Principles and Associated Tools for Counseling Practice
Rick Halstead, Ph.D.
Department of Counselor Education
Saint Joseph College
Table of Contents
Topic
Page Number
Table of Contents..................................................................................................................
Introduction...........................................................................................................................
History of Mental Health Counseling .................................................................................
The Nature of the Counseling Process..................................................................................
Special Considerations and Variables in Counseling............................................................
Steps in the Counseling Process............................................................................................
A Developmental Conceptualization of the Counseling Process: The Hero’s Journey.......
Prochaska's Model of Stages or Phases of Change...............................................................
Conducting an Initial Assessment.........................................................................................
Bio/Psycho/Social Assessment Form....................................................................................
Domains of Focus..................................................................................................................
Diagnosing and Labeling Client Problems............................................................................
A Schema-Focused Classification of Core Issues.................................................................
Client Core Issues Across the Five Schema Domains..............................................
Counseling Theory Models for Understanding Problem Development and Change............
Theories Applied to Counseling............................................................................................
The Impact of Culture on the Person and the Change Process..............................................
Cultural Diversity in the Helping Professions.......................................................................
Overcoming Cultural Tunnel Vision.....................................................................................
Theoretical Approaches to Counseling Practice...............................................................
Counseling Theories Graphed: Action/Insight x Rational/Affective Continuums................
Psychodynamic Oriented Counseling................................................................................
Maturity and Insight Counseling: Theoretical and Practical Foundation.................
The Psychodynamic Perspective...............................................................................
Adlerian Theory and Approach to Counseling.... .....................................................
Behavioral and Cognitive Approaches to Counseling......................................................
Behavior Theory: Theoretical and Practical Foundation..........................................
Contemporary Behavioral Counseling Techniques...................................................
Basic Tools for Self-Regulation....................................................................
Applied Behavior Analysis............................................................................
Cognitive and Cognitive-Behavioral Theory Approaches to Counseling.................
Rational-Emotive-Behavior-Therapy........................................................................
Humanistic Theoretical Approaches to Counseling.........................................................
The Person-Centered Approach to Counseling.........................................................
Gestalt Theory and Approach to Counseling............................................................
Existential Theory and Approach to Counseling: Logotherapy...............................
Transactional Analysis..............................................................................................
Reality Therapy Theoretical Approach to Counseling.............................................
Family Therapy.........................................................................................................
The Contextual Approach.............................................................................
The Structural Approach...............................................................................
The Strategic Approach................................................................................
Understanding Your Family.........................................................................
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Identifying Issues in Your Family of Origin...............................................
Feminist Theory......................................................................................................
Crisis Intervention...................................................................................................
Suicide Lethality Assessment......................................................................
Homicide Risk Assessment.........................................................................
How to Handle a Crisis: The Basics...........................................................
Interviewing A Person in Crisis: A Five Step Procedure............................
Appendix A - Progress Note and Termination Summary........................................
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Introduction
One of the most difficult aspects of becoming a skilled counselor is to synthesize the vast amount
of information that pertains to counseling practice into a unified whole. As difficult as this task may
be it is, nonetheless, a challenge that every graduate student in counseling must successfully meet. In
an attempt to help you, the student, meet this challenge I have complied this document of basic
information regarding counseling theory, counseling process, and tools of counseling practice. This
material is intended to provide the “nuts and bolts” elements that will be needed as one begins the
study of counseling practice in the school counseling or community counseling program at Saint
Joseph College.
It is important to note that the information covered in this document does not provide the student
with in-depth information of any one topic. The basic learning principle intended here is that one is
usually better able to understand detailed and complex ideas if one is first exposed to the primary
concepts upon which the complex ideas rest. Therefore, in the pages that follow provide a “big
picture” overview of important aspects of counseling practice. Once you have reviewed each of the
sections of this document it is suggested that more in-depth reading and study continue on each of the
topics outlined throughout the course of the student’s graduate education.
4
A Short History of Mental Health and School Counseling
In its current form, mental health counseling is only about thirty years old but has enjoyed a rich
history in getting to it current form.
Historical Antecedents
Early treatment prior to the late 18th century
Mental illness viewed as a spiritual disorder - demonic possession
Treatment - exorcism or burning at the stake
- confinement to an asylum w/wretched conditions w/no treatment
Moral Treatment
1793 Philippe Pinel - Director of Bicetre (the largest mental hospital in Paris)
- His first act was to release patient from their chains
- He forbid corporal punishment
- Restraint was used only when patients where a danger to self or others
- In 1795 he introduced these methods to a similar hospital for women
- To the surprise of many his reforms worked
- Pinel kept detailed statistics and “cure” rates where impressive
- He later wrote an influential book on institutionalized treatment classifying various
disorders and advocated the use of occupational therapy as an adjunct to treatment
Late 1790’s - William Tuke, a Quaker, founded the York Retreat in England
- York Retreat focused on providing a restful, orderly environment in which those
suffering from emotional disorders could return to normal functioning
Early 1800’s in the U.S.
- Dorthia Dix and other reformers founded private asylums and state
hospitals operated on humane principles similar to those of Pinel and Tuke
- These highly structured environments emphasized the removal of distressed persons
from their families or other familiar settings
- Focus was manual labor, regular religious devotions, and systematic education
programs aimed at redirecting thought patterns and teaching self-control (milieu
therapy and psychoeducational programs) offers significant alternative to medical and
custodial models of treatment
- Attendant played part in success as role models for appropriate behavior
Post Civil War in U.S.
- State asylums - broader range of patient (e.g. alcoholics, criminally insane)
- Ante-bellum reformer did poor job of training their successors
- New staff were poorly equipped to carry forth humanitarian ideals
- Funding from public and private sources declined
- Medical treatment model reasserted itself as medicine became an organized discipline
- These factors sealed the doom of the moral treatment model 75 years after it began
and the next 50 year saw a steady decline in the treatment of the institutionalized
mentally ill
5
Early 1900's - Clifford Beers - Spent much of his youth and early adult life in mental institutions
and documented his experiences in a book entitled: The Mind that Found Itself.
The Mind that Found Itself
- An autobiographical account of his experiences in mental hospitals
- Served to heighten public awareness
- Interest led Beers to found the National Committee for Mental Hygiene in 1909
- Advocated for the humane treatment of mentally ill and the forerunner of the present
National Mental Health Association
- These groups had powerful positive influence for the next 75 years on public policy
related to mental health issues
Vocational Guidance 1900’s
- Youth unemployment was a major problem during the industrial revolution
- Occupational choice was a major problem for boys and men who had worked on
farms
Frank Parsons - A progressive social reformer
- Founded the Boston Vocational Bureau 1908
- Purpose was to help young men to match their interests and aptitudes w/occupations
- Parson described his process in his book Choosing a Vocation 1909
- His efforts led to the first national conference on vocational guidance in 1910
- In 1913 the National Vocational Guidance Association was founded to foster
vocational guidance in schools and the aid in the exchange of ideas between
practitioners.
Conclusion of the early history of mental health counseling
- Moral treatment - emphasis on the potential possessed by disturbed individuals, the early
concept of recovery, and the earliest form of psychoeducational treatment
- Vocational Guidance Movement - establish the role of the professional counselor, gave birth
the profession of social work, and the early vocational guidance programs were the incubator
of modern mental health counseling
More Recent Antecedents to Professional Practice
Testing and Assessment
- Prior to the 1900’s estimation of human abilities and aptitudes was based on speculation
about the relationship between intelligence and heredity
- At the time, educational achievement was more closely related to socioeconomic status that
intellectual ability
- Two French psychologists - Alfred Binet and Theodore Simon were commissioned by their
government to study ways of detecting measurable differences between children who show
unimpeded development and those where developmental delays were evident. This work led
to a number of standardized tasks that could be performed by children of different mental ages.
- The concept of mental age led to the concept of IQ as a stand measure of intellectual ability.
- Group intelligence tests emerged in the United States entry into WW - I and became a part of
public schools shortly after.
6
- 1912 aptitude tests were first developed for the selection of streetcar motormen and
measured everything form musical ability to clerical speed
- Vocational interests measurement achieved statistical respectability through the work of
E. K. Strong and G. Frederic Kuder
- Objective Personality Testing began in 1910 from the work of Edward Elliot MMPI 1940
- Projective instrumentation - Rorschach Inkblot test, 1921; Thematic Apperception Test,
1938
Non-Medical Approaches to Psychotherapy
- Prior to WW II psychotherapy was medical model only (Psychiatrists)
Carl Rogers
- Counseling and Psychotherapy 1942 - Client Centered Therapy
- No use of diagnostic labels or prescriptive methodologies
- Everyone no matter how bizarre behavior - has within themselves the resources
for positive behavior change
- Stressed the relationship between counselor and the client were the primary
medium through which such change occurs
Behavior Therapies
- Based on principles of learning and conditioning
- View emotional disorders as the result of faulty learning
- Maladaptive patterns can be unlearned and replaced with new behaviors
Theories of Normal Human Development Cognitive Theories - The “how” of human development
- Piaget, Perry, Kohlberg, Selman, Kegan, Loevinger, Gilligan
Psychosocial Theories - The “what” of human development
- Erik Erikson
Group Counseling and Psychotherapy
- Group interventions have been traced back to 1905, J.H. Pratt - found that group
interaction when teaching tuberculosis patients hygiene practices greatly increased their
attention
- About the same time, L.C. Marsh used group techniques with schizophrenic patients
“By the crowd they have been broken; by the crowd they shall be healed"
- Alfred Adler 1912 interviewed children and noticed that they behaved differently in
front to groups of clinician Adler was training. Began to incorporate this into his
practice
- Jacob Moreno 1925 began to work with groups of prostitutes. Very influential in
group work movement and was the originator of psychodrama school of group work.
Psychoeducational Approaches to Treatment
Not present prior to 1960s
- Different in that they denote client as learner as opposed to client as patient and
counselor as teacher as opposed to clinician
- Assumption is that the client is deficient in skills needed for effective living as
opposed to being ill or sick
- Role of counselor is to teach skills in a systematic way so they can be applied to the
presenting problem as well as be generalized to other areas of the client’s life
- Presently there are an array of very well developed psychoeducational programs
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The Four Forces in Counseling:
1st Psychodynamic
2nd Behaviorism
3rd Humanistic Movement
4th Multicultural Counseling
The Nature of the Counseling Process
Counseling as Art and Science
A common purpose: Art and science have different ways of dealing w/experience. The application of
scientifically derived information in an artful way is the hallmark of the talented and skilled counselor.
Art and science have different tools for accomplishing their work but also have overlap.
Five common characteristics
Honesty - Stay close to the scientific information and be genuine regarding allowing self to be
known
Parsimony - Necessary, integral, and meaningful to the whole regarding explanations,
interventions, and language. A balance between too much and too little or either is important to reach.
Duality - Sensitivity and tenacity. Stay with client in the moment - stay with goals over time.
Insight - Seeing or realizing new relationships.
Action - Taking specific action steps designed to bring about change
Counseling as a Creative Process
The counselor and client create a new culture with unique rules, language, and rituals. Mutual trust
forms a relationship that can imagine change. Change then is a creative process by which one
discovers manners of being and strategies that previously where outside the realm of one's awareness.
The Concept of the Scientist-Practitioner - AKA “The Boulder Model”
The Boulder Model - Intellectual pursuit of knowledge and emotional pursuit of understanding. This
model suggests that the counselor is involved in a process of scientific discovery as well as the
application of scientific knowledge to working with clients.
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The Counseling Relationship
The counseling relationship becomes the vehicle for allowing the counselor to become an agent of
persuasion and change. The relationship is necessary but not sufficient for change to occur. What
client and counselor expect of one another is an important factor when considering the nature of the
counseling relationship. Client’s may need help in setting expectations: the nature of the counseling
relationship, how counseling is supposed to work, the rate of change to expect, the idea that the client
might first experience more pain before experiencing relief.
Special Considerations and Variables in Counseling
Healer and Sufferer - All cultures identify healers that those who are in pain seek out for relief of
that pain
Psychological Influence
- Client change takes place in part through social influence
- Counselor must seek to sustain change motivation
- Theoretical variables alter forms of counseling and therapy
The Relationship
The counseling relationship is the vehicle to allow the counselor to become an agent of
persuasion and change. The relationship is necessary but not sufficient for that change to
occur. Rotter (1980) counseling effectiveness: 1) the counselor’s strength of reinforcement;
2) degree to which the counselor is thought to be impartial and objective; 3) the degree to
which the counselor is thought to be knowledgeable, wise, and skilled. Horvath (1981) The
working alliance that is formed between counselor and client consists of three elements: a)
Bond - a mutually trusting relationship, b) Goal - the issue(s) that the counselor and client are
there to work on, c) Task - The activities within and outside of the counseling session that
relate to the goals of counseling. Research has shown that a strong working alliance is one of
the best indicators/predictors of a positive counseling outcome.
Role Expectations
- It is important to consider what the client and the counselor expect of one another
- Expectations: Office, professional presence, gender, age, social status, etc.
- Client’s may need help in setting expectations: How counseling works; Rate of change to
expect; Idea that there may be an experience of more pain during the change process
Other variables
- interpretation, insight, and understanding
- reinforcement
- desensitization
- relaxation
- client information
- reassurance and support
- expectancies as a therapeutic variable
- the placebo response
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Basic Steps in the Counseling Process
Counseling is and activity that takes place over time and as such follows a pattern of steps which,
when taken together form a process. One can think of these steps as the path that the counselor and
client follow when involved in making change.
Initial
Contact
Effort to
Change
Problem Assessment
or Reassessment
Resistance
Termination
Initial Contact - First priority is to establish rapport; Mutuality of purpose; Mutual trust; Emotional
expression; to risk; Client expresses self in own language; Counselor responds and establishes
understanding; Listen, reflect, restate, accurately.
Problem Assessment - Gathering information about the client’s problem and the client’s history and
using this information to compare with a body of know psychological and developmental principles to
arrive at an understanding of the client and the problem which is being presented. (See Conducting
and Assessment on page 12 and Biopsychosocial Assessment form on page 13).
Effort to Change - Change does not come easy. Making permanent changes in one’s life has been
compared to becoming fluent in a different language. It takes a great deal of time and energy and
usually a slow and gradual process. The client must put in a good deal of effort to make change
happen and often the client must make repeated attempts prior to succeeding.
Resistance - One of the elements that makes change difficult is the fact that one is never quite sure
that the change will actually be for the better. People will often continue to do what they are doing
because, even though it may not be working, it is familiar and more comfortable than the unknown.
This holding on to the old and familiar is referred to as resistance. When the client exhibits resistance
to change the counselor must work with the client to help overcome the fear of movement and again
support positive efforts to change.
Termination - Life is a series of beginnings and endings. This is also true of the counseling process.
Once the client has successfully accomplished the goals of counseling the relationship is ended. This
can often bring up feelings for both the client and the counselor. It is important that these feelings are
acknowledged and discussed.
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A Stage/Phase Conceptualization of the Counseling Process:
The Hero’s Journey
One can also think of the counseling process as a means of growth and development. As the client
struggles with new and often difficult situations the is new learning that is not just new information but
also can be a means for transformation.
Innocence
Emergence
Celebration of New
Clarity
The Call to
Learning
The Tests
Empowerment
?
Innocence: A step into the unknown
The Call to Learning: Life always has new learning
The Test: That which calls for a response that you have not yet learned
Empowerment: Finding the new resource/learning that opens to new understanding
Emergence: Moving forth with the new understanding
Celebration of Clarity: The internalized knowing that comes with new perspective
The hero, therefore, is the man or woman who has been able to battle past personal and historic
limitations
Joseph Campbell
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Prochaska's Transtheoretical Model of Stages or Phases of Change
Prochaska, Norcross, and DiClementi (1994) proposed that all change rests within the control of
the individual. Through clinical research, Prochaska et al. have validated six stages of change
that an individual will progress through in making attempts to improve life. The counselor may
wish to consider what stage of change the client is in so that a specific approach of intervention
matches the client's process of change. A shortened way of expressing matching the client's
process is to demonstrate "process empathy."
Precontemplative: The client has no real awareness that there is a need for change
Contemplative: The client is aware that there is a problem and seriously thinking of changing
but no real commitment to taking any form of action
Preparation: The client intends to take action soon, has perhaps begun to test the waters with
some small positive actions or developing the skills need for taking action.
Action: The client modifies behavior, experiences, or environment in order to overcome
problems
Maintenance: The client works to prevent a relapse into past problematic patterns over the long
term
Termination: Counselor and client End work with a consolidation of gains and internalized
self-attribution
The student counselor should draw one very important lesson from Prochaska's work. That
is, one should never assume that the client is ready to actively change just because s/he is in the
counselor's office. Making change is a process with a number of steps and therefore the
counselor must be sensitive to where the client is in that process in order to serve the client well.
