Intro to Psychotherapy Exam 3 Book Notes
Meichenbaum three-stage model for stress inoculation training
(1) the conceptual-educational phase, (2) the skills acquisition and skills consolidation phase, (3) the application and follow-through phase. Some of the techniques that are used during the various phases of the training are: establishing a therapeutic alliance, providing clients with a conceptual framework in simple terms designed to educate them about ways of responding to a variety of stressful situations, learning a new set of coping self statements, practicing relaxation methods, and practicing new self-statements and applying new skills.
Key Concepts CBT
A basic premise of Meichenbaum's cognitive behavior modification (CBM) is that clients, as a prerequisite to behavior change, must notice and become aware of how they think, feel, and behave, and the impact they have on others. For change to occur, clients need to interrupt the scripted nature of their behavior so that they can evaluate their behavior in various situations
REBT stresses ?
A highly didactic, cognitive behavior-oriented approach, REBT stresses the role of action and practice in combating irrational, self-indoctrinated ideas. It focuses on the role of thinking and belief systems as the roots of personal problems.
Contributions Post Modern Approaches
A key contribution of all the postmodern approaches is the optimistic orientation that views people as being competent and able to create better solutions and more life affirming stories. The nonpathologizing stance taken by postmodern practitioners moves away from dwelling on what is wrong with a person to emphasizing creative possibilities. Problems are not viewed as pathological manifestations but as ordinary difficulties and challenges of life. As therapists listen to a client's story, they pay attention to details that give evidence of a client's competence in taking a stand against an oppressive problem. A strength of both solution-focused and narrative therapies is the use of questioning, which can assist clients in developing their stories and discovering better ways to deal with their present concerns and to think about how they might solve potential problems in the future. Effective questioning can help individuals in examining their stories and finding new ways to present their stories
Contributions Feminist therapy
A key contribution of feminist therapy is the potential for integration of feminist therapy principles and concepts with other therapeutic systems. Feminist theorists have contributed to increasing awareness of one's attitudes and biases pertaining to gender and culture, regardless of one's theoretical orientation. Theories can be evaluated against the criteria of being gender free, flexible, interactionist, and life-span-oriented. Therapists of any orientation can infuse feminist practices in their work if they conduct therapy with a positive, egalitarian attitude toward both women and men and are willing to confront patriarchal systems. The feminist approach emphasizes the importance of considering the context of women's lives rather than focusing narrowly on symptoms and behaviors. Feminism has done a great deal to sensitize therapists to the gendered uses of power in relationships, which can be applied to counseling with women and men. In addition, feminist therapy groups actively worked to establish shelters for battered women, rape crisis centers, and women's health and reproductive health centers. Building community, providing authentic mutual empathic relationships, creating a sense of social awareness, and the emphasis on social change are all significant strengths of this approach.
Multicultural Perspectives Family therapy
A key strength of the systemic perspective in working from a multicultural framework is that many ethnic and cultural groups value the extended family. Understanding cultures allow therapists and families to appreciate diversity and to contextualize family experiences in relation to the larger cultures. Therapists, regardless of their model of therapy, must fi nd ways to enter the family's world and honor the traditions that support the family. Contemporary family therapists explore the individual culture of the family, the larger cultures to which the family members belong, and the host culture that dominates the family's life. They look for ways in which culture can both inform and modify their work with a family. A therapist's interventions are adapted to these cultural systems.
Limitations Family therapy
A major limitation of systemic approaches is the potential to lose sight of the individual by focusing on the broader system. If a family comes in for therapy, there are some real advantages to working with the entire unit. However, the language and focus of systems have often placed a primary emphasis on the family whole at the expense of individuals. Postmodern thinking and the natural development of the profession are beginning to integrate the person back into the system.
Key Concepts CT
According to Beck's cognitive therapy, psychological problems stem from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality. Cognitive therapy consists of changing dysfunctional emotions and behaviors by modifying inaccurate and dysfunctional thinking. The techniques are designed to identify and test the client's misconceptions and faulty assumptions
Applications REBT
Applications of REBT include individual therapy, ongoing group therapy, marathon encounter groups, brief therapy, marriage and family therapy, sex therapy, and classroom situations. REBT is applicable to clients with moderate anxiety, neurotic disorders, character disorders, psychosomatic problems, eating disorders, poor interpersonal skills, marital problems, poor parenting skills, addictions, and sexual dysfunctions. It is most effective with those who can reason well and who are not seriously disturbed.
Contributions REALITY THERAPY/CHOICE THEORY
As a short-term approach, reality therapy can be applied to a wide range of clients. It provides a structure for both clients and therapists to evaluate the degree and nature of changes. It consists of simple and clear concepts that are easily understood by many in the human services field, and the principles can be used by parents, teachers, ministers, educators, managers, consultants, supervisors, social workers, and counselors. As a positive and action-oriented approach, it appeals to a variety of clients who are typically viewed as "difficult to treat." The existential underpinnings of choice theory are a major strength of this approach, which accentuates taking responsibility for what we are doing. The heart of reality therapy consists of accepting personal responsibility and gaining more effective control. People take charge of their lives rather than being the victims of circumstances beyond their control. This approach teaches clients to focus on what they are able and willing to do in the present to change their behavior
Applications CBT
Because the cognitive behavioral therapies are structured approaches, they are well suited as brief therapies. Clients acquire new knowledge and skills that they apply to understanding and resolving specific problems. The change process is effective because of the emphasis given to practicing new ways of thinking and acting outside of the therapy sessions through collaboratively designed homework assignments. Cognitive behavioral therapy (CBT) has many applications to a variety of counseling groups in many different settings. Cognitive behavioral group therapy is effective for treating a wide range of emotional and behavioral problems. CBT in groups has been demonstrated to have beneficial results for specific problems such as anxiety, depression, phobia, obesity, eating disorders, dual diagnoses, and dissociative disorders.
