Counseling - Final Exam Review
REBT (Rational Emotive Behavior Therapy)
Parent of today's cognitive behavioral approaches (but credit given to Adler, and Horney)
Albert Ellis Rational Emotive Therapy (RET)
People contribute to their own psychological problems by the rigid beliefs they hold about events and situations
Feminist THerapy
Perspective on Personality Development - emphasize societal gender-role expectations profoundly influence a person's identity from the moment of birth, or even prior to birth once the sex is identified, and become deeply ingrained in adult personality. Gillian recognized that theories of moral development were based almost exclusively on research with White males. Relational-cultural theory (RCT) - have elaborated on the vital role that relationships and connectedness with others play in the lives of women.
Solution Focused Brief Therapy
Positive Orientation - grounded on the optimistic assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives Positive psychology - concentrates on what is right and what is working for people rather than dwelling on deficits, weaknesses, and problems. Emphasizing positive dimensions, clients become involved in resolving their problems, which makes this an empowering approach.
CT/RT
Practice of Reality Therapy characterized as the "cycle of counseling" and has 2 major components. 1. Creating the counseling environment 2. Implementing specific procedures that lead to changes in behavior The art of counseling is to weave these components together to lead clients to evaluate their lives and decide to move int he more effective directions.
CT/RT
Procedures that lead to change Reality therapists operate on the assumption that we are motivated to change: 1. When we are convinced that our present behavior is not meeting our needs and 2. When we believe we can choose other behaviors that will get us closer to what we want. Begin by asking clients what they want from therapy. Wubbolding teaches that clients are not at the mercy and are not victims, and can get a better sense of inner control
SFBT
Scaling questions - used when change in human experiences are not easily observed, such as feelings, moods, or communication, and to assist clients in noticing that they are not completely defeated by their problem. On a scale of 1-10, with zero being how you felt when you first came and 10 being how you feel the day after your miracle occurs and your problem is gone, how would you rate your anxiety right now?
REBT - Therapist's Function and Role
Second step is to demonstrate how the clients are keeping their emotional disturbances active by continuing to think illogically and unrealistically. We are responsible for our own emotional destiny
Generic Cognitive Model
Several common cognitive distortions Arbitrary inferences - conclusions drawn without supporting evidence "catastrophizing" Selective abstraction - forming conclusions based on an isolated detail of an event while ignoring other information Over generalization - process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. Magnification and minimization - consist of perceiving a case or situation in a greater or lesser light than it truly deserves. Personalization - tendency for individuals to relate external events to themselves, even when no basis for making this connection Labeling and mislabeling - involve portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity. Dichotomous thinking - involves categorizing experiences in either-or extremes. Polarized thinking.
Cognitive Therapy
Similarities to REBT, and BT: active, directive, time-limited, present-centered, problem-oriented, collaborative, structured, and empirical. Include homework assignments and require clients to explicitly identify problems and situation in which they occur.
Postmodern Approaches
Socially storied lives, collaboration of the knower with the known Best known postmodern approaches are solution focused brief therapy, solution -oriented therapy, narrative therapy, and feminist therapy.
REBT - Therapist's Function and Role
Third step is to help clients change their thinking and minimize their irrational ideas.
REBT
"People are disturbed not by events, but by the views which they take of them"
CT/RT
"The only person you can control is yourself" Emphasize choice and responsibility-deal with people "as if" they have choices, focus on areas where there are choices Reject Transference-therapists strive to be themselves and use the relationship to teach clients how to relate to others in their lives. Glasser believes transference allows both parties to avoid being who they are and owning what they are doing Keep the therapy in the Present- whatever mistakes were made in the past are not pertinent now, the past is not the problem even if it contributed to the problem, need to live and plan in the present to fix the future, "history is not destiny" Wubbolding. Avoid Focusing on Symptoms - spend as little time on symptoms bc the symptoms will only last as long as they are needed to deal with the unsatisfying relationship or frustration of basic needs. Challenge traditional views of mental illness - rejects notion that people with problematic physical and psychological symptoms are mentally ill. Wubbolding takes a firm stand on using DSM5 in creative ways and adhering to standard practice, which includes diagnosing mental disorders. Glasser warned to be cautious of psychiatry which can be hazardous and criticizes the traditional psyc establishment for relying on the DSM 5
REBT - Three Basic Musts
1. I must do well and be loved and approved by others 2. Other people must treat me fairly, kindly, and well. 3. The world and my living conditions must be comfortable providing me what I want in life
REBT - Emotive Techniques
1. Rational emotive imagery 2. Humor 3. Role playing 4. Shame-attacking exercises
Feminist Therapy
A feminist perspective offers a unique approach to understanding the roles that women and men with diverse social identities and experiences have been socialized to accept and to bringing this understanding into the therapeutic process. Socialization of women with multiple social identities affects their identity development, self-concept, goals and aspirations, and emotional well-being. Socialization results in women giving away their power often without realizing it. Feminist counseling keeps knowledge about gender socialization , sexism and other isms in mind in the work with all. Ethnicity or race may be a bigger deal than gender.
