Theories of Counseling Midterm Review

Empathic Confrontation

"Going with" the client, seeking clarification and possibility. A gentle skill that involves first listening to client stories carefully and respectfully and then encouraging the client to examine self and/or situation more fully. Used to address double messages, incongruities, and discrepancies. Must balance with warmth, positive regard, and respect. Understanding the issue first, then picking apart the inconsistencies in the conversation and letting the client know, but doing it in a respectful manner. Must try to figure out the inconsistencies (this can be done over the course of sessions). Four weeks ago you said this, but now you're saying this. Can you help me understand what happened?

Sue and Sue (2016)

"We need to realize that insight is not highly valued by many culturally different clients. There are also major class differences as well. People from lower socioeconomic classes frequently do not perceive insight as appropriate to their life situations and circumstances. ... Insight assumes that one has time to sit back, to reflect and contemplate about motivation and behavior ... Likewise, many cultural groups do not value insight. In traditional Chinese society, psychology is not well understood. ... Many Asian elders believe that thinking too much about something can cause problems. ... 'Think about the family and not about yourself' is advice given to many Asians as a way of dealing with negative affective elements. This is totally contradictory to Western notions of mental health—that it is best to get things out in the open in order to deal with them."

Body Language (SURETY)

(SURETY) Effective Nonverbal Behavior Sit at the angle to the client: (sit at a slight angle opposite to the client. This creates a non-confrontational sitting arrangement that facilitates communication. Sitting directly in front may be conceived as confrontational and sitting side by side as impersonal). Uncross legs and arms: crossed arms and legs may communicate defensiveness, low interest, or superiority. Uncrossed arms and legs communicate that we are open and receptive to what the person is communicating. Important to avoid a slouched position or one that is too open. Relax: Relax in an appropriate position. It will be inappropriate that you appear to be relaxed or overly concerned when a client is sharing a very disturbing experience. Leaning toward the client may demonstrate active listening, but it is a position to maintain temporarily as it is difficult to sustain. Eye contact: appropriate eye contact is an effective way to communicate that yo are listening. Wandering eyes communicate disinterest. Staring communicates intrusion and insensitivity. Eye contact breaks are expected, as it is to keep eye contact when the client is sharing a distressful event, even if they are looking down, because they may come back and find that you are looking away; this may break trust. Remember that clients from other cultures or with different cultural values may prefer varying styles of eye contact. Touch (tap shoulder or arm) Your intuition: intuition governs the entire process of nonverbal communication in the SURETY model. Research suggests intuition in nursing is an important part of effective clinical decision making that supports safe patient care. Nonverbal and verbal communication are in part an art. Intuition should be used when implementing all of the above components to sense how the client responds and increase communication effectiveness. The minimal clues of discomfort should be intuitively noted and responded to.

2 Components of Empathy

1.) Affective: feeling the emotions with the other person or having a vicarious (e.g., secondhand) experience of the emotional responses of the other. 2.) Cognitive: understanding and grasping the meaning of the other person's experience. Empathy encompasses positive and negative emotions (happiness and sadness). Most theories focus on distress and negative emotions.

Eclectic-integrative, flexible adherence to a single theory, and general theory have the following in common

1.) An awareness that clients respond differently and may need to add the techniques of an alternative orientation to one's own regular method at times; 2.) A respect for worldviews and theories different from one's own; and the ability to see how different theories may be systematically related to one another for client benefit

The Empathy Action-Oriented Counseling Process

1.) Attending Skills 2.) Affective and Cognitive Empathy 3.) Understanding of Client Concerns and Distress 4.) Altruistic Motivation to Help 5.) Counseling Intervention 6.) Action

The neuroscience foundation of DCT

1.) Background feelings (sensorimotor) 2.) Attention to feelings (concrete) 3.) Reflective awareness (formal and dialectic/systemic) The neuroanatomy of emotion has been outlined by Chatwal & Lane (2016), Lane (2008), and Lane & Schwartz (1987). Prefrontal cortex isn't developed until age 25. (Young adulthood) You are stuck in between. Your emotional reasoning isn't fully developed yet until the age of 25 according to neuroscience. If region 3 is active, we are experiencing strong sensations like crying or freezing. Through the EEG method, you can measure brain activity and understand which regions are mainly active in your brain. EEG can determine the present cognitive orientations in the brain. It has been found that different areas of the prefrontal cortex respond to the four levels of DCT.. The focus of their model is on emotion, but its parallels to DCT and therapy are obvious. These researchers focus on affective awareness, and this helps us become more aware of the fact that feelings are expressed differently in the brain—and, of course, verbal expressions and nonverbal behavior.

DCT uses three major theoretical foundations

1.) Co-construction of relationships between counselor/therapist and client. 2.) A reformulation of Piagetian cognitive stages for use in counseling and therapy. 3.) A spherical meta-theory integrating the multiple theoretical voices of counseling and therapy.

Goals to help counselors

1.) Counselors Attitudes and Beliefs: If you are to be empathic with those of different backgrounds, it's essential that you become self-aware. Privileged and marginalized counselors need to become aware of their client's worldviews. values, and group status affect the relationship with their clients. 2.) Counselor Knowledge: Privileged and marginalized counselors work intentionally to acquire knowledge of how the worldviews, values, and experiences with power, privilege. and oppression affect the counseling relationship. 3.) Skills 4.) Action: Both privileged and marginalized counselors act intentionally to increase their understanding of the way they and the client see the world.

The universal approach recommended by Fukuyama challenges all counseling and therapy to become aware of multicultural issues and to recall that all counseling and therapy is culturally based. She argues for a counseling curriculum which

1.) Defines culture broadly (including gender, affectional orientation, age, etc, as well as ethnic/racial issues) 2.) Teaches the danger of stereotyping 3.) Emphasizes the importance of language as the vehicle of counseling and therapy 4.) Encourages loyalty and pride in one's own culture and family ties 5.) Provides information on the processes of acculturation and oppression 6.) Discusses the importance of gender roles 7.) Facilitates each individual's identity development as a member of the community 8.) Builds self esteem and awareness 9.) Facilitates the understanding of one's own worldview and how it relates to family and cultural history

The Five-Stage Interview Model; Pragmatism in Action

1.) Empathic Relationship: establish rapport and structure 2.) Story and Strengths: gather data using the Basic Listening Sequence (BLS) 3.) Goals: set goals collaboratively using the BLS 4.) Restory: explore alternatives via te BLS; confront incongruities.

Carl Rogers' "Necessary and Sufficient Conditions of Therapeutic Personality Change" (1957)

1.) Empathy: Communication of empathy from the counselor to the client. 2.) Congruence: Counselor's responses reflect internal reactions (internal reaction may not overlap with your verbal reaction). Counselor is thinking something different than what they are verbalizing. They might not understand everything the client is saying, but do understand that the behavior is part of them and why they are behaving the way they are. 3.) Unconditional Positive Regard: Recognize what you value about each client.

Locke argues for what he terms a "focused approach" where it is important "to see people both as individuals and members of a culturally different group." This approach obligates us to

1.) Examine our own racial beliefs and attitudes to culturally different individuals and groups 2.) Discuss racially relevant topics at an institutional level and be willing to work on issues of oppression beyond the individual and family session. 3.) View our clients both as individuals and members of the group

4 Dimensions of Attending Behavior

1.) Eye Contact 2.) Body Language (no crossing arms or legs) sit legs straight). 3.) Vocal Tone (talk slowly, calmly, and softly. Some clients do not like being touched might be due to their culture) If a client tries to hug you after a session, I would give them a hug especially if it is a child. It depends on the situation if you can give a hug or not. It also depends on the relationship you have had with the client (like how long you have seen them). You will have to set boundaries if the client starts to make a "routine" out of this. Depending on the culture as well, some clients hug, others do not. As a counselor, you have to make a good judgment, yes it is important about the client's feelings and level of comfort, but it is also important that the counselor feels comfortable as well when it comes to situations of embracing. 4.) Verbal Following Examples: Eye Contact: European Americans: When listening to a person, direct eye contact is appropriate. When talking, eye contact is often less frequent. Other Ethnicities/Cultures/Races: Some African Americans may have patterns directly opposite and demonstrate more eye contact when talking and less when listening. Body Language: European Americans: Slight forward torso lean facing the person. Handshake is a general sign of welcome. Other Ethnicities/Cultures/Races: Certain Eskimo and Inuit groups in the Arctic sit side by side when working on personal issues. A male giving a female a firm handshake may be seen as giving a sexual invitation. Vocal Tone and Speech Rate: European Americans: A varied vocal tone is favored, which some emotionally show. Speech rate is moderate. Other Ethnicities/Cultures/Races: Many Latina/o groups have a more extensive and expressive vocal tone and may consider European-North American styles unemotional and "flat." Physical Space: European Americans: Conversation distance is ordinarily "arm's length" or more for comfort. Others Ethnicities/Cultures/Races: Common in Arab and Middle Eastern cultures is 6-12 inch conversational distance, a point at which the European American becomes uncomfortable. Time: European Americans: Highly structured, linear view of time. Generally, "on time" for appointments. "Time is

Practical implications

1.) Helping us become aware of the importance of early child relationships for later development. 2.) Suggesting that psycho-educational interventions in terms of family education are critically important. 3.) Indicating the importance of infant child care (including extended family, babysitters, and infant school) as important areas of counseling intervention. 4.) Enabling us to identify likely early childhood experiences of our clients, thus underlining the importance of varying our style of therapeutic interaction and relationship, according to the developmental history of our client (for example, an adult who was insufficiently attached as a child may need more support and empathy from the counselor, whereas an adult who was overly attached now may need encouragement to individuate and separate)

Tripartite Identity Model

1.) Individual Level: all individuals are, in some respects, like no other individuals. 2.) Group Level: all individuals are, in some respects, like some other individuals. 3.) Universal Level: all individuals are, in some respects, like all other individuals. The Tripartite Identity Model recognizes that the United States is largely associated with individualism, autonomy, independence, and uniqueness (Level 1) The focus of psychology, counseling, psychiatry, social work, and other related disciplines was to find universal principles and laws to explain human behavior (Level 3) The group identity level was ignored for a long time. Multicultural Counseling Theory brought attention to group identity (Level 2) Each cultural group may have its own interpretations of reality and perspectives on identity development, the nature of people, origin of disorders, standards for judging normality and abnormality, and therapeutic interventions.

A Summary of Basic Ethical Guidelines

1.) Maintain Confidentiality: Counseling and psychotherapy depend on trust between counselor and client. As a therapist, you are in a powerful relationship; the more trust you build, the more power you have. This book asks you to maintain the confidence of your volunteer client, but if you are a student, you do not have legal confidentiality , and your client should be made aware of this. 2.) Recognize your limitations. Maintain an egalitarian atmosphere with your counter clients. Share with them the task you wish to work through. Inform them that they are free to stop the process at any time. Do not use the interview as a place to delve into the life of another person. 3.) Seek consultation. Remain in consultation with your professor, workshop leader, or mentor. Counseling and psychotherapy are private. It is important that you constantly obtain supervision and consultation in your work. You may also find it helpful to discuss your own growth as a helper with other students, without revealing what you have learned about your client. 4.) Treat clients the way they want to be treated. This is the Platinum Rule in counseling and therapy. Put yourself in the place of the client. Every person deserves to be treated with respect, dignity, kindness, and honesty. 5.) Be aware of the individual and cultural differences. An emphasis on cultural issues can lead at times to stereotyping an individual. At the same time, an overemphasis on individuals may miss background multicultural issues. 6.) Give special attention to ethical treatment of children and their rights. Follow the Conventional Rights of the Child (CRC) which indicates that children are born with the right to survival, food, and nutrition, health and shelter, education, and participation. Children are to be heard and protected. 7.) Review ethical standards frequently. For example, American Association for Marriage and Family Therapy (AAMFT), American Counseling Association (ACA) Code of Ethics, American Psychological Association (APA) Ethical Principles of Psychology and Code of Conduct, American School Counselor Association (ASCA), Commission on Rehabilitation Counselor Certification (CRCC) Code Of Professional Ethics for Rehabilitation Counselors, N

Guidelines for adapting therapy to clients' cultures

1.) Practice flexibly and respectfully 2.) Communicate empathy in a culturally appropriate manner 3.) Obtain relevant and effective multicultural competence training 4.) Learn about specific cultural norms, study literature about available culture-specific treatment techniques, and consult with expert colleagues 5.) Conduct a culturally informed but person-specific functional assessment before implementing treatment. 6.) Explore client's views of seeking counseling treatment and the nature of the therapeutic relationship 7.) Do not dismiss traditional treatments as they may serve as potential resources 8.) Review with client services that may be meaningful within their cultural worldview and content 9.) Implement appropriate and specific cultural adaptations 10.) Avoid interpreting cultural differences as deficits 11.) Identify client's culturally related strengths and resources dfor use in treatment 12.) Remain open to what clients bring to counseling

