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Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
THERAPY
- Psychoanalytic Therapy
- Adlerian Therapy
- Existential Therapy
- Person-Centered Therapy
- Gestalt Therapy
- Behavior Therapy
- Cognitive Behavior Therapy
- Reality Therapy
- Feminist Therapy
- Postmodern Therapy
- Family Systems Therapy
CONTENTS FOR EACH THERAPY Theorist/Proponent View of Human Nature Therapeutic Goals Therapist’s Function and Role Client’s Experience in Therapy Relationship between Therapist and Client Therapeutic Techniques and Procedures Limitations and Criticisms
Psychoanalytic Therapy
THEORIST/PROPONENT Sigmund Freud (1856-1939) o First to develop techniques and procedures for psychotherapy. o Works focused on the unconscious mind of people.
VIEW OF HUMAN NATURE Key Concepts: o View of human nature : deterministic, life and death instinct. Libido – energy of all life instincts o Structure of Personality: Id – pleasure principle Ego – reality principle Superego – perfection o The Conscious and Unconscious Mind – behavior is fueled by conscious and unconscious mind. Conscious mind – all mental processes that we are aware of. Unconscious mind – larger part of the mind that exists below our awareness. Aim: Making the unconscious conscious. Dreams Slips of the tongue Posthypnotic suggestions Free-association Projective techniques Symbolic content o Anxiety – feeling of dread resulting from repression emerging to the surface of awareness.
Reality Anxiety – perceives threat from the external world (real threat). Neurotic Anxiety – fear that instincts will go out of hand and will lead to undesirable behaviors. Moral anxiety – fear of doing something against the moral code. o Ego-Defense Mechanisms – aids in coping with anxiety Repression – unpleasant feelings or events are excluded from awareness. Denial – distorts an individual’s way of thinking by refusing to acknowledge one’s current reality. Reaction Formation – expresses the opposite of what they truly feel. Projection – attributes negative traits of oneself to others. Displacement – channels unpleasant emotions away from the one whom he/she hates to a less threatening individual or object. Rationalization – justifying one’s actions or behavior by making illogical excuses. Sublimation – unpleasant feelings and impulses are redirected into behaviors that are socially acceptable. Regression – reverts back to an earlier developmental stage when faced with anxiety-arousing or stressful situations. Introjection – adopting traits or characteristics of other people or object to oneself. Identification – associate’s oneself with people or community that has good cause. Compensation – compensates lack of skills in one are by being better at other areas. o Development of Personality – 3 early stages that often bring people to counseling when not appropriately resolved: Oral Stage – lacks confidence in oneself and others which results to fear love and forming relationships. Anal Stage – lacks ability to understand and express rage, which results in denying one’s own strengths as a person and have no sense of autonomy. Phallic Stage – difficulty in embracing oneself as either man or woman as well as their sexuality.
COMPARISON OF FREUD’S PSYCHOSEXUAL AND ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT PERIOD OF LIFE FREUD ERIKSON First year of life Oral Stage Infancy: Trust versus Mistrust 1-3 years old Anal Stage Early Childhood: Autonomy versus shame and doubt 3-6 years old Phallic Stage Preschool age: Initiative versus guilt 6-12 years old Latency Stage School age: Industry versus inferiority
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
12-18 years old Genital Stage Adolescence: Identity versus role confusion 18-35 years old Genital Stage Continues
Young adulthood: Intimacy versus isolation 35-60 years old Genital Stage Continues
Middle age: Generativity versus Stagnation 60+ years old Genital Stage Continues
Later life: Integrity versus despair
o Erik Erikson Psychosocial Stages – basic psychological and social tasks which individuals need to master at intervals from infancy to old age. Classical Psychoanalysis – based on id psychology, where instincts and intrapsychic conflicts are basic factors in shaping personality Contemporary psychoanalysis – based on ego psychology, which emphasizes the striving of ego for mastery and competence throughout human life span.
THERAPEUTIC GOALS o Ultimate goal: becoming more adaptive functioning, reduce symptoms and resolve conflicts. o Goals of Freudian Psychoanalytic Therapy: Make the unconscious conscious Strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt.
THERAPIST’S FUNCTION AND ROLE o Therapists assume anonymous stance or also called, “ blank- screen” approach ) or having minimal self-disclosure, having neutral stance and fosters transference relationship. o Transference Relationship – cornerstone of psychoanalysis. It is the transfer of feelings from the past person to the present person. o Must first establish a great deal of listening and interpreting. o Process is like putting pieces of puzzle together.
CLIENT’S EXPERIENCE IN THERAPY o Able to commit to a long-term and intensive therapeutic process. o Engage in Free Association – expressing whatever comes to mind without restraint. That is, clients can speak openly with the therapist about anything ( classical psychoanalysis ). o Commits to following the steps of an extensive therapy process with the help of the therapist. o Therapy can be mutually terminated by client and therapist when symptoms and conflicts have been resolved.
RELATIONSHIP BETWEEN THERAPIST AND CLIENT o Being attuned to the nature of the therapeutic relationship.
o Emotional communication with clients is a useful way to gain information and create connection. o Transference – a key component of the therapeutic alliance. The client is revealing to the therapist feelings and desires that are unconscious shifts from past relationships. o Working-through Process – a continuous and extensive exploration of the unconscious material and defenses that mostly stem for childhood. o Countertransference – happens when therapist’s unresolved conflicts from their past is projected onto the client. o Therapists needs to be aware of countertransference to avoid interfering the objectivity and progress of the therapy. o It is crucial for therapist to be objective and refrain from reacting defensively and subjectively when client’s express emotions like rage, love, criticism and other strong emotions. o Not all countertransference is detrimental to therapeutic process. o Basis for analytical progress is awareness and insights into the repressed material. o Dynamic self-understanding is important in substantial personality change and resolution of present conflicts.