Strengths Based CBT
After reasons for therapy are described and explored, the therapist expresses an interest in positive aspects of the client's life. Therapists then help clients develop and construct new positive ways of interacting in the world. For clients resistant to change, SB-CBT proposes that it is easier to construct an entirely new way of doing things then to problem solve or modify a chronic way of doing things. 4 step model to build resilience 1. Search 2. Construct 3. Apply. 4. Practice.
REBT (Rational Emotive Behavior Therapy)
Based on assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship
Solution focused brief therapy
Basic assumptions guiding practice: 1. Individuals who come to therapy do have the capability of behaving effectively, even though this effectiveness may be temporarily blocked by negative cognitions. 2. Thera are advantages to a positive focus on solutions and on the future. If clients can reorient themselves in the direction of their strengths using solution-talk, there is a good chance therapy can be brief. 3. There are exceptions to every problem, or times when the problem was absent. 4. Clients often present only one side of themselves. SFT invite clients to examine another side of the story 5. No problem is constant, and change is inevitable. People need to become aware of any positive changes that are happening. 6.. clients are doing their best to make change happen 7. Clients can be trusted in their intention to solve their problems
Cognitive Therapy
Beck developed specific treatment protocols for each problem. Generic Cognitive Model - to describe principles that pertain to all CT applications from depression and anxiety treatments to therapies for a wide variety of other problems including psychosis and substance use. Linking psychological difficulties with adaptive human responses, beck believes the GCM has the potential to be the only empirically supported general theory of psychopathology. GCM provides comprehensive framework for understanding psychological distress.
Cognitive Therapy
Beck's research indicated that depression could result from negative thinking, but could also be precipitated by genetic, neurobiological, or environmental changes. Beck's early contribution was to recognize that regardless of the cause of depression, once people became depressed, their thinking reflected the "negative cognitive triad"; negative views of the self (self-criticism) the world (pessimism,) and the future (hopelessness). This triad maintained depression, even when negative thoughts were not the original cause of an episode of depression.
Cognitive Therapy
CT is based on the theoretical rationale that the way people feel and behave is influenced by how they perceive and place meaning on their experience. 1. People's thought processes are accessible to introspection 2. People's beliefs have highly personal meanings 3. People can discovery these meanings themselves rather than being taught or having them interpreted by the therapist.
Basic Principles of Cognitive Therapy
CT perceives psych problems as an exaggeration of adaptive responses resulting from commonplace cognitive distortions. Like REBT, CT is an insight focused therapy with a strong psychoeducational component that emphasizes recognizing and changing unrealistic thought and maladaptive beliefs. CT is highly collaborative and involves designing specific learning experiences to help clients understand the links between their thoughts, behaviors, emotions, physical responses, and situations. The goal of CT is to help clients learn practical skills that they can use to make changes in their thoughts, behaviors, and emotions and how to sustain those changes over time. In CT, clients learn how to identify their dysfunctional thinking. Once they identify cognitive distortions, they are taught to examine and weight the evidence for and against them. Process of critically examining thoughts involves empirically testing them by looking for evidence, actively engaging in a Socratic dialogue with the therapist, carrying out homework assignments, doing behavioral experiments, gathering data on assumptions made, and forming alternative interpretations. Clients learn to employ specific problem-solving and coping skills. CT therapy is focused on present problems, regardless of a client's diagnosis. The past is only brought in if it is essential to understand when core DYS beliefs originated. Goals include symptom relief, assisting clients in resolving their most pressing problems, changing beliefs and behaviors that maintain problems, and teaching clients skills that serve as relapse prevention strategies.
REBT ABC Framework
Central to REBT theory and practice. Tool for understanding the client's feelings, thoughts, events, and behavior. A=existence of an Activating event or Adversity, or an inference about an event by an individual B=person's belief about A, largely creates C, the emotional reaction C=the emotional and behavioral consequence or reaction of the individual, the reaction can be healthy or unhealthy Ex. If a person is depressed about divorce, it may not be the divorce that is causing the depression, or inference he has failed, but the beliefs about his failure. So beliefs about the rejection and failure cause the depression
SFBT
Characteristics of Brief Therapy Rapid working alliance between therapist and client Clear specification of achievable treatment goals Clear division of responsibilities between client and therapist, with active client participation and a high level of therapist activity Emphasis on client's strengths, competencies, and adaptive capacities Expectation that change is possible and realistic and that improvement can occur in the immediate future Here-and-now orientation with a primary focus on current functioning in thinking, feeling and behaving Specific, integrated, pragmatic and eclectic techniques Time sensitive, including making the most of each session and ending therapy as soon as possible CORE TASK - learn how to rapidly and systematically identify problems, create a collaborative relationship with clients, and intervene with a range of specific methods. Because most therapy is time limited, therapist should learn to practice brief therapy well
Choice theory/Reality Therapy
Choice theory explains that all we ever do from birth to death is behave, and everything we do is chosen or at least generated from within ourselves. "Total Behavior" teaches that all behavior is made up of four inseparable but distinct components 1. Acting 2. Thinking 3. Feeling 4. Physiology That accompany all of our actions, thoughts and feelings. CH T emphasizes thinking and acting. People are "depressing, head aching, anxietying". People choose misery by developing a range of "paining" behaviors that often get them what they want.
