware of your current ways of relating to important people in your life and how
to be clearer about what you do and don�t want in relationships.
Develop new ways of making meaning of your life that are more helpful and promoting of selfgrowth.
Part III: Ego Psychology, Client-Centered, and Existential (Answer 1 of 2)
10. What is the basic motive or drive in Adler's Individual Psychology and how do you
reconcile it with Adler's social interest? Given these factors, what are the primary goals of
Adler's approach?
Inferiority motivates us. Inferiority is from within, you feel inferior to how you could be. Others
only indirectly make you feel inferior through a direct comparison with yourself. Inferiority is the need to
overcome, a drive towards superiority. Ideally this is a comparison within oneself (and others). Then we
compare to everyone else. Because social interest, motivation changes not to be better than others but
to be better for yourself. Overcome a sense of inferiority and develop within yourself. Both social and
individual goals are compatible with another. Because in social interest it is cooperative. People have to
help each other to progress unlike in hyper-competition.
Goals: counseling is helping individuals change self defeating behaviors (tar baby) and solve problems
more efficiently. Implicit in the goals of psychotherapy and counseling are an increase in the client’s
social interest.
11. What does Adler mean by "reorientation"? What is it's importance in therapy and what
kinds of techniques are used? Which techniques are more (and others less) "in line" with
the psychoanalytic/psychodynamic tradition and why?**
Reorientation is when the patients make changes in beliefs and behaviors to accomplish goals.
Insights from early recollections family dynamics and dreams are used to help the patient accomplish
therapeutic goals which may have altered as patient and therapist explore the patient’s lifestyle.
 Immediacy-expressing the experience of what is happening at this very moment in
therapy.
 Encouragement-usueful in building a relationsip and assessing client lifestyle to change
beliefs and behaviors and help overcome feelings of inferiority.
 Acting as if-helps the patient take an action he/she may be afraid of often because the
patien believes the action will fail.
 Avoiding the tar baby-avoiding maladaptive beliefs that the patient has.
 Spitting in clients soup- therapist makes coments that make the behavior less attractive.
 Catching ones self-developing insight into problematic responses to the world.
Some of these techniques are very similar to cognitive/behavioral methods like catching ones self
and avoiding the tar baby. Adlerians assign homework. Techniques are often action oriented to
lead to new patterns of behavior. Adler worked more with conscious memories and had a goal
oriented future, had multiple techniques while Freud worked more with the conscious, no goal
setting, and had very few techniques comparatively.
They both focus on early childhood. States an imbalance (id, ego, superego and superiority vs.
inferiority).
12. What are the necessary and sufficient conditions of therapeutic change, according to Carl
Rogers? Do you agree with Rogers? Support your answer. How does the Humanistic
approach compare with a Freudian psychodynamic approach, in theory, development of
psychopathology, and in practice?
I feel as though psychoanalysis does not support the idea of free will with its emphasis on a
biologically oriented approach. In regards to development of personality, humanists believe
development occurs continuously. Humanistic psychology emphasizes the uniqueness of the
human experience and the idea that human beings have free will to determine their destiny.
While the humanistic approach is not perfect, as it does seem that an all positive environment
may not bring about behavior change, the therapeutic relationship is a positive experience. As the
therapy progresses, and they experience the empathic understanding of the therapist, they will
talk about themselves in more positive ways and try to please themselves rather than others. The
techniques used in humanistic psychology include a type of nondirective therapy called clientcentered therapy. Humanistic psychologists believe that humans are innately good, behavior is
purposeful and goal-directed, healthy people are aware of all their behavior and they choose their
behavior patterns, a client’s behavior can only be understood from the client’s point of view and
effective therapy occurs only when a client modifies his or her behavior, not when the therapist
manipulates it.