Week 1: The Effective Counsellor

Counsellors/Psychologists/Therapists What's the difference?

"Except for ideology, salary, status and power there are no differences" (Haley, 1977, p165) - Strong similarities between counselling and psychotherapy - The terms are used interchangeably often Both listen, question, interpret, explain, care about clients - Therapists/counsellors are not aimed at 'curing' - It is a 'collaborative process, co-constructing solutions to concerns'

Key Quotes

"It is not the theories and techniques that heal the suffering client but the human dimension of therapy and the 'meetings' that occur between therapist and client as they work together" (Elkins, 2009) "Psychotherapy is a process between two people, both of whom are bound to change" (Corey 2011)

Effective counsellors:

- Have a willingness to become a more therapeutic person - Have a strong identity, sense of self, who they are - Respect and appreciate themselves - Open to change - Authentic, sincere and honest - Make mistakes and are willing to admit them - Able to be in the 'present' - Appreciate the influence of culture - Are passionate - Are able to maintain healthy boundaries

Becoming Multiculturally Competent

- Study the historical background, traditions, and values of your client and be open to learning from him/her - Expand your vantage point to explore your client's ways of life that are different from your own - Develop an awareness of acculturation strategies

Things that therapist inadvertently brings with them:

- Values and biases - Past experiences of relationships - Emotions and needs

Factors that matter

1. The therapeutic relationship - Shared understanding of problem - Feeling understood - Trust, rapport, compassion, connection 2. Intervention used - The techniques used 3. Client expectations - Placebo effect?

Statistics

40% = extra-therapy factors: Nothing to do with sessions: The weather, breakup, divorce, new job....etc 30% = Therapeutic relationship: Do they like you? Can they trust you? Building rapport 15% = The hope you can instil in the client, the clients own outlook 15% = Therapist's techniques and skills

Adlerian Therapy

Adlerians focus on meaning, goals, purposeful behaviour, conscious action, belonging, and social interest.

Overview: Psychodynamic Approaches: - Adlerian therapy

Founder: Alfred Adler. Key Figure: Following Adler, Rudolf Dreikurs is credited with popularizing this approach in the United States. This is a growth model that stresses assuming responsibility, creating one's own destiny, and finding meaning and goals to create a purposeful life. Key concepts are used in most other current therapies.

Experiential and Relationship-Oriented Therapies: - Person-centered therapy

Founder: Carl Rogers; Key figure: Natalie Rogers. This approach was developed during the 1940s as a nondirective reaction against psychoanalysis. Based on a subjective view of human experiencing, it places faith in and gives responsibility to the client in dealing with problems and concerns.

Cognitive Behavioral Approaches - Choice theory/Reality therapy

Founder: William Glasser. Key figure: Robert Wubbolding. This short-term approach is based on choice theory and focuses on the client assuming responsibility in the present. Through the therapeutic process, the client is able to learn more effective ways of meeting her or his needs.

Cognitive Behavioral Approaches - Cognitive behavior therapy

Founders: Albert Ellis and A. T. Beck. Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy, and A. T. Beck founded cognitive therapy, which gives a primary role to thinking as it influences behavior. Judith Beck continues to develop CBT; Christine Padesky has developed strengths-based CBT; and Donald Meichenbaum, who helped develop cognitive behavior therapy, has made significant contributions to resilience as a factor in coping with trauma.

Experiential and Relationship-Oriented Therapies: - Gestalt therapy

Founders: Fritz and Laura Perls; Key figures: Miriam and Erving Polster. An experiential therapy stressing awareness and integration; it grew as a reaction against analytic therapy. It integrates the functioning of body and mind and places emphasis on the therapeutic relationship.

Experiential and relationship-oriented therapies

The existential approach, the person-centered approach, and Gestalt therapy. The existential approach stresses a concern for what it means to be fully human.

Therapist as model

The most powerful ways for you to teach your clients is by the behaviour you model and by the ways you connect with them. I suggest you experience a wide variety of techniques yourself as a client.

What is Counselling?

- A relationship - Based on collaboration - A repertoire of skills - Emphasises self help - Emphasises choice - Provides additional skills (and options) - A process (always will take a period of time)

Defining Counselling

- A relationship of trust. - The process that occurs when a client and counsellor set aside time in order to explore difficulties which may include the stressful or emotional feelings. - The act of helping the client to see things more clearly, possibly from a different viviewpoint and co-constructing solutions.

Why don't psychologists get better with experience?

- Automaticity - Lack of authenticity - Focus on not making mistakes and over confidence Is being psychologically healthy related to being an effective therapist? - Mixed data

Building rapport

- Common courtesy - Punctuality - Grooming - Environment - Freedom from distraction - Maintaining professional behaviour - Work within own expertise

What does a therapist bring to session?