Choice Theory/Reality Therapy
Choice theory posits that we are not born blank slates waiting to be externally motivated by forces in the world around us. We are born with 5 genetically encoded needs that drive us all our lives: 1. Survival or self-preservation 2. Love and belonging 3. Power or inner control 4. Freedom 5. Fun or enjoyment When we feel bad, one of these needs is unsatisfied. Choice theory is based on the premise that because we social creatures that we need to both receive and give love. Glasser believes that the need to love and to belong is the primary need because we need people to satisfy the other needs. It is also the most difficult need to satisfy bc we must have a cooperative person to help us meet it.
Choice Theory/Reality Therapy
Choice theory teaches that we do not satisfy our needs directly. We store information of what we do that feels good in our minds and build a "quality world" which is at the core of our life. It is completely based on our wants and needs, but unlike the needs, it is very specific. The QW consists of specific images of people, activities, events, beliefs, possessions, and situations that fulfill our needs. We have an inner "picture album" of specific wants and ways to satisfy those wants. People we are closest to and enjoy being with are the most important component of our quality world. Therapists needs to get into the QW.
Strengths Based CBT
Christine Padesky and Kathleen Mooney Variant of Beck's cognitive therapy. All the principles and evidence-based treatments developed by Beck are incorporated in Strengths-Based CBT. Main idea is that active incorporation of client strengths encourages clients to engage more fully in therapy and often provides avenues for change that otherwise would be missed. Expands CBT to include methods that help people develop positive qualities. These ideas developed in parallel with positive psychology.
CBM
Clients must notice 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 they can evaluate their behavior in various situations
REBT ABC Framework
D=disputing, which encompasses methods that help clients challenge their irrational beliefs. Three components are detecting, debating and discriminating. Clients learn to discriminate irrational (self-defeating) beliefs from rational (self-helping) beliefs. Once they can Detect irrational beliefs, particularly "shoulds" and "musts", "awfulizing" and "self-downing", clients Debate dysfunctional beliefs by logically, empirically, and pragmatically questioning them. E= effective philosophy - clients are encouraged to develop a new effective philosophy to replace unhealthy irrational thoughts with healthy rational ones.
REBT (Rational Emotive Behavior Therapy)
Consistently emphasizes all 3 modalities making it holistic and integrative approach
Feminist Therapy
Constructs of feminist theory as being gender fair, flexible-multicultural, interaction isn't, and life-span-oriented. "Gender-fair approaches" - explain differences in the behavior of women and men in terms of socialization processes rather than on the basis of our "innate" natures, thus avoiding stereotypes in social roles and interpersonal behavior. "Flexible-multicultural perspective" uses concepts and strategies that apply equally to individuals and groups regardless of age, race, culture, gender, ability, class, or sexual orientation. The "interactionist" view contains concepts specific to the thinking, feeling, and behaving dimensions of human experience and accounts for contextual and environmental factors. "Life-span" perspective assumes that human development is a lifelong process and that personality and behavioral changes can occur at anytime rather than being fixed during early childhood.
Feminist Therapy
Core principles: 1. The personal is political and critical consciousness 2. Commitment to social change 3. Women's and girls voices and ways of knowing, as well as the voices of others who have experienced marginalization and oppression, 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 along with the connections among them
Aaron Beck's Cognitive Therapy
Developed cognitive therapy about the same time that Ellis was developing REBT. They were not aware of each other's work and created their approaches independently. CT was based on empirical research. CT emphasizes education and prevention but uses specific methods tailored to particular issues.
Cognitive Behavior Modification
Donald Meichenbaum
REBT - Blame
Ellis asserted that blame can be at the core of many emotional disturbances. If we want to be psychologically healthy, we have to stop blaming ourselves and others and learn to unconditionally accept ourselves despite our imperfections
REBT - Application to Brief Therapy/Group Counseling
Ellis developed REBT to make psychotherapy more efficient than other systems of therapy. Best and most effective technique teachers clients to tackle present as well as future problems. REBT is well-suited for brief therapy Cognitive behavior therapy groups (CBT) are among the most popular treatments in clinics and community agencies. In group therapy, REBT members are taught how to apple REBT to one another. Group members: learn how their beliefs influence what they feel and what they do, explore ways to change self-defeating thoughts and to learn to minimize symptoms through a profound change in philosophy. Group provides lots of opportunities to work on assertiveness skills, and take risks practicing behaviors, learn from others, interact socially with others.