THERAPEUTIC TECHNIQUES AND PROCEDURES o It aims to raise awareness, encourage insights into the client’s behavior and comprehend the implications of symptoms. Therapeutic processes progress from client’s talk to catharsis to insight to working through unconscious materials.
SIX BASIC TECHNIQUES IN PSYCHOANALYTIC THERAPY
MAINTAINING THE ANALYTIC FRAMEWORK
Procedural and stylistic factors (e.g., analyst’s relative anonymity, regularity and consistency of meetings and start and end of meeting, clarity on fees, etc.)
FREE ASSOCIATION
- Central technique to the therapy and plays key role in maintaining the analytic framework.
- Expressing whatever comes to mind without restraint.
INTERPRETATION
- Analyst points out, explains and even teachers the clients the meanings of dreams, free association, resistances, and the therapeutic relationship.
- Identifies, clarifies, and translates the client’s material.
DREAM ANALYSIS
- Significant process for revealing unconscious materials and providing client with insight into some unresolved problems. - Two Levels of Dreams: Manifest Content (literal meaning) and Latent Content (unconscious and hidden meaning)
- Uncovering disguise meanings by studying symbols in the manifest content of dream is the task of the therapist.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
ADLERIAN Therapy
THEORIST/PROPONENT Alfred Adler (1870-1937) o focuses on the idea that persons can only be understood as integrated, whole beings. o Humas are both creators and creations of their own lives
VIEW OF HUMAN NATURE o First 6 years of living: key in forming the approach to an individual’s life. o Humans are motivated by social relatedness rather than sexual urges; behavior is purposeful and goal-directed ; and the focus of therapy is in consciousness rather than unconsciousness. o Stressed choice and responsibility, meaning in life, and the striving for success, completion, and perfection. Inferiority feelings can motivate us to do better in life. Life Goal – source of human motivation
SUBJECTIVE PERCEPTIONS OF REALITY o Phenomenological Orientation: a ttempts to view the world from the client’s subjective frame of reference o Subjective Reality – individual’s way in which people perceive their world.
UNITY AND PATTERNS OF HUMAN PERSONALITY o Individual Psychology – (from Latin word, individuum, meaning “indivisible) the ability to comprehend a person from all of their life's aspects and how all of these elements interact to help them achieve a certain life goal. o Holistic Concept – we should be understood as our whole self rather than parts of it. Client is integral part of social system with emphasis on interpersonal relationships. o Fictional Finalism – envisioned purpose in life that guide’s a person’s behavior. o Striving for Significance and Superiority – inherent to humans is the recognition of inferiority feelings and subsequent striving for perfection and mastery. o Lifestyle – development of a life goal, which in turn unites the personality and the individual’s fundamental assumptions and values that allows transition from a felt minus toward a desired plus. Encompasses the recurring themes and social norms that give significance to our behavior. Often described as perception of self, others and the world.
SOCIAL INTEREST AND COMMUNITY FEELING o Social Interest – action line of one’s community feeling and being equally concerned about others and oneself. o Community Feeling – feeling a sense of belonging to the community and making the world a better place to live. o Gemeinschaftsgefuhl – person’s awareness of being a part of humanity and their attitude toward interacting in society.
3 Universal Life Tasks Social Task – building friendships Love-Marriage Task - establishing intimacy Occupational Task – contributing to society
BIRTH ORDER AND SIBLING RELATIONSHIPS Plays a crucial role with how a person develops and interacts with their environment. o Oldest Child – family’s center of attention and receives it all. o Second Child of Only 2 – always seem to feel as though they were in a race as if in a competitive struggle with the first child. o Middle Child – squeezed out and assumes a “poor me” attitude o Youngest Child – spoiled and may develop helplessness and putting others in his/her service. Tends to be an outlier o Only Child - may have high achievement drive and typically doesn’t interact with other children well.
THERAPEUTIC GOALS o An agreement shared by the therapist and client is made with the goal of establishing a rapport based on mutual respect for one another. o Main aim: develop a sense of belonging and adopt behaviors characterized by community feeling and social interest. o Changing lifestyles to manage life tasks efficiently by uncovering mistaken beliefs about oneself, others and the world, as well as by increasing self-confidence and reducing inferiority. o Develops a new way of life by reframing childhood experiences.
THERAPIST’S FUNCTION AND ROLE o Looking out for significant errors in judgment, such as mistrust, selfishness, unattainable goals, and lack of confidence. Not labeling clients based on their diagnosis, rather, encourages to better understand, challenge and change their life story. o Major function: make comprehensive assessment of client’s functioning. o Uses Early Recollections (ERs) as assessment procedure. Refers to client’s account of incidents that occur before the age of 10. These are specific events, including emotions and thoughts that clients can recall in childhood. o Lifestyle Assessment – process of gathering early memories.
CLIENT’S EXPERIENCE IN THERAPY o Center their efforts on desired results and adopt a resilient lifestyle that can serve as a new guide for their behaviors.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
o Private Logic – ideas about oneself, people and life that make up the philosophy on which a person bases their way of living. Problems arise because conclusions made in private logic do not conform to the requirements of social living. RELATIONSHIP BETWEEN THERAPIST AND CLIENT o Good Therapist-Client Relationship – to be founded on collaboration, mutual trust, respect, confidence, teamwork, and shared objectives. o Therapist aims to have a person-to-person and egalitarian relationship with clients. Strong therapeutic alliance is essential to successful outcomes. o Contract is not necessary but can bring tight focus to therapy. Outlines the goals of the therapy process and details the responsibilities of both therapist and client.