- Compassion, caring, honesty, realness, sensitivity - Skills & Strategies - Knowledge and qualifications

Importance of the therapists personality

- Counselors facilitate healing through a process of genuine dialogue with their clients. - The kind of person a therapist is remains the most critical factor affecting the client and promoting change. - It is impossible to separate the techniques you use from your personality and the relationship you have with your clients.

Issues Faced by Beginning Therapists

- Dealing with anxieties - Being oneself and self- disclosing - Countertransference - Information giving - Understanding silence - Sharing responsibility with the client - Declining to give advice - Tolerating ambiguity

Limitations of Therapy

- Drop out rate is high - about 47% of people drop out before recommended - "I'd prefer to be mentally ill than speak to you one more time" - It takes time (between about 6 and 50 sessions) - It requires commitment, insight and trust. - It can be expensive

Counselling is not

- Giving advice. - Attempting to sort out the problems of the client. - Expecting or encouraging a client to behave in a way in which the counsellor may have behaved when confronted with a similar problem in their own life. - Being a client's friend

Summary

- You are encouraged to learn about counselling but also learn about yourself - Think about your therapeutic style/orientation - This semester you are 'dipping your toe' into counselling - It is hopefully going to be enjoyable yet at times challenging - Be aware that the 'person' and the 'professional' are intertwined and cannot be separated - Next week we will discuss ethical issues.

How to keep clients quiet

1. Direct and lead: Take control of what the client can and cannot talk about 2. Be judgmental: Imply that the client is not living up to your standards 3. Blame the client: Give the client responsibility for things over which they have no control 4. Moralise and preach: Tell the client how they should be living their lives 5. Label the client: Don't waste your time talking about specific behaviour, label the person 6. Reassure and humour the client: Don't let them wallow in feelings, platitudes are always useful

How to keep clients quiet...continued

7.Don't accept the clients feelings: Tell them they should feel differently 8.Tell the client what to do: Don't give them the opportunity to come up with their own solutions 9.Interrogate the client with personal questions: Make the client feel threatened with inappropriate probing 10.Over-interpret: Confuse the client with complex explanations of their problems 11. Talk about yourself: Lots of inappropriate self- disclosure is always useful 12. Exaggerate your professional experience: If possible, do it in a patronising way 13. Fake attention: Think about the new car you want to buy while your client's talking, and then say "that's very interesting" 14. Place time pressures: Make sure the client knows that you're a very busy (and important) person

Micro-skills: ALCFR

= 'Micro-skills are observable actions of therapists that appear to effect positive change in the session in which active listening involves both receiver and sender' - Attending skills, (nodding, leaning in, eye contact) - Listening skills (paraphrasing, summarising) - Confronting (gently bringing about awareness) - Focusing (themes and keep on track) - Reflection of meaning (explore deeper understanding)

Systems and Postmodern Approaches - Postmodern approaches

A number of key figures are associated with the development of these various approaches to therapy. - Steve de Shazer and Insoo Kim Berg are the cofounders of solution-focused brief therapy. - Michael White and David Epston are the major figures associated with narrative therapy. Social constructionism, solution-focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.

Systems and Postmodern Approaches - Family systems therapy

A number of significant figures have been pioneers of the family systems approach, two of whom include Murray Bowen and Virginia Satir. This systemic approach is based on the assumption that the key to changing the individual is understanding and working with the family.

Counselling/therapy is:

A relationship Based on collaboration A repertoire of skills A process over time Using yourself as the tool Creative An art, not a science

Different forms of therapy view the problem, and therefore the solution in different ways:

Cognitive Behaviour Therapy = Your thinking Interpersonal Therapy = Your Relationships Psychodynamic Therapy = Your past Family Therapy = Your family Solution Focused Therapy = Your strengths Person-centred Therapy = What you pay attention to?

Cognitive behavioural approaches

Cognitive behavioral approaches, sometimes known as the action- oriented therapies because they all emphasize translating insights into behavioral action. These approaches include choice theory/reality therapy, behavior therapy, rational emotive behavior therapy, and cognitive therapy.

Does therapy work?

In most studies of psychological treatment conducted in the last 30 years, the average treated person is better off then 80% of those who did not receive treatment. (note this is not an 80% "success rate") 32 times more cost effective than money at making us happy (Boyce & Wood 2010) For most problems psychological therapy is more effective than alternative treatments like psychoactive medications. • Lower side effect profile • Therapy is more cost effective

Cognitive Behavioral Approaches - Behavior therapy

Key figures: B. F. Skinner, and Albert Bandura. This approach applies the principles of learning to the resolution of specific behavioral problems. Results are subject to continual experimentation. The methods of this approach are always in the process of refinement. The mindfulness and acceptance-based approaches are rapidly gaining popularity.

