Categories of Theories
psychodynamic approaches, experiential and relationship-oriented therapies, cognitive behavioral (action-oriented) approaches, systems perspective, postmodern approaches
The therapeutic relationship
An important component of effective counseling,
the therapist as a person is a key part of the effectiveness of therapeutic treatments
research shoes that both the therapy relationship and the therapy used contribute to treatment outcome
The Effective Counselor
The most important instrument you have is YOU, be authentic, be a therapeutic person (be willing to grow, risk, care, and be involved).
Research on psychotherapy outcomes indicates the centrality of the person of the therapist and the therapeutic relationship are...
key factors in successful therapy
primary determinants of the therapeutic outcome
contextual factors
counseling for the counselor
1. Helps explore motivations for being a counselor, countertransference, and other issues clinical work may trigger
2. is important for personal and professional development
3. how can we inspire clients to examine lives if we do not personally commit to
Counselor Values
avoid value imposition, recognize you are not value-neutral, assist clients in creating goals and finding answers congruent with their own values, and find ways to manage value conflicts between you and your clients
How do you become multiculturally competent?
become aware of your biases and values, become aware of your own cultural norms and expectations, attempt to understand the world from your client's POV, gain knowledge of the dynamics of oppression, racism, discrimination, and stereotyping
How do you become multiculturally competent?
Study historical background, tradition, and values of your clients and be open to learning from them,
expand vantage point to explore your client's way of life
develop an awareness of acculturation strategies
15 Issues faced by beginning therapists
1. dealing with anxieties
2. being oneself and self-disclosing
3. avoiding perfectionism
4. being honest about limitations
5. understanding silence
6. dealing with client's demands
7. dealing with clients who lack commitment
8. tolerating ambiguity
9. los
Professional ethics
counselors must interpret and apply ethical codes to their decision-making
Mandatory Ethics
minimum level of professional practice
aspirational ethics
higher level of ethical practice
positive ethics
an approach taken by practitioners who want to do their best for clients rather than simply meeting minimum standards to stay out of trouble
ethical decision making (the principles that underlie our professional codes)
benefit others, do no harm, respect other's autonomy, be just, fair and faithful
The role of ethical codes
Educate us about responsibilities, are a basis for accountability, protect clients, are a basis for improving professional practice
Making ethical decisions
identify the problem, review relevant codes and laws, seek consultation, brainstorm, list consequences, decide and document reasons for your actions.
role of ethical codes
1. educate responsibilities
2. basis for accountability
3. protect clients
4. improve professional practice
Informed consent
client needs enough info about the counseling process to make informed choices. educates clients about their rights and responsibilities
informed consent should include...
info such as therapeutic procedures and goals, risks/benefits and alternatives to treatment, the right to withdraw from treatment, costs or fees, supervision, and the limits of confidentiality
Biases are reflected when...
neglect social and community factors and focus unduly on individual, assess clients with instruments that have not been normed on population they represent, judge behaviors, beliefs, or experiences that are normal within the clients culture as psychopatho
The assessment process
An ongoing process designed to help the counselor evaluate key elements of a client's psychological functioning, INFLUENCED by the therapist's theoretical orientation, REQUIRES cultural sensitivity, can be HELPFUL in treatment planning
Diagnosis
the process of identifying a pattern of symptoms which fit the criteria for a specific mental disorder defined in the DSM-IV-TR (soon-to-be DSM-V)
Strengths of Evidence-Based Practice (EBP)
use treatments that have been validated by empirical research, usually brief and standardized, preferred by many insurance companies, calls for accountability among mental health professionals to provide effective treatments
Criticisms of EBP
mechanistic and insensitive to individual differences, not well suited for existential concerns, difficult to measure both rational and technical aspects of psychological treatment, has potential for misuse as a method of cost containment for insurance co
multiple or dual relationships
not inherently unethical, must be managed ethically
Lawson & Venart (2005) Discuss impairment
Vulnerability, wellness and prevention of impairment
Shores (2006) article
There's more to graduate school- personal and professional development resources for graduate students & graduate student mentors
There's more to graduate school- personal and professional development resources for graduate students & graduate student mentors
self-awareness, understand and overcoming biases, being open-minded, being an effective counselor
Ramey & Leibert (2011)
Adlerian perspective on wellness (body, mind, spirit)
Center of Wellness wheel and essential characteristic of healthy people
spirituality
mandatory ethics
deals with the minimum level of professional practice
autonomy
Fostering the right to control the direction of one's life
nonmaleficence
avoiding actions that cause harm
beneficence
working for the good of the individual and society by promoting mental health and well-being
justice
Treating individuals equitably and fostering fairness and equality
fidelity
Honoring commitments and keeping promises, including fulfilling one's responsibilities of trust in professional relationships
veracity
dealing truthfully with individuals with whom counselors come into professional contact
Nuremberg
During the Nuremberg War Crimes Trials, 23 German doctors were charged with crimes against humanity for "performing medical experiments upon concentration camp inmates and other living human subjects, without their consent, in the course of which ex
What is a theory
A coherent group of general propositions used as principles of explanation for a class of phenomena" (Random House, 1993, p. 1967).