12
Conducting an Initial Assessment
Assessment of the client and the problems the client presents is a complex process of gathering
information, comparing that information with known bodies of psychological knowledge and
formulating a conceptual framework for understanding the client. This conceptual framework usually
involves biological, psychological, social, and systemic aspects of the client and the client’s symptoms
is described as a diagnosis. The primary reference for diagnostic categories is the Diagnostic and
Statistical Manual 4th edition (DSM-IV-TR). This manual describes the symptoms of dysfunction with
which a client may struggle.
Goals of Assessment
Must understand the nature of the client, the problem, and associated issues presented by the client.
Biological/Psychological/Social
Important to consider all aspects of the clients and how their difficulties are manifested.
Understanding Client’s History and Culture
The client’s history is a major portion of the assessment process because it provides a context for
understanding what factors in the client’s life may have contributed to the client’s problem. Culture
provides the backdrop for how a client’s views self, others, and the world. Understanding the impact
of the client’s culture is extremely important.
Identifying Specific Affective, Cognitive, and Behavioral Manifestations
During the assessment process the counselor is trying to determine the frequency, intensity, and/or
duration of any maladaptive thoughts, behaviors, or feelings and in what situations those elements are
likely to occur is like to occur. It is important that the counselor take the complex nature of the person
into account.
Methods of Assessment
The interview
Life history data
Test results
Situational observation
13
Bio/Psycho/Social Assessment Form
Date:
Work Phone #
Client Name:
Home Phone #
Address:
Gender:
Age:
Ethnicity and Race:
Socioeconomic Status:
PRESENTING PROBLEM(S):
Duration of the presenting problem:
History of presenting problem and/or similar problems in the past:
RISK ASSESSMENT :
Current or past ideation of harmful behaviors (Suicide and Homicide):
Intention to take action on thoughts of harming self or others:
Specificity of plan(s):
Availability of means:
Lethality of method:
History Harmful Behaviors(self, relatives, friends, etc.):
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CLIENT HISTORY:
History of Interpersonal Relationships (include quality of peer relationships, significant losses,
separations, etc.):
Academic History (include any remarkable indicators such as being developmentally gifted,
developmentally delays, learning disabilities, etc.):
Work History:
History of Legal Problems and/or Destructive Behaviors:
Alcohol/Drug History and Current Use Behaviors:
History Self-Abusive Behaviors (e.g., eating, sexual, laxative, spending, cutting of one's self, etc.):
History of Sexual of Abuse (e.g., past or present, nature and duration, abuse of other family members,
any warning signs or indicators of abuse in current relationship, etc.)
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Page 3
History of Previous Counseling:
Yes
No
If yes, when, with whom (name(s) and phone number(s) of past counselors), what issues were
addressed, and will client give you a release for counselor can be contacted?
List psychiatric medications and dosage presently or in the past?
HEALTH STATUS: (Any history of health problems)
Date of last physical exam:
History and/or Current Status of any Health Conditions:
Medications: No
(Yes
Name(s) of Medication(s)
Dose
Level of regular physical activity: _____ High _____ Moderate _____ Low _____ None
Type(s) of physical activity:
SPIRITUALITY: (Religious affiliation or other meaningful spiritually fulfilling practice)
Role that spirituality plays in client's life:
Reported level of satisfaction with spiritual endeavor:
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MENTAL STATUS ASSESSMENT
I. Social Presentation
Appearance
Grooming
_____ Normal
_____ Disheveled
_____ Unusual (explain):
Hygiene
_____ Normal
_____ Body Odor
_____ Bad Breath
_____ Other (explain):
Interpersonal Style: _____ Separates Comfortably from Parents (Child)
_____ Separates Too Easily from Parents (Child)
_____ Would Not Separate at All (Child)
_____ Appropriate, Cooperative _____ Domineering, Demanding _____ Provocative
_____ Guarded _____ Submissive, Passive _____ Threatening, Hostile, Aggressive _____ Pouty
_____ Manipulative _____ Impulsive _____ Fearful _____ Apathetic/Withdrawn _____ Silly
_____ Destructive _____ Dependent _____ Crying _____ Preoccupied _____ Ambivalent
_____ Competitive _____ Self-destructive _____ Other
.
Eye Contact: _____ Unremarkable _____ Maintains Good Eye Contact
_____ Avoids Eye Contact _____ Stares Into Space _____ Other (Explain)
Speech: _____ Normal _____ Pressured _____ Slow _____ Whiny _____ Overly Loud
_____ Stutters _____ Babyish _____ Monotone _____ Rambling _____ Mute
_____ Impaired _____ Broken _____ Incoherent _____ Other
.
II. Behavioral/Affective/Psychomotor Functioning
Motor Activity: _____ Appropriate _____ Relaxed _____ Slow, Under active _____ Sedate
_____ Psychomotor Retardation _____ Restless _____ Pacing _____ Hyperactive
_____ Mannerisms _____ Tremors _____ Tics _____ Poor Coordination
_____ Other
.
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Impulse Control: _____ Good _____ Fair _____ Poor
Mood: _____ Normal/Appropriate _____ Elated _____ Optimistic, Cheerful _____ Pessimistic
_____ Guilty _____ Depressed _____ Anxious _____ Angry _____ Suspicious
_____ Other
.
Affect: _____ Appropriate _____ Inappropriate _____ Blunted, Flat _____ Labile
_____ Constricted _____ Other
.
III. Cognitive Processes
Orientation: _____ x 3 (person, place, self) _____ Disoriented _____ Other
.
Attention: _____ Normal _____ Distractible _____ Hypervigilant
Perception: _____ Normal _____ Auditory Hallucinations _____ Visual Hallucinations _____
Other
.
Insight: _____ Fair to Good _____ Limited; difficult acknowledging problems
_____ Absent; denies problems _____ Blames others for problems _____ Other
Memory:
_____ Intact
.
_____ Impaired Immediate Recall ( 10 to 30 sec)
_____ Impaired short-term (up to 1 and 1/2 hours) _____ Impaired Recent (2 hours to 4 days)
_____ Impaired Recent Past (past few months) _____ Impaired Remote Past (6 months to lifetime)
Thought Processes/Content: _____ Unremarkable _____ Flight of Ideas _____ Blocking
_____ Loose Associations _____ Confabulation _____ Incoherent _____ Confused
_____ Tangential, Circumstantial _____ Obsessive _____ Delusions _____ Suicidal Ideation
_____ Homicidal Ideation _____ Magical Thinking _____ Ideas of Reference _____
Other
.
Judgment: _____ Good _____ Fair to Good _____ Poor; Limited _____ Significantly Impaired
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Intellectual Ability
Overall Intellectual Level: _____ Below Average _____ Average _____ Above Average
_____ Superior _____ Can Not Determine _____ Other
.
_____ General Information (Past four presidents, governor of the state, state capital, direction of
sunrise and sunset, etc.)
_____ Calculations (Serially subtracting 7 from 100. Simple multiplication word problems such as,
“if a pencil costs 5 cents, how many pencils can you buy with 45 cents?”
_____ Abstract Reasoning (Explanation of Proverbs. This assesses the ability to make valid
generalizations. Responses may be literal, concrete, personalized, or bizarre. Example proverbs “Still waters run deep.” or “A rolling stone gathers no moss.”)
_____ Opposites (Fast/Slow, Big/Small, Hard/Soft)
_____ Similarities (Door/Window, Telephone/Radio, Dog/Cat, Apple/Banana)
_____ Attention (Digit Span, or Trials to Learn Four Words)
_____ Concentration (Month of the Year or Days of the Week Backwards)
_____ Reasoning and Judgment (The client is able to connect consequences to choices and behavior.)
FAMILY HISTORY: (Construct and attach genogram if appropriate)
DSM-IV MULTIAXIAL DIAGNOSIS
Diagnosis
Code Number
Diagnosis
Axis I
Axis II
Axis III
Axis IV
Axis V Current:
Highest in Last Year:
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Code Number
Page 7
COUNSELOR'S CONCEPTUALIZATION OF THE CLIENT
COUNSELOR AND CLIENT GOALS FOR COUNSELING:
INITIAL COUNSELING PLAN (Use additional sheets as necessary):
Counselor’s Name:
20
.
Domains of Focus
Any time a counselor conducts and assessment there are decisions to make about what will be
focused on in the counseling sessions. In counseling the focus is usually determined by the counselor
and the client working collaboratively to construct what both think will be a reasonable plan of action
during the counseling process.
Ivey’s Interview Focus
1) Client - Feeling state in the moment; 2) Main theme or problem - Gathering data first broadly
and then specifically; 3) Others - Those members in the client’s life that have played or are currently
playing a significant role in the client’s life; 4) Family - Option #1: Family members who fall into
the “Others” category (see item 3 above). Option #2: Family systems perspective;
5) Mutual Issues or Group - Counselor/client relationship; 6) Interviewer - Counselor “I
statements” in the form of limited self-disclosure; 7) Cultural/environmental/contextual issues Broader issues that in one form or another that can serve as foundation for the client’s world view.
Focus Options After Conducting a Biopsychosocial Assessment
A. Biological and Clinical Syndrome Focus
1. Organic mental disorders
2. Affective disorders
3. Non affective functional psychosis
4. Chemical dependency
5. DSM-IV classified disorders
6. Medical disorders
B. Psychodynamic Focus
1. Personality structure
2. Ego functioning
3. Defense mechanism
C. Developmental Focus
1. Ego development
2. Stages of human maturation
3. Stages of spiritual understanding/practice/expression
D. Sociocultural Focus
1. Natural and social impact of stressful life events
2. Breadth, depth, and accessibility of social support
3. Nature of the client’s sociocultural “group” and client’s interpersonal process
4. Family and ecosystems issues
21
F. Cognitive Focus
1. Cognitive Structures - Schema analysis
2. Beliefs (rational vs. irrational)
3. Automatic thoughts
E. Behavioral Focus
1. Antecedent events causally related to client behavior
2. Consequences causally related to client behavior
3. Behavior as an adaptive response to sociocultural or biological events
4. Deficit in skill areas needed for adaptive response
5. Objective analysis of behavioral functioning level
G. Existential Focus
1. Life philosophy
2. Human will
3. Personal potential/Spiritual actualization
4. Values assessment: Creative, Experiential, Attitudinal
5. Search for meaning in the events that life either offers of “forces” one to experience
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Diagnosing and Labeling Client Problems
A counselor makes an assessment of a client for two specific purposes. The first purpose is to form
a clear understanding of the problem or problems with which the client is struggling. The second
reason a counselor makes a thorough assessment is to aid in deciding what the focus of counseling
might best meet the clients needs and the types of interventions that might be most helpful.
The work that the counselor and client focus on is, to a great extent, determined by how the
counselor and client go about assessing and understanding the problematic nature of the client's
struggle. The most common framework for diagnosing client problems is the Diagnostic and
statistical manual of mental disorders 4th edition Text Revision (American Psychiatric Association,
200) which is commonly referred to as the DSM-IV-TR. The DSM-IV-TR lists all agreed upon
psychiatric disorders and the diagnostic criteria (lists of symptoms) that one would look for to make a
particular diagnosis. The student may wish to review a copy of the DSM-IV-TR to get a clear idea of
how this diagnostic system is set up.
The American Psychiatric Association's system of nomenclature has been extremely helpful over
the last 40 years in giving the mental health profession a common language and understanding of
medically based psychiatric disorders. If, however, one wishes to orient one's work toward placing the
focus of assessment and intervention on the client as opposed to focusing on the client's disorder or a
set of symptoms, the system embodied in the DSM-IV-TR presents the counselor with some serious
limitations. The framework that follows was developed by a psychologist by the name of Jeffery
Young. It focuses not on sets of medically based symptoms but rather on the core nature of the
client’s struggle. This framework is referred to as Schema-Focused Client Core Issues.
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A Schema-Focused Classification of Core Issues
Schema Defined
A schema is a [cognitive] structure for screening, coding, and evaluating the stimuli that impinge
on the organism. It is the mode by which the environment is broken down and organized into its many
psychologically relevant facets. On the basis of that matrix of schemata, the individual is able to
orient himself [herself] in relation to time and space and to categorize and interpret experiences in a
meaningful way (Beck, 1967, p. 283).
Essentially a schema serves as an organizer of meaning and as such provides the person with a way
to organize a view of one’s self and one’s relationships with others. It is thought that schemata begin
to develop in childhood and are then further elaborated on throughout one’s life.
Schema Characteristics
• Schema result from an interaction between the individual and everyday experiences such as a child
with a parent or parents, siblings, peers, and the environment.
• Schema are capable of generating automatic thoughts, strong affect, behavioral tendencies.
• Most people have difficulty in one or more schema areas but a schema is not considered as
maladaptive unless there is a serious interference with one’s functioning.
• Maladaptive schema are capable of interfering significantly with meeting core needs for autonomy,
connection, self-expression, Etc. Schema, unlike cognitions (automatic thoughts or cognitive
distortions) are tied to early goals often referred to as schema domains. Children are developmentally
drawn toward meeting specific goals such as autonomy, connection, self-expression, Etc. Earlymaladaptive schema block the client from meeting these goals and in the process create difficulties and
unhappiness in the client's life.
Young’s Five Domains of Early Maladaptive Schema
• Schema domains are broad groupings of schema generated difficulties.
• These domains help define broad categories of client struggle.
• Each domain also characterizes broad goals that clients are striving to accomplish in their lives.
• The goal of counseling is to help the client achieve the goals that the maladaptive schema are
blocking.
• Knowing the schema domains is helpful in providing a direction for the broad goals of counseling.
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Domain # 1
Instability/Disconnection and Rejection
A sense that the people close to the client can not be relied on to provide safety, security, love, and
companionship. A feeling of instability in relationship and disconnection from other people.
Wounding Event(s): Others were somehow detached, explosive, unpredictable, or abusive.
Domain # 2
Impaired Autonomy and Performance
As the child begins to separate from parents and develop a sense of autonomy the child gets
messages that one can not survive on one's own without continual guidance, direction, and advice
from the family. This domain has to do with the child’s inability to separate and function
autonomously and become a person who can perform and achieve in the external world.
Wounding Event(s): Early relationships are characterized by enmeshment, the child's
judgment is undermined, or the child was overprotected by a care taker.
Domain # 3
Impaired Limits
This is difficulty in accepting the rules and expectations of society. These people have trouble with
meeting the needs of other people and postponing their own needs.
Wounding Event(s): Early relationships were overly permissive and/or overindulgent.
Domain # 4
Other-Directedness
This domain is characterized by excessive focus on the wants, needs, feelings, and/or desires of
others to the detriment of the self. The idea is that by doing for others at the expense of the self, one
will have emotional needs met and/or avoid another’s anger.
Wounding Event(s): In primary care-taking relationships one was forced to deny one’s own
needs, wants, and desire so that the needs, wants and desires of another could be met.
Domain # 5
Overvigilance and Inhibition
This domain addresses the child’s need for pleasure, for happiness, spontaneity, and expression.
Many schema serve to inhibit the child from being able to get a sense of happiness from the world.
Life feels grim, life feels like it is work, sacrifice, and constant performance instead of feeling like
there are pleasures and rewards from living.
Wounding Event(s): Playfulness and pleasure was often devalued while work, sacrifice,
performance, and self-control were greatly valued.
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Client Core Issues Across the Five Schema Domains*
Young (1994) made the point that when you find the specific schema core issue that a client is
dealing with you are, in a sense, entering the world of that schema. A client with an abandonment
schema lives in the world of abandonment. Each core issue has its own origins, its own emotions, its
own choice of partners, its own way of being in a relationship, its own triggering events, etc. The goal
is to understand the different layers of how a particular schema feels like so that you can connect and
empathize with the experience of the client’s struggle.
Instability/Disconnection and Rejection
1. Abandonment/Instability: This is the feeling that the people who we depend on for support are
not consistently reliable or are unavailable. Whoever the client needed to be there for them was not
predictable and/or not experienced as dependable.
Origin: Usually a parent who left the home early, a parent who died early, or parents who
fought a lot. The client, therefore, experienced a loss or an underlying threat of loss. Example:
Parents who divorced and/or were absent or an alcoholic parent who at any moment the parent may
become impaired.
2. Mistrust/Abuse: The feeling that those closest to you might hurt you, lie to you, or manipulate
you. The expectation that others will hurt you or be abusive to you in some manner. Clients with this
schema have expectations that people are out to mistreat or hurt the them or that people are so selfish
that one is going to be used in some way.
Origin: Parents who were physically abusive, emotionally abusive, sexually abusive, etc.
3. Emotional Deprivation: The client has expectations that one’s emotional needs will not be
adequately met by others.
Deprivation of Nurturance - attention, affection, warmth, companionship
Deprivation of Protection - strength, direction, and/or guidance
Deprivation of Empathy - understanding, listening, self-disclosure, mutual sharing
Deprivation of Empowerment - efficacy, support, encouragement
Origin: Parents were unavailable emotionally, unable to communicate, unable to listen, were
weak, depressed, and/or were unable to adequately nurture or protect the child.