THERAPEUTIC TECHNIQUES AND PROCEDURES 4 PHASES: o Phase 1: Establish the Proper Relationship. Collaborative relationship based on sense of interest that grows into caring, involvement and friendship. Main techniques: attending and listening with empathy into the subjective world of client, identify and clarify goals, suggest based on initial hunches of client’s life. o Phase 2: Explore the Psychological Dynamics Operating in the Client (an assessment). Thorough understanding of client’s lifestyle in social and cultural context as well as his/her family constellation.
Family Constellation – central impact on personality. Early Recollections – one-time occurrences, pictured by clients in detail. Integration and Summary – summary of early recollections, personal strengths/ assets and coping strategies that are presented and discussed to clients. o Phase 3: Encourage the Development of Self-Understanding (insight into purpose). Only possible when hidden purposes and goals of behavior are made conscious Insight – special form of awareness; facilitates meaningful understanding and acts as a foundation for change. Interpretation – underlying motive for behaving the way they do in the hear o Phase 4: Help the Client Make New Choices (reorientation and reeducation). Action-oriented phase where clients put insights into practice and focuses on helping client discover a new and more functional perspective.
Reorientation – shifting rules of interaction, process, and motivation. Reeducation – providing information, teaching, guiding to increase understanding. Encouragement – build courage. Discouragement – basic condition which prevents people from functioning.
LIMITATIONS AND CRITICISMS o Written presentations are difficult to follow because of his conflicting decisions to formalize theory or teaching basic concept of Individual Psychology, o Some considered his ideas as loose and too simplistic. o Research on effectiveness of theory is limited and requires empirical testing and comparative analysis.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
♦ Inauthenticity: not accepting personal responsibility. ♦ Freedom: we are responsible for our lives. ♦ Existential Guilt: realizations that we are not what we might have become. ♦ Authenticity: being true to our own evaluation of what is a valuable existence; courage to be who we are. ♦ Basic condition for change: assuming responsibility
STRIVING FOR
IDENTITY AND
RELATIONSHIP
WITH OTHERS
♦ Preserving uniqueness and centeredness while also relating to other beings. ♦ Courage to be – takes courage to discover the “true ground of our being” ♦ Experience of Aloneness – able to stand alone and tap into our strengths. ♦ Experience of Relatedness – relationships should be based on fulfillment. ♦ Struggling with our Identity – got engrossed with ritualistic behaviors that binds us to an image or identity we acquired as children.
SEARCH FOR
MEANING
♦ Distinct human characteristic: struggle to find a sense of meaning and purpose in real life. ♦ Problem of Discarding Old Values is not creating other, suitable ones to replace them. ♦ Meaninglessness is when clients wonder whether it is worth it to continue struggling or even living.
- Existential Vacuum – emptiness and hollowness. ♦ Logotherapy – help clients find meaning in life
ANXIETY AS A
CONDITION OF
LIVING
♦ Anxiety – inevitable; stems from one’s effort to survive, maintain and assert one’s being. ♦ Existential Anxiety – stems from unavoidable result when confronted with the “givens of existence” (e.g., death, freedom, choice, isolation and meaninglessness). ♦ Normal Anxiety ( ontic ) – appropriate response to certain situations. ♦ Neurotic Anxiety – type of worry that is out of proportion to the situation. ♦ Psychologically healthy individual: having little neurotic anxiety as possible.
AWARENESS OF
DEATH AND
NONBEING
♦ Aware that death is a basic human condition. ♦ Ability to grasp reality and inevitability of death.
THERAPEUTIC GOALS
o Assist in moving toward goals and recognize self-deception of clients. o To reclaim and reown their lives. o Central Goal: increased awareness as it allows clients to discover alternatives in their life. o 4 Essential Aims according to Schneider and Kruger (2010):
THERAPIST’S FUNCTION AND ROLE
o Understand subjective world of clients and aid assist them in discovering new insights and options. o Deals with clients who have restricted existence or those who have little self-awareness and lacks clarity about the nature of their problems. o Can use a wide range of techniques from diverse theoretical orientations. o Therapeutic journey is creative and uncertain and different from each client.
CLIENT’S EXPERIENCE IN THERAPY o Encouraged to take ownership of the way they are now choosing to interaction with the world. o Must actively participate in the therapeutic process by exploring fears, guilt feelings, anxiety, etc. o Should address ultimate concerns instead of focusing on current problems.
RELATIONSHIP BETWEEN THERAPIST AND CLIENT o Central prominence in relationship with client. o Therapists should have client-focused attitudes as well as their own personal qualities (e.g., honesty, integrity, and courage). o Therapy is a voyage into self-discovery and a journey of life- discovery for both parties. o Emphasizes 2 fundamental relationships : “I/It” – time and space; necessary starting place for self. “I/Thou” – essential for connecting self to spirit to achieve true dialogue. o Core of Relationship: respect or faith in client’s potential to cope with problems authentically and find alternative ways of being. o Therapist’s presence plays an important role.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
THERAPEUTIC TECHNIQUES AND PROCEDURES
o Less reliant on techniques. o Describes, understands and explores the client’s subjective reality rather than psychological assessment. o Vontress – therapists are philosophical companions rather than people who repair psyches. PHASES OF EXISTENTIAL THERAPY
PHASE DESCRIPTION
INITIAL PHASE Assists clients in identifying and clarifying assumptions about the world. This is accomplished by teaching clients how to reflect on their own existence and assess their involvement in causing their problems in life. MIDDLE PHASE Aids in conducting a more thorough examination of the source and authority of their value system and leads to new insights and reshape values and attitudes. FINAL PHASE Assisting individuals in putting what they are learning about themselves into practice
APPLICATION TO: o Brief Therapy – mirrors time-limited reality of human existence; require more structuring and clearly defined and less ambitious goals. o Group Counseling – enables to become honest of themselves, widening perspective of themselves and others, and clarify what is significant to present and future lives.