case conceptualization
Once we gather an in-depth understanding of the client's narrative (story) of how they got to be with us on their journey - then we begin to conceptualize this
3 ways to conceptualize a case
Developmental
Theoretical
Diagnostically
piaget 1st stage
sensorimotor (0-2) infant explores the world through direct sensory and motor contact. object permanence and separation anxiety develop
piaget 2nd stage
preoperational (2-6 years old) uses symbols (words and images) to represent objects but does not reason logically. also has ability to pretend. child is egocentric
piaget 3rd stage
concrete operational (7-12) Child can think logically about concrete objects and thus add and subtract. understands conservation
piaget 4th stage
formal operational (12 +) can reason abstractly and think in hypothetical
(traffic cop)
...
*psychoanalytic
ruled by reality principle
superego structure of personality
...
(the judge)
...
*psychoanalytic
ruled by moral principle
Clinical evidence for postulating the unconscious:
...
*psychoanalytic
Dreams
Slips of the tongue
...
Posthypnotic suggestions
...
Material derived from free-association and projective techniques
...
Symbolic content of psychotic symptoms
...
NOTE: consciousness is only a thin slice of the total mind
...
*psychoanalytic
...
ANXIETY
Feeling of dread resulting from repressed feelings, memories and desires
Develops out of conflict among the id
ego and superego to control psychic energy
*psychoanalytic
...
3 types of anxiety
Reality Anxiety
Neurotic Anxiety
...
Moral Anxiety
...
Ego-Defense Mechanisms (psychoanalytic)
Are normal behaviors which operate on an unconscious level and tend to deny or distort reality
Help the individual cope with anxiety and prevent the ego from being overwhelmed
...
Have adaptive value if they do not become a style of life to avoid facing reality
...
The Development of Personality in psychoanalytic
First year: ORAL STAGE
Ages 1-3: ANAL STAGE
...
Ages 3-6: PHALLIC STAGE
...
Ages 6-12: LATENCY STAGE
...
Ages 12-60: GENITAL STAGE
...
Psychosocial stages refer to Erickson's basic
psychological and social tasks to be mastered from infancy through old age
Erikson's theory of development holds that:
psychosexual growth and psychosocial growth take place together
During each psychosocial stage
we are faced with a specific crises that must be resolved in order to move forward.
Psychoanalytic Therapeutic Process Goal
The goal is to make the unconscious conscious and strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt
Psychoanalytic Analysts use blank-screen approach to...
foster transference relationship, help clients to achieve insight into their problems, increase their awareness of ways to change, and thus gain more control over their lives
Psychoanalytic Analysts that push the client too rapidly or offer ill-timed interpretations will...
render the process ineffective
Psychoanalytic Phenomena: Transference
occurs when the client reacts to the therapist as he or she did to an earlier significant other
Psychoanalytic Phenomena: Countertransference
is the reaction of the therapist toward the client that may interfere with objectivity
Psychoanalytic Phenomena: Resistance
is anything that works against the progress of therapy and prevents the production of unconscious material
Psychoanalytic Techniques:
...
Maintaining the Analytic Framework
Therapist uses a range of procedural and stylistic factors (e.g., the analyst's relative anonymity, the regularity and consistency of meetings)
Psychoanalytic Techniques:
...