Important constructs that can help communicate feelings of understanding and empathy for the client

1.) Respect and Warmth: Respect is close to positive regard and can be communicated verbally through a language of respect. All of the positive regard, positive asset search, and exploration of resources communicate respect for another person. Ex: statements such as "You express your opinion well" and "Good insight." Warmth is an important factor underlying an empathic relationship. It is an emotional attitude toward the client, expressed through nonverbal means. Vocal tone, posture, gestures, facial expression, and the ability to touch when appropriate see how the warmth and support of a counselor is communicated to a client. Ex: Smiling is found to be the best single predictor of warmth ratings in an interview. Smiling is consistently associated with positive perceptions of the other person: such as sincere, competent, relaxed, and warm. 2.) Concreteness: The task of the counselor is to clarify and understand vague ideas and concerns expressed by the client. 3.) Immediacy and Congruence: There are 2 commonly used definitions of this term in counseling and therapy. One is focused on time dimensions, while the other on the here and now relationship of the interview. Immediacy as time orientation: the most powerful counseling leads are in the present tense and considered the most immediate. Psychoanalytic Theory operates primarily in the past tense and focuses on past experiences. Gestalt Therapy and Existential helping focuses on the now and give special attention to what is happening to the client in the immediate here and now. Behavioral helpers and vocational counselors may delve into the past but are often primarily interested in facilitating client self-expression in the future. Ex: Client: Im scared Analytic Counselor: Free associate to you earliest childhood experiences that relates to that feeling. Existential Counselor: You're sacred. What are you experiencing right now. Behavioral Counselor: What do you want to do about it? Immediacy as here and now: As you move toward a more present-tense orientation in helping, you may find yourself focusing on the here and now experience you and the client are having in the interview. Present tense language is used. 4.) Genuineness: Carl Rogers stat

Cultural expertise and intentionality imply 3 major abilities on the part of individual

1.) The ability to generate a maximum number of thoughts, words, and behaviors to communicate with self and others within a given culture. 2.) The ability to generate a maximum number of thoughts, words, and behaviors to communicate with a variety of diverse groups and individuals. Both clients and counselors need to communicate within their own culture and learn the ability to understand others' culture as well . 3.) The ability to formulate plans, act on many possibilities existing in a culture, and to reflect on these actions. Behavioral approaches to counseling are particularly strong on action. Clear, observable goals are developed with follow-up and evaluation.

9 characteristics of depression from DSM-5

1.) depressed mood 2.) diminished interest and pleasure in daily activities 3.) significant weight loss or gain 4.) insomnia or constant sleeping 5.) psychomotor agitation or retardation 6.) fatigue or loss of energy 7.) feelings of worthlessness or excessive guilt 8.) diminished ability to think or concentrate 9.) suicidal ideation

As a holistic framework, DCT depends on multiple seeing and multiple theories. The following summarizes DCT's integrative view of foundational skills

1.) for effective counseling and therapy, an empathic relationship with a skilled counselor is essential; 2.) most sessions will involve meaning making and decision making; 3.) multicultural factors modify these dimensions and offer additional perspectives. DCT suggests that it is important for you to be skilled and knowledgeable in these foundational dimensions so that you can meet the needs of a highly diverse clientele. Furthermore, DCT's holistic frame of reference offers a paradigmatic bridge to connect supposedly antagonistic worldviews. For example, DCT finds value in individualistic psychodynamic and cognitive-behavioral approaches and interdependent feminist and multicultural systems. This framework also permits the inclusion, and perhaps even the centrality, of spiritual dimensions of being. Basic to the DCT worldview is that multicultural issues deeply influence the way we think about and construct reality. Counseling and therapy are usually thought of as a two-person relationship—specifically, the relationship between a counselor and the client. There is now reason to believe that the concept of relationship in the interview requires a broader understanding.

Carol Gilligan

A Developmental psychologist who pointed out that male and females are very different. She states that they tend to have varying patterns of psychosocial development that result in varying patterns of thinking. Men are linear, or "if-then," thinkers. The male model of thinking tends to focus on results and achieving a specific goal. Gilligan describes women as "relational" thinkers, individuals who think about possibilities and relationships between possibilities before they take action.

Race

A multidimensional identity. Your race is experienced in accord with how you self-identify and in relation to how you are perceived by others. An individual's racial self-classification does not always match how they are perceived racially by others. This phenomenon is referred to as "racial contestation," "racial mismatch," and "racial misclassification." For example, an individual can self-identify racially as African American, but be perceived by most others as non-African American.

Interpersonal Psychotherapy (IPT)

A dynamically-informed, time-limited form of treatment by Gerald L. Klerman and Myrna M. Weissman. The focus of IPT is interpersonal issues. The basic premise of IPT is that social and interpersonal distress exacerbates the onset and relapse of psychological disorders. Psychological disorders are frequently trigger by an interpersonal crisis. Interpersonal issues fall into one of four categories: a)grief—a complicated bereavement reaction following the death of a loved one; b)role transition—an unsettling major life change such as illness or retirement; c)role dispute—a conflict with an important person such as parent, spouse, or boss; or d)interpersonal deficits—difficulties to establish relations or social isolation. The client and therapist identify the central interpersonal crisis or predicament. This critical issue becomes the primary focus of treatment.

Implicit Bias

A form of bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors. We have biases without meaning to have them even if they go against what we believe in. Like being a liberal, democrat, coming from a different cultural background, etc.

How does our nervous system help us understand another person's emotional and cognitive state and anticipate their actions to interact appropriately?

A neural network involved in affective and motivational processing gets activated when we experience or observe another person's physical or psychological pain. This pain-empathy network involves the anterior insula (AI) and medial and anterior cingulate cortex (MCC, ACC) and can be activated by the voluntary or involuntary system. The involuntary process involved in pain-empathy is known as "experience sharing," or "affective empathy." The voluntary process involved in pain-empathy is known as "mentalizing" or "cognitive empathy."

Cultural intentionality

A person being aware of cultural differences between people on an individual and societal level

Separation

A second task that is related to attachment. A securely attached child is able to separate and individuate Bowlby stresses attachment and a stable base in the family as critical for human development.

Accommodation

A term developed by psychologist Jean Piaget to describe what occurs when new information or experiences cause you to modify your existing schemas.

4 Levels Of Observation

According to Porzsolt and colleagues there are 4 levels of observation are used to determine the success of an intervention: 1.) Efficacy: Achieve therapeutic goals in optimal or ideal conditions. 2.) Effectiveness: Achieve therapeutic goals in usual clinical practice. 3.) Efficiency: Achieve therapeutic goals at t he lowest possible cost. 4.) Value of Health Care: Meaning and appreciation of outcomes (Note: outcome can have different meanings, be appreciated differently, and lead to different client and society decisions). Efficacy can be established using a Randomized Controlled Trial (RCT) completed under ideal study conditions. Effectiveness can be established in a Pragmatic Controlled Trial (PCT) completed under real-life conditions. RCT and PCT cannot be evaluated simultaneously. The first describes what researchers expect to observe in mental health care, while the second describes what they observe in the real-world-setting intervention. To demonstrate client benefit, researchers should first establish efficacy by using an RCT and, second, establish effectiveness by using a PCT.

Cultural Intentionality

Acting with a sense of capability and flexibly deciding from among a range of alternative actions. The culturally intentional individual has more than one action, thought, or behavior to choose from in responding to changing life situations and diverse clients.

Decisional Counseling

All (most) roads lead back to Benjamin Franklin's pragmatic decision making. 1.) Defines the issue/concern clearly 2.) Generates alternative possibilities for solution 3.) Weighs the pros and cons of each alternative 4.) Selects one alternative for action and see how it works! 5.) Drawing from social constructivist theory, the five-stage model is a way to consider how interviews are conducted through many forms of therapy

Sympathy

Also different from empathy. The cognitive apprehension of another person's suffering, followed by efforts to alleviate that suffering, instead of co-sharing that suffering interpersonally.

Dream Analysis

Another important technique of psychodynamic approaches. This can be conducted at a surface level by examining the manifest or observed content of the dream. Underlying the conscious parts of of the dream is the latent content containing deeper structures of meaning. Free association is used by psychodynamic counselors in the analysis of dreams at both levels.

Ethical Helpers

Are culturally competent, honor and respect clients' worldviews, and embrace a multicultural approach to work with their clients. They tailor or match their theory application to the racial, ethnic, cultural, and unique characteristics of their clients and the issues affecting them. Last but not least, helpers engage in a continued process of reflection regarding their theories and the outcomes of their interventions. Also, they frequently request feedback from clients, in an ongoing process of self-reflection and self-improvement.

What Do You Bring With You?

You must ask yourself two questions; How am I planning to walk along with the client? What will I bring with me that will help me meet that client?

The Cognitive Worldview

Asserts that the way you perceive and think about things is what promotes your feelings and behaviors. Assessment of cognitive patterns and information processing are the focus of treatment. Cognitive restructuring is typically used as treatment, but they combine this with other behavioral techniques such as relaxation. The cognitive counselor will focus on short-term observable change but will keep an eye on the underlying thoughts involved in the abusive situation in order to sustain change. Counselor/Therapist Ex: i sense that this situation and its pressure makes you angry. It is that very anger that seems to have led to the issues you now face. We'll spend time exploring what makes you angry. We'll be working on how you think and behave to help you change the way you see things and gain control over your violent behavior. We'll begin with a journal of daily events recording when you feel angry and what you do. We will follow this with a discussion of your thoughts during those instances and ways to restructure any negative thoughts to change your behavior.

Cognitive Behavioral Therapists

Assign specific homework assignments so the ideas generated in the interview are taken home and practiced. Most approaches to psychotherapy do not get this specific, but all therapeutic approaches encourage clients to look at their plans and results of their actions.

Worldview and Theory in Counseling and Therapy

Awareness of your views of counseling and expanding your response repertoire for helping is not enough; it is also necessary to examine a larger worldview. The manner in which you identify central issues provides a small picture of how you view the world. It is out of this worldview that, or personal framework, that you make a decision on how to act. Your worldview and theories determine how you relate to others and what you will say to your clients. Counseling and psychological theories, such as psychoanalysis, behaviorism, humanistic cognitive, or narrative, all represent theories or worldviews and are means of conceptualizing and thinking about people and the world. These theories offer a set of intervention techniques through which people may be helped. As a counselor, your task is to use these theories to build your own theory about the world.

Using Listening Skills with Children

Basic listening skills are helpful, with some modification With highly verbal children as young as 5 or 6, listening skills work very effectively. (When counseling a child with an open ended question, this can be confusing. Instead, ask close-ended questions where they can answer yes or no. For example, how they feel when they are playing, going out with parents, etc.

The linear vs. relational orientation

Basic to an understanding of counseling and therapy. While relational issues play themselves out very differently among cultures, Gilligan's distinction is very helpful in regard to understanding not only male and female clients, but also those of many differing cultural groups.

What does DCT recommend?

Both horizontal and vertical development on as many cognitive-developmental and emotional issues as feasible for each client. Higher is not better, but DCT argues that helping clients discuss their issues at multiple levels may indeed be more effective.

Compassion

Caring concerns (feeling with) but not necessarily shared feelings (feeling as).

Confrontation

Clients come to counseling for the resolution of discrepancies; however, they may not always be consciously aware of the nature of the mixed messages they receive and give to others. Ex: On the one hand...and on the other hand..." "You believe you can't, and at the same time you show you can." Phenomenological study found counselors of color: Buffering and bracing for microaggressions, experiencing the intrusion of racial microaggressions, and strategizing and responding in session.

Developing Your Own Theoretical Orientation: Electicism-Integrationalism

Commitment and belief are essential if one is to be competent and make a difference in the lives of others, but a single rigidity may make it impossible to help those who may not respond to your first effort at providing assistance. The task is to be flexible in your use of skills and theory and to remain open to new ideas. There are several routes you can use to develop your own integrated theory of practice in counseling and therapy. Between a third to one half of currently practicing therapists and counselors describe themselves as Eclectics or Integratives. Eclectics use procedures from many theories. The eclectic recognizes that many theories and methods are of merit and deliberately sets up to select aspects of different theories that may be useful to a varied clientele. The strength of eclecticism lies in flexibility and breadth. At the same time, there are those who criticize this position as overly flexible and lacking systematic thinking in that the counselor or therapist has not taken the time or effort to know one orientation well. Integratives: join 2 or more theories in a constant approach.