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4. Defectiveness/Shame: The client has the feeling that s/he is somehow inwardly defective. The
client has the sense that in some basic way s/he is flawed, defective, inadequate. Defectiveness
usually involves some sense of shame and/or some sense of unlovability. “If people really knew me
and who I am deep down they would reject me.” The client tends to be self-critical, self-punishing,
exaggerates expectations of rejection and blame. According to Young (1994) this is one of the most
common schema.
Internal self - aspects of one’s self that are not obvious on the surface, such as anger,
selfishness, sexual desires, or in other words aspects of an individual that you can not see by looking at
them or interacting with them.
External self - aspects of how someone appears in a more social context, appearance, social
skills, etc.
Origin: Usually the client has experienced critical/rejecting parents or a peer group who was
rejecting. The client was constantly given the messages of rejection or of being criticized.
5. Social Isolation/Alienation: This schema is based in one’s sense that one is outwardly undesirable
to others or that one is isolated from the rest of the world. This schema has to do more with how a
client feels when s/he is in a group as opposed to when s/he is with those closest to him or her. This
schema addresses social connections with the world at large. The client often has a sense of being
different, or cut off by others, alienated, or unacceptable to others.
Origin: Usually based on being different in some significant way from people and not
receiving support in that difference.
Impaired Autonomy and Performance
This grouping has to do with the child’s attempts to separate from their parents and become more
independent in their functioning as individuals.
6. Dependence/Incompetence: The client has a strong belief that s/he is not able to handle everyday
responsibilities competently on his/her own. There is difficulty trusting one’s own judgment or
decision making and therefore must turn to others for advice and direction. The client has a sense that
one can not do it on one’s own. Everyday life functioning is a struggle for these people and they feel
as though they really can not cope on their own without someone else to guide them.
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Origin 1: An over protective parent or a parent who gave messages that the child can not cope
on his/her own. Often these clients have memories of their childhood being warm and protective. The
problem is that it was so warm and safe that they are not really able to deal with leaving the home for
the harsh realities that are sometimes characteristic of the outside world.
Origin 2: Parent(s) who continually implied to the child that s/he can not make good decisions
or succeed independently. When the child tried to do something on his/her own the parent implies that
it was wrong or done poorly. “You didn’t make the right choice.” “You should have asked me first
because I can do it better than you.”
7. Vulnerability to Danger (random events): These clients have a sense that disaster could strike at
any time. There is an exaggerated fear that disaster is about to strike. This danger could be something
medical, emotional, natural, or anything that is out of one’s control. This is a very common schema
for clients with phobias or clients with generalized anxiety disorder.
Origin 1: A parent who was overprotective and was continually warning the child of dangers
and then gave messages regarding how one could avoid dangers in the world.
Origin 2: A phobic parent who taught his/her own schema to a child.
8. Enmeshment/Undeveloped Self: Excessive fusion or merging identities with one parent or the
other. Emotional involvement with significant others at the expense of individuation or social
development. The parent merges with the child and tries to limit differences between them. This
creates a situation where the child grows into an adult who has a sense that one can not function
without the person that one is enmeshed with. The parent's message was, “We are one person and we
must always be together.” This creates a tremendous sense of guilt when the child has to separate.
This can also result in a sense of being an undeveloped self. This is evidenced by statements such as:
“I do not know who I am” and/or “I do not have a sense of 'me' that is separate from my parent.” A
person may not have an identity that is separate from the parent and therefore may not know what
career to choose, what kind of car s/he would like, etc. This client lives an existence that is largely an
extension of the parent.
Origin: A parent who was afraid of abandonment and chooses one child through whom to
live. It could be a way of compensating for abandonment, compensating for defectiveness, or any
number of other schema. The parent chooses the child, over connects with the child, and basically
does not allow the child to develop an independent identity.
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9. Failure: The client has a sense that s/he has failed or will fail in areas of achievement (school,
career, athletics, etc.). The belief that one will inevitably fail or is inadequate relative to members of a
peer group. Feelings of being stupid, inept, untalented, ignorant, lower in status, less successful, Etc.
In some way this person feels that s/he is less able to succeed than others.
Origin 1: A child who has failed for one reason or another. Repeated situations when the
child could not compete and had the experience of failing. As adults these clients often have the
memory of being in a classroom and not being able to read out loud, failing spelling or math tests,
never being able to hit or catch the ball, etc. Also seen in clients who have a sibling who was
consistently more successful.
Origin 2: A parent who undermined the child’s successes by continuously criticized them “You’re stupid” or “You always mess everything up.” The child was made to feel that in areas of
achievement they never measure up. This is similar to the dependence/incompetence schema but here
we are addressing issues of achievement as opposed to managing broader life tasks.
Origin 3: The parent, on an emotional level, did not really want the child to succeed. The
parent emotionally withdraws from the child when the child succeeded for fear that if the child is too
successful the child will no longer want to be close to them. So the message was: “If you do too well
then you are going to be a threat to me because I may lose you.” Therefore, the parent pulled back
from the child if the child was too successful.
Impaired Limits
This grouping addresses people who are unable to accept or apply discipline to their lives. They
are unable to accept limits to their own emotional expression or behavior. There is an inability to
empathize with the needs of other people and to take those needs into account in guiding one’s own
behavior. The inability to accept limits may pertain to internal limits of self-discipline or the external
limits that reflect the needs of others.
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10. Entitlement/Domination: Insistence that one should be able to have whatever one wants
regardless of the cost to others. Also can be seen in the client dominating another to get what s/he
feels is needed.
Origin 1: An overindulgent parent who spoiled the child or gave the child a sense that s/he is
more special than everyone else.
Origin 2: Person who operates out of an emotional deprivation and/or a defectiveness schema
and develops entitlement as a form of schema compensation.
11. Insufficient Self-Control/Self-Discipline: This schema addresses issues of impulse control.
These clients have difficulty with imposing internal limits, postponing short-term gratification, and
controlling impulses in order to gain longer term gratification. They exhibit pervasive difficulty
exercising sufficient self-control and frustration tolerance to achieve their own personal goals.
Origin: The parent had difficulty providing sufficient discipline. The child was not taught to
behave in a responsible, consistent, and disciplined way. The child was given too much latitude to
express emotions and impulses.
Other Directedness
We all have natural inclinations toward experiencing pleasure. There are basic innate types of
activities that give us pleasure, gratification, and fulfillment. A healthy person is able to act in a
manner that brings pleasure into one’s own life. A healthy person learns what it is that makes them
feel good, actualized, and fulfilled and they act on that knowledge. Some parents teach their children
to tune out their natural inclinations and instead to focus on what other people want. Each of the three
schema in this domain are forms of focusing one’s attention on the needs of other people rather than
one’s own natural inclinations.
12. Subjugation: Excessive surrendering of control over one’s own decisions and preferences,
usually to avoid anger, retaliation, or abandonment. “I must surrender control to others around me or
else they are going to retaliate, get angry, reject me, or abandon me." A client might say, "I am not
giving into other people because I want to. Rather, I am giving in because if I don't t they are
30
somehow going to retaliate. Therefore I must give in.” With this schema there is usually a high level
of suppressed anger. Most people have learned to push their anger down so others do not retaliate.
Origin: Parent(s) who were extremely controlling, domineering, and did not care about the
needs of the child. Everything had to happen on the parent(s) terms. The child’s needs did not count.
The child had the experience of not being heard.
13. Self-Sacrifice: Excessive focus on meeting the needs of others, at the expense of one’s own
gratification. These people voluntarily give up meeting their own needs in order to take care of other
people. Usually the motivation here is to spare other people pain. By sparing others pain the client
hopes to help stay connected to others.
Origin: A parent who was in emotional pain and/or depressed or a narcissistic parent who
needed all the attention from the child and does not give much emotional attention back to the child.
14. Approval Seeking: The excessive emphasis on gaining approval, recognition, and attention from
other people. Attempting to "fit in" at the expense of developing a secure and true sense of self.
These clients develop skill in determining what others want and finding ways of providing it for them.
The problem is that they do this by tuning out their own individual differences. This is the client who
knows what other people want to hear and because of this will not give an honest opinion that others
might disagree with. These individuals have a very difficult time making major decisions.
Origin 1: Parents who placed major emphasis on status, appearances, and how things should
look in the eyes of other people.
Origin 2: Parents who gave conditional approval to the child. They helped the child feel
special when s/he was behaving in a very successful high performing way and somehow implied that
s/he was less valued when s/he was less successful or less achieving.
Overvigilance and Inhibition
These are clients who have learned to inhibit their own feelings, impulses, and/or choices in an
extreme way. They are unable to be spontaneous, and they tend to become fearful if they act on what
they feel or what they spontaneously want. In some ways this is the opposite of the limits problem. A
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client operating from the over-vigilance and inhibition domain is so sensitive to what could go wrong,
the mistakes they could make, or what might upset other people, that they basically are very
controlled, inhibited, and are lacking in spontaneity.
15. Vulnerability to Error or Negativity (controllable events): The exaggerated expectation in
work, financial life, and/or interpersonal situations that things will go seriously wrong or that life is
going to fall apart at any moment. They have a pervasive focus on the negative aspects of life. They
have a sense that if you make one mistake then everything is going to collapse. These clients do not
want to miss anything on their list. These clients do not want to make any errors in decision making.
Any error could lead to something catastrophic even though the client does not know what it is. These
clients have a sense that everything is going to go out of control, "I am going to go broke, everyone is
going to know, and I am going to be humiliated for life. "So there is a strong sense that they have to
watch everything so that nothing goes wrong. This schema does not include medical problems or
other random events such as a natural disaster. It is limited to controllable events like a financial
situation such that if you are not careful with every dollar you might be subject to financial ruin. The
idea that it only takes a little bit for things to go very wrong. So there is an underlying sense of
pessimism that things could easily go wrong and the negative is waiting just around the corner. “Do
not go up too high because the higher you go up the further you have to fall.” “Do not feel too good
because it is going to be a very big let down when you fall.” “It is better to prepare for the worst all
the time so when it comes you are not disappointed.” These people are pleased if they can just keep
things steady.
Origin 1: Pessimistic parent(s) who worried all the time.
Origin 2: A person who had a major catastrophe as a child and actually did have an
experience where everything fell apart.
Origin 3: Parent(s) who were extremely critical and over reacted to any mistake. For example
the child spills a glass of milk as the parent would respond by screaming at the child. The parent was
so unable to distinguish between a serious problem and a minor one that s/he gave the child a sense
that any error is catastrophic.
16. Over Control: This schema is primarily a strategy for adaptation. This is a response to feeling a
vulnerability to error. It is basically the inhibition of action, feeling, or communication in order to
keep a bad thing from happening. Subcategories:
1) Inhibition of anger 2) Compulsive ordering and planning 3) Inhibition of positive impulses like
joy 4) Excessive adherence to routine or ritual 5) Difficulty expressing vulnerability 6) Not
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communicating freely. All of these are ways that people who operate with this schema try to keep bad
things from happening. Important to distinguish between over control and entitlement/domination. In
Entitlement/Domination, I dominate you to get you to give me what I want to make me happy and
meet my needs regardless of your needs. In Over Control I am trying to protect both of us by making
sure that neither of us makes a mistake. I am going to tell you exactly how to do things so that we are
both protected from something bad happening. With over control then there is the feeling that I am
doing this for everyone’s good.
Origin 1: Often a parent who was over controlling but over controlling in a sense that s/he
was over inhibited and the child picks up on this and models the parent.
Origin 2: A child who was made to feel that any mistake is going to lead to terrible
consequences so they have to watch and over control everything to keep from a problem occurring.
17. Unrelenting Standards: This client operates out of the sense that there is a right way to do
everything. Everything should be done the proper and correct way without mistake. This is a form of
perfectionism. One should strive to do things in a way such that nothing is incorrect. There is also a
rigidity about rules. There is a kind of tight and self-righteous flavor to this schema. It is an
internalized sense that there is a right way and a wrong way to do things that one imposes on one’s self
and/or other people. It can also involve the components of time and efficiency. “I have a limited
amount of time and I have to do everything right.” “I need to know that I have to use my time very
efficiently so do not approach me.” These clients strive to meet internalized standards at the expense
of their own gratification. Undue emphasis on any one or more of the following six broad areas:
• Achievement or competition
• Social status
• Moral, ethical, religious precepts • Perfectionism
• Self-control or discipline
• Control of environment
Origin 1: Parent(s) with unrelenting standards where the child engages in direct modeling and
internalized the caretakers standards. This does not necessarily come from criticism.
Origin 2: Overcompensation for defectiveness.
18. Punitiveness: These clients have a tendency to be angry, intolerant, harshly critical, and
impatient with those who do not meet their expectations or standards. Difficulty forgiving mistakes,
tolerating limitations and a tendency toward not wanting to look at extenuating circumstances. “It
does not matter why you made the mistake, I am going to punish you anyway." The purpose of the
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punishment is not just to get the other to do it right, it is to make the other feel badly for doing the
wrong thing. This client has a sense that you need to be made to feel badly about yourself to make up
for what you did wrong. “I won’t stop punishing you until the punishment is equal to the crime that I
feel you committed." The tone of voice is a good indicator of this schema. These clients will often
talk to themselves about their own behavior in a harsh way. “You idiot! How could you do something
like that?” Often these clients do not feel that they should get better. Their internalized view is that
they are so bad that they do not deserve to have good things happen to them. So they are continuously
punishing themselves for the bad things they have done.
Origin: Punitive parent(s). Parent(s) who were very unforgiving, very punishing, and does
not allow(s) for excuses.
* Young, J. (1994). Cognitive therapy for personality disorders: A schema-focused approach.
Sarasota, FL: Professional Resources Press.
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Counseling Theory: Models for Understanding Problem Development and Change
Counseling Theory
A theory is nothing more than a set of assumptions or beliefs that help the one to a) understand the
nature of some aspect of the world and b) a framework for making predictions about that aspect of the
world to which one is wishing to attend. When the focus is counseling theory, that which is trying to
be understood is that nature of human development and change. More specifically, what are the critical
factors that contribute to the client’s development and how might we utilize these critical factors to
help foster change?
It has been said that everyone has a personal theory that helps one understand the day-to-day
behavior of others. These "personal theories-of-use" consist of often loosely strung together beliefs
and assumptions that seem to operate in everyday life. Personal theories have been influenced by
ethnic, socioeconomic, gender, biological factors, early life experiences, and family history factors.
When it comes to working as a counselor, the models that one uses for understanding and fostering
change, just any old theory is not good enough. The truth is that some "personal-theories-of-use" are
at times inaccurate and do a lousy job at helping one to conceptualize the complex aspects of human
motivation and change. Counseling theories, on the other hand, have been subjected to thorough
examination and testing with regard to their accuracy, and utility for explaining and predicting the
nature of a change process. Therefore, when one works as a counselor it is important to be familiar
with models of change that are valid, have been shown to be effective in helping counselors
understand the nature of a client's struggle, and in suggesting a course of intervention.
Theories Applied to Counseling
Counseling is the artful application of scientifically derived psychological knowledge and techniques
for the purpose of changing human behavior (behavior can be defined to broadly to include thoughts
and feelings)
Evaluating a Counseling Theory
A Theory must be
• Logical - follow sequential steps of logical thought
• Testable - open to experimental replication and analysis
• Language - consistent, comprehensive, and comprehensible
Eclecticism - Two definitions
• The right approach for the right problem (technique salad). Most commonly used as
a catch all for not knowing how to integrate theoretical principles
• Organized approach to understanding the issues clients and a unified process for
helping to bring about change
Most recently attempts at integration 1) humanistic and behavioral theories
2) cognitive and behavior
3) brief/solution focused and many varieties
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The Concept of Self-Regulation and Maturity or Growth Models
Self-Regulation - derived from behavioral models that identify specific excesses/deficits in thoughts,
feelings, and/or problem behaviors. The goal is to help the person exercise some control over
behavior
Maturity or Growth - derived form psychoanalysis and person centered theories - relationship and
insight lead to change. Maturity is the movement toward developing one’s potential and deepening
one’s awareness of self and others. A call to productivity and competence.
Model of maturation process
Insight
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Understanding ------------> Acceptance ------------> Determination -------------> Action
Integration of Self-Regulation and Maturity
Counseling Goals: Initial goals revolve around stabilization and self-regulation
Secondarily assist the client to seek insight that will naturally lead to maturation
The Impact of Culture on the Person and the Change Process
Behaviors, problem solving techniques, and interventions are all culture based and therefore are
suprapersonal.
Suprapersonal = concepts, words, strategies, mannerisms, views of human nature, given to us through
learning within a culture.
Levels of cultural impact are dependent on how close they are to the self. In the diagram below, the
influence on the self is decreased as one move outward from the center.
Variables: Institutions, economic realities, political system, attitudes, values - Therefore,
interventions must account for broader cultural context
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Individual and the Cultural Environment
Study of individual behavior is essential in understanding adjustment.
Social learning theory - attempts to capture the complex interaction between person and the
environment.
Behavior is determined by stimuli, reinforcement, and cognition.
Think/act/feel
<-------------> Environment
Demoralization and Personal Power
A sense of personal power and control, real or perceived, is the key to an individual’s feelings of well
being.