REBT (Rational Emotive Behavior Therapy)
Ellis hypothesizes that we have strong tendencies to transform our tendencies, desires, and preferences into "shoulds, oughts, and musts" demands and commands.
Strengths Based CBT
Empirically based; 1. Therapist should be knowledgeable about evidence-based approaches pertaining to client issues in therapy 2. Clients are asked to make observations and describe the details of their life experiences so what is developed in therapy is based in the real data of client's lives and 3. Therapist and clients collaborate in testing beliefs and experimenting with new behaviors to see if they help achieve desired goals
Cognitive Therapy
Evidence-based CT approaches were developed for depression, panic disorder, social anxiety, phobias, post traumatic stress disorder, schizophrenia, and other psychotic disorders, hypochondriasis, body dysmorphic disorder, eating disorders, insomnia, anger issues, stress, chronic pain and fatigue and distress due to general medical problems like cancer.
Feminist Therapy
Feminist aim to empower all people to create a world of equality that is reflected at individual, interpersonal, institutional, national, and global levels. Making oppression transparent is the first step but the ultimate goal is to replace sexism and other forms of discrimination and oppression with empowerment for all marginalized groups. Feminist counseling strives for transformation for both the individual client and society as a whole.
Feminist therapy
Feminist therapy is based firmly in feminist philosophy that centralizes the sociocultural context of client's mental health status Feminist therapists have shared assumptions about therapy but they come from diverse backgrounds and have lived experiences that may affect how techniques are applied as well as how clients are conceptualized. Integrated feminism, multiculturalism and other social justice perspectives into their approach to therapy and into their lives. Feminists share common ground with Adlerian therapists in their emphasis on social equality and social interest and with existential therapists who emphasize therapy as a shared journey. Relationship is person to person, not hierarchy.
Choice Theory/Reality Therapy
Glasser maintained that clients should not be labeled with a diagnosis except when it is necessary for insurance purposes. Diagnoses are descriptions of the behaviors people choose in their attempt to deal with the pain and frustration that is endemic to their unsatisfying present relationships and labeling these ineffective behaviors as mental illness is inaccurate. Glasser limits the term mental illness to conditions such as Alzheimer's disease, epilepsy, head trauma, and brain infections.
CT/RT
Goal is to get client reconnected with people they have chosen to put in their QW, learn better ways of fulfilling all of their needs, including achievement, power or inner control, freedom or independence and fun. Therapist is the teacher and client is the student. "How would you most like to change your life?"
REBT - Therapist's Function and Role
First step is to show clients how they have incorporated many irrational "shoulds", "oughts", and "musts" in their thinking. Therapist disputes irrational belief and encourages clients to engage in activities that will counter their self-defeating beliefs and replace "musts" with preferences
CBM
Focuses on changing the client's self talk. Self statements affect a person's behavior in much the same way as statements made by another person
Postmodern Approaches
Forms of language and use of language in stories create meaning; there may be as many meanings as there are people to tell the stories, and each of these stories expresses a truth fo the person telling it Every person involved in a situation has a perspective on the "reality" of the situation, but the range of truths is limited due to the effects of specific historical events in social constructionism, the therapist disavows the role of expert, preferring a more collaborative or consultative stance. Clients are viewed as experts about their own lives. The collaborative partnership is more important than assessment or technique. Understanding narratives and deconstruction language processes are the focus for understanding individuals and helping them construct desired change. SC theory is grounded on the premise that knowledge is constructed through social processes. What we consider to be "truth" is a product of interactions between people in daily life.
SFBT
Formula First Session Task - form of homework a therapist might give clients to complete between their first time and second sessions. "Between now and the next time we meet, i would like you to observe, so you can describe to me next time, what happens in your ______ that you want to continue to have happen. NOT IF CHANGE WILL OCCUR BUT WHEN
REBT Therapist's Function and Role
Fourth Step is to strongly encourage clients to develop a rational philosophy of life so that in the future they can avoid hurting themselves again by believing other irrational beliefs.
Solution-Focused Brief Therapy
Future focused, goal oriented therapeutic approach to brief therapy developed by Steve de Shazer and Insoo Kim Berg. SFBT emphasizes strengths and resiliencies of people by focusing on exceptions to their problems and their conceptualized solutions. SFBT is an optimistic, antideterministic, future-oriented approach based on the assumption that clients have the ability to change quickly and can create a problem-free language as they strive for a new reality.
Feminist Therapy
History is relatively brief and no single individual can be identified as the founder of this approach, reflecting collaboration by feminist therapists who wanted improved mental health treatment for women. Therapy is a partnership between equals and built mutuality and collaboration in to the process. Therapy needed to focus on understanding the social, political and cultural forces in society that damage, oppress, and constrain girls and women, as well as boys and men.