Personal Style and Interpersonal Influence

Communication and influence are at the core of talk therapy. One cannot communicate, and the related idea that one cannot not influence are known principles of communication.

The Multicultural Counseling and Therapy (MCT)

Concerned with counseling and psychotherapy as liberation and social justice—the viewing of self-in-relation to others and to social and cultural context. Interdependence is basic to philosophy and action in MCT. It also seeks to work with the individual and family in an egalitarian fashion. Furthermore, MCT hopes to see clients and therapists cooperatively working together in the community and society to alleviate and prevent future concerns and issues. Always an exchange between yourself and the people around you. There is a blend that is your cultural self. The most important implication of MCT, is that it stands as a distinct theoretical orientation in itself, with as much or more potential than the traditional therapies. Yet, MCT will continue to be defined by further theory, research, and practice.The Developmental Counseling and Therapy Integrative Worldview

The Focused Culture-Specific Approach

Current descriptions of multiculturalism are inclusive and embrace race, ethnicity, social class, gender, sexual orientation, disability, spirituality, and other cultural dimensions. Multicultural counseling occurs when a counselor and client are from different cultural groups. Sue and Sue (2016) define multiculturalism as "the integration, acceptance, and embracing of cultural differences that include race, gender, sexual orientation, and other sociodemographic identities."

When to Use IPT

Empirical research supports the use of IPT for a variety of affective disorders, anxiety disorders, eating disorders, combat stress, addictions, and living with HIV Children and adolescents to older adults. IPT is typically used in individual therapy, but group applications are effective and are used by the World Health Organization.

Research

Counseling and psychotherapy draw heavily on the concept of the scientist-practitioner: a helping professional who draws on research for more effective practice, and who uses information from clinical work to generate new research questions and plans. The professional practice (or practitioner-scientist/researcher model) focuses more on actual work with clients but employs foundational research in their daily practice. The local clinical scientist model uses information from scientific research, academics, and professional experience to articulate communicable conceptualizations of the issues they face within the local context of their practice. You personally may not be a researcher, but regardless of the model you select, you will be part of the scientific background of the field. Research is telling us that science shows us that counseling and psychotherapy are effective. Psychotherapy is more effective than many evidence-based medical mental health practices being the reason that it is less costly and produces fewer negative effects. Its outcomes or benefits are larger than those observed in many medical treatments. Current studies, meta-analyses and meta-analytical reviews of past studies show that many clients improve to a level of full recovery and maintain this over time. You may realize by now that the helping field offers you a bewildering array of competing theories and techniques. At this point, there is no single correct way to begin a theoretical commitment, although some will strongly suggest what you should do. Your task, we suggest, is to examine the field and make your own decision as to how you systematically will organize your counseling and therapy work.

The Existence of Multiple Defense Mechanisms

Counselors and therapists tend to think about defense mechanisms as abstract ideas. In truth, clients indicate again and again in very concrete ways their defensive style. Bowlby's attachment theory provides some very concrete ways showing how you can use defense mechanisms to assist in understanding clients and in helping them break out of ineffective patterns of thinking, feeling, and behaving. These defense mechanisms are learned through our developmental history in the culture.

What is interconnected?

Culture, community, families, groups, and individuals. Difficulty or trauma in the community such as a tornado, mass shooting, loss of jobs will deeply affect not only individual lives, but also what occurs in family and various community groups. In effect, one major community event can change the total culture. In turn, the madness or skill of one individual will affect the total system as well. Witness what occurs when a criminal terrorizes a family or the positive impact of a single individual such as Martin Luther King Jr. Individual counseling and therapy exist within a social context. If we want to understand any individual, we need to see that person as a whole. Many individual issues and concerns are related to the community, especially when we consider family as central to that community.

4 Main Therapeutic Factors

Current research revealed 4 main therapeutic factors contributing to client improvement therapy: 1.) Techniques from specific therapies (15%) 2.) Expectancy placebo effects (15%) 3.) Common factors (e.g., therapeutic relationship;empathy (30%)) 4.) Client/extra therapeutic factors (e.g., ego strength; social support (40%)) The 4 main therapeutic factors suggest that the contributions of the client (expectations and client/extratherapeutic factors) account for the largest amount of therapeutic change. This sobering finding clearly indicates that the client is the hero/heroine of the change process. Does this mean that your counseling and psychotherapy theories are not important? No, counseling theories do matter, as they provide the foundations for the treatments offered and the type of therapeutic relationship established. Theories are included in the current definition of Evidence-Based Practices (EBP) offered by the American Psychological Association (APA): evidence-based practice in psychology is "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences." Current research reveals a number of Empirically Supported Treatments (EST) (e.g., exposure and response prevention treatment for Obsessive-Compulsive Disorder (ODC)) and Empirically Supported Therapy Relationship (ESR) factors. Researchers interested in enhancing counseling outcomes study both the technical procedures (treatments) and the relational aspects (relation) of counseling and therapy. Treatment methods are relational acts, and relational acts are treatment methods. Relationship and treatment are always interwoven and can be subjected to scientific studies. Current research reveals a number of Empirically Supported Treatments (EST) (e.g., exposure and response prevention treatment for Obsessive-Compulsive Disorder [OCD]) and Empirically Supported (therapy) Relationship (ESR) factors (e.g., empathy).

Co-construction of knowledge, assimilation, and accommodation

DCT emphasizes that clients and counselors learn together. The word co-construction is similar to the self-in-relation concepts of feminist therapy and holistic Afrocentric theory, as the word emphasizes the importance of interdependence of counselor and client—and it is a specific attempt to move toward a less hierarchical, more egalitarian therapist/client relationship.

The Epistemology of Counseling and Therapy

DCT has organized many counseling and therapy's strategies into categories that are predominantly sensorimotor, concrete, reflective/formal, and dialectic/systemic. DCT terms this categorization the "Epistemology of Counseling and Therapy." For treatment of depression, DCT theory argues that each area needs to be considered as a treatment alternative and that most effective treatment will ensure that clients consider their issues at multiple levels with multiple voices. Body work: acupuncture acupressure massage yoga Emotional Catharsis: gestalt hot seat imagery medication mediation relaxation training Predominantly Concrete Strategies: automatic thoughts chart (A.T. Beck) assertiveness training concrete telling of stories and narratives crisis intervention decisional counseling desensitization therapy positive asset search for strengths rational emotive analysis of a single event solution-oriented therapy thought stopping Predominately Reflective/Formal Strategies client-centered therapy cognitive therapy dream analysis logo therapy treatment of hyper-reflections pattern analysis of stories, narratives, or other concrete strategy psychodynamic therapies Malaysian dream analysis rational emotive therapy Predominantly Dialectic/Systemic analysis of projective identification analysis of transference comm]unity genogram family genogram family dream analysis introspective developmental counseling trauma treatment Theories and Strategies that attempt to work with muliple levels cognitive behavioral therapy (predominately concrete and reflective/formal) developmental counseling and therapy family therapy feminist therapy multicultural counseling and therapy self help groups (AA. ACOA, bulimia groups, weight watchers, etc) stress management DCT does not reject any form of therapy. Rather, it seeks to find what is best in each therapy, and more than that, how each therapy might be beneficial to some individual client or family.Must make sure we use DCT appropriately. Might not work for every client you encounter. The community and multicultural orientation is vital to effective practice of Developmental Counseling and Therapy. DCT also offers a theoretical framework for integrating seemingly

Cultural Context: Deeply affects the way you and your family interact with the world.

Deeply affects the way you and your family interact with the world.

The Psychodynamic Worldview

Described as an "uncovering therapy, in that the goals of therapy are focused on discovering the unconscious processes governing behavior Once these unconscious processes are discovered in their full complexity, the individual is believed to be able to reconstruct the personality Client developmental history is important and needs to be considered for full client understanding. Freud is often considered the first developmental psychologist. Basic to his orientation and the psychodynamic frame of reference is the importance of childhood experiences in determining how we act and behave in the present. Important in our development history are the key people we have related with over time-our object relations. In psychodynamic language, object relations is the term given to relationship with people in our life. We develop in relationship to people-our family, friends, and peers. We are unaware (unconscious) of the impact of biological needs, of past developmental object relations, and of cultural determinants on our present behavior. The unconscious is the reservoir of our memories and biological drives, most of these we are unaware of. We constantly act out in our daily lives our developmental hostroy and our unconscious biolgical drives. Fromcthe psychodynamic frame of reference, we are heavily rule, soemtimes even completely determined, by foeces, outside our awareness. However, some psychodynamic theoires claim biology is central in unconscious development, whereas others focus more on life-span developmebt issues. Increasingly, the influence oof multiculutral factors in unconscious development is being rcognzied. The task of counseling and therapy is to help the client discover the unconscious roots of present behavior. Through psychodynamic techniques and concepts, such as free association, interpretation, and analysis of transference, we can help the client discover and understand the background of present behaviors, thoughts, and feelings. Received criticism from women and minorities. Many still think of psychoanalytic theory as monolith, with orthodox interpretations based on libido theory and unconscious sexuality. Psychodynamic approaches are focused on insight. Stresses that the past is

Free Association

Developed by Freud. This term can be used to summarize psychodynamic methodology. At an elemental level ,it encourages the client and counselor to say anything that comes to mind. Freud developed free association in his early works with hysterics, encouraging these patients to search for underlying unconscious factors. He refined the technique in his own self-analysis, particularly in his work with dreams. It was out of dream analysis that Freud discovered the "royal road to the unconscious." If one is allowed to say anything at all that comes to mind (no matter how irrelevant), there is a pattern that frequently emerges to explain the ,meaning of a behavior, a dream, or random thought. The basic technique and strategy of the psychodynamic approach. The method according to which, without exception, voice must be given to all thoughts that enter the mind. Those thoughts can be based on a specific element (word, number, dream image, or any kind of idea at all) or can be produced spontaneously.

Community Genogram

Developed by Ivey, as a way to introduce a positive, strength-oriented view of self, showing how we are all selves in relation to one another. It is also a way to discover the important groups (church, school, peer groups, neighborhood, etc) that influence the process. It also provides a way for the counselor and client to learn more directly how cultural factors, implicit and explicit in the community, underlie individual and family development. Together, the family and community genograms provide a solid way to ensure the individual issues are seen in their full contextual background. Also seeks to understand the context or past or present issues. Using a model with clients is also beneficial. Rather than fixing on a single visual framework, Ivey suggests that the counselor work with each client to develop their own model. Some clients like to draw maps of their communities with pictures of family, school, and church. One useful visual model is that of a star, circle, or square that behave as lines connecting each area.

Assimilation

Developed by Piaget. A cognitive process that manages how we take in new information and incorporate that new information into our existing knowledge.