Key Concepts Family Systems Therapy
Because there are so many separate schools of family therapy, it is difficult to identify general concepts that cut across all of these orientations. Each school of therapy has its own key concepts: ■ Adlerian family therapists focus on a relationship based on mutual respect, investigation of birth order and mistaken goals, and reeducation. ■ Bowenians focus on extended-family patterns. This multigenerational approach is based on a number of key ideas, two of which are differentiation of the self and triangulation. ■ Satir's human validation process model utilizes a communication process to assist a family in moving from status quo through chaos to new possibilities and new integrations. ■ The experiential family therapists take a developmental perspective in explaining individual growth in a systemic context. ■ Structuralists emphasize the family as a system, subsystems, boundaries, and hierarchies. The therapist joins the family in a leadership role and changes these structures. ■ Strategic therapists base their interventions on a communications model, which focuses on stuck interactional sequences in a family. Change occurs through action-oriented directives and paradoxical interventions. ■ A multilayered process of family therapy provides a context for developing an integrative approach in working with families.
CT emphasizes?
Beck's CT shares with REBT the active, directive, time-limited, present-centered, structured approach used to treat various disorders such as depression, anxiety, and phobias. It is an insight-focused therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs. Meichenbaum's cognitive behavioral approach suggests that it may be easier and more effective to behave our way into a new way of thinking, than to think our way into a new way of behaving.
Multicultural Perspectives CBT
CBT tends to be culturally sensitive because it uses the individual's belief system, or worldview, as part of the method of self-exploration. The collaborative nature of CBT offers clients the structure many clients want, yet the therapist still strives to enlist their active participation in the therapeutic process. Because of the way CBT is practiced, it is ideally suited to working with clients from diverse backgrounds. Some factors that make CBT diversity effective include tailoring treatment to each individual, addressing the role of the external environment, the active and directive role of the therapist, the emphasis on education, relying on empirical evidence, the focus on present behavior, and the brevity of the approach. Cognitive behavioral practitioners function as teachers; clients acquire a wide range of skills they can use in dealing with the problems of living. This educational focus appeals to many clients who are interested in learning practical and effective methods of bringing about change.
Contributions CBT
Cognitive behavior therapy has wide applicability. A strength of CBT consists of integrating assessment throughout therapy, which is an action that communicates respect for clients' viewpoints regarding their progress. Counseling is brief and places value on active practice in experimenting with new behavior so that insight is carried into doing. It discourages dependence on the therapist and stresses the client's capacity to control his or her own destiny
Techniques and Procedures CT
Cognitive therapy (CT) emphasizes a Socratic dialogue and helping clients discover their misconceptions for themselves. Through a process of guided discovery, the CT practitioner functions as a catalyst and guide who helps clients understand the connection between their thinking and the ways they feel and act.
Applications CT
Cognitive therapy is a structured therapy that is present-centered and problem oriented; CT can be effective in treating depression and anxiety in a relatively short time. CT has been applied successfully in treating a broad range of problems with children, adolescents, and adults. It has applications for managing stress and parent training. Cognitive methods have also been very useful in treating posttraumatic stress disorder, schizophrenia, bipolar disorders, and various personality problems
Philosophy and Basic Assumptions CBT
Donald Meichenbaum's cognitive behavior approach to training—(self-instructional training and stress inoculation training—focuses more on helping clients become aware of their self-talk and the stories they tell about themselves. Meichenbaum's cognitive-behavioral modification process consists of helping clients interrupt the downward spiral of thinking, feeling, and behaving, and teaching them more adaptive ways of coping using the resources they bring to therapy. His stress inoculation training is a complex, multifaceted cognitive-behavioral intervention that is both a preventive and treatment approach
Key Concepts REBT
Ellis makes it clear that REBT holds that although emotional disturbance is rooted in childhood, people keep telling themselves irrational and illogical sentences. The approach is based on the A-B-C theory of personality: A = actual event; B = belief system; C = consequence. Emotional problems are the result of one's beliefs, which need to be challenged by a variety of different methods. Cognitive restructuring involves detecting and debating faulty thinking and substituting negative self-talk with constructive beliefs and thoughts. ---Eventually, clients acquire an effective philosophy and also create a new set of feelings.
Applications Family therapy
Family therapy is not limited to working exclusively with families. There are many ways to apply concepts of family systems therapy to both individual and group counseling. To focus primarily on the internal dynamics of an individual without adequately considering family dynamics yields an incomplete picture of the person. Thus, it is useful to bring a client's family background into the context of individual and group counseling when appropriate. For individual counseling, during the assessment process, the therapist can raise questions about a client's family of origin and how certain experiences in the family have current influences. With respect to group counseling, there are ample opportunities for group members to explore concerns they have with parents and siblings. In many therapeutic groups, considerable time is devoted to a discussion of painful events associated with growing up in a family. Even though family members are not part of a counseling group, the members can still do considerable work with them through role playing and other techniques aimed at helping members explore how they are still being affected by family experiences.
Limitations Feminist therapist
Feminist therapists do not take a neutral stance; they advocate for change in social structures. A potential limitation pertains to therapists who may impose their values on clients regarding the need to challenge the status quo. However, culturally competent feminist therapists look for ways to work within the clients' culture by exploring consequences and alternatives without making decisions for clients. There is an appreciation of the complexities involved in changing within one's culture. Another criticism is that feminist therapy was developed by White, middle-class, heterosexual women and that its underlying assumptions are biased due to this narrow viewpoint
Multicultural Perspectives Feminist therapy
Feminist therapy and multicultural/social justice perspectives have a great deal in common. The feminist perspective on power in relationships has application for understanding power inequities due to racial and cultural factors. The "personal is political" principle can be applied both to counseling women and counseling culturally diverse client groups. Neither feminist therapy nor multicultural perspectives focus exclusively on individual change. Instead, both approaches emphasize direct action for social change as a part of the role of therapists. Many of the social action and political strategies that call attention to oppressed groups have equal relevance for women and for other marginalized groups. Both feminist therapists and multicultural therapists have worked to establish policies that lessen the opportunities for discrimination of all types—gender, race, culture, sexual orientation, ability, religion, and age.