Applications of CT
Initially used to treat depression , but extensive research has been devoted to the study and treatment of many other psychiatric disorders. Popularity is due to "strong empirical support for its theoretical framework and to the large number of outcome studies with clinical populations" Successful in treating depression, anxiety disorders, cannabis dependence, hypochondriasis, body dysmorphic disorder, eating disorders, anger, schizophrenia, insomnia, and chronic pain, suicidal behavior, borderline personality, narcissistic personality disorders, substance abuse, medical illness, crisis intervention, couples and families therapy, child abusers, divorce counseling, skills training, and stress management. Also used with children and adolescents
Postmodern Approaches
Introduction to Social Constructionism - SC is a psychological expression of this postmodern worldview; it values the client's reality without disputing whether it is accurate or rational.. —any understanding of reality is based on the use of language is largely a function of the situation in which people live. Our knowledge about realities is socially constructed. A person is depressed when he adopts a definition of self as depressed. Once a definition of self is adopted, it is hard to recognize behaviors counter to that definition .
SFBT
MIRACLE QUESTION: Therapy goals are developed by using what de Shazer calls the MIRACLE question, which is a main SFBT technique "If a miracle happened and the problem you have was solved overnight, how would you know it was solved, and what would be different?" Clients are then asked to enact the what would be different in spite of perceived problems. If a client says they want to feel more confident and secure, the therapist might say "if you leave your office today and you are on trac to acting more confidently and securely, what will you be doing differently?"
Feminist Therapy
Jean Baker Miller, Carol Zerbe Enns, Olivia M. Espin, Laura S. Brown
SFBT
KEY TECHNIQUES: Pretherapy change: simply scheduling an appointment sets positive change in motion Exception Questions: there were times in clients lives when the problems they identify were not problematic. These times are called EXCEPTIONS and represent "news of difference". Solution-focused therapists ask exception questions to direct clients to times when the problem did not exist, or when the problem wasn't as bad. Exceptions are those past experiences when it would reasonable to have expected the problem to occur, but somehow it did not.
Narrative Therapy
Key Concepts: Focus of NT - the therapist is encouraged to establish a collaborative approach with a special interest in listening respectfully to client's stories, search for times in lives when they were resourceful, and to use questions as a way to engage clients and ease exploration, avoid diagnosing and labeling clients, assisting clients in mapping the influence a problem has had on their lives and to assist clients in separating themselves from dominant culture stores they have internalized. The Role of Stories - problems are manufactured in social, cultural and political contexts. We live our lives by the stories we tell about ourselves and that other tell about us. Our stories shape reality and construct and constitute what we see, feel and do. Stories grow out of our conversations in a social and cultural context. Change occurs by exploring how language is used to create and maintain problems. Therapy clients have vivid stories to recount. Listening with an Open Mind- all constructionist theories emphasize learning without judgment or blame, affirming and valuing them. Narrative practice goes further in deconstructing the systems of normalizing judgment that are found in medical, psych and educational discourse. "Normalizing judgment" is any kind of judgment that puts a person on a normal curve and are usually internalized. DON'T USE Normalizing Judgment Separate the person from the problem "double listening"
REBT
Large part of therapy is "educational process" where therapist functions and the teacher, collaborating with client on homework assignments and introducing strategies for constructive thinking.
REBT - Therapeutic Goals
Lead toward clients minimizing emotional disturbances and self-defeating behaviors by acquiring a more realistic, workable and compassionate philosophy of life. Collaborative effort between therapist and client to choose realistic and life-enhancing goals Therapist task was to help clients differentiate between realistic and unrealistic goals and also between self-defeating and life-enhancing goals. Teach clients how to change dysfunctional emotions in to healthy ones. Assist clients in the process of achieving "unconditional self acceptance (USA)", "unconditional other-acceptance (UOA)", and "unconditional life acceptance (ULA) "Life has inevitable suffering as well as pleasure" - Ellis
Solution-Focused Brief Therapy
Looking for what is working - focus on what is working in a clients life
Feminist Therapy
Majority of clients in counseling are women and practitioners at master's level are women, but most theories that are traditionally taught, were founded by white males from western cultures which only Adler taking a pro-feminist stance in early theory development. Feminist therapists have challenged male-oriented assumptions regarding what constitutes a mentally healthy individual. Early efforts focused on valuing women's experiences, recognizing political realities, and understanding the unique issues facing women within a patriarchal system. Contemporary practice keeps the impact of gender socialization in the forefront and has a diverse approach that includes an understanding of multiple oppressions, power, privilege, multicultural competence, social justice, and oppression of all marginalized people. Gender cannot be considered apart from other identities related to race, ethnicity, socioeconomic class, age and sexual orientation. The contemporary version and the multicultural and social justice perspectives to counseling have a great deal in common and want for social change not just individual change.