The Developmental Counseling and Therapy Integrative Worldview

Developmental counseling and therapy (DCT) is a practical theory with specifics for here and now application. It was developed originally by Allen Ivey (1986) and has been expanded with more specifics by Geiger (2016), Ivey, Ivey, Myers, and Sweeney (2005), and Zalaquett, Chatters, and Ivey (2013). DCT uses theory of cognitive development as a metaphor. The stages are identical but it's the reinterpretation of what Piaget developed. Through observation, Piaget found that children constructed knowledge at 4 different levels: Sensorimotor, Concrete, Formal, and Post-Formal. According to Piaget, these stages repeat. According to Piaget, there is a hierarchy in between. You can go out of order regarding the hierarchy of levels (for example, a client might start at level 4, then go to level 1 to 2 then 3). This theory focuses on intellectual development. Tries to understand humans reaction to certain events (Ex: if someone experiences a traumatic event his/her reaction might range from crying or identifying emotions like stating, I am sad upset, or show reasoning and understand that this is becoming a pattern there is more of a reflective reasoning or thought. Putting thought on emotions and understanding why you are feeling this way. When dealing in crisis counseling, it is important to bring the client to a concrete level first. It is important to know how the client is coping with the situation. It shows the counselor what the client is going through. Start with concrete level then work your way up to concrete then formal and finally, dialectic/systemic style. Psychotherapists who employ this integrated model use developmental theory to assess clients and select appropriate cognitive/emotional style interventions to address client needs DCT includes an emphasis on establishing an egalitarian and strength-based psychotherapeutic relationship; therapists work with clients, not on clients (collaborative effort between client and counselor), to foster mutuality in relationship, goals, and treatment plans; they also share equal responsibility for the change process with their clients. At the core of DCT is an adaptation and reinterpretation of the thinking of the Swiss epistemologist/psychologist/biologist Jea

The issue of therapeutic constructions, ideas, and language becoming those of the client

Difference in psychodynamic (look at past experience) psychoanalysis only related to Freud but both focus on past experiences. Traditionally, therapeutic theory starts with the worldview of the theorist, and then the counselor or therapist takes that view and set of techniques and applies them to the client. For example, when a client goes through psychoanalysis, we can anticipate that Freudian worldview will provide an outline for what happens. Through free association, dream analysis, interpretation, and related techniques, the client gradually learns to talk about his or her issues or concerns in Freud's language and eventually often comes to accept the Freudian worldview as truth. Freud's voice has become the client's voice and the language and words applied to one's own thoughts and behaviors. There is a famous and highly influential film showing a single client, Gloria, being interviewed by Carl Rogers, Fritz Perls, and Albert Ellis (Shostrum, 1966). In a series of classic studies, researchers examined the film in detail (Meara, Shannon, & Pepinsky, 1979; Meara, Pepinsky, Shannon, & Murray, 1981). Through linguistic analysis, they found that the client, Gloria, tended to assume the language pattern of each different therapist. Gloria used client-centered language with Rogers, Gestalt language with Perls, and a rational emotive language with Ellis. There is danger in you as a therapist superimposing your perceptions or worldview on the client. You are in a powerful position with a vulnerable client, and he or she is likely to take your words very seriously, even to the point of learning your language. In the film, Gloria talks about her difficulties with men and her own father. Each of the three therapists focuses on the individual issues that Gloria faces. None of them focuses on how her issues may be the result of being a woman in a predominantly male world or on developmental and family issues. Some reassurance on language and focus of the session, however, is offered by classic research that successful White counselors tend to join their African American clients in language patterns rather than trying to impose their own frames either consciously or unconsciously.

Interpersonal Psychotherapy

Dynamically-informed, time-limited form of treatment developed by Gerald L. Klerman and Myrna M. Weissman Social and interpersonal distress exacerbates the onset and relapse of psychological disorders IPT's theory incorporates Sullivan's and Meyer's observations of the importance of interpersonal context and environment in the course psychological disorders, and Bowlby's understanding of emotional attachment and the consequences of interpersonal loss and separation

An example of the complexity of establishing culturally appropriate goals

Eating disorders of bulimia and anorexia. These disorders affect women in North American culture, although male eating disorders are markedly increasing at this time. Thinness is what is valued by the culture, yet the goal of the therapist is to help the client generate a more positive body image and accept whatever weight he/she has. Through helping the client accept a heavier body image, the counselor is actually working against culture imperatives. Therefore, cultural awareness and consciousness-raising often need to be part of the treatment of bulimia and anorexia.

Ethics of Counseling and Psychotherapy Theory Application

Effective practice is not only scientific, it is also ethical. Professional helpers are expected to abide by the principles stated in the Code of Ethics of their professions. Codes like the American Counseling Association's (ACA) usually indicate the need of professionals to be aware of best practices and prescribe the use of techniques or interventions grounded in theory or scientific knowledge. Professionals are expected to know their chosen theories well and be competent in their application. A clear theoretical framework will allow helpers to be flexible with that approach and to know when it works and when it does not. They also realize that no one theory can respond to the diversity of issues and individuals requesting their help.

What Do Effective Counselors Provide?

Empathy: the capacity to understand the clients' thoughts, feelings, and difficulties from the client's view, has a demonstrated association with positive therapeutic outcomes. Empathy is a necessary (and sometimes sufficient) condition for the relationship that can enable client change by itself. Listening is the building block of the relationship. New Japanese brain research using Functional Magnetic Resonance Imaging (fMRI) reveals that "listening lights up the brain." Kawamichi and colleagues found that the Rogerian microskills of attending behavior, paraphrasing, reflecting feelings, and summarizing create the foundation for a strong relationship and the benefits that we sees stemming from this alliance. Therapeutic Alliance: a strong and positive collaborative relationship positively affects outcome. positive regard, congruence/genuineness, feedback, repair of alliance ruptures, self-disclosure, and the management of countertransference. The field of counseling and psychotherapy is moving away from simple presentation of theories in the realization that presentation and consideration of theory without employment of research data is missing much of what is actually happening in the real world. The field is moving toward accountability and contracting with clients for specific results from therapy. Again, science and practice become central. It is important to integrate research on your therapeutic action as part of the helping process.

Abraham Maslow and Carl Rogers

Humanistic psychologists who are important figures in the helping establishment, and are recognized for their interest in culturally diverse groups, yet the placing of self actualization as the top of a hierarchy with relational issues placed below is now considered by many as a male and Western statement not relevant to all cultures.

Introspective Developmental Counseling and Life Review

Erikson remains a classic foundation of developmental theory as he defines the developmental task of early childhood (ages 2 to 4) as focused on developing a sense of autonomy. If you think back on the Afrocentric idea or the nature of childhood in Japan and in many South American cultures, the goal of this period is not autonomy, but rather a sense of connectedness to the caregiver. Exaggerated autonomy and separation is considered pathological in many cultures. At the same time, too much dependence on others can occur in any culture. Cultural identity self-development represents a cognitive/emotional/behavioral progression and expansion through identifiable and measurable levels of consciousness or stages. While theorists vary in the specifics, these stages appear to follow a sequence of: (a) naïveté and embedded awareness of self as a cultural being; (b) encounter with the reality of cultural issues; (c) naming of these cultural issues; (d) reflection on the meaning of self as a cultural being, and (e) some form of internalization and multi-perspective thought about self-in-system. With each level of stage development comes different attitudes toward oneself (self-identity) and others (reference group identity or differences). Each client (individual, family, group, organization) has multiple cultural identities that most likely will not progress or expand at the same rate. Different clients have different issues that are most important and salient to them. For example, an individual's identity as a Navajo may be quite high, while awareness of self as a heterosexual or Gulf War veteran may demonstrate less awareness. African American college students may be expected to focus on issues of racial identity, while other issues are often less central to them. The gay or lesbian person will often focus on this sexual identity and place less emphasis on race and ethnicity.

John Bowlby

Established Attachment Theory Bowlby's attachment theory represents a central part of the history of psychoanalysis, although he did not follow the traditional individualistic points of view (Schwartz, 2015). Bowlby (personal communication, January 1987) describes his ideas as having developed in opposition to Melanie Klein, the first major object-relations theorist. Bowlby is also interested in information-processing theory, social ecology, and psychological science. He may be construed as a developmental ecologist, as he stresses the importance of the child developing in relation to context and environment. Bowlby observed that young children who were separated from their parents became depressed and morose but gradually learned to cope and to behave more "normally." When their parents visited them, most children did not greet them enthusiastically; rather, they edged toward their parents carefully. Some might display anger and even seek to hurt their parents. He also pointed out that anxiety associated with the loss of the caregiver was so intense that the children defended themselves against another loss. Avoidant behavior and acting out behavior are two types of defense mechanisms that protect not only children but also adults from deeper internal conflicts and the experience of anxiety.

Attachment Theory

Established by John Bowlby The primary task in the mother-child relationship is for the child to learn how to become securely attached. If the child can become attached, it has a secure base for exploring. Emphasizes the joint construction of the mother-child relationship: the child is not only affected by the environment, but the child also impacts that same environmental context. (For example, some children seem to be neurologically equipped for closer relationships than others.) Moreover, Bowlby points out that the child's natural biological endowment develops in relationship with the mother. Child and caregiver grow (or deteriorate) in an ecological process of mutual social influence. Bowlby points out 3 major patterns of attachment exist: 1.) Securely attached 2.) Anxious-Resistant (Both generated by an ambivalent and alternating accepting-and-rejecting parent-child relationship) 3.) Anxious-Avoidant (Generated by a rejecting and impoverished parental relationship) Current research continues to validate this system, identify neural basis of attachment, offer practical applications to the field of education, counseling and psychotherapy, and suggest future areas of research (Bush et al., 2017; Cassidy, Jones, & Shaver, 2013). Most important in supporting Bowlby's theories, however, is longitudinal research that shows that children's pattern of attachment assessed in the early months is highly predictive of later adjustment.

The Family Systems Worldview

Family counselors and therapists remind us that so-called individual issues and difficulties are often developed in a family context. Rather than working with individuals, family therapists argue that it is more effective to work with family systems. For example, the abusive parent in the interview may be currently experiencing abuse from the partner and transferring it to the child. Counselor/Therapist Ex: At our next session together, I would like for you to bring your child and your partner. Our behavior and thoughts are generated in a system of relationships. We will explore how your family interactions, past and present, reflect your present issues. But, for the moment, let us start with developing a family chart or genogram. Knowing about your family of origin can help us look more completely at the context.

The "Forces" of Counseling

First Force: Psychodynamic Theory Second Force: Behavioral Therapy Third Force: Existential-Humanistic Theory Fourth Theory: Cognitive Theory Fifth Theory: Multicultural Counseling and Therapy

Focus and Selective Attention

Focus on the person, not the problem. Counselors inspire clients to utilize "I statements" by themselves using the personal pronouns you, your, etc., and by using their clients' names. Avoid responses that generalize, focus on the person sitting in front of you! The difference between... Don't say, "it's hard to lose someone," say, "you're struggling with grief right now." Avoid general statements. 1.) Focus Analysis 2.)

Strong (1968)

Found that 3 factors: expertness, trustworthiness, and attractiveness were central dimensions of how well counselor and therapists were perceived by clients.

Frued and the Big Bang of Psychotherapy

Freud's mentor, Josef Breuer, is at a loss for how to counsel the titular German philosopher out of his despair. He says "there is no medicine for despair, no doctor for the soul." Breuer recommended therapeutic spas or a meeting with a priest (When Nietzsche Wept, Yalom, 1992). Freud and his mentor Breuer were the first to introduce the idea of having a doctor for the soul in Vienna in 1880s. Before them, there was no record of psychotherapy or "talk therapy" in a systematic way from a theoretical framework. In today's landscape of psychotherapy practice, Freud is more compelling as a philosopher rather than a psychotherapist. Neuropsychoanalysis: "a marriage between neuroscience and psychoanalysis." Mark Solms: "We don't need Freud; we need an approach which takes seriously the mental nature of the mind. And since Freud was the one who has done that most thoroughly, that seems to me the correct place to start."

Theorists

Frued: Psychoanalysis Bowlby: Attachment Theory Adler: Individual Psychology •- equality, parent education, the influence of birth order, life style, and the holism of individuals. Jung: Collective Unconscious Horney: Psychoanalytic Theory - Criticized "Penis Envy" that leads to inferiority. Erikson: •8 stages of psychosocial development. Klein: Object relations and play therapy Sullivan: Anxiety is a result of mother's experience-not a result of the tension between the superego and the id.

The Universal Approach to Multicultural Counseling

Fukuyama (1990) argues for a transcultural, universal approach to Multicultural Counseling and Therapy—certain factors are important regardless of culture. Foremost is the fact that historically traditional counseling theory has been unaware of culture. 1.) Defines culture broadly (including gender, affectional orientation, age, etc as well as ethnic/racial issues) Fukuyama would point out that if you review the theories presented in this book, there is still a tendency for these theories to focus on values of individualism, rationalism, and self-determination.

General Theory

George Kelly (personality theorist) has pointed out that as eclectics become more systematic in their thinking, they are developing their own theory or general theory of helping. They have integrated several different orientations into one unified approach. This theory is all about moving systemically and knowledgeably from theory to theory using trans-theoretical skills and concepts. General theory (also referred to as metatheory): may be described as a larger conceptual view than either eclecticism or adherence to a single theoretical orientation. It also seeks to connect and organize pieces of theory in a coherent and systematic framework. General theory could be described as a systematic "eclecticism." It is possible to be primarily committed to a single theoretical orientation and still be a general theorist. A general theorist from a behavioral orientation, for example, might work primarily from this point of view but, at the same time, could respect different theories and adapt portions of them in practice. For example, cognitive theorist Aaron Beck has a clear central theoretical commitment, but he is nonetheless able to draw on concepts of humanistic psychology, behaviorism, and psychodynamic theory at times to enrich his basic orientation.

Liberation psychology

Has gained central attention since Freire (1972) used the term conscientizacào as a general goal of education—and by extension, counseling and therapy as well. The liberation of client consciousness could be considered as a general rule for all counseling and therapy that is socially aware, whereas some individualistic theories are so focused on "one client" that the larger context of family, community, and cultural oppression may be missed.