Demoralization happens when the person does not meet the demands expected (by self or others).
Results in syndromes associated with depression, anxiety, guilt, etc.
Self-regulation and maturity need to focus on helping the client to overcome demoralization.
Cultural Diversity in the Helping Professions
There are universal themes that link people in spite of their differences
- Not important to be the same but is important to have experiences that allows for greater
understanding.
- For helpers growing up in a monocultural society it can be a very big challenge
- Each of us bring attitude and values must understand those influences
Must be willing to explore:
• cultural encapsulation
• cultural approaches to life (East vs. West
• recognize biases, prejudices, and racism
• challenging stereotypical assumptions
• becoming a culturally skilled helper
Multicultural Perspective on Helping
Forms of Culture:
Ethnographic Variables - race, nationality, ethnicity, language, religion
Demographic Variables - age, gender, place of residence
Status Variables - education, socioeconomic variables
Need for a Multicultural Emphasis:
• Monocultural - Identification with one cultural word view
• Ethnocentrism - Encapsulation within one ethnic value set
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• Multicultural - World view that is open to varied cultural perspectives
Regardless of whether you chose to recognize culture it will have an influence on your work
with clients. It is also important to realize that difference within cultural groups are at time just a great
a those differences that exist between cultural groups. Therefore, you must address the individual
The goal is to be culturally skilled helpers.
Current Trends in the Multiculturalism Movement in Counseling
1) Special Issue of the Journal of Counseling and Development "Forth Force in Counseling"
(Pedersen, 1991).
2) Wide spread impact on many segments of society and therefore the counseling profession
3) Adaptation of counseling theory and techniques to serve broader segments of society
4) Emphasis on increasing counselors awareness of cultural
5) Development of multicultural competencies in counseling training
6) ACA include sections in the Code of Ethics to address issues of cultural
7) Multicultural emphasis is suggested in conducting assessments
Overcoming Cultural Tunnel Vision
Two problems:
1) Transmit own values to the client
2) Generalization about members of group
Important to:
Examine your own expectations, attitudes, and assumptions about cultural group
Major Mistakes
• Deny the importance of cultural variables
• Overemphasis on cultural differences
• Imposing your view
• Making value judgments for the clients
• Through cultural encapsulation can misinterpret patterns from clients of other cultures
- It is important to respect cultural heritage of others. It is also important to help the client consider
the cost of not accepting certain values in the society in which they live.
Many theories and techniques were developed for Western European Middle Class Caucasian clients
and therefore there may be many limitations to generalizing these theories. This point, however, is yet
to be researched.
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Challenging Your Cultural Assumptions
• Assumptions about time
- meanings may be different
• Assumptions about self-disclosure
- may be incompatible w/culture values
- may need to find other methods to intervene
• Assumptions about family values
- obedience to parents
- hierarchy of helping
• Assumptions about nonverbal behavior
- meaning of silence, body language, eye contact
• Assumptions about trusting relationship
•
•
•
•
- trusting relationships form at different paces
Assumptions about self-actualization
- self vs. group
Assumptions about directness
- varies by culture
Assumptions about assertiveness
Assumptions about emotional expression
Eastern Vs Western
Aspects of cultures associated eastern vs. western philosophy
Must be careful about assumptions
Needs of Special Populations
• Elderly
• Disabled
Effective Multicultural Helpers
Multicultural Competencies and Standards
• Awareness of one’s own cultural heritage, biases, values, preconceived notions
• Acquire knowledge of culturally diverse groups and understand their world view
• Develop a range of intervention strategies and skills that are appropriate, relevant,
and sensitive for diverse groups
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Theoretical Approaches to Counseling Practice
Counseling Theories and their Relative Positions
Graphed on the Action/Insight and Rational/Affective Continuums
(Frey’s Model)
Frey's Model provides a reference point for various counseling theories by placing them on a grid of
two intersecting continuums that range from the focus placed on client insight vs. client action and the
degree to which the focus is on thoughts vs. feelings.
Insight
Psychoanalytic
Transactional Analysis
Neopsychoanalytic
Adlerian
Person Centered
Logo Therapy
Rational
Affective
Cognitive
Family
Learning Theory
Behavioral
Gestalt
Action
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I. Psychodynamic Oriented Counseling
Maturity and Insight Counseling: Theoretical and
Practical Foundation
Maturity and the Role of Insight
Maturity = Growth toward increased understanding and ability to manage a changing environment
Insight is the knowledge of experience necessary to discern the real nature and demands of a situation.
Insight allows one to change maladaptive thought and behavior
Three Factors: 1) Time frame - Past, Present, Future 2) Intellectual Insight - Understanding
3) Emotional Insight - Experience
The Psychodynamic Perspective
Summary of Basic Assumptions and Key Concepts of Psychodynamic Approaches to Counseling
1. Psychodynamic counselors pay particular attention to unconscious material and to early childhood
as crucial determinants of personality and behavior. Normal personality development is based on a
successful resolution of conflicts at various stages of psychosexual development. When one does not
successfully resolve the conflicts that arise at a particular stage of development intrapsychic conflicts
will get played out at later points in one's life. These intrapsychic conflicts are unconscious and are
usually associated with varying levels of anxiety. (Anxiety is managed by the ego through the us of
defense mechanism - they use up energy.) Transference
2. Psychodynamic counseling focuses on the influence of the past as a determinant of current
personality functioning. Experiences during the first six years of life are seen as the roots of one's
conflict in the present. Psychodynamic counseling focuses on the historical basis of current behavior
for the purpose of resolving its persistence in the present. Because it is necessary for clients to relive
and reconstruct their past and work through repressed conflict in order to understand how the
unconscious is affecting them now, psychodynamic counseling is intensive and generally involves a
long-term commitment. There are, however, some forms of brief psychodynamic counseling that
attempt to compress this work into a shorter span of time by using an aggressively confronting client
resistance.
3. The counseling relationship provides a context for the re-creation of the primary care-taking
relationships within the family, so that the client can work through the unresolved issues that have
their origin in early pychosexual developmental stages. The client's reaction to the counselor are
assumed to reveal symbolic clues about the nature of the client's psychodynamics and about the
client's relationships with significant figures in his/her family of origin. The client's reactions in the
counseling session are traced back and analyzed in terms of past influences.
4. The counseling relationship also provides opportunities to observe defensive behaviors (egodefense mechanism) used as far back as childhood. Through the counselor offering interpretative
feedback the client can gain insight and awareness in to how current patterns of responses are not
working for them and eventually choose a more constructive way of dealing with anxiety.
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5. A major portion of the work in counseling work consists of dealing with client resistance, working
through transference, experiencing catharsis, developing insight and self-understanding, and learning
the relationship between past experiences and their effect on current development.
6. Psychodynamic oriented counselors tend to remain relatively anonymous and encourage the client
to project onto them the feelings that they have had toward the significant people in their lives. The
analysis and interpretation of transference leads to insight and personality change. Some analytically
oriented counselors do not remain anonymous, however; they may respond to clients in personal ways.
A central task of the counselor is to enable clients to work through their transference distortions as
they become evident in counseling.
7. Some of the unique advantages of psychodynamic counseling are as follows: clients re-experience
relationships that are similar to their own early family relationships; there are opportunities to
experience and process the client's transference; and clients can gain insight in their defenses and
resistances more dramatically than they can in other forms of counseling work.
Sigmund Freud (neurologist) developed these ideas out of a biological tradition.
The Nature of the Mind
The role of the mind is to distribute and redistribute energy. Energy exists as instinctual the libido psychic, sexual, and aggressive energy. Energy Terms: Cathexis - the process of energy investment;
Principle of Economy - Cycle of energy use and replacement; Principle of Stability - Homeostasis
and equilibration
The Structure and Function of the Mind
Id - Operates under an unconscious pleasure principle
Ego - Operates under the reality principle - choosing appropriate behaviors to reduce
tension. The ego directs cathexis
Superego - Promotes moral behavior. When unconscious impulses come into
consciousness anxiety increases - this forms the ego idea and determines “shoulds”
The Development of Personality - Personality is developed during the first six years of life.
Each stage is associated with an erotogenic zone that is the primary focus of tension reduction. If
tension reduction is in some way impeded or confused, a person can become fixated. Fixation in a
particular stage determines pathological character types. Everyone have some form of fixated
character - must look at extremes and amount of energy diverted. Personality during the first five to
six years of life. Personality development takes place by moving through psycho-sexual stages that
are biologically determined and socially oriented
Oral Stage - Mouth - Birth until 2nd year
Psychosexual gratification - sucking, eating, biting, and oral exploration
Characterization - Narcissism
Fixation - Overindulgence, over protectiveness
Anal Stage - Anus - 2nd year to 3rd year
Psychosexual gratification- Toilet training, fecal matter elimination
Characterization - Independence
Fixation - Selfish, narrow, suspicious, orderly and cleanliness
Phallic Stage - Genitalia - 4th year to 5th year
Psychosexual gratification - Manipulation of the genitals
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Characterization - Power (M- Castration fear, F- Penis envy)
Fixation - Aggressive in attempt to over power others
The Mature Self
1) Develops a sexually and psychologically intimate relationship with a partner
2) Redirects libidinal energy into socially sanctioned activities (work, parenting, creativity) through
sublimation
Anxiety
1) The psychological response to real or anticipated threats to the physical and/or psychological wellbeing of a person.
2) Realistic anxiety is the result of accurate appraisal of real events in the external world
• an accurate perception of the demands of a specific situation in the external world
• realistic appraisal of the individual’s ability to handle demands
• acceptance of outcome - not defeatist
3) Neurotic anxiety result of unconscious distortions of the demands of the external world
• inaccurate perception of demands
• unrealistic appraisal of ability to handle demands
• Ego-defenses resulting in unsuccessful resolution of the real-life situation
4) Moral anxiety is guilt that results from demand of the super ego
View of Maladaptive Behavior: Psychopathology stems from an unconscious, unresolved conflict
that occurred in childhood. Hysteria arises from a conflict related to childhood sexual experiences,
while phobias are the result of displacement of anxiety onto an object or event symbolic of the object
or event involved in an unresolved conflict. Depression is caused by a loss of a narcissistically-chosen
object coupled with anger and aggression toward the lost object turned inward, and mania occurs when
the ego recovers from object loss and channels psychic energy in to a search for new object (Roose,
1996).
Counseling Goals: The goals of psychodynamic oriented counseling are to reduce of eliminate
pathological symptoms by bringing the unconscious into the conscious and then integrating previously
repressed material into the personality. This involves having the client attempting to make meaningful
connections between present and repressed past experiences. The counseling process involves the use
of catharsis to break through resistance and discovering links between present behavior and past
experiences.
The Process: Abreaction - expression of repressed emotion and the working through of thoughts and
feelings to decrease ego defenses and give up protective symptoms
Methods
• Free Association
• Dream Analysis
• Transference
- Mirrors the parent child relationship.
- Resolved by probing repressed impulses - This triggers resistance and defense
mechanisms which are then dealt with.
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The Neopsychoanalytic Perspective - Marks a break for Freud and some of his ideas.
The Self: Psychoanalytic: Instinctual gratification
Neopsychoanalytic: Maintenance of behavior based on psychosocial inputs
The Development of the Self: Interaction with others in a sociocultural context
The Mature Self: Realistic appraisal of strengths and how they can be applied to the world
to create healthy interpersonal relationships
The Process of Intervention
• Sessions are limited and termination is a continual topic
• Client selection is important - ability to engage in the counseling relationship
• Dynamic focus identified by counselor - a central theme, conflict, dilemma, behavior pattern
• Analysis of resistance and transference
- Anything that disturbs communication between client and counselor in the process of
halting the analysis of the transference.
- Underlying the client’s defensive behavior are unconscious beliefs, conflicts, or
fantasies that set the interpersonal pattern.
- Focus on how inadequacies and traumas of childhood are expressed in a cyclical
maladaptive patterns
- Change Process:
Interpretation: 1) awareness of self-defeating interpersonal patterns;
2) understanding the meaning an purpose of the pattern; 3) try alternative ways
of acting; 4) Corrective interpersonal experiences; 5) re-narrates the client’s
own stories to bring out themes and patterns to which the client has been
resistant.
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Adlerian Theory and Approach to Counseling
Summary of Basic Assumptions and Key Concepts
1. The underlying assumptions of the Adlerian approach are as follows: Humans are primary social
beings, motivated by social forces and shaped largely by social interactions. Conscious, not
unconscious, processes determine their personality and behavior. People are creative, active, selfdetermined, and autonomous beings, not the victims of fate. They are significantly influenced by their
perceptions and interpretations of past events. As they gain awareness of the continuity of their lives
they are able to modify their faulty assumptions.
2. All people have basic feelings of inferiority that motivate them to strive for superiority, mastery,
power, and perfection. Their lifestyle comprises unique behaviors and habits that they develop in
striving for power, meaning, and personal goals. It is influenced first by the family constellation and
family atmosphere, especially by relationships among siblings. This lifestyle, which is formed early in
life to compensate for specific feelings of inferiority, also shapes their views of the world.
3. The goals of Adlerian counseling are: establishing and maintaining the proper counseling
relationship, exploring the dynamics that are at work within the individual, communicate to the client
an understanding of his/her internal struggle, and assist the client in making new alternatives and
making new choices.
4. Adlerian counselors make use of several assessment techniques that help in the formulation of the
client's struggle. Assessments of the clients' family constellation, relationship difficulties, early
recollections, use of dreams, and art work provide clues to the client's life goal and lifestyle. The
counselor's task is to help the client integrate and summarize themes from the lifestyle investigation
and to interpret how mistaken notions are influencing the clients. Adlerian counselors tend to
encourage clients to become actively involved with other people and develop a new lifestyle through
relationships.
5. Adlerian counselors often challenge clients to have faith and hope, to develop the courage to face
life actively, and to choose the kind of life they want. Clients are urged to live as if they were the way
they want to be.
Roots of Adler’s Theory:
Adler’s own life experiences
Childhood - Disease, injury, family position
Marxist Socialism - prevention orientation
Freud’s Work - A reference point for difference
Indivisibility of Purpose
• Behavior is inseparable from its social context
• Personality is viewed as a life style that move the person toward a conscious or as yet
unconscious goal, idea, purpose, or act
• Awareness of the individual’s subjective experience is the key to understanding and
changing human behavior
• Unconscious ideas or feelings are not alien or opposed to the conscious; they are simply
unrealized or unarticulated
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Personality Theory
Inferiority feelings, striving for superiority, style of life and social interest are key concepts in
Adler’s personality theory. Feeling of inferiority develop during childhood as the real or perceived
biological, psychological, or social weaknesses, while a striving for superiority is an inherent tendency
toward “perfect completion.” The specific ways an individual chooses to compensate for inferiority
and to achieve superiority determine his or her style of life. An individual’s style of life provides a
unity of personality so that all “parts” or aspects of the personality are in the service of the whole
person (Mosack, 1979).
Adler distinguished between a healthy and unhealthy (or mistaken) style of life, and proposed that
social interest in the primary characteristic that differentiates the two. While a healthy style of life is
marked by goals that reflect optimism and confidence in the process of contributing to the welfare of
others, an mistaken style of life is characterized by goals reflecting self-centeredness, competitiveness,
and striving for personal power.
The development of a person’s style of life is affected by his/her early experiences, especially those
occurring within the context of the family. Of particular importance are whether the child is pamper
of neglected by his or her parents. Pampered children do not develop social feelings, while neglected
children may be dominated for needs of revenge. The child’s position in the family, especially his or
her psychological position is extremely important. Sibling family positions are: first, middle, and last.
One’s psychological position is defined in terms of how the child is treated by virtue of the distance in
years between siblings. For instance, if two children in a family are separated in age by ten years, the
younger sibling might have the position of an only child if the older sibling functions as an additional
parent (Mosak, 1979).
View of Maladaptive Behavior
For Adler, mental disorders represent a mistaken style of life, which is characterized by
maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving
personal power, and a lack of social interest.
Counseling Goals and Techniques
Counseling begins with establishing establish rapport with the client and developing a strong
working relationship. Next the counselor helps in identifying and understanding his/her style of life
and it consequences and assisting the client in reorienting the client’s beliefs and goals so that they
support a more adaptive style of life. Encouragement is used to help the client utilize assets to change
behavior and acting on alternative ways of thinking.