CBM
Meihenbaum's self-instructional training focuses more on helping clients become aware of their self-talk and the stories they tell about themselves. Meich suggests it is easier and more effective to change our behavior rather than our thinking. Emotions and thinking are two side of the same coin. Therapeutic process consists of teaching clients to make self-statements and training clients to modify the instructions they give to themselves so that they can cope more effectively with the problems "cognitive restructuring". "Behavior change occurs through a sequence of mediating processes involving the interaction of inner speech, cognitive structures, and behaviors and their resultant outcomes"
Narrative Therapy
Michael White and David Epston (1990) developed a form of therapy based on each individual's personal narrative. The personal narrative metaphor is the story that defines and organizes each individual's life and relationship with the world. As we live and accumulate experiences, we each develop a personal story or narrative that gives our lives meaning and continuity. Much like a well-written story, our personal narrative includes an organized plot, characters, points of tension and climax, and a beginning, middle, and end. White and Epston are best known for their use of narrative in therapy. Individuals construct the meaning of life in interpretive stories which are then treated as the "truth". Because of the power of dominant culture narratives, individuals tend to internalize the messages with work against life opportunity.
Generic Cognitive Model
Our beliefs play a major role in determining what type of psychological distress we will experience. - each emotional and behavioral disorder is accompanied by beliefs specific to that problem. Central to CT is the empirically supported observation that "changes in beliefs lead to changes in behaviors and emotions" - if the students in the previous example can change the way they think about not being accepted to their first choice, their depression and anxiety are likely to be lessened. If beliefs are modified, clinical conditions are likely to reoccur - even without counseling or a change in beliefs, people often recover from feelings of depression or anxiety and return to their usual healthy functioning.
Feminist Therapy
Multicultural and social justice issues are equally relevant to the therapeutic enterprise, and feminist counseling puts intersections of gender and other social identities, social location, and power at the core of the therapeutic process. Feminist counseling is built on the premise that it is essential to consider the social, cultural and political context that contributes to a person's problems in order to understand that person. Feminist psychotherapy is a philosophical orientation that lends itself to an integration of feminist, multicultural, and social justice concepts with a variety of psychotherapy approaches. Central concept is is the importance of understanding and acknowledging psychological oppression and constraints imposed by the sociopolitical status to which women, underrepresented, and marginalized individuals have been relegated.
REBT
Multimodal and integrative. Uses cognitive, emotive, behavioral, and interpersonal modalities to dispel self-defeating cognitions and to teach people how to acquire a rational approach to living. Therapists are flexible and creative in use of methods, tailoring techniques to unique needs of each client.
Family Systems
Murray Bowen (multigenerational family therapy) Virginia Satir (conjoint family therapy, a human validation process model) Family therapy movement began in the 1940's During the 1950's, systemic family therapy began to take root (considered a revolutionary approach to treatment 1960's - 1970's - psychodynamic, behavioral, and humanistic approaches (called the first, second, and third force, respectively) dominated counseling and psychotherapy. Today, the various approaches to family systems represent a paradigm shift that we might even call the "fourth force". Family systems therapy is represented by a variety of theories and approaches, all of which focus on the relational aspects of human problems.
CBM - Stress Inoculation training
Psychological and behavioral analog to immunization. Individuals are given opportunities to deal with mild stress in successful ways and gradually develop a tolerance for stronger stimuli. 1. Expose clients to anxiety-provoking situations by means of role playing and imagery 2. Require clients to evaluate their anxiety level 3. Teach clients to become aware of the anxiety-provoking cognitions they experience in stressful situations 4. Help clients examine those thoughts by reevaluating their self-statements 5. Have clients note the level of anxiety following this reevaluation Phases of SIT 1. Conceptual-educational phase-creating alliance with therapist 2. Skills acquisition and consolidation phase-giving clients a variety of behavioral and cognitive coping skills to apply to stressful situations 3. Application and follow-through phase - carefully arranging for transfer and maintenance of change to everyday life.
Generic Cognitive Model
Psychological distress can be thought of as an exaggeration of normal adaptive human functioning.-disorder begins when these normal emotions and behaviors become disproportionate to life events in degree or frequency. Ex. When a person begins to worry most of the time, even about situations that most people take in stride, that person is showing signs of generalized anxiety disorder. Faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioral reactions. - our thinking is directly connected to our emotional reactions, behaviors, and motivations. When we think about things in erroneous or distorted ways, we experience exaggerated or distorted emotional and behavioral reactions as well.
Some Differences Between CT and REBT
REBT is highly directive, persuasive, and confrontational, and the teaching role of the therapist is emphasized. The therapist models rational thinking and helps clients to identify and dispute irrational beliefs. In contrast, CT uses Socratic dialogue, posing open-ended questions to clients with the aim of getting clients to reflect on personal issues and arrive at their own conclusions. CT places more emphasis on helping clients identify misconceptions for themselves rather than being taught. Through reflective questioning, the CT therapist collaborates with clients in testing the validity of their cognitions "collaborative empiricism". Therapeutic change is the result of clients reevaluating faulty beliefs based on contradictory evidence they have gathered Also differences in the way Beck and Ellis view faulty thinking... Ellis works to persuade clients that certain of their beliefs are irrational and dysfunctional. Beck views his clients distorted beliefs as being the result of cognitive errors rather than being driven solely by irrational beliefs. Beck asks clients to conduct behavioral experiments to test the accuracy of their beliefs. Beck believes that people live by "rules" (underlying assumptions), they get into trouble when they label, interpret and evaluate by a set of rules that are unrealistic or when they use rules inappropriately or excessively.