Janet Helm's White Racial Identity Model

Helms' model assumes that racism is an important component of White racial identity. 1.) Contact: Whites believe that everybody has equal chance of success and are unaware of any aspects of racism and discrimination. Also, they may have limited social or work experiences with people of color. Ex: "I don't pay attention to race. "We are all equal." 2.) Disintegration: A white person acknowledges his or her whiteness and ascribed privileges but becomes conflicted over racial moral dilemmas. He/she may experience dissonance, conflict, guilt, helplessness, or anxiety. Ex: "I hate to feel that I am privileged by the color of my skin; hat is why I don't deal with issues of race. 3.) Reintegration: white persons regress to a basic belief of white superiority and minority inferiority. Negative conditions associated with black people are though to result from blacks inferior intellectual moral and social qualities. Ex: "Blacks are given social security and all, but they can't use all that support to get ahead....they are basically lazy." 4.) Pseudo-independence: white persons make conscious and deliberate attempts to understand racial differences and interact with people of color. They begin to search for a new white identity but still can behave in racist ways. These attempts remain within the intellectual domain and do not yet reach the effective domain. 5.) Immersion/Emersion: Whites demonstrate an increasing willingness to redefine their whiteness and confront their prejudices. They search for accurate information about race and gain a deeper understanding of their own racist socialization. May become involved in social activism to fight racism. There is also an increased experiential and effective understanding that was previously lacking. Affective and experiential upheaval leads to a feeling of rebirth. 6.) Autonomy: whites become knowledgable about racial differences, value the diversity, are no longer uncomfortable with the experiential reality of race, and establish a non-racist attitude.

Neuroscience- Based Counselor Wellness

Helping those in need is a noble and incredibly rewarding task, but it is also stressful. An effective mental health professional needs to be in sound mind and body to fully attend and assist clients who are sad about romantic breakups, distressed about martial conflict, or plagued by suicidal thoughts. Myers, Sweeny, and Witmer define wellness as "a way of life oriented toward optimal health and well-being, in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community.

The three main components of human personality: The id, ego, and superego.

Id: the instinctual aspect of the personality Its contents are unconscious Part hereditary and innate, part acquired and repressed Alost totally unconscious and may be either playful and creative or destructive Traditional analytic theory to uncover the roots of anxiety, supportive of medication. Superego: conscience, ideals, and values Totally learned as child matures in family and society May seek to control, whereas id is uncontrolled Internalized rules of the family and culture Superego functioning exploration would include gender roles, attitudes toward one's affectional orientation, and other multicultural issues (learned behavior and attitudes) Erikson or Hatmann most are most helpful (development of ego overtime) Ego: mediator between id (unconscious rebellion, playful storehouse) and superego (conscious rules from family and society) Ego functioning develops over the lifespan allowing more control over one's own life Ego strength and personal agency are major goals of therapy Achieved through understanding the interplay of ego with id and superego Ego operates at conscious, preconscious, and unconscious levels of experience. Environmental contextual issues, more in accord with multicultural counseling and therapy approach.

First, Do No Harm

Identification and rejection of harmful therapeutic treatments has been promoted by Lilienfeld's publication of psychological treatments that cause harm and Barlow's publication of neagtive effects from psychological treatments. Wendt, Gone, and Nagata remind us of the importance of avoiding potentially harmful counseling and psychotherapy. Also, they make us aware of the need to include lack of multicultural counseling among potentially harmful therapeutic interventions. If our mandate is to do no harm, then monocultural counseling applied to culturally diverse clients may violate our mandate. Cheek and Sue and Sue, provide ample support for this potentially negative affect. Wendt and others, provide a compelling argument for the integration of potentially harmful therapy and multicultural counseling discourses. Counseling and psychotherapy can be inherently ethnocentric and as such capable of harming minority clients. Studies of harm should be integrated with a multicultural and social justice perspective.

Freudian Defense Mechanisms

Implemented as a means of protecting the individual dealing with anxiety from harm. Repression: Unknowingly placing an unpleasant memory or thought in the unconscious. Ex: Not remembering a traumatic incident in which you witnessed a crime. Regression: Reverting back to immature behavior from an earlier stage of development. Ex: Throwing temper tantryms as an adult when you don't get your way. Displacement: Redirecting unacceptable feelings from the original source to a safer; substitute target. Ex: Taking your anger toward your boss out on your spouse or children by yelling at them and not your boss. Sublimation: Replacing socially unaccepting impulses with socially acceptable behavior. Ex: Channeling aggressive drives into playing football or inappropriate sexual desires into art. Reaction Formation: Acting in exactly the opposite way to one's unacceptable impulses. Ex: Being overprotective of and lavishing attention on an unwanted child. Projection: Attributing one's own unacceptable feelings and thoughts to others and not yourself. Ex: Accusing your boyfriend of cheating on you because you have felt like cheating on him. Rationalization: Creating false excuses for one's unacceptable feelings, thoughts, or behavior. Ex: Justifying cheating on an exam by saying that everyone else cheats.

Empathy Rating Scale

Incorporates 7 levels that provide individuals a way to measure their own degree of empathy and acceptance.

Why is it important to understand our reasons for becoming a counselor/therapist?

In the field of mental health, the professionals providing counseling and psychotherapy are the primary agents of change. The client is the primary executor of those changes, but you can greatly advance or detract from their therapeutic success. Your personal attributes and competencies can make a difference. Negative motivation or reasons for entering these types of studies can impair your delivery of good therapy. Even attempting to help others while you are struggling with stressful events may lead to a negative outcome. A stressed out therapist may not be able to listen carefully to the plight of the client and may not understand the main issues, thus failing to provide effective help. Thus, your reasons for becoming a counselor or therapist will affect in a positive or negative fashion the way you practice counseling. Understanding your own motivations will help you appreciate what you most want for yourself from our work (e.g., making sense of clients; behavior or establishing a humane connection with a person in need). Paradoxically, learning about your motivation to become a counselor will help you become more aware of your "blind spots," defined by Farber as "our tendency to continue to see the world through their own lens." Offering only what you value and want, rather than what your client needs or wants, is bound to end in early termination of the profession. Therefore, it is highly important to reevaluate your motives from time to time which will help to determine if you are doing well, if you need to rejuvenate your commitment to the profession, or if you need to make changes to improve your job satisfaction.

Cultural Considerations

In traditional rural Puerto Rican culture, the caregiver is really the entire extended family. In Africa and Aboriginal Australia, the primary caregiver may be anyone in the extended family or the whole community. Issues of single parenthood, adoption, and same-sex parents further change the concept of caregiver. Some would argue that day-care workers need to be considered part of the caregiver complex. Regardless of terminology, all are important objects in the development of the child.

Erik Erikson's Psychosocial Stages of Development

Infancy (0-1) Basic Conflict: Trust vs. Mistrust (trust or mistrust that basic needs such as nourishment and affection will be met. Virtue: Hope Early Childhood (1-3) Basic Conflict: Autonomy vs. Shame/Doubt (develop a sense of independence in many tasks) Virtue: Will Play Age (3-6) Basic Conflict: Initiative vs. Guilt (take initiative on some activities, may develop guilt when unsuccessful or boundaries overstepped) Virtue: Purpose School Age (7-11) Basic Conflict: Industry vs. Inferiority (develop self-confidence in abilities when competent or sense of inferiority when not) Virtue: Competence Adolescence (12-18) Basic Conflict: Identity vs. Confusion (experiment with and develop identity and roles) Virtue: Fidelity Early Adulthood (19-29) Basic Conflict: Intimacy vs. Isolation (establish intimacy and relationships with others) Virtue: Love Middle Age (30-64) Basic Conflict: Generativity vs. Stagnation (contribute to society and be part of a family) Virtue: Care Old Age (65-above): Basic Conflict: Integrity vs. Despair (assess and make sense of life and meaning of contributions) Virtue: Wisdom

Phases of IPT

Initial Phase (usually sessions 1-3): Evaluation, diagnosis, identification of any comorbid disorder and application of the interpersonal inventory to review current and past relationships. Case formulation: definition of diagnosis and its relationship with the key interpersonal issue. Treatment Plan:description of intervention with clear focus on interpersonal issue and set action steps to achieve change. Middle Phase (usually sessions 4-9): Comprises the main work of resolving the interpersonal issues and reduce symptoms. Key techniques used during this phase includes clarification, communication analysis, interpersonal incidents, use affect, role playing, problem solving, and homework. Final Phase (sessions 10-12): Includes discussion of termination review improvement, consolidates gains, and anticipates future problems. Typically, resolving the interpersonal issue reduces interpersonal stress, enhances interpersonal skills, and improves sociak support,

Identity Development Theory for White American Counselors and Therapists

Joseph Ponterotto developed a theory of identity development for white counselor trainees. His stage model is similar to those described above, particularly that of Jackson. The White counselor trainee of-ten works through the following stages when confronted with multicultural concerns:

Interviewing, Counseling, and Psychotherapy

Interviewing: a method of information gathering and will typically be characteristic of information gathering in a welfare office, employment agency, placement service, or career counseling. Counseling: a more intensive process concerned with assisting people without or with less severe pathological issues to achieve their goals or function more effectively. Psychotherapy: a longer-term process concerned with reconstruction of the person and larger changes in personality structure. This is also often restricted in conception to those with pathological disorder. Interviewers who discover serious issues might move with the client into a brief form of psychotherapy. Counselors often have longer sessions and go more in depth than psychotherapists. Psychotherapists perform interviewing and counseling.

Employing Logical Consequences

Leading clients to understand the possible consequences of their actions (pointing out how one thing tends to lead to another). Ex: This is also a possibility in the future since you stated this... This should be occurring after 5 or 6 sessions (Regarding school counseling this would be implemented right away).

Identity Development Theory for White American Counselors and Therapists

Joseph Ponterotto developed a theory of identity development for white counselor trainees. His stage model is similar to those described above, particularly that of Jackson. The White counselor trainee of-ten works through the following stages when confronted with multicultural concerns: 1.) Preexposure: The white counselor/trainee has not thought about counseling and therapy as a multicultural phenomena. He or she might say that "people are just people" and in counseling practice may engage in unconscious racism and sexism, or more positively, try to treat all clients the same. 2.) Exposure: When multicultural issues are brought to his/her attention, the white therapist/trainee (or experienced professional) learns differences about cultural differences, matters of discrimination and oppression, and that previous educational experiences have been incomplete. The trainee at this age may become perturbed and confused by the many incongruities that have been presented 3.) Zealotry or Defensiveness: Faced with the challenge of multicultural issues, students and professionals may move in one to two directions. Some become angry and active proponents of multiculturalism - even to the point of offending some colleagues. Another common response is to the incongruities posed by exposure at Stage 2 is a retreat into quick defensiveness. Criticisms of Eurocentric culture, "the system," and therapeutic theory are taken personally. These students become passive recipients of information and retreat back into the predictability of white culture. 4.) Integration: The counselor requires a respect and awareness of cultural differences. He/she becomes aware of personal family and cultural history and how this might affect the interview and treatment plan. There is an acceptance that one can't know all dimensions of Multicultural Counseling and Therapy all at once, and plans are made for a lifetime of learning.

Multitudes People Contain

Language Gender Ethnicity/Race Religion/Spirituality Affectional Orientation Age Physical Ability Socio-Economic Status (SES) Trauma

Essential for wellness and for the treatment of stress and mental disorders

Lifestyle factors and diet Nutrition, exercise, and sleep affect behavior, mood, and cognitive processes, and play an important role in the etiology, progression, and treatment of mental disorders. Therapeutic lifestyle changes positively affect your brain and the cognitive functions it supports.

An Overall Goal for Counseling: Culturally Intentional Individuals

Most counseling and psychotherapy theories seem to accept the idea that effective daily living and positive relationships with others are the goals of healing.

Sigmund Freud

Medical doctor, neurologist, who made the assumption that human motivation was propelled by conflicts between instinctual, mostly unconscious, psychological forces (the forces: id, ego, superego)

Schema

Mental structures that an individual uses to organize knowledge and guide cognitive processes and behaviour. Ex: When a child is young, they may develop a schema for a dog. They know a dog walks on four legs, is hairy, and has a tai

Mirroring Nonverbal Behavior

Movement complementarity or movement symmetry: "passing" of movement back and forth between client and counselor. *Client pauses, counselor nods, client finishes sentence* In movement symmetry, counselor and client unconsciously assume the same physical posture—their eye contact is usually direct, and their hands and feet may move in unison. If a client makes a movement the counselor might react in a certain way. Ex: Client stands up during session due to anxiety, the counselor will stand up to to mirror the client's actions/behaviors.