LIMITATIONS AND CRITICISMS o Main Limitation: this kind of therapy needs a great deal of maturity, wisdom, life experience, and training. o Lacks systematic statement of the principles and practices of psychotherapy. o Difficult to apply research to determine the effectiveness of therapy. o Cannot be evaluated and measured in quantitative and empirical ways.
PERSON-CENTERED Therapy
THEORIST/PROPONENT Carl Rogers (1902-1987) o 50 years ahead of his time. o First to formulate a comprehensive theory of personality and psychotherapy grounded in empirical research o Known as “quiet revolutionary” o Proposed a theory that centered on the client as the primary agent for constructive self-change
BASIC ASSUMPTION o People are trustworthy o People have the potential to understand themselves and resolve their own conflict without therapist’s intervention. o People are capable of self-directed growth if involved in a specific kind of therapeutic relationship.
4 PERIODS OF DEVELOPMENT
FIRST PERIOD (1940)
♦ Published Counseling and Psychotherapy: Newer Concepts in Practice (1942) describing philosophy and nondirective counseling. SECOND PERIOD (1950s)
♦ Rogers published, Client-Centered Therapy and renamed his approach as Client-Centered Therapy THIRD PERIOD (late 1950s-1970s)
♦ Addressed the necessary and sufficient conditions of therapy ♦ On Becoming a Person (1961) addresses being true to oneself FOURTH PERIOD (1980s-1990s)
♦ Expanded to variety of settings, increasing the scope of influence. ♦ Theory became Person-Centered Approach.
EXISTENTIALISM VERSUS HUMANISM
EXISTENTIALISM SIMILARITIES HUMANISM
♦ We are faced with the anxiety of ♦ choosing to create an identity in a world that lacks intrinsic meaning ♦ Writings often ♦ focus on death, anxiety, depression, and isolation
♦ Respect for client's subjective experience ♦ Emphasis on concepts like freedom, choice, values, etc. ♦ Little value on techniques and emphasize genuine encounter.
♦ More optimistic view that each person has a potential to self-actualize. ♦ Less anxiety- provoking position.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
conveying a sense of private meanings to the person. Objective Empathy – knowledge sources outside client’s frame of reference. ♦ Accurate Empathy – cornerstone approach and necessary ingredient of any effective therapy.
THERAPEUTIC TECHNIQUES AND PROCEDURES o Earlier View - grasping the world of the client and reflecting this understanding. o Evolution of Person-Centered Methods: Roger’s contribution wherein he stressed the notion of quality therapeutic relationship. Therapist’s ability to establish strong connection with clients is a critical factor for successful therapy. “Being with” clients and entering their subjective world is sufficient to facilitate the process of change. Techniques are not basic in this kind of therapy, rather, it can be suggested to foster the process of client and therapist being together in an empathic way. Therapists can freely use a variety of responses or techniques to assist clients. Presence of the therapist is essential for client’s progress. Immediacy is highly valued in this approach as it address what’s going on between the client and therapist. o Role of Assessment Traditional assessment and diagnosis are considered not useful in this approach. The best source of knowledge is the individual client. o Application of Philosophy Effective in treating problems such as anxiety disorders, alcoholism, psychosomatic disorders, depression, etc. Viable than goal-oriented therapies. o Application to Group Counseling Group counselor is a facilitator rather than a leader. Facilitator creates a safe and healing climate.
EXPRESSIVE ARTS THERAPY: PERSON-CENTERED TECHNIQUE o Natalie Rogers – proponent o Spontaneous creative expression that symbolizes deep and sometimes inaccessible feelings and emotional states. o Principles Uses various artistic forms (e.g., drawing, music, writing, etc.) toward the ed of growth, healing, and self-discovery. Creative Connection – our movement affects how we write and paint and it affects how we feel and think. o Creativity and Offering Stimulating Experiences Deep faith in the individual’s innate drive to become one’s full self.
MOTIVATIONAL INTERVIEWING: PERSON-CENTERED TECHNIQUE o Motivational Interviewing (MI) Developed by William R. Miller and Stephen Rollnick
Directive, client-centered counseling approach to elicit behavior change by helping clients explore and resolve ambivalence. o MI SPIRIT – rooted in the said therapy but with a “twist” Uses attitudes and skills such as open-ended questions, employing reflective listening, affirming and supporting client, nonconfrontational approach to resistance, guide ambivalence discussion and reinforcing “change talk” o Basic Principles Strives to experience client’s world without judgment.
Emphasizes Reflective Listening Reluctance is viewed as normal and expected. Designed to explore both discrepancies and ambivalence. o 5 Stages of Change Progress in this stage is not in a linear fashion. Client’s progress can fluctuate. Reluctant or resistance indicates misjudgment of therapist on client’s readiness to change.
EMOTION-FOCUSED THERAPY (EFT) o Rooted in person-centered approach but integrative as it integrates gestalt and existential therapy. o Aims to understand the role of emotion in psychotherapeutic change. o Stresses importance of awareness, acceptance, and understanding of emotion and visceral experience of emotion.
LIMITATIONS AND CRITICISMS o There are errors in methodology such as relying on self-reports as a major technique to evaluate effectiveness of therapy, and uses inappropriate statistical procedures, fails to use control groups, subjects are not candidates of therapy, and has inappropriate statistical procedures. o Downplays the significance of techniques to influence client’s behavioral change. o Another challenge for counselors who use this approach is whether they are actually helping clients in discovering their own path. o Practitioners and interns have tendency to be very supportive of clients without being challenging.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
GESTALT Therapy
THEORIST/PROPONENT Frederick S. (“Fritz”) Perls, MD, PhD (1893- 1970) o Primary inventor and developer of the said approach. Laura Posner Perls, PhD (1905-1990) o Brought significant contributions to Gestalt’s development and maintenance of therapy movement around the world.