Applications Feminist therapy
Feminist therapy can be applied to individual therapy for both women and men and for couples therapy, family therapy, group counseling, and community intervention. Feminist principles can also be applied to supervision, teaching, consultation, ethics, research, theory building, and to addressing social injustices. Key concepts of this approach can be applied to most of the other theories of counseling. Group work fits well with the spirit of feminist therapy. Consciousness-raising groups initially provided a forum for women to share their experiences with oppression and powerlessness. Self-help groups offered many women encouragement to challenge social patterns of the time. Groups provide a context in which women can examine the messages they have internalized about their self-worth, their gender-role identity, and their place in society. Although these groups are as diverse as the women who comprise them, they share a common goal of offering support for the experience of women. By participating in a group, women may become aware that their individual experiences are often rooted in problems within the system. Ideally, a group experience can motivate the members to get involved in some type of social action to bring about both individual and system change
Key Figures and Major Focus Feminist therapy
Feminist therapy does not have a founder or a single individual who developed the approach. Some of the women who have made significant contributions are Jean Baker Miller, Carol Gilligan, Carolyn Enns, Laura Brown, Lillian Comas-Diaz, and Olivia Espin. Feminist therapy has developed in a grassroots manner, responding to the emerging needs of women. Gender and power are at the heart of this approach. A central concept in this perspective is the concern for the psychological oppression of women and the socialization of women that affects their identity development.
Techniques and Procedures Feminist Therapy
Feminist therapy is a technically integrative approach that stresses tailoring interventions to meet clients with their strengths. Feminist practitioners also draw upon strategies from many other therapy models, such as the use of therapeutic contracts, homework, bibliotherapy, therapist self-disclosure, empowerment, role playing, cognitive restructuring, reframing, relabeling, and assertiveness training. feminist procedures include gender-role analysis and intervention, power analysis and intervention, and social action. Feminist therapists have challenged assessment and diagnostic procedures on the grounds that they are often influenced by subtle forms of sexism, racism, ethnocentricism, heterosexism, ageism, or classism. In the feminist therapy process, diagnosis of distress becomes secondary to identification and assessment of strengths, skills, and resources. Many of the strategies of multicultural feminist therapy fall under the general umbrella of empowerment, which enables people to see themselves as active agents on behalf of themselves and others. Feminist therapists work in an egalitarian manner and use empowerment strategies that are tailored to each client
Key Concepts Feminist therapy
Feminist therapy is based on six interrelated principles: 1 The personal is political. 2 Commitment to social change. 3 Women's and girl's voices and ways of knowing are valued and their experiences are honored. 4 The counseling relationship is egalitarian. 5 A focus on strengths and a reformulated definition of psychological distress. 6 All types of oppression are recognized. A key concept of feminist therapy is the notion that societal gender-role messages influence how individuals view themselves and behave. Through therapy the impact of these socialization patterns are identified so that clients can critically evaluate and modify early messages pertaining to appropriate gender-role behavior. Most feminist therapists believe gender is always an important factor, but they realize that ethnicity, sexual orientation, and class may be more important factors in given situations and across situations for many women. The practice of contemporary feminist therapy is based on the assumption that gender cannot be considered apart from other identity areas such as race, ethnicity, class, and sexual orientation. A key concept pertaining to understanding symptoms is that problematic symptoms can be viewed as coping or survival strategies rather than as evidence of pathology. Although individuals are not to blame for personal problems largely caused by dysfunctional social environments, they are responsible for working toward change.
Key Figures and Major Focus POSTMODERN APPROACHES
Founders and Key Figures: Two co-founders of solution-focused brief therapy are Insoo Kim Berg and Steve de Shazer. Two co-founders of narrative therapy are Michael White and David Epston. Many of the postmodern approaches do not have a single founder, and instead, they represent a collective effort by many. Some of the major postmodern approaches include social constructionism, solution-focused brief therapy, and narrative therapy. In these approaches the therapist disavows the role of expert, preferring a more collaborative and consultative stance. Solution-focused brief therapy (SFBT) is a future-focused, goal-oriented therapeutic approach to brief therapy that shifts the focus from problem solving to an emphasis on solutions. SFBT emphasizes people's strengths and resiliencies by focusing on exceptions to their problems and their conceptualized solutions. In narrative therapy the focus is on searching for times when clients were strong or resourceful and on helping clients separate from the dominant cultural narratives they have internalized so as to open space for the creation of alternative life stories.
Key Figures and Major Focus of CBT & REBT
Founders: Albert Ellis is the founder of rational emotive behavior therapy (REBT) and is the grandfather of the other cognitive-behavioral approaches. Aaron Beck is the founder of, and key spokesperson for, cognitive therapy (CT). Another key figure in the development of cognitive therapy and teaching this approach is Judith Beck. Donald Meichenbaum is a pioneer in cognitive behavior modification and his cognitive-behavioral approach combines some of the best elements of behavior therapy and cognitive therapy.