Neuroscience and empathy

Neuroscience research offers a refreshing biological view of empathy. Researchers have identified a brain network responsive to emotional and motivational interpersonal experiences and to the observed experiences of others through voluntary and involuntary processes called "affective empathy" and "cognitive empathy." These processes match the affective and cognitive dimensions of empathy long recognized by counselor and therapists. Neuroscience provides new opportunities to advance therapeutic work. It is possible that neurofeedback training, a neuroscience-based technique used for the regulation of emotional responses, may be used to train professionals' empathic response.

Examples of Multicultural Issues and Psychoanalysis

Seen as male and elitist Based on libido theory and unconscious sexuality Sexist concepts (e.g., penis envy) Highly verbal, intellectualized orientation Reputation for long periods of treatment...therapy for the wealthy

Object-Relations Theory

Object-relations theory is concerned with examining the relations between and among people and how the history of interpersonal relationships is transferred from the past to present behavior. The major object or person in a client's history is the caregiver, most often the mother. Depending on social, economic, and cultural considerations, the caregiver can be the father, a couple, or a grandmother.

Meta-analysis

One of the most effective research methods. It is a complex statistical procedure that computes the average impact or effect size of counseling and therapy. It also combines the results from multiple research studies to answer questions about their effect. Meta-analysis studies have repeatedly confirmed that psychotherapy is an effective, efficacious (powerful), and efficient treatment. It is effective across a broad range of treatments and across a variety of disorders. Overall, 67% of those receiving therapy improve significantly, compared to 33% of those who do not receive treatment over the same period of time.

The Family Genogram

One of the most useful diagnostic tools in the counseling field. This is used for clients to understand themselves better.

Basic Listening Sequence (BLS)

Open Questions: "what?" facts, "how" processes/feelings, "why" reasons, "could" general picture Function in interview: used to bring out major data and facilitate conversation Closed Questions: usually begin with a "do," "is," or "are" and can be answered in a few words. Function in interview: used to quickly obtain specific data, close off lengthy answers. Encouraging: repeating back to client a few of the client's main words. Function in interview: encourages detailed elaboration of specific words and their meanings. Paraphrasing: repeating back the essence of a client's words and thoughts using the client's own main words. Function in interview: acts as a promoter for discussion; shows understanding; checks on clarity of counselor understanding. Reflection of Feeling: selective attention to emotional content of interview. Function in interview: results in clarification of emotion underlying key facts; promotes discussion of feelins. Summarization: repeating back of client's facts and feelings (and reasons) to client in an organized form. Function in interview: useful in beginning interview (intake); periodically used in session to clarify where the interview has come to date and to close the session .

Freudian Psychosexual Development

Oral Stage: Birth to 1 year. Erogenous Zone: Mouth Anal Stage: 1 to 3. Erogenous Zone: Bowel and bladder control Phallic Stage: 3 to 6. Erogenous Zone: Genitals Latent Stage: 6 to puberty. Libido inactive Genital Stage: Puberty to death. Maturing sexual interest

Positive Regard

Part of the empathic attitude that meets all clients with a positive and optimistic attitude and emphasizes their strengths. Positive regard means that you as the therapist are able to recognize values and strengths in clients different from yourself, even when the client holds attitudes far different from yours. The greatest challenge to positive regard occurs when you work with clients or families that seem to be destructive to themselves and others.

Carl Rogers

Produced a landmark paper in 1957 titled, "The Necessary and Sufficient Conditions of Therapeutic Personality Change." This writing made a strong case that empathy and related constructs are all that is needed to produce change in a client. To help a person grow, requires an integrated congruent relationship with the client; unconditional positive regard for the client, and the communication of empathy from the counselor to the client.

3 Step Model of Empathy

Provides a framework for balancing the uniqueness of the individual before you with your own general knowledge and with that of counseling and therapy theory. 1.) Listen to and observe you client and his/her comments. 2.) Respond using the client's main words and constructs. Generally, use the attending and listening skills. When culturally and individually appropriate, add your own experience, knowledge, or intuitions. 3.) Check out your statement or intervention by asking, "How does that sound?" "Is that close?" or some statement that allows the client to respond to you. You may also do check-out by raising your voice at the end of your response in a questioning tone of voice. At this point, recycle to the first and second steps and change your style and comments as necessary until you and the client are both comfortable. Empathy is best considered a process wherein counselor and client explore the nature of the client's worldview and beliefs about the concerns together. There is no final standard of "superior" empathy, rather empathy requires the counselor to constantly to attune themselves to the wide variety of individual clients with whom they will work with. Most important of the 3 steps in terms of building a solid, empathic relationship is the check-out or perception check. "Have I heard you correctly?" implies empathy, shows respect for the client, is and authentic response, and will provide the counselor with concrete data as to the effectiveness of the counselor's comment or intervention. If the counselor responds accurately, the client will often smile and say yes or some other term and continue. If off target, the client will correct you, and you can use your new understanding to proceed with the session.

Community

Puts us in touch with culture. Consists of our family/extended family, friends, neighbors, schools, work settings, the physical geography of the community territory, church/spiritual connections, and other unique factors. OUr personal experiences with the community are unique.

Basic Listening Sequence (BLS); Framework for attending skills

Questions (open & closed) Encouraging the client to continue Paraphrasing Reflection of feeling Summarization Intended to bring out the client's story You will always need to know the facts and how the client feels about those facts and then organize them for further analysis. Regardless of your theoretical orientation, the BLS (Basic listening skills) is a critical therapeutic tool. In a school counseling session this is at a fast pace because you're seeing so many students for about 15 minutes. Always starts with a question . The ability to conduct a full interview using only basic listening sequence skills is a basic counseling competency. Avoid giving advice, direction, or suggestions. Early theories of non-directive counseling as presented by Carl Rogers advocated using only listening skills and even went so far as to severely criticize use of questions. Open Questions: "what?" facts, "how" processes/feelings, "why" reasons, "could" general picture Function in interview: used to bring out major data and facilitate conversation Closed Questions: usually begin with a "do," "is," or "are" and can be answered in a few words. Function in interview: used to quickly obtain specific data, close off lengthy answers. Encouraging: repeating back to client a few of the client's main words. Function in interview: encourages detailed elaboration of specific words and their meanings. Paraphrasing: repeating back the essence of a client's words and thoughts using the client's own main words. Function in interview: acts as a promoter for discussion; shows understanding; checks on clarity of counselor understanding. Reflection of Feeling: selective attention to emotional content of interview. Function in interview: results in clarification of emotion underlying key facts; promotes discussion of feelins. Summarization: repeating back of client's facts and feelings (and reasons) to client in an organized form. Function in interview: useful in beginning interview (intake); periodically used in session to clarify where the interview has come to date and to close the session .

Common Sense and Theories

Regarding common sense, theories of counseling and psychotherapy differ in many ways. Both are formal fields of academic study; research and practice. From a common sense point of view, counseling is a way to understand everyday experiences and act appropriately. Theories: Summarize, explain, and organize facts, suggest novel ways to look at events, are parsimonious (use few principles to explain many behaviors or situations) , Provide operational definitions of key concepts under study, and make specific predictions that are testable. They also involve the use of qualitative and quantitative research experience and statistical analysis. Theories tend to be internally consistent; common sense often relies on contradictory statements ("opposites attract," "birds of a feather flock together"). Good theories are also grounded in facts. Common sense: Relies more on lay descriptions of key concepts that are used to make basic judgments and predictions. These can be hard to test because they are commonly stated in vague and inconsistent terms. Common sense does not use qualitative and quantitative research experience and statistical analysis and is not necessarily consistent with facts.

Henrich, Heine, and Norenzayan (2010)

Report that the majority of participants in psychology studies are overwhelmingly WEIRD: Western, Educated, and from Industrialized, Rich, and Democratic countries. The majority are college students participating in studies for class credit.About 96 percent of participants in studies published in 6 top psychology journals between 2003 and 2007 were WEIRD (Western Education, Industrialized, Rich, and Democratic). This does not show a true representation.

Analysis of Resistance

Resistance includes everything in the words and behaviors of the client that prevents access to unconscious material. The temptation in many approaches to helping is to ignore resistance and find another, easier route toward client verbalization. The effective psychodynamic counselor or therapist, by contrast, often gives primary attention to areas of client resistance. Well managed, working through resistance may be key to the relationship and to change. It can be an opportunity rather than a problem. The German word Freud used for resistance—Widerstand—is actually better translated as a rheostat that controls the amount of electricity available. Freud was telling us that resistance is the amount of unconscious psychic energy the client can allow out at a particular time. Unfortunately, resistance, the English translation, implies working against the therapist, a serious conceptual error in much of today's counseling and therapy practice. What many consider resistance is actually the client's best effort to communicate with you, not against you. One approach to analysis of resistance is to label or interpret the resistance and then encourage the client to free associate to the facts and feelings associated with the resistance. Examples: In the process of counseling, a client will sometimes fail to hear an important statement from the counselor. The client may say, "What?" and a puzzled look may appear on her or his face. Alternatively, the client may hear the therapist but forget what was said within a minute or two. Other types of resistance occur when the client blocks on something he or she is trying to say, leaves out a key part of a dream, comes late to an interview, or refuses to free associate.

Three major patterns of attachment:

Securely attached Anxious-Resistant (generated by an ambivalent and alternating accepting-and-rejecting parent-child relationship.) Anxious-Avoidant (generated by a rejecting and impoverished parental relationship.)

Empathy

Seeing the world through another's eyes, hearing as they might hear, and feeling and experiencing their internal world. The first step of empathy is acceptance. Acceptance is the foundation of empathy. Is difficult to show if it goes against your values. An individual's ability to experience another person's emotions and feelings as they occur and to share that person's perspective on his/herself and the environment. Seeing the world through another's eyes, hearing as they hear, and feeling and experiencing their internal world.

The Existential-Humanistic Worldview

Seeks to understand how the client makes sense of the world. Believing firmly in self-actualization, these therapists often listen to clients carefully in the belief that clients will ultimately find their own positive direction in life. Counselor/Therapist Response Ex: It sounds as if you are deeply troubled and angry about being here. At the same time, I hear that you desperately want to straighten things out. Am I hearing you accurately?)

Specific theories over the years emphasize such things as

Self-actualization Understanding your unconscious Self efficacy Personal growth and development Okayness Clarifies values An increased behavioral repertoire. These are only a sampling of the many alternative descriptions of what helping is about.

Microskills

Single, identifiable skills of counseling and psychotherapy Specific goals and anticipated results Organized within the framework of the microskills hierarchy (Higher is not "better," you merely must have the foundation before you can move up the pyramid). "Without the foundational attending skills, the upper reaches of the pyramid are meaningless and potentially damaging.

What does Multicultural work require?

Social advocacy. If you see something, say something. Must raise awareness, let your supervisor know. As a counselor you must be resourceful for social advocacy. The basic most fundamental idea in social justice and advocacy. You must understand the resources. You have to know the services, case management services, homeless shelters. This all depends on the population you work with.

Basic psychological knowledge underlying IPT

Social supports protect against psychopathology Whatever the '"cause" of a depressive episode, it always occurs in an interpersonal context and usually involves disruption of significant attachments and social roles; Death of a significant other (grief), antagonistic relationships (role disputes), life disruptions of losses (role transitions), and isolative lack of social support (interpersonal deficits) are negative life events or circumstances that place vulnerable individuals at risk for a depressive episode It is useful to work on change in social functioning in the "here and now" to improve symptoms.

The Lacanian Z Diagram

Some theorists now suggest that the interview is not just a relationship between the two people physically present in the session. At times, when you think you are reacting to the client, you may simply be acting from your own encapsulated historical and cultural background. The Lacanian Z diagram (1966/1977) regards the counselor, client, and the cultural social history of each one. Much traditional counseling and therapy focuses solely on the client and counselor relationship. DCT and multicultural theory would also stress the importance of relationships, but would add that understanding of context—family, groups, community, and culture is essential if we are to work effectively and holistically. The community genogram is a DCT strategy.