VIEW OF HUMAN NATURE o 2 Agendas: Moving the client from environmental support to self- support. Reintegrating the disowned parts of one’s personality o Rooted in existential philosophy, phenomenology and field theory. Genuine Knowledge: a result of what the perceiver can clearly see in their experience o Aim: awareness and contact to both external (other people) and internal (disowned parts of self) worlds. o Basic Assumption: humans have self-regulating capacity when they are aware of what is happening around them. o Paradoxical Theory of Change: authentic change comes from being who you are than from striving to be someone you’re not. SOME PRINCIPLES OF GESTALT THERAPY
HOLISM ♦ Gestalt – German word meaning “ whole or completion.” A form that cannot be separated into parts without losing its essence. ♦ The idea that nature is regarded as a unified, coherent whole that differs from the sum of its parts. ♦ Emphasis on f igure (prominent aspects at any given time) and ground (aspects that are out of his/her awareness). FIELD THEORY ♦ The organism must be understood as a component of the dynamic environment, or context. ♦ Everything is relational, in flux, interrelated and in process. FIGURE- FORMATION PROCESS
♦ Describes how the individual organizes experience from moment to moment. ♦ Differentiates into a foreground (figure) and a background (ground). ORGANISMIC SELF- REGULATION
♦ Intertwined with the figure-formation process. ♦ Process where equilibrium is “disturbed” by the emergence of a need, sensation or an interest.
♦ Humans have capabilities to self- regulate by taking actions and make contacts to restore equilibrium.
THE NOW
o Emphasis on gaining awareness of and participation in the present moment; “Power is in the present” (Polster, 1973) o Phenomenological Inquiry - paying attention to what is occurring now. o Aim: for clients to become aware of their present awareness. Dialogue in present tense Asks “what” and “how” questions, but rarely the “why”
UNFINISHED BUSINESS o Unresolved problems from the past can be manifested in unexpressed feelings such as resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment. o Unacknowledged feelings create unnecessary emotional debris that clutters present-centered awareness. o Effects can op in some blockage within the body
CONTACT AND RESISTANCE TO CONTACT o Contact - necessary if change and growth are to occur. made by seeing, hearing, smelling, touching, and moving. Effective Contact – interacts with environment without losing one’s sense of individuality. o After contact experience, there is typically a withdrawal to integrate what has been learned. 2 functions : to connect and separate. o Contact Boundary Phenomena – resistance SOME PRINCIPLES OF GESTALT THERAPY
INTROJECTION
♦ tendency to uncritically accept others’ beliefs and standards without assimilating them to make them congruent with who we are.
PROJECTION
♦ reverse of introjection. Disowning certain aspects of ourselves by assigning them to the environment.
RETROFLECTION
♦ turning back onto ourselves what we would like to do to someone else or doing to ourselves what we would like someone else to do to or for us.
DEFLECTION
♦ process of distraction or veering off, so that it is difficult to maintain a sustained sense of contact. CONFLUENCE (^) ♦ blurring the differentiation between the self and the environment.
ENERGY AND BLOCKS TO ENERGY o Attention is given to where energy is located, how it is used, and how it can be blocked. Blocked energy – defensive behavior manifested by some tension in certain parts of body, posture, numbing feelings o Therapist helps clients identify blocked energy and transform it into more adaptive behaviors.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
♦ Top dog and underdog are engaged in a constant struggle for control. ♦ Empty-chair technique – one way of getting the client to externalize the introject. Clients become the top dog and then shift to underdog. MAKING THE ROUNDS
♦ asking a person in a group to go up to others in the group and either speak to or do something with each person.
REVERSAL EXERCISE
♦ ask a person who claims to suffer from severe inhibitions and excessive timidity to play the role of an exhibitionist REHEARSAL EXERCISE
♦ Therapists encourage clients to share their rehearsals out loud
EXAGGERATION EXERCISE
♦ Person is asked to exaggerate the movement or gesture repeatedly, which usually intensifies the feeling attached to the behavior and makes the inner meaning clearer.
STAYING WITH THE
FEELING
♦ Clients refer to a feeling or a mood that is unpleasant and from which they have a great desire to flee, the therapist may urge clients to stay with their feeling and encourage them to go deeper into the feeling or behavior they wish to avoid.
GESTALT
APPROACH TO
DREAMWORK
♦ The intent is to bring dreams back to life and relive them as though they were happening now. ♦ According to Perls: dreams are a royal road to integration; dream is the most spontaneous expression of the existence of the human being.
o Application to Group Counseling Well-suited for a group context. Leaders take an active role in creating experiments to help members tap their resources. Creates a great deal of creativity in using interventions and designing experiments. Experiments need to be tailored to each group member and used in a timely manner; they also need to be carried out in a context that offers a balance between support and risk.
LIMITATIONS AND CRITICISMS o Many criticisms pertain to older version or style of Fritz Perls. o Therapists should be well trained to be effective in practice. Should have advanced clinical training and supervised experience as well as engaging in their own personal therapy. o Some therapists do not have solid grounding of theory and practice, resulting in an abuse of power.
BEHAVIOR THERAPY
THEORIST/PROPONENT B.F. SKINNER (1904-1990) o Considered as the father of the behavioral approach to psychology. o Radical Behaviorism – primary emphasis on the effects of environment on behavior. ALBERT BANDURA (b.1925) o Social Cognitive Theory – we function as self-organizing, proactive, self-reflective and self- regulating beings. o We are not simply reactive organisms shaped by environmental forces or driven by inner impulse. ARNOLD A. LAZARUS (b.1932 ) o A pioneer in clinical behavior therapy and the developer of multimodal therapy o A comprehensive, systematic, holistic approach to behavior therapy.