Therapeutic Relationship Postmodern Approaches
From the social constructionist viewpoint, therapy is a collaborative venture; the therapist strives to carry out therapy with an individual, rather than doing therapy on an individual. Instead of aiming to make change happen, the therapist attempts to create an atmosphere of understanding and acceptance that allows individuals to tap their resources for making constructive changes. Both solution-focused and narrative therapists adopt a "not-knowing" position to put clients in the position of being the experts about their own lives. The therapist-as-expert is replaced by the client-as-expert. Therapists do not assume that they know more about the lives of clients than they do. Clients are the primary interpreters of their own experiences. Therapists attempt to create collaborative relationships based on the assumption that collaboration opens up a range of possibilities for present and future change. One way of creating a working therapeutic partnership is for the therapist to show clients how they can use the strengths and resources they already possess to construct solutions. In the narrative approach, the therapist seeks to understand clients' lived experience and avoid efforts to predict, interpret, or pathologize. Narrative therapists collaborate with clients in assisting them to experience a heightened sense of agency or ability to act in the world
Philosophy and Basic Assumptions POSTMODERN APPROACHES
From the viewpoint of social constructionism, the stories that people tell are about the creation of meaning. There may be as many stories of meaning as there are people who tell stories, and each of these stories is true for the individual who is telling the story. Postmodernists assume that realities are socially constructed. There is no absolute reality, and therapists should not impose their vision of reality or their values on an individual. Both solution-focused brief therapy and narrative therapy are based on the optimistic assumption that people are healthy, competent, resourceful, and possess the ability to construct solutions and alternative stories that can enhance their lives. Complex problems do not necessarily require complex solutions. The expertise of the therapist involves helping clients recognize the competencies they possess. Attention is given to what clients are doing that is working and helping them to build on their potential, strengths, and resources. Narrative therapists strive to avoid making assumptions about people out of respect for each client's unique story and cultural heritage. Change begins by deconstructing the power of cultural narratives and then proceeds to the co-construction of a new life of meaning
Role and Function of Family Therapists
Here are some central roles associated with the major approaches to family therapy. ■ Adlerian family therapists assume the roles of educators, motivational investigators, and collaborators. ■ In Bowen's multigenerational therapy, therapists function as guides and objective researchers. Therapists monitor their own reactions and take an active role in facilitating change in a family. Once individuals have gathered information about their family of origin, the therapist coaches each person in developing strategies for dealing with significant others outside of the therapy sessions. ■ In the human validation process model of family therapy, the fundamental function of the therapist is to guide the individual family members through the process of change. The therapist provides the family with new experiences and teaches members how to communicate openly. In this model the therapist is an active facilitator who models congruence and serves as a resource person. ■ The experiential family therapist functions as a family coach, challenger, and model for change through play. Therapists have various functions at different points in therapy, including being a stress activator, a growth activator, and a creativity stimulator. ■ Structural family therapists function as stage directors. They join the system and attempt to manipulate family structure for the purpose of modifying dysfunctional patterns. The therapist's central task is to deal with the family as a unit, in the present, with the goal of initiating a restructuring process. ■ In the strategic model therapists function in active and directive ways. Working as consultants and experts, they are manipulative and authoritarian in dealing with resistive behaviors. The therapist is the agent responsible for changing the organization of a family and resolving the family's presenting problems. ■ In the integrative approach to family therapy, therapists look at a family from multiple perspectives and collaboratively work out with a family specific processes and practices that will lead to change.
Philosophy and Basic Assumptions Family Systems Therapy
If we hope to work therapeutically with people, family therapists believe it is critical to consider clients within their family system. An individual's dysfunctional behavior grows out of the interactional unit of the family as well as the larger community and societal systems. Almost all of these theories view the family from an interactive and systemic perspective, which sees an individual's dysfunctional behavior as a manifestation of dysfunctional behavior within the system or as affecting the system negatively. Family therapy is a diverse fi eld, comprising various theories of how change occurs within the family and an equally diverse set of intervention strategies. The theories of family therapy share a common philosophy of the importance of dealing with all parts of a system if change is to take place and be maintained. The family systems therapy models are grounded on the assumptions that a client's problematic behavior may (1) serve a function or purpose for the family, (2) be a function of the family's inability to operate productively, especially during developmental transitions, or (3) be a symptom of dysfunctional patterns handed down across generations. All these assumptions challenge the more traditional intrapsychic frameworks for conceptualizing human problems and their formation. The multilayered process of family therapy represents different perspectives in working with any family. The goal is to provide the therapist with multiple perspectives for tailoring therapy to the needs and situations of a family.
Therapeutic Relationship Family Systems Therapy
In the strategic and structural approaches to family therapy, the therapeutic relationship is not emphasized. However, the experiential and human validation mode based on the quality of that relationship. Many family therapists are primarily concerned with teaching members how to modify dysfunctional interactional patterns and change stereotypical patterns. Some family therapists are more concerned with implementation of techniques designed to solve presenting problems than with the quality of the therapeutic relationship. Others realize that their relationship with family members is temporary, and thus they focus more on the quality of relationships within a family
Key Concepts Postmodern Approaches
Key concepts of solution-focused brief therapy include a movement from problem-talk to solution-talk and a focus on keeping therapy simple and brief. There are exceptions to every problem, and by talking about these exceptions, clients are able to conquer what seem to be gigantic problems. Solution-focused therapists make the assumption that clients are competent and that the therapist's role is to help clients recognize the competencies they already possess and apply them toward solutions. Thus, attention is paid to what is working, and clients are encouraged to do more of this. Change is constant and inevitable, and a small change leads to other changes until the "solution momentum" outweighs the problem momentum. Little attention is paid to pathology or to giving clients a diagnostic label. A therapist's not-knowing stance creates an opportunity for the client to construct a solution
Key Figures and Major Focus Family Systems Therapy
Key figures of Adlerian family therapy are Alfred Adler and Rudolf Dreikurs. The key figure of the multigenerational approach to family therapy is Murray Bowen. He stresses exploring patterns from one's family of origin. The key figure of the human validation process model is Virginia Satir. This form of therapy focuses on the interpersonal relationship between the therapist and the family members. The key figure associated with experiential family therapy is Carl Whitaker. His approach assumes that it is experience that changes families, not education. T he key figures associated with structural-strategic family therapy are Salvador Minuchin, whose structural model focuses on the family as a system and its subsystems, boundaries, and hierarchies; and Cloé Madanes and Jay Haley, whose strategic model stresses parental hierarchies and cross-generational coalitions.