Experiential and Relationship-Oriented Therapies: - Existential therapy

Key figures: Viktor Frankl, Rollo May, and Irvin Yalom. Reacting against the tendency to view therapy as a system of well-defined techniques, this model stresses building therapy on the basic conditions of human existence, such as choice, the freedom and responsibility to shape one's life, and self-determination. It focuses on the quality of the person-to-person therapeutic relationship.

What do you bring to this elective?

Knowledge and qualifications yet not displaying human qualities of compassion, caring, honesty, realness, sensitivity would be more like a 'technician' according to Corey. - Counsellors/therapists must explore their own values, attitudes and beliefs in order to be effective - Applying the material from these PSY3120 lectures and this textbook to yourself personally will take you beyond an academic understanding

Help to begin the interview

Open answer questions: "How can I help you?" "What would you like to talk about today?" "How have you been since we last spoke?" "Perhaps you could tell me something about why you came to see me today?" "What brought you here today?"

The role of values

Our values influence how we act We aim to be objective However, we are caught up in our own worldview Not our function to persuade clients to share our values Need to respect their values even if you don't agree

Psychodynamic approaches

Psychoanalytic therapy is based largely on insight, unconscious motivation, and reconstruction of the personality.

Overview: Psychodynamic Approaches: - Psychoanalytic therapy

Psychodynamic Approaches: Psychoanalytic therapy Founder: Sigmund Freud. A theory of personality development, a philosophy of human nature, and a method of psychotherapy that focuses on unconscious factors that motivate behavior. Attention is given to the events of the first six years of life as determinants of the later development of personality.

Who does counselling?

Psychologists Psychiatrists Counsellors - though difficult to define Some social workers and occupational therapists Some general practitioners Does training matter? - Little difference between psychologists, social workers, psychiatrists. PhD, Masters. - More differences within professions rather than between

Reality therapy & Behaviour therapy

Reality therapy focuses on clients' current behavior and stresses developing clear plans for new behaviors. Like reality therapy, behavior therapy puts a premium on doing and on taking steps to make concrete changes.

The effective practitioner: Experience? Not Necessarily

The effective practitioner Experience? Not Necessarily - Psychologist Paul Clement published data from 26 years of practice (683 cases failing into 84 diagnoses). He expected to find that his outcomes improved over time along with his experience. They didn't.

The existential approach

The existential approach stresses a concern for what it means to be fully human. It suggests certain themes that are part of the human condition, such as freedom and responsibility, anxiety, guilt, awareness of being finite, creating meaning in the world, and shaping one's future by making active choices.

Systems and Postmodern Approaches - Feminist therapy

This approach grew out of the efforts of many women, a few of whom are Jean Baker Miller, Carolyn Zerbe Enns, Oliva Espin, and Laura Brown. A central concept is the concern for the psychological oppression of women. Focusing on the constraints imposed by the sociopolitical status to which women have been relegated, this approach explores women's identity development, self-concept, goals and aspirations, and emotional well-being.

How to be a well grounded counsellor?

To be effective, you also must have supervised experiences in counselling and sound knowledge of counselling theory and techniques. Further, it is essential to be well grounded in the various theories of personality and to learn how they are related to theories of counselling.

Differences between the theories

What you will hopefully notice throughout PSY3120 is that there are many parallels and similarities between the theories An integration of the approaches is usually what happens, based on your own style, background, interests and values

The person-centered approach

Which is rooted in a humanistic philosophy, places emphasis on the basic attitudes of the therapist. It maintains that the quality of the client-therapist relationship is the prime determinant of the outcomes of the therapeutic process

Gestalt therapy

Which offers a range of experiments to help clients gain awareness of what they are experiencing in the here and now—that is, the present. In contrast to person-centered therapists, Gestalt therapists tend to take an active role, yet they follow the leads provided by their clients.

Role of values in developing goals

Who should establish the goals in counselling? Client's responsibility- how to ask them about goals... "What are your expectations of counselling?" "Why are you here?" "What do you hope to leave with?"

Should practitioners have counselling?

Yes, enormously beneficial to have had the experience of being a client and to gain self-awareness It can be before your training, during it or both It can be a very good way of 'healing the healer' (rather than using your clients as therapy!)

Why don't people seek counselling?

• "Speaking about my problems is weak" • Men are less likely to seek help than women • Self reliance - "I should be able to work it out by myself" • Some people "don't believe in mental illness" or have limited ability to recognise mental ill health • Stigma around "being mental" • Shyness/shame/embarrassment • Concerns about confidentiality