ASPECTS OF LANGUAGE THERAPISTS MIGHT FOCUS ON
CLASSICAL
CONDITIONING OR
RESPONDENT
CONDITIONING
♦ Refers to what happens prior to learning that creates a response through pairing. ♦ Key Figure: Ivan Pavlov ♦ Joseph Wolpe’s Systematic Desensitization - can be applied to people with intense fears such as phobia.
OPERANT CONDITIONING
♦ A type of learning in which behaviors are influenced mainly by the consequences that follow them. ♦ Can be instrumental in developing prosocial and adaptive behaviors.
SOCIAL LEARNING
APPROACH
(SOCIAL-COGNITIVE
APPROACH)
♦ A triadic reciprocal interaction among the environment, personal factors (beliefs, preferences, expectations, self-perceptions, and interpretations), and individual behavior. ♦ A basic assumption is that people are capable of self-directed behavior change and that the person is the agent of change. ♦ Self-Efficacy: belief or expectation that humans can master a situation and bring about desired change.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
COGNITIVE
BEHAVIOR
THERAPY
♦ operates on the assumption that what people believe influences how they act and feel. ♦ Cognitive factors as central role in understanding and treating emotional and behavioral problems.
VIEW OF HUMAN NATURE
o Grounded on a scientific view of human behavior that accommodates a systematic and structured approach to counseling o The person is both the producer and the product of his or her environment. o SEVEN KEY CHARACTERISTICS:
1. Based on principles and procedures of the scientific
method Experimentally derived principles Systematic adherence to precision and empirical evaluation
2. Not limited to overt actions but also encompasses
internal processes (e.g., cognitions, images, beliefs and emotions). Characteristics of behavior can be operationally defined.
3. Deals with current problems and factors influencing
them. Specific factors that influence present functioning and the factors to modify performance. Undergoes process of functional assessment or behavioral analysis. Recognizes the importance of the individual, the individual’s environment, and the interaction between the person and the environment in facilitating change.
4. Clients are expected to assume an active role in therapy
Required to do something than only talk about it by monitoring behaviors both during and outside therapy sessions, learn and practice coping skills, and role-play new behavior. Therapy is an action-oriented and an educational approach, and learning is viewed as being at the core of therapy.
5. Assumes change can take place without insight into
underlying dynamic behavior can occur prior to or simultaneously with understanding of oneself, and that behavioral changes may well lead to an increased level of self- understanding.
6. Assessment is an ongoing process of observation and
self-monitoring Asses client’s culture.
7. Behavioral treatment interventions are individually
tailored to each client Several techniques can be used.
THERAPEUTIC GOALS o General Goals: (1) increase personal choice, and (2) create new conditions for learning. o Goals must be: clear, concrete, understood, and agreed on by the client and the counselor. o Continual assessment throughout therapy determines the degree to which identified goals are being met. o Behavior therapists and clients alter goals throughout the therapeutic process as needed.
THERAPIST’S FUNCTION AND ROLE o Conduct a thorough functional assessment (or behavioral analysis) to identify the maintaining conditions by systematically gathering information about the ABC Model: A. Situational A ntecedents B. The dimensions of the problem B ehavior C. C onsequences of the problem. o Suggests that behavior (B) is influenced by some particular events that precede it, called antecedents (A) , and by certain events that follow it, called consequences (C). o Use techniques common to other approaches such as summarizing, reflection, clarification, and open-ended questioning. o Therapists should be active and directive , possess intuitive skills and clinical judgment in selecting appropriate techniques, use strategies that are supported by research , and conduct follow-up assessments. o Baseline - outcome measure that are given to the client at the o beginning of treatment; collected during and after treatment also.
CLIENT’S EXPERIENCE IN THERAPY o Unique contributions of behavior therapy: it provides the therapist with a well-defined system of procedures to employ. o Client and therapists have clearly defined roles , and the importance of client awareness and participation in therapy. o Active role for both therapist and client. o Client engages in behavioral rehearsal with feedback until skills are well learned. They also receive homeworks to complete between therapy sessions. o Clients are encouraged to experiment for the purpose of enlarging their repertoire of adaptive behaviors
RELATIONSHIP BETWEEN THERAPIST AND CLIENT o Stresses the value of establishing a collaborative working relationship with their clients. therapeutic relationship and therapist behavior are critical factors in the process and outcome of therapy. o Therapeutic flexibility and versatility enhance treatment outcome. o Therapists conceptualizes problems behaviorally and makes use of the client-therapist relationship in facilitating change.
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
o Follow-up phase is critical for clients in establishing a range of effective behaviors that can be applied to many social situations
- Anger Management Training – designed for individuals who have troubles with aggressive behavior
- Assertion Training – useful for people who lack assertive skills. Useful for those who: o (1) who have difficulty expressing anger or irritation, o (2) who have difficulty saying no, o (3) who are overly polite and allow others to take advantage of them, o (4) who find it difficult to express affection and other positive responses, o (5) who feel they do not have a right to express their thoughts, beliefs, and feelings, or o (6) who have social phobias
7. Self-Management Programs and Self-Directed Behavior
- “Giving psychology away” - psychologists being willing to share their knowledge so that “consumers” can increasingly lead self-directed lives and not be dependent on experts to deal with their problem
- Basic Idea: change can be brought about by teaching people to use coping skills in problematic
- Basic Steps to succeed in self-management: o 1. Selecting goals – goals should be established one at a time; realistic; measurable, attainable, positive and significant for the client o 2. Translating goals into target behaviors – identify behaviors targeted for change. Anticipate obstacles and think of ways to negotiate them o 3. Self-monitoring – deliberately and systematically observe your own behavior and keep a behavioral diary o 4. Working out a plan for change – devise action program; self-reinforcement. o 5. Evaluating an action plan – determine whether goals are achieved and adjust/revise plan to meet goals; evaluation is an ongoing process; self-change is a lifelong practice
8. Multimodal Therapy: Clinical Behavior Therapy
- comprehensive, systematic, holistic approach to behavior therapy developed by Arnold Lazarus
- Although the assessment process is multimodal, the treatment is cognitive behavioral and draws upon empirically supported methods; grounded in social- cognitive therapy and applies diverse behavioral techniques - Premise: Therapeutic flexibility and versatility, along with breadth is most important than depth, are highly valued - BASIC I.D. – divided into 7 major areas of functioning: o B = behavior o A = affective responses o S = sensations o I = images o C = cognitions o I = interpersonal relationships o D = drugs, biological functions, nutrition, and exercise.