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II. Behavioral and Cognitive Approaches to Counseling
Behavior Theory: Theoretical and Practical Foundation
Definition: The use of experimentally established principles of learning for the purpose of changing
non-adaptive behavior. Non-adaptive habits are weakened and eliminated; adaptive habits are initiated
and strengthened. The counselor assumes that clients are in control of their behavior or be able to
enhance their self-regulation,
Fundamental Contentions:
• Control over thoughts, feelings, and behaviors in the goal
• There are a variety of approaches
• Social learning framework
• Sometimes thought of as manipulative or controlling
1)
2)
3)
4)
Common Features of Behavioral Perspectives
Resists the disease models
Resists intra-psychic phenomenon
Focus on current determinants of behavior
Researched based
5) Evaluate change in behavior as treatment outcome evaluation
6) Specify treatment in objective and operational terms
Summary and Basic Assumptions of Behavioral Theory and Interventions
1) A basic assumption is that all problematic behaviors, cognitions, and emotions have been learned
and that they can be modified by new learning. The behaviors that clients express are considered to be
the problem, rather than merely symptoms of the problem. Counseling is seem as a teaching/learning
process whereby clients are encouraged to try out more effective ways of changing their behaviors,
cognitions, and emotions. The counselor does not focus on the client's past, on unconscious material
or on other internal states. Rather, the focus in on manipulating environmental variables and or the
client's response to them.
2) The target behaviors to be changes are specified; observable events in the environment that
maintain behavior are studied; the environmental changes and the intervention techniques that can
modify behavior are specified; data-based assessment is a part of the intervention procedure; and there
is a focus on transferring new skills learned in counseling to everyday situations.
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3) The decision to use certain techniques is based on their demonstrated effectiveness as ascertained
through ongoing evaluation. All the techniques used by the counselor are based on principles of
learning and are geared toward behavior change. There is a wide variety of techniques, and
behaviorally oriented counselors are typically familiar the use of many so that interventions can be
appropriately designed and applied.
4) A counselor working from a behavioral orientation is active and directive, functioning in some
ways as a trainer or teacher. Some of the counselor's functions orienting the client to a behavioral
approach, teaching the client about the process, planning procedures for change, assessing problems
the client might have implementing the various techniques and working to resolve them, evaluating the
progress of the sessions, and establishing a transfer and maintenance program for new behaviors.
Behavioral counselors assess the client's problem as it arises. Data on client satisfaction, completion
of assignments, participation, and attendance are typically collected and used as a basis for
determining problems. Once the problems are identified and acknowledged by the client, they are
dealt with by means of systemic procedures.
5) A basic assumption is that a good working relationship between the counselor and the client is a
necessary, but not sufficient, condition for change to take place. The client must actively participate in
the process and be willing to experiment with new behavior by taking a role in bring about changes in
behavior.
Contemporary Behavioral Counseling Techniques
Overview:
Three views of problems that lend to behavioral interventions
1) Difficult experiences form the past where high levels of anxiety get generalize to other situations
2) Social skill deficit
3) Faulty or irrational thinking
1) Reciprocal-inhibition techniques - Goal is to teach alternative responses strong enough to
replace the anxiety
Thought-Stopping - Counselor assists the client in stopping (vocally and then sub-vocally) pervasive
thoughts that are unrealistic, unproductive, anxiety producing, and/or negative.
Assertiveness Training - Helping the client to develop skills that enable them to express thoughts
and emotions and experience decreasing levels of anxiety. Training is based on the source of anxiety:
Inhibition, social skill deficit, faulty cognitions
Steps: 1) Behavioral Assessment 2) Training is outlined 3) Behavioral rehearsal 4) Transfer Skills
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Systematic Desensitization - Techniques to overcome habitually fearful responses by interrupting the
association between anxiety and the situation that evokes it.
Steps: 1) Have client assess subjective units of discomfort (SUDS) “On a scale form 0 - 100
how much discomfort are you feeling?”; 2) Learn Deep Muscle Relaxation to enable the
client to reduce level of experienced discomfort; 3) Establish anxiety hierarchies with SUDS;
4) Pairing visual images of anxiety provoking situation with the relaxation response.
2) Anxiety-evoking techniques
Flooding - The client is exposed to anxiety provoking situation (imagined or in vivo) and not allowed
to escape. Goal is extinction of the anxiety response. Caution: Can be dangerous to expose people to
anxiety provoking situations
Paradoxical Intention - Encouraging the client to exaggerate maladaptive behavior thereby linking a
sense of control to the behavior and the resulting anxiety.
3) Operant Techniques - Applied in a variety of settings where principle of reinforcement,
punishment, behavior shaping/conditioning, and extinction are used to change behavior and the
anxiety associated with that behavior.
Steps: 1) Complaint; 2) Translate problem into specific behavior excesses/deficits and
contingencies; 3) Establish the relationship between behavior and consequences
4) Modeling techniques
Observational Learning - acquisition of new behaviors through observation
1) Inhibitory and Disinhibitory Effect - behavior increases or decreases as result
2) Response Facilitation - Models encourage like behavior
3) Cognitive Standard for Self-Regulation - Establishes what behaviors are appropriate
Processes Involved in Modeling
Modeling can be broken down into four separate processes
1) Attentional processes - what behaviors are being attended to
2) Retention processes - what behaviors are being remembered
3) Motor reproduction - skill trials and period of refinement
4) Motivational processes - anticipation of reinforcement
Types of Modeling
1) Overt Modeling - live models 2) Symbolic Modeling - video models 3) Participant Modeling client is involved with role play 4) Covert Modeling - imagery
Modeling Techniques in Context
1) Presenting the rationale behind training 2) Modeling 3) Role-play 4) Feedback
5) Homework
Assessment and Accountability in Behavior Therapy
Behavior therapies measure responses and avoid personality constructs. Assessment sets the stage for
the intervention.
Identify the specific complaint -----> quantify it ----> measure change.
Behavior Assessment
1) Description of the problem
2) History of development
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3) Situation that maintains the problem
4) Measure of biological factors
Basic Tools for Self-Regulation
Self-regulation is a common goal of behavior therapy
Effective Behavior
Stressor
Disengagement
Decisiveness
Problem Solving
Assertiveness
Goal Reformulation
Humor
Stress Response
Avoidant Behavior
Indecisiveness
Inaction/passivity
Overreaction
Hostility or Anger
Fear and Worry
Addiction
The Stress Response
Hans Selye - Generalize Stress Response - Environmental demands arouses sympathetic division of
the autonomic nervous system; Sympathetic - Flight or Flight response; Stressors: physical, social,
interpersonal, psychological; These can be real, anticipated, or imagined environmental demands
Benson - Relaxation Response
Activation of the parasympathetic division of the autonomic nervous system
We can learn to evoke the relaxation response thus giving us more control over our
response to stressful situations
Covert Conditioning - Client use deep muscle relaxation and the imagination and imagery to pull up
the pleasurable but inappropriate behavior and the pairs this with an unpleasurable behavior.
Covert Positive Reinforcement - Desired behavior and pleasant scene
Covert Negative Reinforcement - Pleasant behavior and removal of unpleasant scene.
Covert Extinction - Imagine unwanted behavior without reinforcement
Covert Response Cost - Imagine a positive reinforcement is removed following the unwanted
behavior
Self-Control Triad 1) Thought Stopping 2) Breathing 3) Covert Positive Reinforcement
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Applied Behavior Analysis
• Involves the application of the principles of operant learning to change human behavior
• Operant technology is widely used by many practitioners
• Problems are due to the controls that are placed on them and they react with anxiety, anger,
depression, etc.
The fundamental ideas of applied behavioral analysis:
1) Consequences of behavior is either pleasure pain. We want to maximize pleasure and minimize
pain.
2) Behavioral deficit or excess leads to failure in successfully adapting to environmental demands.
3) As inadequate adjustment intensifies emotional reactions (fear, anxiety, depression) intensify
leading to behavioral reactions like escape, avoidance, withdrawal.
4) Behavior is required through learning.
5) Humans manifest behaviors in response to stimuli in the environment.
6) A contingent relationship is established between the operant behavior and the consequences of that
behavior such that the consequences depend on the performance of the operant behavior.
7) The consequences of an operant behavior are either positive reinforcement, negative reinforcement,
or punishment.
8) Positive reinforcement - presentation of a positive event of a behavior it follows that increases the
frequency and/or intensity of a targeted behavior.
Negative reinforcement - removal of an aversive stimulus of a behavior it follows that increases the
frequency and/or intensity of a targeted behavior.
Punishment - Presentation of an aversive stimulus or removal of a pleasant stimulus that decreases
a targeted behavior.
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Effect
Behavior Increase
Stimulus
Presented
Behavior Decrease
Positive
Reinforcement
Punishment
Negative
Reinforcement
Punishment
Operation
Stimulus
Removed
9) Human beings often learn patterns that lead to self-defeating behavior.
10) Focus on thorough behavioral assessment of contingencies of reinforcements existing in the
client’s life and initiating new schedules of reinforcement designed to extinguish or modify
maladaptive patterns of behavior and initiate or increase adaptive patterns.
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Cognitive and Cognitive-Behavioral Theory Approaches to Counseling
The counseling approaches associated with cognitive and cognitive-behavioral approaches to
counseling differ in important ways but share several assumptions (Ingram & Scott, 1990):
1. People respond to cognitive representations of events rather than to the events themselves.
2. Learning is cognitively mediated
3. Cognition mediates emotion and behavioral dysfunction.
4. At least some types of cognition can be monitored and altered.
5. Dysfunctional emotions and behaviors change when cognitions are modified.
6. Behavioral and cognitive techniques are both useful and can be integrated.
Rational-Emotive-Behavior-Therapy
From the perspective of Rational-Emotive-Behavior-Therapy (REBT), behavior is a chain of events
- A, B, and C - where A is the Activating external event to which the person is exposed; B is the
Belief the individual has about A; and C is the emotional or behavioral Consequence that results from
B. The primary cause of neurosis is the continual repetition of certain common irrational beliefs (it is
necessary to be loved by everyone; one should be thoroughly competent, intelligent, and achieving in
all aspects of life).
In REBT two more events - D and E - are added to the ABC chain: D is the counselor’s attempt to
Defeat and alter the individual’s irrational beliefs, and E is the Experiencing of the alternative
thoughts and beliefs that result from D. To help the clients replace irrational beliefs with more
appropriate ones, REBT counselors adopt an educational, confrontive, and persuasive approach and
use a variety of techniques including modeling, behavioral rehearsal, problem-solving, in vivo
desensitization, REBT imagery, and homework assignments.
Beck’s Cognitive Therapy
Beck’s (1967, 1984) Cognitive Therapy (CT) focuses on the impact of cognitive schemas,
automatic thoughts, and cognitive distortions as they are related to emotions and behavior. The basic
tenants of cognitive theory are that the individual constructs a cognitively based view of the world and
in turn responds in a manner that is congruent with the beliefs, thoughts, and attitudes associated with
that world view. The world view itself is created by the development of schemas. Schemas are deep
cognitive meaning-making structures that forms through repeated interactions with the environment.
They determine the rules that consist of core beliefs and that determine how individuals codify,
categorize, and interpret their experiences. Cognitive schemas develop early in life as the result of
biological, developmental, experiential, and environmental factors. Once formed, schemas provide a
primary reference point for understanding the nature of the self, others, and the world. Schemas can
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be either (1) functional or dysfunctional and (2) dormant or active. The relationship between one's
scheme and one's thoughts, feelings, and beliefs are represented in the diagram below.
Early
Childhood
Experiences
Development of
Schemas, Basic
Beliefs, and
Conditional
Beliefs
Critical Incidents
Activation of
Schemas, Basic
Beliefs, and
Conditional
Beliefs
Automatic
Thoughts
Emotions
Behaviors
Physiological
Responses
(Scharf, 1996, p. 380)
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Cognitive Distortions
Depressogenic schemas and other dysfunctional schemas may be dormant until they are activated
by internal or external stressors, especially stressors that are similar to those under which the schemas
originally developed. Dysfunctional schemas impair reality testing and the ability to think reasonably.
They are manifested in irrational automatic thoughts and are supported by cognitive distortions (errors
in logic).
An individual's important beliefs schemas are subject to cognitive distortions when dysfunctional
schemas are activated. These distortions reflect errors in reasoning and are based on inaccurate or
ineffective processing of information. Clinical research has shown that there are specific types of
distortions that either cause difficulties of keep clients stuck. These distortions are as follows:
Dichotomous Thinking or Polarize Thinking - All or nothing orientation to perceiving self, others,
or the world;
Selective Abstraction - Picking out specific elements that support a thought or belief;
Arbitrary Inference - Coming to a conclusion that is not supported by the facts/data;
Catastrophizing - Exaggeration of an event that one is concerned about until it becomes dreadful;
Overgeneralization - Making a rule based on a few (usually negative) events;
Labeling and Mislabeling - Establishing a view of one's self based on a few errors or mistakes;
Magnification or Minimization - Magnifying negative points or minimizing positive points;
Personalization - Taking an event that is unrelated to the self and making it meaningful to the self
(Example: "It always rains when I want to do something outside.").
According to Beck, each psychological disorder is characterized by a different cognitive profile.
Depression, for example, involves the “cognitive triad” of a negative view of oneself, the world, and
the future. The core beliefs underlying the cognitive triad fall into two categories - those associated
with helplessness (“I am powerless”) and those associated with unlovability (“I am unlikable and
unattractive”). In contrast, the cognitive profile for anxiety reflects an excessive form of normal
survival mechanisms and consists of unrealistic fears about physical and psychological threats.
Anxious individuals overestimate the risk and consequences of perceived dangers. Finally, cognitive
profile for panic disorder consists of catastrophic misinterpretations of mental and bodily experiences.
Goals of Counseling
The primary goal of CT is to alter dysfunctional and distorted assumptions and beliefs and assist in
considering new ways of constructing new meanings about self, others, or nature that is not based on
the biases of distorted cognitions. This is done be engaging the client in a process of cognitive
restructuring. Cognitive restructuring is working to change automatic thoughts and cognitive
distortions. Using the natural learning concepts of assimilation and accommodation to change the
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schemas that generate negative self-talk and develop new and more adaptive cognitive schema
frameworks that allow the client to feel, think, and act in way more consistent with reaching desired
goals.
CT makes use of a broad range of behavioral and cognitive techniques to achieve this goal.
Behavior strategies include graded homework assignments, activities scheduling, behavior rehearsal,
social skills training, and relaxation. Cognitive strategies include “the downward arrow” (If so, then
what?), questioning the evidence, decatastrophizing, mental imagery (e.g., replacement imagery), and
cognitive rehearsal. An early homework assignment requires the client to keep a “Daily Record of
Dysfunctional Thoughts.” which helps the client and counselor identify the irrational automatic
thoughts that underlie the client’s undesirable emotions and behaviors.
CT is distinguished from other cognitive therapies by several characteristics. First, CT is referred to
as “collaborative empiricism” because it is founded on a collaborative counselor-client relationship
and involves gathering evidence and testing hypotheses about the client’s beliefs and assumptions.
Second, CT is a time-limited intervention, with the average length of counseling being about 15
sessions, and sessions are always structured and goal-oriented. With regard to the latter, the first
session ordinarily addresses the following goals (Beck, 1995): 1. Establish rapport and trust; 2.
Socialize the client to cognitive oriented counseling; 3. Educate the client about the nature of his or
her problem or core issue, the model of cognitive counseling, and the counseling process; 4.
Normalize the client’s complaint and instill as sense of hope; 5. Determining and, if necessary,
correcting the client’s expectations about counseling; 6. Collect additional information about the
client’s problem; 7. Develop a goal list. The third area of uniqueness is that while the focus of CT is
on the client’s current experiences, historical material may be addressed in order to clarify core beliefs.
Fourth, because CT assumes that relevant cognitions become accessible and modifiable only with
affect arousal, imagery and other techniques may be used to foster affect. Fifth, relapse prevention is a
focus throughout the counseling process. For instance, during the course of counseling, the counselor
emphasizes the client’s part in causing change in mood and behavior, and , toward the end of
counseling, the counselor works with the client to develop a plan to help maintain gains and how to
handle problems that arise in the future.
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III. Humanistic Theoretical Approaches to Counseling
The humanistic approaches to counseling are a diverse collection of therapeutic ideas and
techniques that share the following characteristics:
 a phenomenological approach that assumes that, to understand a person, one must understand the
person’s subjective experience ( “phenomenal field”);
 an emphasis on the uniqueness and “wholeness” of the individual;
 a focus on current behaviors;
 a belief in the individual’s inherent potential foe self-determination and self-actualization;
 involves an authentic, collaborative, and egalitarian relationship between counselor and client.
The Person-Centered Approach to Counseling
Summary of Basic Assumptions and Key Concepts
1. Clients are basically trustworthy and have the potential for self-direction. The client can become
aware of problems and the means to resolve them if the counselor encourages the client to explore
present feelings and thoughts. Because the client has the potential for self-direction, there is a
minimum of direction needed from the counselor, for this would undermine respect for the client.
2. The person-centered approach emphasizes the personal qualities of the counselor rather than a set
of strategies for counseling, because the primary function of the counselor is to create a climate in
which healing and growth can occur. Therapeutic relationship between the counselor and the client is
what helps the client grow.
3. The person-centered framework for understanding impairment rests with the degree of congruence
between the idealized self-concept and the organismic self. The organismic self is that portion of the
individual that is genuinely open experiencing the fullness of life in a supportive unconditional
atmosphere. The idealized self-concept is that portion of the individual which has been shaped by a
series of conditions or external expectations about who one must be of how one must be in order to be
loved and accepted. According to Roger, one's level of impairment is directly proportional to the
degree to which there is a lack of congruence between the idealized self-concept and the organismic
self.