Analysis of resistance
Therapist helps clients become aware of the reasons for their resistance so that they can deal with them.
Psychoanalytic Techniques:
...
Analysis of transference
Therapist uses this technique as a route to elucidating the client's intrapsychic life
Psychoanalytic Techniques: Free Association
Client reports immediately without censoring any feelings or thoughts
Psychoanalytic Techniques:
...
Interpretation
Therapist points out, explains, and teaches the meanings of whatever is revealed
Psychoanalytic Techniques:
...
Dream Analysis
Therapist uses the "royal road to the unconscious" to bring unconscious material to light
Psychoanalytic Group work provides a rich framework for working through transference feelings
The group becomes a microcosm of members' everyday lives
Psychoanalytic Group work and projections onto the leader and members are...
valuable clues to unresolved conflicts within the person that can be identified, explored, and worked through in the group.
Jung's Analytical Psychology is An elaborate explanation of human nature that combines ideas from
history, mythology, anthropology, and religion
Jung's Analytical Psychology Places central importance on psychological changes associated with
midlife
Jung's Analytical Psychology Achieving individuation
the innate and primary goal,the harmonious integration of the conscious and unconscious aspects of personality
Jung's Analytical Psychology-
...
To become integrated
it is essential to accept :,our dark side, or shadow
Jung and Dreams:
are aimed at integration and resolution; they contain messages from the deepest layer of the unconscious, the collective unconscious, our source of creativity
Jung's ARCHETYPES (the persona
the anima and animus, and the shadow),The images of universal experiences contained in the collective unconscious
Contemporary Psychodynamic Therapy: Object Relations
Emphasizes interpersonal relationships as these are represented intrapsychically, and as they influence our interactions with people
Contemporary Psychodynamic Therapy:
...
Self Psychology
Emphasizes how we use interpersonal relationships (self objects) to develop our own sense of self
Contemporary Psychodynamic Therapy:
...
Relational Psychoanalysis
Emphasizes the interactive process between client and therapist
Contemporary Psychodynamic Therapy:
...
Brief Psychodynamic Therapy
Applies the principles of psychodynamic theory and therapy to treating selective disorders within 10 to 25 sessions
Erikson's psychosocial approach
...
-Strengths from a Diversity Perspective
With its emphasis on critical issues in stages of development, has particular application to people of color
This approach stresses the value of intensive psychotherapy for therapists
to help them become aware of their own sources of countertransference, including biases, prejudices, and racial or ethnic stereotypes
Erikson's psychosocial approach
...
Limitations from a Diversity Perspective
Perceived as being based on upper- and middle-class values
Cost of treatment is prohibitive for many people
...
Cultural expectations may lead clients to want more direction and structure from the professional
...
Generally more concerned with long-term personality reconstruction than with short-term problem solving
...
Approach fails to address social
cultural, and political factors that are oppressive to clients
Contributions of Classical Analysis helps therapists (psychoanalytic) understand Human behavior from a:
psychosexual perspective, which can be a powerful framework when paired with the psychosocial perspective
That unfinished business can be worked through to provide a new ending to events that have restricted clients emotionally
...
Contributions of Classical Analysis helps therapists (psychoanalytic) understand the value of concepts such as
unconscious motivation, the influence of early development, transference, countertransference, and resistance
how the overuse of ego defenses keep clients from functioning effectively
...
Limitations of Classical Analysis
This approach may not be appropriate for all cultures or socioeconomic groups
Deterministic focus does not emphasize current maladaptive behaviors
...
Minimizes role of the environment
...
Requires subjective interpretation
...
Relies heavily on client fantasy
...
Lengthy treatment may not be practical or affordable for many clients
...
Brief Psychodynamic Psychotherapy
...
The Therapeutic Alliance
...
Bordin (1979) describes three components of the therapeutic alliance/relationship
1. Relationship
2. Mutual agreement on goals
...
3. Mutual agreement about the tasks
...
Bordin refers to the Therapeutic Alliance/Relationship as the emotional bond.
...
The therapeutic alliance consists of:
the "real relationship" between the two people.