9. Mindfulness and Acceptance-Based Cognitive Behavior
Therapy
- “Third Wave” of behavior therapy, emphasize considerations that were considered off limits for behavior therapists until recently.
- 5 core themes: (1) an expanded view of psychological health, (2) a broad view of acceptable outcomes in therapy, (3) acceptance, (4) mindfulness, and (5) creating a life worth living
- Mindfulness - being aware of our experiencing in a receptive way and engaging in activity based on this nonjudgmental awareness.
- Acceptance - receiving one’s present experience without judgment or preference, but with curiosity and kindness, and striving for full awareness of the present moment.
- Four major approaches: o Dialectal Behavior Therapy (DBT) – treatment for borderline personality disorder or people with problems in emotional regulation Skills are taught in four modules: - Mindfulness - Interpersonal Effectiveness - Emotional Regulation - Distress Tolerance o Mindfulness-Based Stress Reduction (MBSR) – 8-10-week group program to cope with stress and promote physical and psychological health Aims to assist people in learning how to live more fully in the present rather than ruminating about the past. o Mindfulness-Based Cognitive Therapy (MBCT) – treatment for depression o Acceptance And Commitment Therapy (ACT) – encourage clients to accept rather than attempt to control or change unpleasant sensations
- Application to Group Counseling: o Teach self-management skills and a range of new coping behaviors, restructure thoughts
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
- Distinguishing characteristic of behavioral practitioners : systematic adherence to specification and measurement
- Tend to utilize short-term, time-limited interventions aimed at efficiently and effectively solving problems and assisting members in developing new skills.
LIMITATIONS AND CRITICISMS o Behavior therapy may change behaviors, but it does not change feelings. o clients are not encouraged to experience their emotions o Behavior therapy does not provide insight. o Behavior therapy treats symptoms rather than causes. o Unless historical causes of present o Behaviors are therapeutically explored; new symptoms will soon take the place of those that were “cured. o Behavior therapy involves control and social influence by the therapist
COGNITIVE BEHAVIOR Therapy
THEORIST/PROPONENT ALBERT ELLIS (1913-2007) o developed an approach to psychotherapy, the Rational Emotive Behavior Therapy (REBT). o Grandfather of Cognitive Behavior Therapy AARON TEMKIN BECK (b.1921) o developed a cognitive theory of depression, which represents one of the most comprehensive conceptualizations o He found the cognitions of depressed individuals to be characterized by errors in interpretation that he called “cognitive distortions.” o Father of Cognitive Therapy JUDITH BECK (b.1954) o she and her father, Aaron Beck, opened the nonprofit Beck Institute for Cognitive Therapy in suburban Philadelphia, and she is currently president of the institute DONALD MEICHENBAUM o Conducted research on the development of cognitive behavior therapy (CBT). o Psychotherapeutic approach of constructivist narrative therapy, in which clients to tell their stories and describe what they did to “survive and cope.”
ALBERT ELLIS ’ RATIONAL EMOTIVE BEHAVIOR THERAPY
Rational Emotive Behavior Therapy (REBT) – first of the cognitive behavior therapies. Focuses on cognition and behaviors and also stresses thinking, judging, deciding, analyzing, and doing. o Basic Assumption : people contribute to their own psychological problems, as well as to specific symptoms, by the rigid and extreme beliefs they hold about events and situations o Integrative approach o Alfred Adler and Karen Horney (tyranny of shoulds): precursor to rebt; Epictetus : stoic Greek philosopher o Basic Hypothesis : our emotions stem mainly from our beliefs, which influence the evaluations and interpretations we make of the reactions we have to life situations. o Self-indoctrination : maintain self to identify acquired dispute irrational beliefs o Implications: working with thinking and acting rather than expressing feelings; therapy as an educational process
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
o Behavioral Techniques - assignments are done systematically and are recorded and analyzed on a form. Homeworks such as desensitization and life exposure to daily life situations. o Applications of REBT to Various Settings - applicable to a wide range of settings and populations o Application of REBT as a Brief Therapy - well suited as a brief form of therapy o Application to Group Counseling - employ an active role in getting members to commit themselves to practicing in everyday situations what they are learning in the group sessions
AARON BECK ’ S COGNITIVE BEHAVIOR THERAPY
COGNITIVE THERAPY - perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality. o Theoretical Assumptions: (1) that people’s internal communication is accessible to introspection, (2) that clients’ beliefs have highly personal meanings, and (3) that these meanings can be discovered by the client rather than being taught or interpreted by the therapist
BASIC PRINCIPLES o Automatic Thoughts – personalized notions that are triggered by particular stimuli that lead to emotional responses. Primary focus: assist clients in examining and restructuring their core beliefs o Cognitive Distortions - Systematic errors in reasoning that leads to faulty assumptions and misconceptions Arbitrary Inferences - making conclusions without supporting and relevant evidence. “Catastrophizing” or thinking of the absolute worst scenario and outcomes for most situations Selective Abstraction - forming conclusions based on an isolated detail of an event. Overgeneralization - process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. Magnification and Minimization - perceiving a case or situation in a greater or lesser light than it truly deserves. Personalization - tendency for individuals to relate external events to themselves even when there is no basis for making this connection. Labeling and mislabeling - portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to defi ne one’s true identity. Dichotomous thinking - categorizing experiences in either- or extremes. Polarized thinking labeled in black or white terms.