4. External measures such as diagnosis, testing, interpretation, advice giving, and probing for
information are not useful in person-centered counseling. Instead counseling comprises active
listening, reflection and clarification, and understanding the inner world of the client. Accurate
empathy is the core of practicing a person-centered approach to counseling.
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5. A basic characteristic of the person-centered approach to counseling is the focus on the client as the
center of counseling as opposed to the problem that is being presented. The entry of this theoretical
approach marked a major shift in the helping professions. Proposed a fundamental contention that
each human being is essentially capable of self-directed behavior change.
Personality Theory
“The central concept in person-centered theory is the notion of self, or the organized, consistent
conceptual gestalt composed of perceptions of the characteristics of the “I” or “me” and the
perceptions of the relationships of “I” or “me” to others and to various aspects of life, together with the
values attached to these perceptions” (Rogers, 1959, p. 200). To grow toward self-actualization, the
self must remain unified, organized, and whole.
View of Maladaptive Behavior
The self becomes disorganized when there is incongruence between the self and experience. In
congruence results when a person encounters a condition of worth. This occurs, for example, when a
child finds out that positive regard from his/her parents is conditional rather than unconditional; that is,
when the child learns that she will receive affection and attention from his/her parents only when s/he
behaves in certain ways. In this situation, the child will feel incongruence between her sense of self
(how she acts) and her experience in the world (the behavior the parents want).
Incongruence between self and experience, according to person-centered theory, produce
unpleasant visceral sensations that are subjectively experienced as anxiety and serve as a signal that
the unified self is being threatened. A person may attempt to alleviate anxiety through the defensive
maneuvers of personal distortion and denial. Although these maneuvers may be temporarily effective,
they are counter to self-actualization: If a person learns as a child that his/her parents only show
approval when the child behave without emotion the child may begin to deny the experience of
emotions, and, as a consequence, will not develop his/her personal capacities to the fullest.
Goals in Counseling
The primary goals of person-centered counseling is to help the client achieve congruence between
self and experience so that s/he can become a more fully functioning, self-actualizing person.
The Process of Intervention
1) Philosophical orientation and relies heavily on the qualities of the practitioner for allowing change
to take place.
Genuineness and Congruence; Unconditional positive regard; Ability do be empathic
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2) The relationship as experienced by the client
 Client has the experience of responsibility in the session
 Client has the experience of exploration
 Client discovers denied attitudes
 Client experiences a reorganization of the self
 Client experience of progress
 Client experience of ending of the counseling relationship
3) The counselor accesses the client’s actualizing tendency - each person is in a process of becoming
a fully functioning individual.
- Increasingly open to experience
- Increasingly accepting of one’s own feelings
- Increasingly present from moment to moment
- Increasingly free to make choices and act on those choices freely
- Increasingly entrusting of self and human nature
- Increasingly realistic expression of affection and aggression
- Increasingly creative and nonconformist
4) The counselor also uses the following theoretical principles to help bring about change.
• Self-concept - Organized configuration of perception of the self.
a) abilities; b) relationships; c) values; d) goals
• Ideal Self - is the self-concept one would like to have
• Congruency- is a match between ideal-self and self-concept
• Psychological maladjustment denies and distorts experience causing incongruency
• Incongruency --------> Anxiety
5) Steps in the Counseling Process
Stage 1 - Client are unwilling to enter in relationships that require revelation
Stage 2 - Able to talk about topics unrelated to themselves
Stage 3 - Express feelings and be able to talk about feelings of others
Stage 4 - Talk acknowledge own intense feelings
Stage 5 - Clients live more directly in the present with unexpected and intense feelings
“bubbling up”
Stage 6 - Clients live comfortably with themselves as a congruent whole
Stage 7 - Transfer of learning to real life
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Gestalt Theory and Approach to Counseling
Gestalt oriented counseling is based on the premise that each person is capable of assuming
personal responsibility for his/her own thoughts, feelings, and actions and living as an integrated
“whole.” Like other forms of humanistic counseling, Gestalt theory incorporates principles drawn
from psychoanalysis, phenomenology, and existentialism. It also makes use of concepts from Gestalt
psychology which addresses issues related to perception. These concepts include the following: (1)
people tend to seek closure; (2) a person’s “gestalts” (perceptions of parts as wholes) reflect his/her
current needs; (3) a person’s behavior represents a whole that is greater than the sum of it parts; (4)
behavior can be fully understood only in its context; and (5) a person experiences the world in accord
with the principle of figure/ground (Passons, 1975).
Summary of Basic Assumptions and Key Concepts
1. The "here and now" experience of the client in the session is a central tenet of the Gestalt approach
to counseling. The counselor focuses on the "what" and "how," instead of "why," and on anything that
prevents effective functioning in the present. The past, which has a significant fore is shaping current
behavior, is brought into the present by reenacting earlier situations that are still unfinished. Clients
are encouraged to reexperience unexpressed feelings of resentment, pain, guilt, and grief.
2. The Gestalt theoretical perspective is that people are essentially responsible for their own conflicts
and that they have the capacity to deal with their life problems. Therefore, clients are often asked to
make their own interpretations and discoveries of meaning around their experiences.
3. The counselor challenges the client to become aware of the ways in which they are avoiding
responsibility for their own feelings and encourages them to look for internal, rather than external
support.
4. Gestalt counselors use a wide range of action-oriented techniques in assisting clients increase their
awareness. Through interaction in the counseling session, it is assumed, clients will become more
aware of conflicts and places where they "get stuck" (arrive at an impasse), and in counseling move to
a new level of integration.
5. One of the counselor’s tasks is to help clients locate the ways in which they are blocking energy
and expressing their resistance in their body. Through body-awareness work, clients are mobilized
and can take an active responsibility for their work in counseling. They can then be encouraged to try
more adaptive behaviors.
6. Although the Gestalt counselor encourages clients to assume responsibility for expanding their
awareness, the counselor also takes an active role increasing experiments designed to help the client
tap their resources. The essence of creative counseling interventions is designing experiments that
grow out of the existential nature of the counseling encounter. The imaginative counselor/client dyad
invents experiments that are tailor made for what is happening in the moment. Through these
experiments, clients are able to confront the crises of their lives by playing out their troubled
relationships in the safety of the counseling setting.
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Personality Theory
Personality consists of the self and the self-image. The self is the creative aspect of the personality
that promotes the individual’s inherent tendency for self-actualization, or the ability to live as a fully
integrated person. The self-image, the “darker side” of the personality, hinders growth and selfactualization by imposing external standards. Which aspect of the personality dominates depends, in
large part, on the person’s early interactions with the environment. During childhood, for instance, a
person’s parents must provide support and opportunities to overcome frustration in order for the self to
develop. If the child is given support only in the form of approval and/or is shielded from all
frustration, this will curtail development of the self and facilitate development of the self-image.
Self-Actualization and Responsibility
• Living in the here and now (now = experience = awareness = reality)
This allows for the development of one’s unique potential is a by product of total awareness.
The Role of the Intellect
• Intellect removes us from experience of the here and now
View of Maladaptive Behavior
Neurotic (maladaptive) behavior is considered a “growth disorder” that involves an abandonment
of the self-image and a resulting lack of integration. Disordered behavior often stems from a
disturbance in the boundary between the self and the external environment, which interferes with the
person’s ability to satisfy his or her needs to maintain homeostasis or balance.
The Nature of Neurosis
• Anxiety is a response to the individual being unable to determine the boundary between the self and
the environment. According to Perls (1973) there are four major boundary disturbances. They include:
Confluence - Loss of boundary between the individual and the environment.
Introjection – Non-critical acceptance of all ideas. Loss of boundary. “They” means “I.”
Projection - Insensitive imposition of one’s ideas on others. Loss of boundary. “I” means “They.”
Retroflection - A combination of introjection and projection. “I” and “They” merge as “We”
Goals of Counseling
The major goal of Gestalt oriented counseling is to help a client achieve integration of the various
aspects of the self in order to become a unified whole.
Process of Intervention
• The Goal is to get clients to "re-own" themselves
• By identifying and resolving unfinished business, the client becomes aware of selfdefeating patterns and real needs, desires, and goals, and lives life without anxiety,
guilt, and depression.
• Often a major focus is re-experiencing the past in the here and now.
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The Therapeutic Relationship
Must have a strong relationship with client so that s/he will tolerate confrontation,
frustration, and the challenges to accept responsibility and become self-reliant
Counseling Techniques
Rules for Conducting Counseling Sessions
1) Present focus - here and now
2) Must use personal pronouns
3) Avoid asking questions
4) No “shoulds”
5) Recognize that there is an awareness continuum
Shuttle Technique - Awareness shifts between poles
Top dog/Under dog
The empty chair
Dream work
Existential Theory and Approach to Counseling: Logotherapy
Logotherapy (Frankl, 1959) and other existential approaches to counseling are derived from
existential philosophy. These approaches to counseling share an emphasis on the human conditions of
depersonalization, loneliness, isolation and the assumption that people are not static but, instead, are in
a constant state of “becoming.”
Summary of Basic Assumptions and Key Concepts
1. People become what they choose to become; although there are factors that restrict choices, selfdetermination is ultimately the basis of their uniqueness as individuals. The counselor focuses on
independent choices and freedom, the potential within humans to find their own way, and search for
identity and self-actualization.
2. In existential counseling, basic human themes constitute the content of interactions. Existential
crises frequently concern the meaning of life, anxiety and guilt, recognition of one's aloneness, the
awareness of death and finality, and fear of choosing and accepting responsibility for one's choices.
Because these "crises" aren't necessarily pathological, they can't be externally alleviated; they should
be lived through and understood in the context of counseling.
3. The counselor's major tasks are to grasp the subjective world of the client and to establish an
authentic relationship in which they can work on understanding themselves and their choices more
fully. The counselor's ultimate goal is enabling clients to be free and responsible for the direction of
their own life. Therefore, the clients are largely responsible for what occurs in counseling.
4. Existential counselors do not be have in rigid of prescribed ways, for they can't predict the exact
direction of content of any counseling session. The counselor does not operate out of the expert role
by implementing a set treatment plan or utilize specialized techniques; rather, they establish real
relationships with their clients.
5. The counselor's presence, or willingness to be there for the client and confront the client when
appropriate, is a major characteristic of effective counseling. The counselor must be willing to take
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responsibility for his/her own thinking. feeling, and judging. The counselor is present as a person with
the client.
6. Existential counseling is best considered as an invitation to clients to recognize the ways in which
they are to living fully authentic lives and to make choices that will lead them to become what they are
capable of being. This approach does not focus on curing sickness of merely providing problemsolving techniques or strategies. Rather it offers the client an opportunity to address and wrestle with
the complex issues that arise as one attempts to live an authentic existence.
The Humanistic-Existential Perspective
Not a single theory nor do these approaches have a central figure
Can be viewed as a reorientation of psychology toward the significance of
1) Human and personal experience
2) Life long growth
3) Self-determinism in existence
4) Relationship is authentic, caring, and self-disclosing
5) The full range of human response is normal
The Self
Proactivity - The ways in which the undamaged self interacts with the world- Planning,
problem solving, creating
Actualizing the Self
- Be all that you can be
- On going actualization of potentials, capacities and talents as fulfillment of mission, as a fuller
knowledge of and acceptance of, the person’s own intrinsic nature, as an unceasing trend toward unity
integration, or synergy with the person.
- Progressive vs. Regressive choices determine the actualization potential
- Life provides opportunities to find meaning, increase actualization, increase maturity
1)
2)
3)
4)
5)
6)
7)
8)
The Mature Self
Accurate perception of reality
Accepts self, others, and nature without complaint
Spontaneous inner naturalness and behaves according to those values
Problem centered
Need for privacy
Freedom to react to react to the environment
Freshness of perception
Deep and profound interpersonal relationships
Freedom of Will
• Spiritual of Existential (noögentic/noölogical) dimension - allows us to go beyond our physical and
psychological limitations
• Ability to find happiness through our discovery of meaning in logic, suffering, and the
accomplishment of personal missions
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- Self-detachment: Heroism and Humor
- Self-transcendence: Beyond egocentricity
The Will to Meaning
• Being meaningfully engaged in life offers the by product of pleasure
- Power, Happiness, Success, Self-actualization
• Meaning comes from the realization of specific human values
- Creative Values - Actualized by performing tasks or completing missions
- Experiential Values - actualize by involvement in the “Good, the True, and the Beautiful
through ideas, science, arts, nature, interpersonal relationships
- Attitudinal Values - actualize by finding meaning in the face of limits - especially feelings
such as guilt, suffering, and death.
The Meaning of Life
• We are all in a continual process of answering the question what the nature of the meaning of life
• Through the process of realizing creative experiential and attitudinal values
View of Maladaptive Behavior
For the existential counselor, maladaptive is a natural part of the human condition. Anxiety, for
example, is considered a normal response to the constant threat of nonbeing (death).
Counseling Goals and Techniques
The goals of counseling are to help clients overcome their troublesome feelings (e.g., feelings of
meaninglessness) so they can live in more committed, self-aware, authentic, and meaningful ways. In
counseling, clients are helped to recognize their freedom and to accept responsibility for changing
themselves. The counselor-client relationship is considered the most important therapeutic tool,
although specific interventions are sometimes used. In Logotherapy, de-reflection is used to treat a
client’s self-observation and self-attention. It requires the client to ignore the problem or to focus on
something pleasant. Paradoxical intention is used to reduce a client’s fear and require the client to
focus in an exaggerated and humorous way on the feared situation.
The Process of Intervention
• Continually involved in the challenging the client to become more fully, more uncomplainingly
involved in life.
• Counselor/client relationship is the key component for helping the client change
• Education toward responsibility
• Logotherapy supports developing a context of mean and meaning making
- No language or terms of its own
- Directs a focus on the future
- Choosing attitudes that are consistent with creative, attitudinal, and experiential values
- Encourages the client to use the human capacity for self-detachment and self-transcendence
- Supports client’s ability to change, that the client is worthy of good things that will happen
when change occurs
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• Logotherapy as a Specific Counseling Approach
- Noögenic neurosis - spiritual/existential in nature
- Frustration of the will to meaning, conflicts of conscious
- Works toward addressing the Neurotic Triad - Depression, anxiety, addiction
- Asks what can I become? vs. What has made me this way?
- Uses Paradoxical Intention - Clients are encouraged to do, or wish for, the very things they
fear. This confrontation forces the client to face that which is holding them back and make
conscious decisions about how what attitudes they choose to have in the fearful situation
Interventions - Psychological interventions are directed toward stopped or slowed growth.
The process itself tends to be more active; it can be confrontive; relationship is one of trust and
genuine caring; little focus on the past; the counselor often models for the client.
Transactional Analysis
Transactional Analysis (TA) has been described as “a rational approach to understanding behavior .
. . [that is] based on the assumption that all individuals can learn to trust themselves, think for
themselves, make their own decisions, and express their feelings” (James & Jongeward, 1971, p. 12).
Some authors classify TA as a type of group counseling since it is commonly used in group settings,
but others include TA as a humanistic approach to counseling because of its positive view of human
nature.
Summary of Basic Assumptions and Key Concepts
1. Based on messages that we receive in childhood, we make necessary decisions early in life that
may later become inappropriate. The re-decisional model of TA emphasizes that we react to stresses,
receive messages about how we should be in the world, and make early decisions about ourselves and
others that become manifest in our current patterns of thinking, feeling, and behaving. In TA oriented
counseling clients relive the context in which they made these early decisions, and thus they are able
to choose new decisions that are more functional.
2. In order to make new, appropriate decisions, clients are taught to recognize ego states, to
understand how injunctions and messages they incorporated as children are affecting them now, and to
identify life scripts that are determining their actions. A basic assumption of TA is that we are in
charge of what we do, how we think, and how we feel. People are viewed as capable of going beyond
their early programming and choices by making new choices in the present that will affect their future.
3. TA is largely a didactic and a cognitive form of counseling, with the goal of liberating clients from
the past and assisting them to re-decide how they will live based on new awareness. In the context of
the counseling relationship client can re-experience their life script unfolding before them through the
interactions within the counselor. Client will, in various ways, represent family members from the
past as well as people in their present lives. TA offers client many opportunities to review the
challenges of their past decisions and experiment with new ones.
4. Clients can best achieve the goals of TA counseling by being active in the counseling process. To
ensure that clients actively and responsively participate, they contract with the counselor to work on
specific issues, and these contracts direct the course of counseling.
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Personality Theory
Ego states, life position, and life script are key elements of the personality theory underlying TA.
All three are affected by early environmental conditions, especially the childrearing practices of one’s
parents. Adequate parenting involves the consistent provision of unconditional positive “strokes,” or
units of affection that are given for “being” rather than “doing,” while inadequate parenting is
characterized by conditional negative strokes and injunctions (harsh “don’t” messages).