The Microskill of Focusing and MCT

Starting with humanistic theory, for example, we would again draw on the micro skill of focus. Our clinical experience is that most of the traditional Rogerian skills and values can perhaps even be enhanced if we change the words "You feel ..." to "You feel this in relationship to ... (family and/or cultural background)." Cognitive-Behavioral Theory is an effective treatment modality with many clients, but it can be considered a theory of pacification if insufficient attention is paid to environmental determinants. For example, we often attack irrational ideas without looking for possible rational elements when we view the client's statements from a cultural perspective. Very little is done with rational-emotive or cognitive therapy to inform clients of how family and cultural issues affect their being. Is a client irrational in being stressed by environment by environmental issues, such as lack of money, sexual harassment, or some other issue? Focusing specifically on the individual and the irrationality of the context may be a way to reframe cognitive theory and practice. From a more behavioral perspective, stress management programs that focus on mediation, relaxation, and cognitive issues may give insufficient attention to how the client is reacting normally to massive environmental stressors, particularly those of racism, sexism, classism, and homophobia.

Multicultural Counseling and Therapy (MCT)

Starts with awareness of differences among and within clients—it is thus very person centered. However, it adds the importance of family and cultural factors affecting the way clients view the world and so is also culture centered.MCT challenges practitioners, theoreticians, researchers to rethink the meaning of our counseling and psychotherapy. African American authorities over the years have been highly influential in redefining counseling and therapy as a multicultural endeavor. Donald Cheek commented on the counseling and psychotherapy field in 1976. "...I am advocating treating one segment of our population quite differently from another. This is implicit in my statement that Blacks do not benefit from many therapeutic approaches to which Whites respond. And I have referred to some of these approaches of counselors and therapists as "White techniques." Harold Cheatham comments first on the danger of therapy that is culturally insensitive and then suggests fundamental changes needed for a truly Multicultural Counseling and Therapy (1990, pp. 380-381): "... the helping professional doubtless will violate the Black client's sense of integrity or "world view." ... Blacks are products of their distinct sociocultural and sociohistorical experience. Counseling and therapy are specific, contractual events and thus, may proceed more effectively on the basis of understanding of the client's cultural context."Cheatham argues that the role of the therapist is not just to work with an individual, but also with the family and extended networks that may be important for the client. An African American client who suffers from depression should not be treated just as an individual; his or her cultural context, which may be pervaded by racism that may contribute to that depression, must also be addressed. According to Cheatham, Multicultural Counseling and Therapy will not be effective until the counselor focuses on and intervenes in issues of racism, sexism, and oppressive societal elements. According to Sue and Sue (2016) counseling and psychotherapy have done great harm to diverse cultural groups by invalidating their life experiences, defining their cultural values or differences as deviant and pathological, denyin

The Psychodynamic Worldview

Stresses that the past is often a prelude to the future. Research clearly indicates that those who often suffer from abusive childhoods themselves. A psychodynamic counselor believes that clients have some sense of how their present actions relate to their past experiences. ( Counselor/Therapist Response Ex: You say you were beaten by your own parents and now you find yourself doing the same thing to your own child. It will take some time, but our goal is to find out how your past experiences are being reflected in your present behavior with your child. The therapist will then allow the client to begin sharing his/her own thoughts and feelings of what happened to him/her during childhood.)

Systemic

Systemic therapy is a unique approach that focuses on the individual in the context of their relationships with others. It recognizes that an individual is not isolated but is part of a larger unit or system, such as a family, couple, organization, or community.

Family Unconscious and Multicultural Psychodynamic Theory

Taub Bynum talks about 3 interrelated levels of unconscious functioning: 1.) Individual 2.) Family 3.) Collective/Multicultural Unconscious The family unconscious is composed of extremely powerful affective (emotional) energies from the earliest life of the individual. The family is where we first experience and learn the culture. The family unit is a culture bearer- and we need to recall that the nature of the family and its functions vary widely among cultures. Taub Bynam speaks of "powerful affective energies" we experience in the family. The interplay between individual and family affective experience is the formative dialectic of culture. It is not really possible to separate individuals, families, and culture, for their interplay is so powerful and persistant.

Sex Role Development

The Oedipal period (four to seven years) is the time that the child learns to understand the sex role he or she is to undertake Many now would consider this a bit naïve As can be seen in the oral and anal periods, the child has already received considerable training in sex roles through the holding environment and how the control issues of the anal period been have been handled by the culture What is distinctive about the Oedipal period is that the child develops awareness of the meaning and importance of sex roles themselves and brings together all previous learnings in a total Gestalt

Theoretical Approaches used by counselors

The Psychodynamic Worldview The Existential-Humanistic Worldview The Behavioral Worldview The Cognitive Worldview The Family Systems Worldview The Multicultural Worldview

Co-construction of knowledge in the interview

The Fry, Knopf, and Coe study cited above reminds us that not only does the counselor influence the client, but if counselors are flexible, they are also influenced by the client. The theory behind a dialectic co-constructivist approach is complex but may be summarized as follows: 1.) Client and therapist exist in a unique dialectical relationship. Each has a unique family and cultural developmental history that affects their perceptions and the meanings they make. Who we are depends on our personal experience interacting with others. 2.) Thus a new dialectic or interactional system occurs in the therapeutic relationship. Client and counselor act on each other, thereby potentially changing both. Reality is co-constructed between counselor and therapist. 3.) In turn, counselor and client are each molded by their dialectical relationship with the culture. As in the Gestalt figure of the "young" and "old" woman, what we see and the meanings we make are influenced by our developmental history in a multicultural setting. 4.) We are not just culture bearers, we also have the capability to create and change culture. Just as therapist and client can change each other, so can both affect the environment and culture that led to our perceptions. We are part of a "multiplicity in One." The co-constructive process may become a bit clearer when we examine some interpretations of Piagetian theory. If you observe your clients carefully, you will find that they do indeed talk about their experience at different cognitive-developmental levels. Some clients will be almost to-tally within one orientation, while others will present several simultaneously. Still others will move from level to level throughout an interview or treatment series. For example, you may be working with a client going through a divorce. He or she may talk about the divorce from different cognitive and emotional orientations. As you read the following, recall that it is highly likely that clients who present to you at different cognitive/emotional levels are highly likely to need varying types of counseling and therapy. DCT operates on the assumption that one task of the therapist and counselor is to match language and treatment techniques with the

The Multicultural Worldview

The Multicultural counseling and therapy (MCT) worldview is integrative and freely uses other orientations to help, such as those mentioned above. Multicultural counselors tend to see individuals in a family and cultural context. This means that one part of the therapeutic process is to help clients see how their difficulties may be related to societal and social justice issues concerning race or ethnicity, gender, or socioeconomic status. This view also stresses that individual and family counseling can only be fully effective if supplemented by direct action in the community. The MCT Worldview may require more than individual action. The client is seen as part of a larger social system where both past and present communities are important. Counselor/Therapist Ex: We will need to look at this issue from 3 levels. First, I would like to hear your story as you make sense of it. Then, I would like to introduce some stress management techniques that may help you deal with the immediate concerns. As part of this process, we'll be looking at how gender, race, and class play a big part in your issues. I would particularly like to know about what the word community means to you and the nature of your present support systems.)

Single Theoretical Commitment

The contrasting orientation to eclecticism is represented by the many therapists who may have adopted a strong and studied commitment to a single theory, such as: Cognitive therapy Behavior modification Psychoanalysis Multicultural Narrative Structural Family Therapy. The strengths of this approach are in-depth knowledge of technique and method and an ability to modify the theory to meet individual client needs. Some criticize those committed to a single theory, however, as being rigid and unwilling to change their methods when clients don't respond to the approach.

Neuroscience and the Helping Process

The counseling relationship changes the brain, facilitating neurogenesis and strengthening the development of new neural networks. Counseling is a planned interpersonal conversation that can also help "rewire" the brain for more effective living. Neuroscience and neurobiology have shown that the vast majority of what our field has done for years is correct and makes a positive difference for our clients.

Anxiety & Ego Defense Mechanisms

The ego is defending itself from anxiety. Anxiety tends to come from conflicts between internal biological drives and wishes (id) and demands of the environment (superego). Thus, ego defense mechanisms are oriented to protecting and strengthening the ego, which somehow must balance these competing demands. How did defense mechanisms arise? Through Bowlby's observations of British children who were separated from their parents during WWII. The children were taken from their homes in London to protect them from the intense German bombing and placed in homes in countryside.

The Specifics of Cultural Identity Development Theory

The essential idea of cultural identity theory is that individuals have varying levels of consciousness about their ethnic/racial background. It is important that counselors and therapists be able to recognize cultural identity level or awareness. Then, it is considered helpful to be able to match your interviewing style to the level of client awareness. The most highly developed models of cultural identity have been generated by African Americans. Charles Thomas (1971) and William Cross (1995) are regarded as the originators of the model, although the ideas were generated independently in many settings. Cultural identity theory, however, has come to be used for many other different multicultural groups, including but not limited to Biracial groups (Kerwin & Ponterotto, 1995; Perkins, 2014); students with disabilities.

Microaggressions

The everyday slights, put-downs, invalidations, and insults directed to socially devalued group members by well-intentioned people who may be unaware that they have engaged in such biased and harmful behaviors. Comes out of the blue. As a counselor, it is important to refrain from making jokes when engaging in professional behavior. Examples of racial microaggressions: A third-generation Asian American student is complimented by a White classmate for speaking such "good English." (Hidden message: Asian Americans are perpetual aliens in their own country.)

Sensorimotor Stage

The first level of DCT that occurs between ages Birth-2 Body sensations and fleeting ideas without much organization represent what Lane terms "background feelings." These sensations typically show as body feelings, although the body or body part may not be mentioned. Develop habits. Start doing things intentionally. Realization of object permanence. Believe that objects exist even when we can't see them. Learn to sit, crawl, stand, sit, and run. This leads to increased cognitive development. Pain can be in different parts of the body like the head for example. The here and now experience is foundational for Level 1 (Present feelings that are in the moment. These can continue going forward). Share more about what you are feeling right now.. Background feelings and body states underlie conscious experience in the moment. For this reason, the default network plays a large role here. This is the network most active when you act or rest without a specific goal in mind. Becomes egocentric meaning we see the world through our own point of view. Might have a difficult time verbalizing emotions. A 1 year old will cry when they are upset, not verbalize. Do not have full capacity to understand what that feeling is. The counselor can help the client start to understand how they are feeling. Level 1 must be processed first. Crying is the most often you see in a counseling session. Must be able to process why they are crying. Crying can be positive like calm or warm. Later on at age 4 they can start verbalizing it. At this level, the client may use words representing physical sensation, based on the five senses Examples of body sensations usually experienced as negative: bruised, achy, sore, tense, tight, nauseous, closed in, dizzy, shaky, breathless, pounded, wound up tight, frozen, blocked, cold, dark, numb. In a more positive sense: light, calm, energized, smooth, warm, cool, relaxed, open, flowing, open, released, loose, in control, able to let go, joy. When clients use these words, recall the micro-skills of reflection of feeling or paraphrasing: In a counseling setting, Tears may be present, the client may talk in a random, confused fashion, but may simultaneously deny feelings of hurt and anger. At times

Horizontal development

The first task is to assess client developmental level and match interventions to the cognitions of the client. Horizontal development occurs when we help a client explore further issues at the entering cognitive/emotional-developmental orientation. An African American female, for example, may enter counseling with an Afrocentric therapist at a Level 2 consciousness (concrete resistance and anger). The first task is to help that client expand awareness and competence within that orientation and Cheek's (1976) culturally aware cognitive-behavioral approach may be especially appropriate. A reflective/formal operational European American male may enter counseling with doubts about the self and might profit from horizontal development with a client-centered or psychodynamic frame of reference. The European American male client might benefit from the same sensorimotor imaging to help him understand the roots of his self-doubt. In turn, both might benefit from further horizontal development inside the sensorimotor orientation on personal and cultural issues. Both might benefit from these exercises in terms of emotional stress.

Proposition I-MCT

The following metatheory of MCT represents only one of many possible paradigms. We have chosen to work with some of the MCT propositions originally proposed by Sue (1995), who suggested that they needed to be refined with the consequent development of corollaries and basic tenets. As much as possible, we have attempted to ground the propositions and corollaries in the available research and theory of multiculturalism. Proposition I-MCT: MCT is a meta-theory of counseling and psychotherapy. It is a theory about theories, and offers an organizational framework for understanding the numerous helping approaches that humankind has developed. It recognizes that theories of counseling and psychotherapy developed in the Western world and those indigenous helping models intrinsic to other non-Western cultures are neither inherently "right or wrong" or "good or bad." Each theory represents a different worldview.