REBT - Cognitive Methods
REBT usually incorporates a persuasive cognitive methodology into therapy process. They demonstrate to clients what is it they are continuing to tell themselves, then challenge these self-statements so they no longer believe them, and acquire a philosophy based on facts. REBT relies heavily on thinking, disputing debating, challenging, interpreting, explaining, and teaching. 1. Disputing Irrational beliefs 2. Doing cognitive homework 3. Bibliotherapy 4. Changing one's language 5. Psychoeducational methods
Choice Theory/Reality Therapy
RT believe the underlying problem for most clients is the same: they are either involved in a present unsatisfying relationship or lack what could be called a relationship. Many problems are caused by their inability to connect, get lose to others, or to have a satisfying or successful relationship with at least one significant person in their life. Therapist guides clients toward a satisfying relationship and teaches them more effective ways of behaving. The more clients are able to connect with people, the greater chance they have to experience happiness. Reality therapists recognize that clients choose their behaviors as a way to deal with the frustrations caused by unsatisfying relationships.
Choice Theory/Reality Therapy
Reality therapy is based on Choice theory. Choice theory is the theoretical basis for reality therapy; it explains why and how we function. Reality therapy provides a delivery system for helping individuals take more effective control of their lives. If choice theory is the highway, reality therapy is the vehicle delivering the product. Therapy consists of helping and sometimes teaching clients to make more effective choices as they deal others the people they need in their lives. It is essential for the therapist to establish a satisfying relationship with clients as a prerequisite for effective therapy., then skill of therapist as listener and teacher assumes a central role. Reality therapy has been used to counseling, social work, education, crisis intervention, corrections and rehab, institutional management, and community development. It is popular in schools, state mental health hospitals, halfway houses, and alcohol and drug abuse centers.
Feminist Therapy
Techniques and Strategies 1. Empowerment 2. Self-disclosure 3. Gender-Role or Social Identity Analysis 4. Gender-Role Intervention 5. Power analysis 6. Bibliotherapy 7. Assertiveness Training 8. Reframing and Relabeling 9. Social Action 10. Group Work The Role of Men in Feminist Therapy
NT
Techniques and procedures Questions and more questions Externalization and Deconstruction Search for Unique outcomes Alternative Stories and Reauthoring Documenting the evidence Application to group counseling
SFBT
Terminating - from the very first interview, therapist is working toward termination. Once the therapist constructs a satisfactory solution, the relationship can be terminated.
Postmodern Approaches
The Collaborative Language Systems Approach Therapy is another conversational system that becomes therapeutic through its "problem organizing problem dissolving" nature. Therapist enters from a "not-knowing" position and enter conversation with curiosity and intense interest in discovery.
Albert Ellis Rational Emotive Therapy
The first of the cognitive therapies - emphasizes thinking, assessing, deciding, analyzing and doing
Solution Focused Brief Therapy
The solution focused philosophy rests on the assumption that people can become mired in unresolved past conflicts and blocked when they focus on past or present problems rather than on future solutions. Therapists focus on what is possible, and they have little or no interest in gaining an understanding of how the problem emerged. Behavior change is is viewed as the most effective approach to assisting people in enhancing their lives. Don't need to know cause of problem to solve it.
SFBT
The therapeutic process Rest on foundation that clients are the expects on their own lives and often have a good sense of what has not worked or what has in the past and what might work in the future. Dr. Shazer: 1. clients given opp to describe their problems. Therapist listens respectfully and carefully as client's answer "How can I be useful to you?" 2. Therapist works with clients in developing well-formed goals as soon as possible. The question is posed, "what will be different in your life when your problems are solved?" 3. Therapist asks clients about those times when their problems were not present or when the problems were less severe. Clients are assisted in exploring those exceptions, with emphasis on what they did to make these events happen. 4. At the end of solution-building, the therapist offers clients summary feedback, provides encouragement, and suggests what clients might observe or do before the next sessions to further solve their problem. 5. Therapist and clients evaluate the progress being made in reaching satisfactory solutions by using a rating scale. Clients are asked what needs to be done before they see their problem as being solved and also what their next step will be.