Key Figures and Major Focus REALITY THERAPY/CHOICE THEORY
Key figures: William Glasser and Robert Wubbolding. Reality therapy was developed by William Glasser in the 1950s and 1960s. Then Glasser began teaching control theory, which states that all people have choices about what they are doing. By 1996 Glasser had revised this theory and renamed it choice theory, which provides a framework of why and how people behave. Choice theory is concerned with the phenomenological world of the client and stresses the subjective way in which clients perceive and react to their world from an internal locus of evaluation. Behavior is viewed as our best attempt to get what we want. Behavior is purposeful; it is designed to close the gap between what we want and what we perceive we are getting. Specific behaviors are always generated from this discrepancy. Our behaviors come from the inside, and thus we choose our own destiny
Philosophy and Basic Assumptions CT
Like REBT, cognitive therapy rests on the premise that cognitions are the major determinants of how we feel and act. CT assumes that the internal dialogue of clients plays a major role in their behavior and feelings. Changing thoughts is the path to changing behaviors and feelings. The ways in which individuals monitor and instruct themselves and interpret events shed light on the dynamics of disorders such as depression and anxiety
Limitations Post Modern Approaches
Many of the limitations of both solution-focused and narrative therapies pertain to lack of skill on the part of the therapist when implementing techniques. Some inexperienced or untrained therapists may be enamored by any number of techniques: the miracle question, scaling questions, the exception question, and externalizing questions. Although a number of techniques are available to both solution-focused and narrative therapists, the attitude of the therapist is critical to the success of outcomes. To effectively practice solution-focused brief therapy, it is essential that therapists are skilled in brief interventions. This means that in a relative short time practitioners are able to make quick assessments, assist clients in formulating specific goals, and effectively use appropriate interventions. In the practice of narrative therapy, there is no recipe, no set agenda, and no formula that the therapist can follow to assure desired outcomes. These are not necessarily limitations, but unless the therapist is personally and professional mature, the techniques used will have little therapeutic value
Applications stress inoculation training (SIT)
Meichenbaum's stress inoculation training (SIT) has useful applications for a wide variety of problems and clients and for both remediation and prevention. Some of these applications include anger control, anxiety management, assertion training, improving creative thinking, treating depression, and dealing with health problems. Stress inoculation training has been employed with medical patients and with psychiatric patients. SIT has been particularly successful in treating people with posttraumatic stress disorder (PTSD) and with veterans and combat-related PTSD.
Contributions Meichenbaum Stress Inoculation
Meichenbaum's stress inoculation training places special emphasis on practicing new skills both in the training itself and in daily life, and homework is a key part of the training process. A key strength of this approach involves clients learning how to generalize coping skills to various problem situations and acquiring relapse prevention strategies to ensure that their gains are consolidated
Therapeutic Goals Family Systems Therapy
Most family therapists share some general goals, but specific goals are determined by the practitioner's theoretical orientation or by a collaborative process between the therapist and the family. Global goals include intervening in ways that enable individuals and the family to relieve their distress. Although many family therapists agree on the goals, their interventions differ Here is a summary of the therapeutic goals associated with some of the various theories of family therapy: ■ Adlerian emphasize unlocking mistaken goals and interactional patterns in the family and promotion of effective parenting. ■ Bowenian (multigenerational) therapy seeks to (1) decrease anxiety and bring about relief from distressing symptoms and (2) bring about the maximum self-differentiation for each family member within his or her family and cultural context. ■ The goals of the human validation process model parallel Satir's view of the process of change. Specific goals include generating self-esteem and hope, identifying and strengthening coping skills, and facilitating movement toward health and actualization. ■ The goals for experiential family therapy include increasing awareness of one's present experiencing, facilitating individual growth and more effective interactional patterns, and promoting authenticity. ■ Structural family therapy aims at both treating symptoms and changing dysfunctional transactional patterns within the family. Rules are identified that govern interactions among family members, with the purpose of helping them develop clear boundaries and appropriate hierarchies. ■ In strategic family therapy insight is considered unimportant. The central goal of this approach is to resolve a family's presenting problem (or symptoms) by focusing on changing its current behavioral sequences.
Narrative Therapy Techniques
Narrative therapy emphasizes the quality of the therapeutic relationship and the creative use of techniques within this relationship. In narrative therapy the therapy process provides the sociocultural context in which clients are assisted in separating themselves from their problems and are afforded the opportunity of authoring new stories. Some specific narrative techniques include externalizing, mapping the effects, deconstruction, co-authoring alternative stories, and building an audience as a witness to the emerging preferred story. Narrative therapy's most distinctive feature is captured by the statement, "The person is not the problem, but the problem is the problem." Externalizing conversations are aimed at separating the problem from the person rather than insisting that the person own the problem. Externalization is based on the notion that when clients view themselves as "being" the problem they are greatly limited in the ways they can effectively deal with the problem. The assumption is that clients can develop alternative and empowering stories once they have distanced themselves from the problems and cultural notions they have internalized. In narrative therapy it is through a systematic process of careful listening, coupled with curious, persistent, and respectful questioning that the therapist works with clients to explore the impact of the problem on them and what they are doing to reduce the effects of the problem. It is through this process that the client and therapist co-construct enlivening alternative stories.
Why did the name change from BT to CBT?
Originally called behavior therapy, the more contemporary term cognitive behavior therapy (CBT) was introduced in the mid-1970s as therapists began emphasizing the interaction among behavioral, cognitive, and affective dimensions. Contemporary CBT is a blend of cognitive and behavioral concepts and techniques.
Applications REALITY THERAPY/CHOICE THEORY
Originally designed for working with youthful offenders in detention facilities, choice theory and reality therapy are applicable to people with a variety of behavioral problems and for relationship enhancement. Choice theory can be applied to counseling, marital and family therapy, social work, and education. Used on both the elementary and secondary school levels, the approach has been applied to teaching and administration. The approach is also applicable to crisis intervention, institutional management, and community development. It has found wide application in military clinics that treat alcohol and drug abusers. Applied to group counseling, reality therapy provides a context for group members to explore their wants, needs, and perceptions to determine if what they are doing is helping them satisfy their needs. Once group members get a clearer picture of what they have in their life now and what they want to be different, they are able to use the group in exploring alternative ways of behaving. It is the members, not the leader, who evaluate their own behavior and decide whether or not they want to change. Considerable time in a group is devoted to developing and implementing action plans. Reality therapy focuses on making changes in the present and is an effective, short-term approach to group work.