Real" here is about the transference free relationship
as well as, being free of countertransference
This is the "essential ingredient" in all counseling and psychotherapy
...
It is the best predictor of treatment outcome
...
Alfred Adler's Individual Psychology:
...
(8 points)
Based on the concept of holism
A phenomenological approach
...
Teleological explanation of human behavior
...
Social interest is stressed
...
Birth order and sibling relationships
...
Therapy as teaching
informing and encouraging
Basic mistakes in the client's private logic
...
The therapeutic relationship�a collaborative partnership
...
The Phenomenological Approach:
...
Adlerians attempt to view the world from
the client's subjective frame of reference
How life is in reality is less important than how the individual believes life to be
...
Our present interpretation of childhood experiences matters more than the actual events
...
Unconscious instincts and our past do not determine our behavior
...
Adler's most significant and distinctive concept
Social interest
Adler's Social Interest refers to:
an individual's attitude toward and awareness of being a part of the human community
Adler's Social Interest embodies
a community feeling and emphasizes the client's positive feelings toward others in the world
Adler's social interest measures Mental health by
the degree to which we successfully share with others and are concerned with their welfare
Adler's social interest relates Happiness and success to
social connectedness
Adlerian therapy helps clients to
effectively navigate lifestyle tasks
Adlerian lifestyle
private logic
Values
life plan, perceptions of self and others
Unifies all of our behaviors to provide consistency
...
Makes all our actions "fit together
...
Adlerian feelings of inferiority
Are normal and are the wellspring of creativity
Develop when we are young--characterized by early feelings of hopelessness
...
Adlerian feelings of Superiority
Promote mastery and enable us to overcome obstacles
Adlerian Five psychological positions:
Oldest child- receives more attention, spoiled, center of attention
2) Second of only two- behaves as if in a race
often opposite to first child
3) Middle- often feels squeezed out
...
4) Youngest- the baby
...
5) Only- does not learn to share or cooperate with other children
learns to deal with adults
Adlerian Phase 1
Establishing the Proper Therapeutic Relationship:
Supportive
collaborative, educational, encouraging process
Person-to-person contact with the client precedes identification of the problem
...
Help client build awareness of his or her strengths
...
Adlerian phase 2
Exploring the Individual's Psychological Dynamics
Lifestyle assessment
...
Subjective interview
...
Objective interview
...
Family constellation
...
Early recollections
...
Basic Mistakes
...
adlerian phase 3
Encouraging Self-Understanding/Insight
Interpret the findings of the assessment
...
Hidden goals and purposes of behavior are made conscious
...
Therapist offers interpretations to help clients gain insight into their private logic and lifestyle
...
adlerian phase 4
Reorientation and Re-education
Action-oriented phase; emphasis is on putting insights into practice
...
Clients reoriented toward the useful side of life
...
Most distinctive intervention; central to all phases of Adlerian therapy
Encouragment
Adlerians and discouragement
the basic condition that prevents people from functioning
Adlerian and group counseling
Group provides a social context in which members can develop a sense of community and social-relatedness
Sharing of early recollections increases group cohesiveness
...
Action-oriented strategies for behavior change are implemented to help group members work together to challenge erroneous beliefs about self
life, and others
Employs a time-limited framework
...
adlerian Strengths From a Diversity Perspective
The Adlerian approach stresses the effects of social class, racism, sex, and gender on the behavior of individuals
The therapeutic process is grounded within a client's culture and worldview
...
Contemporary Adlerians appreciate the role of spirituality and religion in the lives of clients
since these factors are manifestations of social interest and responsibility to others
Limitations of the Adlerian Approach
Adler spent most of his time teaching his theory as opposed to systematically documenting it
Some consider Adlerian theory simplistic
...
Many of Adler's theoretical constructs (i.e. lifestyle) are difficult to measure and require empirical testing
...
Research on treatment efficacy is limited
...
Taber technique in Adlerian tradition
Inform
Solicit the ER (Early recollection)
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Listen & Take Notes
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Collect an Emotion
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Write down the Emotion
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Get a snapshot
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Repeat
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Process the Ers
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Present your conclusions
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Refine with client
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Existential psychotherapy is born from
philosophy