DIFFERENCE BETWEEN REBT AND CBT
REBT CBT
♦ highly directive, persuasive, and confrontational; teaching role of the therapist; therapist models rational thinking and helps clients identify and dispute irrational beliefs. ♦ Ellis view faulty thinking as irrational and nonfunctional
♦ uses Socratic dialogue by posing open-ended questions with the aim of getting clients to reflect on personal issues and arrive at their own conclusion. Identify misconceptions; reflective questioning process ♦ Beck views faulty thinking as more inaccurate than irrational ♦ Collaborative Empiricism – attempts to collaborate with clients in testing the validity of their cognitions.
THE CLIENT-THERAPIST RELATIONSHIP o Emphasis on the therapeutic relationship) – first necessary step o Effectivity of therapy : combine empathy and sensitivity along with technical competence o Effective cognitive therapists strive to create “warm, empathic relationships with clients while at the same time effectively using cognitive therapy techniques that will enable clients to create change in their thinking, feeling, and behaving” o Collaborative Relationship: good therapeutic alliance = well done homework o Aim: identify specific, measurable goals and to move directly into the areas that are causing the most difficulty for clients o Bibliotherapy: clients complete readings dealing with the philosophy of cognitive therapy o Homework: experiment. Complete homework if tailored to their needs
APPLICATIONS OF COGNITIVE THERAPY o “strong empirical support for its theoretical framework and to the large number of outcome studies with clinical populations” o Has been successful in treating problems and mental disorders (e.g., phobias, psychosomatic disorders, eating disorders, anger, panic disorder, GAD, PTSD, etc.) o Applying Cognitive Techniques – strategies are both cognitive and behavioral techniques Cognitive techniques : identifying and examining a client’s beliefs, exploring the origins of these beliefs, and modifying them if the client cannot support these beliefs Behavioral techniques : activity scheduling, behavioral experiments, skills training, role playing, behavioral rehearsal, exposure therapy o Treatment of Depression - content of the depressive’s negative thinking and biased interpretation of events Cognitive Triad:
- clients hold a negative view of themselves
Corey, G. (2012). Theory and Practice of group- counseling. Brooks/Cole, Cengage Learning.
- tendency to interpret their personal world in a negative manner (selective abstraction)
- depressed clients’ gloomy vision and projections about the future Beck Depression Inventory (BDI) – assess depth of depression o Application to Family Therapy family interaction patterns, and family relationships, cognitions, emotions and behavior are viewed as exerting a mutual influence on one another A cognitive inference can evoke emotion and behavior, and emotion and behavior can likewise influence cognition in a reciprocal process that sometimes serves to maintain the dysfunction of the family unit.
MEICHENBAUM ’ S COGNITIVE BEHAVIOR MODIFICATION
o Focuses on changing the client’s self-verbalizations o Self-statements affect a person’s behavior in much the same way as statements made by another person o Distressing emotions are typically the result of maladaptive thoughts o Self-instructional training - helping clients become aware of their self-talk and the stories they tell about themselves. Cognitive restructuring plays a central role. Practices through role-play Cognitive structures - organizing aspect of thinking, which seems to monitor and direct the choice of thoughts through an “executive processor” that “holds the blueprints of thinking” that determine when to continue, interrupt, or change thinking o How Behavior Changes - behavior change occurs through a sequence of mediating processes 3-phase change process Phase 1: Self-observation Phase 2: Starting a new internal dialogue Phase 3: Learning New Skills. o Stress Inoculation Training (SIT) - teaching clients stress management techniques a combination of information giving, Socratic discovery- oriented inquiry, cognitive restructuring, problem solving, relaxation training, behavioral rehearsals, self-monitoring, self- instruction, self-reinforcement, and modifying environmental situations. o 3-Stage Model of SIT conceptual-educational phase - primary focus is on creating a working relationship and therapeutic alliance with clients skills acquisition and consolidation phase - giving clients a variety of behavioral and cognitive coping skills to apply to stressful situations application and follow-through phase - carefully arranging for transfer and maintenance of change from the therapeutic situation to everyday life.
o Relapse Prevention - procedures for dealing with the inevitable setbacks clients are likely to experience as they apply what they are learning to daily life o Constructivist Narrative Perspective (CNP) - stories people tell about themselves and others regarding significant events in their lives. We are all storytellers o Successful therapy: clients become their own therapists and take the therapists’ voice with them
LIMITATIONS AND CRITICISMS ELLIS’ REBT o Question’s REBT’s assumption about exploring the past is ineffective in helping clients change faulty thinking and behavior. o Misuse of the therapist’s power by imposing ideas of what constitutes rational thinking. o REBT is a forceful and confrontational therapy. o For practitioners who value a spiritual dimension of psychotherapy, Ellis’s views on religion and spirituality are likely to raise some problems. BECK’S CBT o Focusing too much on the power of positive thinking; being too superficial and simplistic; denying the importance of the client’s past; being too technique oriented; failing to use the therapeutic relationship; working only on eliminating symptoms, but failing to explore the underlying causes of difficulties; ignoring the role of unconscious factors; and neglecting the role of feelings. o Therapists do not explore the unconscious or underlying conflicts but work with clients in the present to bring about changes in their core beliefs. MEICHENBAUM’S CBM o Some practitioners focus too much on client’s reaction to stress or their internal dialogue. o Cautions cognitive behavioral practitioners against the tendency to become overly preoccupied with techniques. o The therapist’s level of personal development, training, knowledge, skill, and perceptiveness. o therapists need to learn the specific cognitive formulation for each disorder they treat and learn how to address the key cognitions and behavioral strategies for each disorder.