Philosophy and Basic Assumptions Feminist therapy
Practitioners interpret the basic tenets of therapy in different ways depending on the feminist philosophy they espouse. Currently, there are at least eight basic philosophies underlying feminist practice: liberal, cultural, radical, socialist, postmodern, women of color, lesbian, and global/international. These various philosophies have differing views on the sources of oppression and what is needed to bring about substantial social transformation. All of these theoretical perspectives focus on issues of diversity, the complexity of sexism, and the centrality of social context in understanding gender issues. Feminist therapists have challenged the male-oriented assumptions regarding what constitutes a mentally healthy individual. The underlying philosophy of feminist theory can be described as being gender neutral, flexible, interactional, and life-span-oriented. Feminist therapists emphasize that gender-role expectations profoundly influence our identity from birth onward. Thus, therapy has the task of bringing to one's awareness how gender-role socialization is deeply ingrained in adult personality
Philosophy and Basic Assumptions REBT
REBT assumes that thinking, evaluating, analyzing, questioning, doing, practicing, and redeciding are at the base of behavior change. REBT is a didactic and directive model. Therapy is a process of reeducation. The cognitive behavioral approaches are based on the assumption that a reorganization of one's self-statements will result in a corresponding reorganization of one's behavior.
Limitations REBT CBT
REBT does not provide a rationale for or clear explanation of why one tends to reindoctrinate oneself with irrational beliefs or why one clings to those beliefs. It does not apply to persons with limited intelligence. Possible dangers are the imposition of the therapist's own philosophy on the client and the psychological harm done to the client by the therapist who is overly confrontive or persuasive. Some cognitive behavioral approaches have the limitation of not emphasizing the expression and exploration of emotional issues. Increasingly, contemporary CBT practitioners are emphasizing the interplay of thoughts, feelings, and behaviors. In CBT the focus is on the present, which can result in failing to recognize the role of the past in a client's development. Cognitive behavioral assessments involve the investigation of a client's personal history. If therapists are unaware of a client's cultural beliefs that are rooted in the past, they may have difficulty in interpreting a client's personal experiences accurately.
Contributions REBT
REBT is a comprehensive, integrative approach to therapy that uses cognitive, emotive, and behavioral methods to try to change disturbances in thinking, feeling, and behaving. REBT has shed much light on how people can change their emotions by changing the content of their thinking. It is in many ways the forerunner of other increasingly popular cognitive behavioral approaches.
Techniques and Procedures REBT
Rational emotive behavior therapists are eclectic in that they use a variety of cognitive, affective, and behavioral techniques, tailoring them to individual clients. The approach borrows many methods from behavioral therapy. Cognitive techniques include disputing irrational beliefs, cognitive homework, changing one's language, cognitive role playing, and the use of humor. Emotive techniques include rational emotive imagery, role playing, and shame attacking exercises. Behavioral techniques include operant conditioning, self-management strategies, and modeling. Techniques are designed to induce clients to critically examine their present beliefs and behavior. With respect to techniques and therapeutic style, there are some differences between REBT and cognitive therapy. REBT is highly directive, persuasive, and confrontational.
Limitations REALITY THERAPY/CHOICE THEORY
Reality therapy does not give enough emphasis to feelings, the unconscious, the therapeutic value of dreams, the place of transference in therapy, the effect of early childhood trauma, and the power of the past to influence one's present personality. There is a tendency for this approach to play down the crucial role of one's social and cultural environment in influencing behavior. It may foster a treatment that is based on solving problems and discourage an exploration of deeper emotional issues.
Multicultural Perspectives REALITY THERAPY/CHOICE THEORY
Reality therapy is based on universal principles, which means that it is highly relevant in the area of multicultural counseling. However, reality therapy principles and procedures need to be applied differently in various cultures and must be adapted to the psychological and developmental levels presented by individuals. Reality therapists demonstrate their respect for the cultural values of their clients by helping them explore how satisfying their current behavior is both to themselves and to others. After clients make this assessment for themselves, they identify those problems that present difficulty for them. They are then in a position to formulate realistic plans that are consistent with their cultural values. This type of specificity and the direction that is provided by an effective plan are beneficial in working with diverse client groups
Philosophy and Basic Assumptions REALITY THERAPY/CHOICE THEORY
Reality therapy is grounded on the basic premises of choice theory, which asserts that we are self-determining beings. Because we choose our total behavior, we are responsible for how we are acting, thinking, feeling, and for our physiological states. Choice theory posits that we are not born blank slates waiting to be externally motivated by forces in the external world. A major premise of choice theory is that all behavior is aimed at satisfyingly the needs for survival, love and belonging, power, freedom, and fun. Acting and thinking are chosen behaviors, which should be the focus of therapy. When we change our acting and thinking, we also indirectly influence how we are feeling as well as our physiological state. Choice theory explains how we attempt to control the world around us and teaches us ways to satisfy our wants and needs more effectively
Therapeutic Goals Feminist Therapy
Six goals for feminist therapy have been proposed: equality, balancing independence and interdependence, self-nurturance, empowerment, social change, and valuing and affirming diversity. Feminist therapists believe gender is central to therapeutic practice and that understanding a client's problems requires adopting a sociocultural perspective. A goal of feminist therapy is to empower all people to create a world of equality that is reflected at individual, interpersonal, institutional, national, and global levels. Both individual transformation and societal changes are crucial goals of therapy. At the individual level, therapists work to help women and men recognize, claim, and embrace their personal power. As a consciously political enterprise, another goal is social transformation. The aim is to replace the current patriarchy with a feminist consciousness, thus creating a society that values equality in relationships, that stresses interdependence rather than dependence, and that encourages people to defi ne themselves rather than being defined by societal demands
Multicultural Perspectives Post Modern Approaches
Social constructionism is congruent with the philosophy of multiculturalism. With the emphasis on multiple realities and the assumption that what is perceived to be a truth is the product of social construction, the postmodern approaches are a good fi t with diverse worldviews. Solution-focused therapists learn from their clients about their experiential world, rather than approaching clients with a preconceived notion about their experience. Narrative therapy, which is grounded in a sociocultural context, makes this therapy especially relevant for working with culturally diverse clients. Narrative therapists operate on the premise that problems are identified within social, cultural, political, and relational contexts rather than existing within individuals. They incorporate in their practice factors such as gender, ethnicity, race, disability, sexual orientation, social class, and spirituality and religion. Therapy becomes a place to reauthor the social constructions and identity narratives that clients are finding problematic.