Ego States: Everyone possesses three ego states - the adult, the parent, and the child - which
loosely correspond to Freud’s id, ego, and superego. Positive parenting leads to an appropriate
balance of the three ego states.
Life Position: All children begin life with a healthy “I’m OK - You’re OK” life position. The
childrearing practices of their parents determine whether that life position is maintained or an
unhealthy position is eventually adopted. There are three unhealthy life positions: “I’m OK - You’re
not OK”; “I’m not OK - You’re OK”; and “I’m not OK - You’re not OK.”
Life Script: A script is a person’s life plan, which develops out of decisions made during
childhood and which forms the core of the person’s identity and destiny (Corey, 1991). The choice of
a life script is affected largely by early experiences that indicate a person’s worth and place in life.
View of Maladaptive Behavior
Maladaptive behavior reflects the adoption of an unhealthy life script.
Counseling Goals
Although TA recognizes the role of early experiences and decisions on personality and behavior, it
also proposes that people are not entirely bound by the past. Decisions made early in life are
reversible. Consequently, the primary goal of TA is to help clients make new decisions about their
lives that reflect integration of the three ego states, an “I’m OK - You’re OK” life position, and
flexible, autonomous (“scriptless”) behavior.
Process of Intervention
By design TA is:
• Interactional - client’s growth develops through interaction with the counselor
• Didactic - Teaching component
• Contractual - Adult to Adult mutual responsibilities
• Decisional - Client is encouraged to change what appears to be patterns of game playing
• Developed in Four Phases
Phase I
- Ego States Analysis
Phase II
- Transactional Games Analysis
Phase III
- Script Analysis and Life Position
Phase IV
- Taking Action
Counseling Techniques
TA is an intellectual, insight- and action oriented approach to counseling. It begins by establishing
an egalitarian relationship between the counselor and the client and having the counselor and client
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agree on a contract that clearly defines the client’s goals for counseling. The achieve these goals, TA
makes use of the following techniques.
Transactional Analysis: Whatever happens between people always involves the transaction
between ego states: A complementary transaction occurs when a message sent from a particular ego
state of one person evokes a response from the appropriate ego state of the other person, while crossed
transaction occurs when a communication is received by or receives a response from an inappropriate
ego state. Ulterior transactions involve two ego states in the initiator and/or responder and an ulterior
(disguised) message.
Game Analysis: “Games” are repetitive ulterior transactions that may initially appear to
generate intimacy and provide strokes but that actually help people avoid getting close to each other
and that serve to advance their scripts. Various methods are used to identify a client’s games (“drama
triangle”). Game analysis recognizes ulterior transactions in which overt messages conceal covert
ones
It is assumed that the client is facing two major problems: 1) living out parental scripts that are self
defeating; and/or 2) expending energy and time in ego states that are self-defeating
Script Analysis: The client’s current script is identified with the aid of a “script checklist,”
which contains items related to life position, games, and rackets (unpleasant feelings that the client
uses to justify his/her decisions).
Reality Therapy Theoretical Approach to Counseling
Reality Therapy was developed on principles consistent with those associated with control theory,
which proposes that “human behavior is purposeful and originates from within the individual rather
than external forces” (Corey, 1991, p. 372). Consequently, reality therapy is based on the premise that
people can take control of their lives.
Summary of Basic Assumptions and Key Concepts
1. Reality therapy is grounded on the premise that human behavior is purposeful and originates from
within the individual rather than from external forces. All behavior is motivated by the striving to
fulfill five basic psychological needs. These needs include the need for love, belonging, power,
freedom, fun, and survival. This approach focuses on solving problems, on coping with demands of
reality in society, and taking responsibility for and control of one's life. It is through self-evaluation of
what one wants, one is to achieve increased control of one's life and thus be able to shape one's
destiny.
2. A basic tenet of Reality Therapy is that one perceives the world against a background of one's
needs rather than the way it is in reality. The individual tends to create a private inner world.
Although a person must behave in some manner one is not locked into any one mode of behavior.
One's behavior is an attempt to control one's perceptions of the external world to fit one's internal and
personal world.
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3. Control theory is based on the assumption that everything we do can be understood within the
context of total behavior, which always involves the four elements: thought, affect, behavior, and
physiology.
4. The Reality-therapy counselor assists the client through a process of skillful questioning that is
aimed at getting them to assess what the want. Counselors generally assume a verbally active and
directive role in the counseling session. The main task is seen as encourage the client to face reality
evaluate and their present behavior. Thus behavior is the focus, rather than insight. Counselors tend
to focus on the strengths and potentials of clients rather than failures. This is done by challenging
clients to look at their unused potential, to fulfill their needs, and to gain more effective control of their
life.
5. Counselors tend to focus clients on what they can do now to change their behavior by evaluating
what they are doing, making a plan for action, committing themselves to doing what it will take to
change, and following through with their plan. Thus, counselors do not focus on exploring the past,
and they do not accept any excuses for the future of clients to follow through with their commitments.
6. The practice of reality therapy oriented counseling involves two major components: (1) the
counseling environment/relationship and (2) specific procedures that lead to changes in behavior. This
is referred to as the cycle of counseling. A great deal of emphasis is placed on creating a supportive
environment that allows clients to change. Through a process of skillful questioning, counselors help
clients recognize, define, and refine how they wish to meet their needs. The procedures that lead to
change are based on the assumption that human beings are motivated to change when (1) they are
convinced that their present behavior is not getting them what they want and (2) they believe that can
choose other behaviors that will get them closer to what they want. Clients explore what they want,
what they have, and what they are not getting. Counselors help the client focus on the question, "What
do I see for myself now and in the future?"
Personality Theory
According to Reality Therapy people have several basic innate needs - four psychological needs
(belonging, power, freedom, and fun) and one physical need (survival). When a person fulfills his or
her needs in a responsible way - that is, in a conscious and realistic manner that does not infringe on
the rights of others to fulfill their needs - the person has adopted a successful identity. When a person
gratifies his/her needs in irresponsible ways, the person has assumed a failure identity.
View of Maladaptive Behavior
Most forms of mental and emotional disturbance are viewed as the result of the decision not to
fulfill one’s psychological and physical needs in responsible manner, which then produces a failure
identity.
Counseling Goals
The primary goal of Reality Therapy is to help clients identify responsibility and effective ways to
satisfy their needs and thereby to develop a success identity.
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Counseling Strategies
Reality Therapy is verbally active, intellectual, and confrontive. In contrast to more traditional
modalities of counseling it (1) rejects the medical model and concepts of mental illness; (2) focuses on
current behaviors and beliefs; (3) views transference as detrimental to progress in counseling; (4)
stresses conscious processes; (5) emphasizes value judgments, especially the client’s ability to judge
what is right and what is wrong in his/her daily life; and (6) teaches clients specific behaviors that will
enable them to fulfill their needs (Glasser & Zunun, 1979).
The counselor-client relationship is considered an important aspect of the counseling process, and,
to be effective, the counselor must exhibit the qualities of warmth, respect, caring, and interpersonal
openness. Reality Therapy counselors model responsible behaviors for their clients, and make use of
techniques that are designed to help clients learn to live more intentionally and responsibly (e.g., roleplaying; systematic planning; and exploring wants, needs, and perceptions).
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Family Therapy
History
Family developed out of the psychodynamic and neopsychoanalytic theories
Systems Theory - focuses on the interpersonal process of the system
The Contextual Approach
Theoretical Foundations
Contextual Family Therapy utilizes three areas to formulate the therapy process
1) Systems Theory; 2) Object-Relations; 3) Existential
Systems Theory - Pathology emerges from the interaction of individuals
Psychoanalytic roots - pathology is outside the awareness of the individuals in the family. The
problems are embedded the family members’ pasts
Basic Constructs
Contextual - views family situation in the context of the relationships significant to each individual
in the system.
Object-Relations - Basic levels of trustworthiness and fairness developed out of the care and
support given by a primary care taker during early life.
Intergenerationally Oriented - Investigates the influence of each generation on the system.
Four dimensions of assessment and treatment
1) Facts about the family; 2) Intrapsychic dimension of each member of the system
3) Interpersonal strategies members of the family use to meting their needs; 4) Ethical fairness or
equability among individuals in the family
Accountability and the family ledger
After contributing in significantly to the family, the member earns the entitlement allow person to
complete the individuation process. Patterns of separation an under what conditions members are
allowed to separate (marriage, employment, illness, etc.) are very important aspects from this
perspective.
Legacy and Loyalty
Expectations the individual is bound to fill. Name sakes, occupational press, numbers of offspring are
often part of this dynamic.
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The Process of Intervention
The goals of treatment - 1) Return a sense of trustworthiness to the system (Object-relations); 2)
Realize that there are always equal signs in relationship interactions
The role of the practitioner - Be a guide and a resource for the family to facilitate the insight
process. Each member of the family offers a perspective and the others respond.
The Structural Approach
• Developed by Salvaor Minuchin
Basic Constructs
• Families develop patterns of relatedness and these patterns form the family structure
• Family structure is the invisible set of functional demands that organizes the ways in which family
members interact. Structures become the patterns of verbal and non-verbal communication that reflect
the rules and regulations governing collective and individual behavior that establish and maintain
organization and authority in the system.
Dominate and Subordinate Structure
Dominate structures - patterns of interaction that occur frequently and form the basis for most family
operations. Example: Father is in charge and what ever he says goes.
Subordinate structures - less frequent but serve to undergrid the dominate structure.
Example: Kids come to Mother to ask permission. Mother goes to Father privately and presents case.
This supports the rule that Father is in charge.
Subsystems
• Parental subsystem
• Sibling Subsystem
Boundaries
• Ideally clear boundaries separate subsystems
• Rigid boundaries (disengagement) or blurring of boundaries (enmeshment) creates problems
Disengaged
Clear Boundaries
--------------Inap prop riate rigid
boundaries
Normal range
Enmeshed
- - - - - - - Diffuse boundaries
• A family is dysfunctional to the extent that patterns of enmeshment or disengagement have
permanently replaced clear boundaries. In dysfunctional families, patterns of enmeshment or
disengagement prevent the family system from successfully responding to internal or external
demands.
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Families that are enmeshed tend to respond to quickly and families that are disengaged tend to lack
appropriate responses.
Alignments and Power
• Alignments are interpersonal patterns based on mutual needs, interests, goals, and opinions.
• Power (or force) refers to the real or perceived influence that individuals have over each other in the
family that allows necessary tasks to get done.
The Process of Interaction
Focus is on the family and not the identified patient
The goal of treatment
• Contention in that lasting changes in individual behavior are the result of changes in the structure of
the system of which the individual is a part. Therefore, the primary goal of structural family therapy
is to transform dysfunctional family structures.
• The therapist thus attempts to disrupt the homeostasis of the dysfunctional family so that the family
will reorganize.
The role of the practitioner
• First the therapist must join/be taken in by the family (acts as if part of the system).
1) Maintenance of the system 2) Track the structure of the system and subsystem 3) Mimic
the interactions
• Second, once on the inside, the therapist begins to formulate changes to the system (becomes the
director of the system).
1) Help family realize the patterns 2) Build or modify boundaries 3) Increase stress to see
interaction patterns 4) Offers members tasks to point up patterns 5) Focus on symptom of the
identified patient 6) Manipulate or intensify the dominate mood 7) Support, educate, and guide the
system
The Strategic Approach
• Aimed at specific behaviors of the identified patient to be changes
Basic Constructs
• Emphasizes the circular/mutually reinforcing patterns of interpersonal communication
• Change is the responsibility of the therapist
• Problems are identified by the family
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The dysfunctional family
• The dysfunctional family can not communicate openly and therefore can not adjust to the transitions
occurring in the life-cycle of all families
1) Courtship 2) Early marriage 3) Childbirth and parenting 4) Middle marriage 5) Separation of
parents and children, and 6) Retirement and old age.
Control and Communication
• Control is at the heartbeat of the dysfunctional family’s inability to adjust to its life cycle, and
interpersonal communication is the vehicle through which control is exercised.
Problems as Control Maneuvers
• Haley (1976) - Problem represent the crystallization of patterns of communication, and phobias or
periods of depression are really tactics, interpersonal maneuvers that fit into the power or control
patterns of the family.
The Process of Intervention
The goal of treatment
• Strategic family therapy is a planned attack on specific problems exhibited by the identified patient
The role of the practitioner
• Therapist must join the family and gain control of it through whatever interpersonal process
maneuvers are necessary. The problem remains the focus of the intervention.
• Stages of intervention:
1) The social stage: Engages the family and gains an understanding of how the system works
2) The problem stage: Asks what has brought the family in. Starts with the one in power but
eventually hears a description form everyone involved. The practitioner remains neutral in gathering
differing perspectives.
3) The interaction stage: Assess the interaction patterns of the system that take place around the
problem. Practitioner asks to see the problem and how members of the system react to the problem.
4) The goal setting stage: Each member of the system must agree on the problem and a specific goal
gets set. When the target problem has changed then everyone will know the therapy has been
successful.
5) Giving directives: Specified behaviors are given to be performed that create a change in the system
around the target problem.
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Understanding Your Own Family as a Starting Place
• Your family has had a impact on how you developed and how you experience the world.
• Families create and maintain patterns of interaction.
• We continue to generate these patterns in our lives
A Systems Approach
• Symptoms are viewed as an expression of a dysfunction within a system
• Changing any part of the system affects all parts of that system.
• The system assumes its own personality
Working with Your Family of Origin Issues
• Resolving family of origin issues often make one a better counselor
• Important part of one’s own development
• Unmet needs can get played out in a variety of settings professional and personal
Identifying Issues in Your Family of Origin
• Origins of strong emotions that are evoked by a client that one is working with
• We carry with us biases that are often projected onto clients if we are not clear about issues we have
Therefore, it is important to know how we carry our past into the present.
• You can make changes in your perspectives but only if you are willing to identify and deal with your
family of origin experiences.
Key Elements
• Family Structure
- Type of family you grew up in
- Current family structure
- Qualities of relationships and alliances
- Childhood memories about self - Character, hopes, fears, school, successes,
failures, role in family, role in peer group, significant events in your
development
- Issues and problems - Family’s role and current options for you
• Parental Figures and Relationships with Parents
- Father/Mother
What were they like as people? How are you like each of them? How do hey
each compliment/criticize you? What advise did they give you as a child? How
could you disappoint them? How could please each of them? What were their
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relationship with the children? What are their current relationships to children?
What did each tell you about you? About life? Death? Love? Sex? Marriage?
Men? Women? Your birth? Race? Religion?
• Becoming Your Own Person
- Individuation - A balance between belonging and separating. Differentiating
from the family allows for acceptance of personal responsibility a psychological
maturity.
- There is a cultural context to this issue especially related to families.
- Differing cultural values determine the degree to which you must struggle for
autonomy.
• Triangular Relationships
- Low self-esteem and insecurity in relationship is the source of triangulation.
- What triangles developed in your family?
• Coping with Family Conflict
- The key to successful relationships lies not in the absence of the conflict but
in recognizing its source and being able to cope directly with situations that
lead to conflict.
• The Family as a System
- The influence of family rules
• Significant Developments in Your Family
- Crisis points
- Unexpected events
- Problems in the family
- Additional births
- Illnesses
Stages in Learning About the History of Your Family
1. Collect data
2. Organize data via a genogram
3. Identify important events and turning points in their lives vis-à-vis the family
4. Sketch an emotional diagram
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Proceed with Caution
A note of caution. As one begins to investigate and learn more about one’s own family, the family
system may exhibit a reaction. The counseling student needs to be aware of this fact prior to any work
toward researching your own family history.
Feminist Theory
The term Feminist Theory, as applied to counseling, refers to a number of therapeutic approaches
that share several characteristics, which distinguish them from more traditional approached to
counseling. An essential characteristic is an emphasis on the power differences and how that power
differential impacts behavior (Dutton-Douglas & Walker, 1988). For counselors working from a
feminist perspective, intrapsychic events always occur - and must be interpreted - within an oppressive
social context.
View of Maladaptive Behavior
Feminist oriented counseling is built on the premise that the person is political; i.e., that a woman’s
circumstances always reflect the position of women in society. Consequently, symptoms are
considered (1) to be related to the nature of traditional feminine roles or conflicts that are inherent to
those roles; (2) survival tactics or a means of exercising personal power; and/or (3) arbitrary labels that
society has assigned to certain behaviors in order to impose sanctions or exert social control (Travis,
1988)
Counseling Goals
Feminist oriented counselors are less interested in changing their clients to fit the mainstream than
in identifying and altering the oppressive forces n society that have affected their clients’ lives. A
primary goal of counseling is empowerment, or helping clients become more self-defining and self
determining.
Counseling Techniques
Techniques that distinguish feminist oriented counseling from other forms of counseling include
the following (Cammaert & Larsen, 1988; Rosewater, 1988; Worrell & Remer, 1992):
Striving for and Egalitarian Relationship: Feminist oriented counselors acknowledge the power
differential that is inherent to the counselor-client relationship, but they attempt to minimize it by
promoting “power with” rather than “power over.” Techniques used to achieve this goal include
making appropriate self-disclosures during the course of counseling; demystifying the counseling
process; encouraging clients to set their own goals and evaluate the progress of counseling; and
reducing the discrepancy between the counselor’s and client’s skills.