Acceptance

The foundation of empathy. Counseling and therapy ask you to accept the client. It can be far less easy to accept the bully on the playground or the perpetrator of family violence. The feelings you experience in your own body may be the best indicator of your degree of acceptance and ability to be empathic. Taking the time to learn how your body is reacting to clients in the present will help you gain a better understanding of deeper client feelings. This awareness can also help you avoid mixing your feelings incorrectly with those of a client. It is fairly easy to note warm feelings of compassion in your stomach when you talk with a client you like. However, most of us have difficulty when working with those who hurt others. The bully, rapist, or abuser needs empathy and acceptance as much as the child, adolescent, or adult who survived the attack. Therefore, it is important to become aware of personal internal body reactions which is a skill that will take time to develop.

Dialectic/Systemic Style

The fourth level of DCT. Important at this level is the impact of context and social systems on clients' lives. Post-formal thought is in action when you bring multicultural and social justice issues into the counseling session. Social justice action in society exemplifies our commitment to our clients' long-term welfare. Expect the main area of your counseling and therapy to operate at Levels 2 and 3. We are suggesting, however, that addition of Level 1 sensations and body experience, as well as Level 4, more complex thinking, will make you a more flexible person and therapist able to reach more people at their level of feeling and thinking. In a counseling setting, the client takes multi-perspectives on the divorce and is able to see the spouses's frame of reference. The client may see how patterns learned in the family of origin were repeated in the couple relationship. Multicultural issues of gender, ethnicity, and religion may be part of the awareness.

Conscientizacào

The general goal in counseling that focuses on the liberation of the individual from personal, social, and economic oppression. Many of your clients come to you blaming themselves for their condition. Your task is to liberate these clients from self-blame, to encourage them to see their issues in a social context, and facilitate personal action to better their situation, as well as that of others.

Interpretation/Reframing

The interpretation or reframe, may be considered the central influencing skill. It provides clients with new perspective, frame of reference, and ways of thinking about issues. These may come from your observations; may be based on varying theoretical orientations the helping field; or they may link critical ideas together and alternative ways of viewing their challenges and themselves that can lead to a change in worldview. Can stretch the client beyond their frame of reference to incorporate the frame of reference of the therapist. Maximum: 2-3 sessions. Clients can only accommodate so much challenging of their existing frame of reference, and overuse of interpretation will result in a client rejecting your wisdom or perhaps leaving the interview completely. Having the client think in a different/new way. (You are thinking this way, but can you think about it this way? Why don't we try thinking about it like this?)

Developing New Theoretical Approaches from an MCT Perspective

The most recent innovation in the microskills is a new type of multicultural application—can the microskills approach offer some direction in generating more culturally relevant theory and practice One route toward this objective has been to start with an examination of a specific African culture and then examine how discoveries here may relate to African Americans, Asian Americans, European Americans, Latina/o Americans, and other groups.

Indifference

The opposite of empathy. The inability to experience another individual's emotional reaction.

Power Differential

The person seeking help is in a less powerful position than the counselor or therapist. Culturally intentional counselors will always keep this in mind as they offer their services to others and will be sure to evaluate their position as one of power, as well as one of helping. Humility and wisdom on the part of the therapist are required. It is unknown how to assist all people to meet all their needs; the issues are simply too complex for the present state of the art and science. Further, the actual time spent between a therapist and a client is minuscule compared with the amount of time the client spends in the rest of the world. Even a series of 30 interviews over 30 weeks is but 30 hours out of a lifetime. It is remarkable that counseling and psychotherapy do make a difference in the lives of clients, considering the time constraint.

Unconscious

The portion of our mind that is not accessible to the conscious mind, but nonetheless affects behavior, thought, and feeling.

Concrete Stage

The second level of DCT that occurs between the ages of 7-11 Clients can label emotions and can tell stories. This level contains mostly stories that you are seeing concretely. Clients will tell you a story every week. I went here last week and did this, etc. You must be able to process and understand the story. Clients might focus on what the counselor thinks of the stories then moves onto the next one after feedback or reaction is given. This tends to not be as productive. This is the foundation of reflection of feeling. The client names their feelings and emotions, but they need you to clarify what they mean and their con-text. Really describing what you are feeling or seeing. You feel__________ because______, which represents "if____, then _____" causative thought. This is a more cognitive approach to feelings, and words become central rather than body experience. I am asking how you are feeling here and now. If you ask how you are feeling they might discuss how they felt at the time when the story took place. This can be quite difficult to deal with. Typically, you want the client to be brought back to the present and what feelings they are having at that time. Want to identify those emotions. It isn't strictly about the stories, it's about the emotions that are attached to the stories. The client has to process the different levels. The therapeutic process cannot be properly accomplished if the client doesn't go through each of the 4 stages in order. The counselor must facilitate the counseling sessions based on these levels. Sensation often will be ignored at this level. Rogerian person-centered therapy and CBT work at this level, as well as the formal below. In a counseling setting, the client may talk to you, giving many details and stories about their divorce for example. Feelings around specific situations may be named, but you may note an absence of self reflection and considerable blaming and anger toward the spouse.

Therapeutic Relationship

The therapy relationship accounts for why clients improve (or fail to improve) more than a particular treatment method. Empirically Supported Relationships (ESR) include: elements of the therapy relationship primarily provided by the counselor or therapist and methods of adapting the therapy to the particular client characteristics.

Reflective/Formal Stage

The third level of DCT that occurs between age 12 and up Here, our clients are further removed from sensation and have become more abstract in their thinking. Here, we are thinking about feelings, as compared to naming them and experiencing them. The client is often out of touch with the back-ground deeper feelings while intellectualizing. This brings with it advantages, as looking at one's feelings and emotions provides a safe distance to appraise what is going on. The client can begin to see patterns in emotions and in cognitive thought. When one sees her or his world more in depth, we have more power to change. We also learned about ourselves by observing others. Important for this process are the brain-based mirror neurons. These neurons respond to perceived actions with clear goals, providing the basis for our ability to understand others' actions, as well as ours and the intentions behind. In a counseling setting, the client speaks more abstractly. If you listen carefully, you would find that specifics of what happened between the couple are seldom (rarely) discussed. Rather, the client discusses repeated patterns of interaction. The client is able to reflect on the self and feelings.

The Importance of Your View of Helping

Theories provide you with a map for conceptualization and action. Exploration of motives increases your understanding of reasons for engaging in this journey. Reflecting on competencies enhances your ability to walk along with your clients. Whether or not you have engaged in counseling, you have lived through many helping situations, all of which have given you some sense of what good helping and not-so-good helping are. Reflecting on such experiences will increase awareness of your current views of helping. This is important as you will catch yourself leaning towards those theories that best fit your own views. Over time, it will become important to expand your current views to embrace the complexity and diversity of the experiences your clients will bring with them. Each individual has a unique life experience, even with the same family. This has long been central to individually oriented counseling and therapy. We all grow and develop in a family context. Our experience in the family is basic to the ways we view the world. Your family experience is important in the way you construct and think about reality. As a helper, it is extremely beneficial to think and reflect upon your own family influences on your worldview.

Counseling and Theories

Theories: summarize, explain, and organize facts suggest novel ways to look at events are parsimonious (use few principles to explain many behaviors or situations) provide operational definitions of key concepts under study make specific predictions that are testable Understanding the role of theories will increase your enthusiasm for learning them, identifying their role in the helping process, formulating your own views of helping, and establishing your theoretical orientation. Give you a framework and a lens through which to look at your clients and their circumstances They can often give you direction toward what information seems most relevant, insight into the nature of the counseling relationship and how change happens. Theories of counseling and psychotherapy provide a map or framework for understanding what is going on with the client and how we can help them. This is a process known as conceptualizing client issues, establishing goals, formulating a plan to change thoughts and behaviors, and improve action Counseling and theories are formal fields of academic study, research, and practice. From a common sense POV, counseling is a way to understand everyday experiences and act appropriately.

Integrating Skills, Theory, and Practice: Looking Forward

Theory provides the ideas that organize key principles of helping. Skills form the toolbox of counseling and therapy. Practice occurs when you take your skills and theories and apply them directly to clients. If you have a solid foundation of skills and an intellectual understanding of theory, you are well prepared for the practice of therapy and counseling.

The Behavioral Worldview

This approach is more oriented to action and short-term treatment. Parent education, relaxation training, and stress management are some treatment techniques and strategies that might be used. The behavioral counselor will focus on antecedents and consequences of violent behavior, as well as short-term observable change, but will keep an eye to the future and work with the client for long-term maintenance of behavioral change. Counselor/Therapist Response Ex: There is a lot happening in your life. We'll be doing a lot of things during our time together. What I find most helpful as a beginning step is dealing with your personal frustration and issues of loss of self-control. We'll be working on how you behave to help you work with your child more effectively and to feel better about yourself. We'll start with some stress management techniques and move on to look at some specifics of behavior.)

Summary of The five-Stage Model of Cultural Identity Development

This model presents the cultural identity and women's identity theory and illustrates how both European American and minority women develop consciousness. 1.) Naïveté: Lacks awareness of system. "Buys into the status quo." 2.) Encounter: Becomes aware of women's oppression through contact with multiple issues that illustrate the failure of naïveté. 3.) Naming: Identifies issue as sexism. Angry with men and take action to produce change 4.) Reflection in Self: Pride in being a woman. Often separates from men to find self and self in relation to other woman 5.) Views male/female relationships in cultural/historical perspective. Values aspects of maleness, sees men selectively, able to take parts of women's identify theory interchangeably and accept, act, and reflect as the situation warrants. Cross (1995) points out that each developmental stage has a special value. Jackson (1976) would argue that all but the first and second stages are valuable places for an African American to spend her or his entire life. Even so, for any individual to be subject to constant oppression, the denial represented by naïveté at times may be necessary for survival and sanity. While there may seem to be advantages in the fifth level of consciousness, this level involves a multi-perspective division of consciousness that sometimes makes action in a racist society more difficult. Furthermore, this level of critical consciousness may be emotionally and cognitively exhausting at times.

Vertical development

Vertical development, within the DCT spherical frame, can be either up or down. As all dimensions of consciousness are considered important for holistic development, higher is not better. Both the African American female and European American male client might benefit from imaging, relaxation training, and other sensorimotor techniques at the sensorimotor level. For the African American, the techniques might be useful to help her come in better touch with her hurt feelings around racism.

Counseling and Psychotherapy: Personal Style, Influence, and Worldview

We are all in the same world, but each of us makes a different sense of what we see. We have our own unique perspectives on things. There are many counseling and therapy approaches for helping clients.

Immediacy (aka "feedback")

When you share personal feelings about the client, the therapy, or the therapeutic relationship in the moment.

Empathic/Self-Disclosure (CSD)

When you share your own life experience with the client, as when you say any version of "me too." The counselor is using "empathy." Emphasizes counselor "I" statements. Be careful not to share too much about your personal life. It is not very therapeutic or helpful when counselors make self disclosures since it takes away from the client's time. Also it is not about your problems, it is about the client's

Relativity by M.C. Escher

Where is your attention drawn? Why does the picture make as much sense upside-down as it does rightside-up? In the picture, 2 individuals are located on the stairs at the top and center. Two people are moving side by side and in the same direction, and yet one of them is going downstairs and the other upstairs. There is no contact between them since they live in different worlds and therefore have no knowledge of each other's existence. Counseling and therapy operate on the assumption that significant contact between client and counselor is possible. You, as a helper, counselor, or psychotherapist, are called on to show competence, creativity, and artistry in the way you observe and interact with your client as they walk down life's path. If you can enter your clients' worlds for a time and join them on their journey, you may find a new understanding and respect for how their worlds are different from your own. What is the purpose? Sometimes, simply validating your clients' alternative perceptions of reality may be all that is needed. Other clients may want to change direction, to find new perspectives and new ways of acting. In these cases, your task is more difficult because you will need to see their ways of thinking and being, to share yourself and your knowledge, and to work with them to seek new directions for the future.

What did Heesacker, Pritchard, Rigazio-DiGilio, and Ivey discover?

While conducting early research on how developmental issues impact client mental health found fewer physical and emotional symptoms in individuals who were able to function within multiple orientations, whereas mono-orientation people were more at risk for illness.

Influencing Skills and Strategies

You can impact the speed of the change process Influencing skills are complex and often more effective if used sparingly and in careful concert with listening skills. Your knowledge of theory and skills, personal life experience, and specific understanding of the unique client and their culture, you can share more of yourself and your knowledge to the benefit of your client. Includes: Interpretation/Reframing

Multiculturalism

a condition in which ethnic groups exist separately and share equally in economic and political life

Individualism/Collectivism

the degree to which a person believes that people should be self-sufficient and that loyalty to one's self is more important than loyalty to team or company.

Metatheory

theories about other theories that try to change other theories.