Techniques and Procedures Postmodern Approaches
Social constructionists use a range of techniques, depending on the therapist's orientation. Some therapists ask the client to externalize the problem and focus on strengths or unused resources. Others challenge clients to discover solutions that might work. Their techniques focus on the future and how best to solve problems rather than on understanding the cause of problems
Applications Post Modern Approaches
Solution-focused brief therapy can be applied to individual therapy in a wide array of settings, including inpatient treatment centers, schools, and medical settings. ---The approach has been used to address diverse clinical problems, including substance abuse, depression, sexual abuse, child abuse, and spousal abuse Narrative therapy has been applied to a broad range of human problems, including relationship problems, depression, eating disorders, and problems in childhood and adolescence. ----Narrative ideas are applied in various areas, some of which are school counseling, marital and family therapy, couples therapy, mediation, substance abuse counseling, and clinical supervision Solution-focused brief therapy (SFBT) has many applications for different kinds of counseling groups in various settings. ------Because SFBT is designed to be brief, the counselor has the task of keeping group members on a solution track rather than a problem track. -----Members are assisted in developing small, realistic, and achievable goals as soon as possible. ------Group leaders ask questions from a position of respect, genuine curiosity, sincere interest, and openness. ------They use questions that presuppose change and are both goal-directed and future-oriented. -----SFBT holds a good deal of promise for counselors who want a practical and time-effective approach in both school settings and community agencies. The narrative approach to group counseling also lends itself well to working with children and adolescents in the school setting. ------The narrative emphasis on creating an appreciative audience for new developments in an individual's life lends itself to group counseling
Key Concepts of Narrative Therapy
Some key concepts of narrative therapy include a discussion of how a problem has been disrupting, dominating, or discouraging the person. The therapist attempts to separate clients from their problems so that they do not adopt a fixed view of their identities. Clients are invited to view their stories from different perspectives and eventually to co-create an alternative life story. Clients are asked to find evidence to support a new view of themselves as being competent enough to escape the dominance of a problem and are encouraged to consider what kind of future could be expected from the competent person that is emerging
Contributions Family therapy
The main contribution of a family systems approach is the inclusion of all parts of the system rather than being limited to the "identified patient." A major strength of most systemic approaches is that neither the individual nor the family is blamed for a particular dysfunction. Instead of a blaming stance, the entire family has an opportunity to (a) examine the multiple perspectives and interactional patterns that characterize the unit and (b) participate in finding solutions. Because an individual's problems are relational, it makes sense to focus on all of the interactions and external factors that impinge on the person. A systems perspective recognizes that individuals and families are affected by external forces and systems such as illness, shifting gender patterns, culture, and socioeconomic considerations. If change is to occur in families or with individuals, therapists must be aware of as many systems of influence as possible. Given the larger systems in which families are embedded, a multilayered approach to family therapy is essential.
Key Concepts REALITY THERAPY/CHOICE THEORY
The main idea is that behavior is our attempt to control our perceptions of the external world so they fit our internal and need-satisfying world. Total behavior includes four inseparable but distinct components of acting, thinking, feeling, and the physiology that accompanies all our actions. Although we all possess the same five human needs, each of us fulfills them differently. We develop an inner "mental picture album" (or quality world) of wants, which contains precise images of how we would best like to fulfill our needs. A core principle of reality therapy/choice theory is that no matter how dire the circumstances, people always have a choice. The emphasis of reality therapy is on assuming personal responsibility and on dealing with the present. Reality therapy rejects the
Therapeutic Goals REALITY THERAPY/CHOICE THEORY
The overall goal of this approach is to help people find better ways to meet their needs for survival, love and belonging, power, freedom, and fun. Reality therapists assist clients in making more effective and responsible choices related to their wants and needs. Changes in behavior should result in the satisfaction of basic needs. Other goals besides behavioral change include personal growth, improvement, enhanced lifestyle, and better decision making. Therapists help clients gain the psychological strength to accept personal responsibility for their lives and assist them in learning ways to regain control of their lives and to live more effectively. Clients are challenged to examine what they are doing, thinking, and feeling to figure out if there is a better way for them to function. Clients are assisted in evaluating their own behavioral direction, specific actions, wants, perceptions, level of commitment, possibilities for new directions, and action plans. The therapist does not determine what behaviors clients should change. Rather, clients make this decision and then formulate a plan to facilitate desired changes
Techniques and Procedures REALITY THERAPY/CHOICE THEORY
The practice of reality therapy can best be conceptualized as the cycle of counseling, which consists of two major components: (1) the counseling environment and (2) specific procedures that lead to change in behavior. These procedures are based on the assumption that human beings are motivated to change (1) when they determine that their current behavior is not getting them what they want (2) when they believe they can choose other behaviors that will get them closer to what they want. Some of the specific procedures in the practice of reality therapy are summarized in the "WDEP" model, which refers to the following clusters of strategies: W = wants: exploring wants, needs, and perceptions. D = direction and doing: focusing on what clients are doing and the direction that this is taking them. E = evaluation: challenging clients to make an evaluation of their total behavior. P = planning and commitment: assisting clients in formulating realistic plans and making a commitment to carry them out
solution-focused approach Technique