Avoiding Labels: To avoid pathologizing clients’ problems, feminist oriented counselors do not use
traditional labels to describe feelings and behaviors and do not emphasize traditional assessment and
diagnosis.
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Avoid Revictimization: Feminist oriented counselors avoid blaming clients for their current
problems. Rather than viewing the client a inadequate, they place the responsibility for the problem
on the ways in which others in the environment have treated the client and emphasize the client’s
strengths to manage the problem in an empowered and empowering manner.
Empowerment: Clients become empowered by recognizing and valuing their strengths, improving
their interpersonal and life skills, and identifying and challenging external conditions that subordinate
them. Techniques used to empower clients include sex-role analysis and power analysis.
Involvement in Social Action: Feminist oriented counselors believe that, to be effective, they must be
social and political activists.
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Crisis Intervention
A crisis involves a precipitating situation or maturational event that is time limited and that disrupts
the individual’s usual coping and problem solving capabilities. There are situational crises and
maturational crises. Natural disasters, loss of a job, and assault are examples of situational crises; the
birth of a child or retirement are potential maturational crises.
Goals of Crisis Intervention
Although the goals of crisis intervention depend on the specific nature of the crisis, the primary
goals of any intervention to reach people in an acute state of stress and to provide them with enough
support over a limited period of time so that they can rely once again on their own coping
mechanisms.
Characteristics of a Crisis
What is a crisis?
People have traditional methods of solving problems. A person's equilibrium is upset when this
traditional method does not work. When this happens a person may become anxious, scared, but they
continue to use traditional problem solving strategies. When usual problem solving methods
repeatedly fail they institute an emergency method. The emergency method is something they
typically wouldn't use but is in the realm of possibility. If the emergency method also fails, the person
begins to feel greater levels of anxiety and begins to panic. This is the birth of a crisis.
A crisis affects 3 aspects of a person's life.
1. Cognitive: Judgment becomes impaired
- Becomes confused - over inclusive, takes in too much information and becomes
overloaded
- Tunnel vision - preoccupied with the problem & can not see how to solve it.
2. Affective: Uncomfortable feelings of being out of control
- Agitated, panicky & anxious are very common
- Sometimes depressed
- Hopelessness, helplessness
- Overwhelmed
3. Behavioral: Exhibiting behavior that would be considered out of the ordinary
- Act out by engaging in activities that are excessive or bizarre
- Shut down and do nothing
When does a crisis occur?
A crisis is usually the result of:
1. Extreme situational pressure
2. Developmental transition points
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How does a crisis get resolved?
1.
2.
3.
4.
There are basically four ways that a crisis will be resolved (usually within 4 to 6 weeks)
Attempt at suicide
Adapt at a lower level of functioning
Get back to per-crisis level of functioning (general goal)
Resolution leaves person functioning at better and healthier level than before crisis
Comprehensive Model for Crisis Intervention
This model is based on what the person in crisis needs from the crisis worker and consists of
three skill areas.
A. Listening and Understanding Skills
1. Establish rapport and trust
2. Find precipitating cause
3. Deal with feelings
B. Assessment
1. Determine severity of crisis
How long? (4-6 weeks is the usual limit of a crisis)
How severe? - client's assessment
How severe? - counselor's assessment
How able is the person to exercise rational judgment, feel appropriately and behave
accordingly?
Must assess the client across three domains.
a. Cognitive - too unfocused or to constricted - usually one extreme or the other
b. Affective - extreme dilation or constriction of emotions - again one way or the other
c. Behavioral - limited behavior or acting out
2. Assess Coping patterns - strengths and resources available
3. Assess Suicide potential
In each of these areas one needs to know what the person was like prior to the crisis situation. The
more severely these areas are affected the more severe the crisis.
The final area in determining severity is whether behavior is situational of chronic. Is the client a
normal person in crisis or is this one of many crises in a chain of chronic crisis events? A person who
is chronically in crisis usually has a maladaptive life-style: drinking problem, legal difficulty,
character disorder, etc. Usually their lifestyle keeps them in crisis.
In the crisis situation the non-chronic and chronic person will look about the same. Therefore it is
important to take a brief history to differentiate the two so appropriate interventions can be introduced.
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Action
There are generally three levels of action involvement by a crisis worker. The level of action
necessary depends on the degree to which the client can function on his or her own.
1. Non-directive:
- Solution decided upon by the client
- Useful with less sever problems and with persons who have plentiful resources.
2. Cooperative:
- Both come up with joint plan of action
- Both have equal responsibility and can contribute to solving the problem
3. Directive:
- Counselor takes responsibility to resolving problem because person in crisis can not
- Usually client is too scared or confused
- Use with most severe and/or suicidal crises
- Hospitalization is the most directive alternative the counselor has.
Brief Social History includes:
1.
2.
3.
4.
5.
Interpersonal relationships
Academic/Job history
Handling of finances
Legal history
Handling of alcohol/drug abuse
1. Interpersonal behavior - Dating behavior. By 22 or 23 years of age the client should have had at
least one steady relationship. If not, find out what the person offers as reason for this. If person is in
their 30's or older and not married or in serious relationship this should be investigated. Also
investigate multiple marriages/divorces. How people relate on an interpersonal level is what we are
interested in finding out because it may suggest the type of social support in the client’s life.
2. Academic/job history
a. Look at level of education.
b. GPA compare with IQ
c. How settled has the person been in work life in job history - if never employed for longer
than 3 months, this may suggest long standing interpersonal problems.
3. Finances
If the client is their in mid 40's, does not own house, is late on rent, no savings, or mismanages
money, this may signs of being maladaptive
4. Legal history - frequent legal problems indicates some level of being maladaptive
5. Substance abuse - Extended abuse leads to (indicates) maladaptive behaviors
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These 5 areas give indication if a person leads a maladaptive lifestyle or is a normal person in a
situational crisis. If it is determined that person is living maladaptive lifestyle, this crisis may be one
of many. An individual for whom crisis is chronic will usually require more than crisis intervention
which may include counseling to modify maladaptive lifestyles and develop new coping skills. With a
normal crisis, helping the person establish support and maintaining some structure and activity will
often be enough.
Evaluating Resources
1. Internal (one's previous coping patterns & strengths)
How did they handle crisis in the past? What has worked for them? How successful have they
been? Are successful strategies available now?
Crisis counselor must realize that a person in crisis will often not be aware of what worked in past
because s/he is so upset and tied up in what's happening now. Therefore, the counselor needs to point
out what worked. The key skill here is to utilize past strengths, experience to resolve present crisis.
2. External (significant others or intimate friends)
People in crisis need other people
Technique: Draw 3 concentric circles-- Intimate others, Friends, Acquaintances
The goal is to find people in the inner circle, people they can count on.
Suicide Lethality Assessment
Goal is to determine how high the suicide risk; whenever dealing with person in crisis, we are
actually doing a suicide assessment. It is important to be able to talk about and discuss suicide
comfortably.
Basis statistics: 7th leading cause of death in U.S. Minimum of 25,000 Americans per year commit
suicide. Indications are that actual number is 2 to 5 times higher. Because many are listed as
accidents or many go unreported due to taboo assigned to suicide in our culture. For individuals 15-24
years of age suicide is the 5th leading cause of death. Suicide attempts are 10 times more frequent
than deaths and threats of suicide are 100 times more frequent than deaths by suicide.
Myths and Facts
1. People who talk about suicide won't do it. Fact: Approximately 80% of individuals talk about
suicides before making an attempt. Listen, and take treats seriously.
2. Once suicidal, always suicidal. Facts: Suicide ideation in crisis usually last a short time during the
crisis period.
3. Suicidal behavior is inherited. Fact: No factual support for a genetic predisposition for suicide
4. People who commit suicide are crazy. Fact: Only small number of suicides are actually psychotic.
People kill themselves for variety of reasons, but underlying this behavior are some basic emotions:
Loneliness - no connections with others; Depression - Hopelessness; Rage - Anger towards others
who are untouchable, so rage turned inward against self
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5. Once person makes suicide attempt and improves, the risk is over:
Fact: The opposite is often true. Some clients make repeated attempts.
Reasons - As the person begins to feel better there is renewed energy
- Support from others may slack off as one improves
- As person feels better, they soon realize that problems remain,
disappointment develops and thoughts of suicide may start again
6. If you talk about suicide with someone, you are putting it into their heads.
Fact: They have probably already thought about it and are often relieved to have it brought out in the
open. Giving permission to talk about not only suicide but also the difficult feelings that the person
may be dealing with in isolation.
Six general areas of importance in Evaluating Suicide Potential
1.
2.
3.
4.
5.
6.
Getting basic demographic data
Knowing the suicide plan and the suicide history (background)
Evaluate stress factors - severity, duration
Psychological symptoms
Medical status
Resources - availability of others to help
A. Demographic Data
1. Age - suicide potential increases with age
a. Women peak risk at 45
b. Men - increase steadily through life
2. Gender
a. Women attempt suicide 3 times as often
b. Men are 3 times more likely at completing a suicide
3. Race
a. Blacks lower than Caucasians and tends to decrease with age
(Exception to #1 above) Young blacks - males higher
4. Marital Status
a. Separated/divorced - high potential
b. Widowed - moderately high potential
c. Single - moderately low potential
d. Married - low potential
e. Married with children - lowest potential
5. Living arrangements
a. Alone - Lethality goes up
b. With someone - lethality goes down
6. Employment
a. Unemployment - up
b. Employed - down
7. Physical health
a. Good - lower
b. Poor - moderately higher
c. Hospitalized in last 6 months or have chronic illness - lethality higher
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B. Stress (relative - how person feels)
1. Acute significant stress (death of loved one) - lethality high
2. Acute multiple stress - also high
3. Stress low - lethality low
C. Suicide plan & history (most important). If this area is high and all others low, still consider
person as being a danger to self.
1. Specificity of plan - in what detail
2. Availability of means to kill self
3. Lethality of method
4. Degree that person is willing to and planned for being rescued
Risk Levels Given Specific Factors
Specificity of Plan - The more thorough the detail - the higher the risk
- if a person is locked into a plan and knows exactly where, when & how - lethality is
exceptionally high
- if plans are general - moderate risk
- if the person is vague general or has no plans - lethality lower
Lethality of method (how dangerous) - in terms of how difficult to reverse the process:
- gun, explosives, hanging, jumping from high buildings - lethality high
- poison, sleeping pills, slash wrists, aspirin, some over the counter drugs are serious
Availability
- if means in hand - risk high
- if available with minor effort - moderate
- if not available - low
Chance of rescue
- high if person taken steps to prevent rescue
- moderate, counting on rescue
- low, not wanting to die - familiar surroundings - rescuers present
Suicide history
- if made 1 or more lethal attempts in past - lethality high now
- if 1 or more nonlethal attempts - lethality moderate
- if no past attempts, threats - lower now
D. Psychological symptoms
1. Cognitive - inability to concentrate, control hallucinations - high
- confused - moderate
- rational- low
2. Physical - insomnia, marked appetite change, recent unsuccessful surgery - high
- fatigue, lack of energy - moderate
- no particular symptoms - low
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3. Emotional - withdrawal, depression, apathy, agitation, hopelessness
- bored, helpless - moderate
- anger, resentment, guilt - lower
E. Medical status - Lethality rises with chronic medical problems or with recent onset of serious
difficulty
F. Resources (external) - important to include people who are close to suicidal person in picture
- need to find out who are those people close to person for help and support
Homicide Risk Assessment
It is also very important to assess a client's potential for harming others. The major things to keep in
mind in doing an assessment for homicidal behavior are: 1) The client's intent to harm another
person; 2) History of violent behavior; 3) Ability to control impulses; 4) Level of drug and/or
alcohol use; 5) A plan to carry out the intention to harm another; 6) Having the means to carry out
any plan that may have been constructed.
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How to Handle a Crisis: The Basics
Assessment
1) What has occurred?
2) How immediate is the intervention needed?
3) What kind of intervention/support is needed?
a) Medical
b) Psychological
c) Law enforcement
d) Administrative
4) What are the resources available to you?
a) Types of assistance - Staff and outside-office personnel
b) Personal skills, abilities, and knowledge
Action
1) Who will act and how?
2) What will the time sequence be?
3) What types of support will you call and when?
a) Medical
b) Law enforcement
c) Psychological
d) Spiritual
Follow-up
1) Information Dissemination
2) Consultation with relevant others
a) Complete review of the situation and its impact on others
b) Review for evaluation of how the crisis was managed
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Interviewing a Person in Crisis: A Five Step Procedure
The goals of the crisis interview are to reestablish psychological equilibrium and ensure that the
persons judgment is intact so as not to be of danger to self or others (Hersh, 1985).
Step 1 - Approaching the Situation
Calm Confidence - Most Individuals are reassured when approached in a calm and confident
manner. You must serve as a symbol of someone in control. This serves to structure the situation and
greatly reduces anxiety. Most crisis situations involve a great deal of anxiety. It is your job to reduce
that anxiety.
Hopeful Expectation - Individuals who are in crisis often feel as though their whole world has
collapsed and that it can never be good again. You must convey a message that you are there to help
and that together the two of you will find out what will make this person’s life better.
Space, Time, and Attention - A person in crisis often feels trapped and on the edge. Your
interaction with the person can serve to break up the trapped feeling.
Step 2 - Making Contact
Structure the Introduction - Introduce yourself; explain who you are; ask the person what
they understand their trouble to be. This introduction serves to provide structure and contact at the
same time.
Empathy - You must be open to sharing in the person's confusion, scare, and/or pain. This can
be a challenge but necessary if the intervention is to be beneficial.
Authenticity - A person in crisis often feels vulnerable and therefore is often guarded. This
person will, in most cases, be very alert to false genuineness.
Directness - If you want to say something to the person it is best to say it directly. This does
not mean that you should say the first thing that comes into your mind or be insensitive.
Authority - The person in crisis may temporary need someone to take charge. This may be
you. If so you must be willing to accept responsibility for limit setting and final disposition. The
basic guideline is whether this person is a threat to self or others.
Step 3 - Making an Assessment
Approaching the Student - The person in crisis is someone you need to negotiate with in an
attempt to reach the person's goal of feeling better. After the client states what the problem is then you
must ask what they need to do to feel better. "How do you hope I can help?" or "What do you want?"
Gathering Basic Information - Name, address, family or friends that can help, etc., provides
you with additional information and a sense of how well oriented the person is.
Mental Status - Three questions need to be answered.
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1) Danger to self or others?
2) Sufficiently intact judgment and reality contact?
3) Person’s level of functioning before the crisis situation?
Identifying the Precipitating Events of the Crisis - Not always clear what the event was so
you may have to probe with questions.
Step 4 - Making Interventions
The goals of crisis intervention is to reestablish pre-crisis equilibrium and to insure the client's
safety.
 Help the Person Gain an Understanding of the Crisis
 Facilitate Appropriate Release of Feelings
 Exploration of Coping Behavior - Explore alternative ways of coping
Step 5 - Making a Disposition
After all the information is gathered come to a conclusion as to what the best course of action will
be.
Questions to guide the process:
- Has the person's level of anxiety decreased significantly?
- Can the person independently describe a plan of future action?
- Is the person genuinely hopeful regarding the immediate future?
- Is there an adequate social support system in place (friends, family members etc.)?
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Appendix A
Progress Note
Date:
Client:
Counselor:
Description of the Client's Situation as Reported by the Client in this Session
Counselor's Assessment of the Information Reported by the Client in the Session
Responses of the Counselor and Client as Work Progressed in this Session
Treatment Implications and Plan for Future Counseling Sessions
Signed
.
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Termination or Transfer Summary
Client’s Name:
Date Summary:
I. Presenting Problem/Diagnosed Disorders/Core Issues/Client Strengths
entered counseling over concern about
.
.
was referred to counseling by
Specifically, it appeared that
.
.
.
.
Other problems include
.
.
The strengths identified include
.
.
II. Goals and Counseling Plan
The goals of treatment were
.
.
.
.
The counseling plan included (indicate treatment modalities, frequency of sessions, number of
sessions, and who participated)
.
.
.
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Page 2
The process of counseling was characterized by
.
.
III. Progress Made in Counseling
Progress appeared to have been made with regard to
.
.
.
Problems which still remain include
.
.
IV. Reason for Termination or Transfer
Counseling terminated or client was transferred to another counselor when
.
.
In my opinion, termination or referral was _____ appropriate/______ inadvisable at that time because
.
.
I conveyed this opinion to
_____ during a session/_____ telephone call/
_____ in a letter. If referral, to whom was the client referred?
.
V. Future Help
Issues that may need to be addressed in any subsequent treatment include:
.
.
___________________________________
Supervisor’s Signature (in any)
__________________________________
Counselor’s Signature
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