The solution-focused approach represents a different perspective from most of the traditional therapy models with respect to thinking about and doing brief therapy. A number of solution-focused brief therapy techniques are frequently used, including pretherapy change, exception questions, the miracle question, scaling questions, homework, and summary feedback. ■ Pretherapy change involves asking clients at the first session, ---"What have you done since you called for an appointment that has made a difference in your problem?" ---Asking this question tends to encourage clients to rely less on the therapist and more on their own resources to reach their goals. ■ Exception questions direct clients to those times in their lives when their problems did not exist. ---The therapist asks clients what has to happen for these exceptions to occur more often. Exploring exceptions offers clients opportunities for evoking resources, engaging strengths, and creating possible solutions. ---Illustrations of questions looking for exceptions are: --------"When was the last time that things were better? Talk about times when things were going well for you? What were you doing then? What are some things that you have done that helps with your problem? How will you know when you are handling your problem well?" ■ The miracle question allows clients to describe life without the problem. ---This question involves a future focus that encourages clients to consider a different kind of life than one dominated by a particular problem. ---The miracle question focuses clients on searching for solutions. ---Examples are: "How will you know when things are better? What will be some of the things you will notice when life is better?" ■ Scaling questions require clients to specify, on a scale of zero to 10, improvement on a particular dimension. ---------This technique enables clients to see progress being made in specific steps and degrees. ■ Homework often consists of asking clients to observe events that they would like to see occur more frequently in the future. ■ Summary feedback involves the therapist pointing out particular strengths that clients have demonstrated
Therapeutic Goals Postmodern Approaches
The solution-focused model emphasizes the role of clients establishing their own goals and preferences. This is done when a climate of mutual respect, dialogue, inquiry, and affirmation are a part of the therapeutic process. Working together in a collaborative relationship, both the therapist and client develop useful treatment goals. Through the use of the miracle question, solution-focused therapists help clients identify goals and potential solutions. The heart of the therapeutic process from the postmodern perspectives involves identifying how societal standards and expectations are internalized by people in ways that oftentimes constrain and narrow the kind of life they are capable of living. The general theme of narrative therapy is to invite clients to describe their experience in fresh language, which tends to open up new vistas of what is possible.
Techniques and Procedures Family Therapists
The techniques and procedures family therapists employ are best considered in conjunction with their personal characteristics. Although techniques are tools for achieving therapeutic goals, these intervention strategies do not make a family therapist. Personal characteristics such as respect for clients, compassion, empathy, and sensitivity are qualities that influence the degree to which techniques are effective. Faced with meeting the multiple demands of clinical practice, family therapists need to be flexible in selecting intervention strategies. An integrative approach to the practice of family therapy includes guiding principles that help the therapist organize goals, interactions, observations, and ways to promote change. Certain family systems therapy models focus on perceptual and cognitive change, others deal mainly with changing feelings, and still other theories emphasize behavioral change. For any theoretical orientation that a family therapist operates from, change needs to happen relationally, not just intrapsychically. Regardless of the theoretical orientation therapists assume, it is critical for them to be aware of their values and monitor how these values influence their practice with families.
Therapeutic Relationship Feminist Therapy
The therapeutic relationship is based on empowerment, deliberately equalizing the power base between client and therapist. Empowerment and egalitarianism are guiding principles. The structure of the client-therapist relationship models how to identify and use power responsibly. Emphasis is given to mutuality, or a condition of authentic connection between client and therapist. The therapist works to demystify therapy and to include the client as an active partner in the assessment and treatment process. The process of feminist therapy begins with the informed consent process, which establishes a framework that is egalitarian. Collaboration with the client in all aspects of therapy leads to a genuine partnership with clients. Therapists teach clients to recognize that how they define themselves and how they relate to others are inevitably influenced by gender-role expectations
Therapeutic Relationship REALITY THERAPY/CHOICE THEORY
The therapist initiates the therapeutic process by becoming involved with the client and creating a warm, supportive, and challenging relationship. Clients need to know that the therapist cares enough about them to accept them and to help them fulfill their needs in the real world. Both involvement with and concern for the client are demonstrated throughout the entire process. Once this involvement has been established, the counselor confronts clients with the reality and consequences of their actions. Throughout therapy the counselor avoids criticism, refuses to accept clients' excuses for not following through with agreed-on plans, and does not easily give up on clients. Instead, therapists assist clients in the continual process of evaluating the effectiveness and appropriateness of their current behavior.
primary intervention strategies associated with the various schools of family therapy
There is a diversity of techniques, depending on the therapist's theoretical orientation, and a considerable degree of flexibility in applying them, even among practitioners within a school. Family therapists tend to be active, directive, oriented toward the solution of problems, and open to using techniques borrowed from various approaches. Here are some of the primary intervention strategies associated with the various schools of family therapy. ■ Adlerian family therapists employ techniques such as family constellation, reporting of a typical day, goal disclosure, and logical consequences. ■ Multigenerational family therapy focuses on asking questions, tracking interactional sequences, assigning homework, and educating. ■ Throughout Satir's use of the human validation process model, various techniques are used to facilitate enhanced interpersonal communication within the family, a few of which are drama, reframing, humor, touch, family reconstruction, role playing, family life-fact chronology, and family sculpture. ■ Experiential family therapists utilize themselves as their best therapeutic technique, creating interventions that grow out of the phenomenological context in working with a family. ■ Structural family therapists engage in tracking transactional sequences, reframing, issuing directives, joining and accommodating a family, restructuring, and enactment. ■ Strategic therapists utilize reframing, directives, and paradoxical interventions, and they also track interactional sequences
Contributions CT
With respect to cognitive therapy, Beck has made pioneering efforts in the treatment of anxiety, phobias, and depression, and this approach has received a great deal of attention by clinical researchers. He developed specific cognitive procedures that are useful in challenging a depressive client's assumptions and beliefs and in teaching clients how to change their thinking.