Feminist Therapy
Therapeutic Goals: Become aware of their own gender-role socialization process Identify their internalized messages of oppression and replace them with more self-enhancing beliefs Understand how sexist and oppressive societal beliefs and practices influence them in negative ways Acquire skills to bring about change in the environment Restructure institutions to rid them of discriminatory practices Develop a wide range of behaviors that are freely chosen Evaluate the impact of social factors on their lives Develop a sense of personal and social power Recognize the power of relationships and connectedness Trust their own experience and their intuition
Feminist Therapy
Therapeutic Goals: Goals include empowerment, valuing and affirming diversity, striving for change rather than adjustment, equality, balancing independence and interdependence, social change, and self-nurturant. A key goal of feminist therapy is to assist individuals in viewing themselves as active agents on their own behalf on a behalf of others. At the individual level, feminist and other social justice therapists work to help individuals recognize, claim, and embrace their personal power. A related goal is to help individuals come together to strengthen collective power. Through empowerment, clients are able to free themselves from the constraints of their gender-role socialization and other internalized limitations and to challenge ongoing institutional oppression
SFBT
Therapeutic goals Basic notions about change, about interaction, and about reaching goals. SFBTherapist believes people have the ability to define meaningful goals have the resources required to solve them. Goals are unique to each client and constructed by the client to create a richer future. Small, realistic, achievable changes that can lead to additional positive outcomes because success builds on itself. Murphy emphasizes importance of assisting clients in creating well-defined goals that are: 1. Stated positively in the client's language 2. Are action-oriented 3. Structured in the here and now 4. Are attainable, concrete, specific, and measurable 5 are controlled by the client.. Clients must first feel their concerns are heard before they can make precise goals Changing the "viewing" of a situation or frame of reference Changing the "doing" of the problematic situations Tapping clients strengths and resources
Narrative Therapy
Therapeutic process: Collaborate with client to come up with mutually acceptable name for the problem Personify the problem and attribute oppressive intentions and tactics to it Investigate how the problem has been disrupting, dominating or discouraging to the client Invite the client to see his or her story from a different perspective by inquiring into alternative meanings for events Discover moments when the client wasn't dominated or discouraged by the problem by searching for exceptions Find historical evidence to bolster a new view of the client as competent enough to have stood up, defeated, or escaped from the dominance or oppression of the problem Ask the client to speculate about what kind of future could be expected form the strong competent person who is emerging. As the client becomes free of the problem-saturated stories of the past, he or she can envision and plan for a less problematic future Find or creat an audience for perceiving and supporting the new story. It si not enough to recite a counter story. Client needs to live the counter story outside of therapy.
CT- Client-Therapist relationship
Therapeutic relationship is basic and necessary first step to application of CT. Effective therapists combine empathy and sensitivity with technical competence. Rogers core therapeutic conditions are necessary but not suffice to produce optimum therapeutic effect..
SFBT
Therapist Feedback to Clients - take a break of 5-10 minutes at end of session to compose a summary message for clients and formulate feedback with strengths, signs of hope and identifying exceptions De Jong and Berg describe 3 parts to the structure of the feedback: 1. Compliments-genuine affirmations of what client is already doing 2. Bridge - links the initial compliments to the suggested tasks that will be given 3. Suggesting a task-homework that could be observational, behavioral
SFBT
Therapist adopts a not knowing position (similar to postmodern and social constructionist) to put CLIENT AS EXPERT Attitude of the therapist is CRUCIAL to effectiveness of therapeutic process Dr. Shazer: 3 kinds of relationships that may develop between client and therapist 1. Customer: client and therapist jointly identify a problem and a solution to work toward. Clients realizes to attain his goals, personal effort will be required 2. Complainant; the client describes a problem, but is not able or willing to assume a role in constructing a solution, believing a solution is dependent on someone else's actions. The client generally expects the therapist to change the other person to whom the client attributes the problem 3. Visitor: client comes to therapy bc someone else thinks the the client has a problem. This client may not agree he has a problem and may be unable to identify anything to explore in therapy.
Treatment Approaches to CT
Therapist introduces additional skills such as "thought records", which help clients identify negative "automatic thoughts" and test them. When evidence does support the problematic thought, clients are helped to create the "action plan" to solve the problem rather than ruminating on it. Depression treatment lasts 16-20 sessions Panic disorder - 6-12 sessions
REBT-Client's Experience in Therapy
Therapy focuses on client's experiences in the present. REBT emphasizes the here-and now experiences and client's ability to change the patterns of thinking and emoting. Therapist may not spend much time on the past unless doing so helps the process. REBT does not place much value on free association, working with dreams or dealing with transference phenomena. (Transference is not encouraged). Clients should work actively outside of sessions to learn to minimize irrational thinking and disturbances in thinking and feeling. "Homework" is carefully designed and agreed upon to get clients to carry out productive actions that contribute to emotional and attitudinal change.
NT
Therapy goals Describe their experience in new and fresh language and develop new meanings for problematic thought, feelings and behaviors and includes an awareness of dominate culture on life.
CBM
Three phase process for change 1. Self-observation - clients learn how to observe their own behavior, critical factor is willingness to "listen" to themselves and realize they are not "victims" of negative thoughts 2. Starting a new internal dialogue - clients learn to notice their maladaptive behaviors, and see opportunities for adaptive behavioral alternatives. Clients must initiate a new behavioral chain that is incompatible with their maladaptive behaviors. 3. Learning new skills - clients learn to interrupt the downward spiral of thinking, feeling, and behaving, and therapist teaches adaptive ways of coping using the resources they bring to therapy.
REBT - Behavioral Techniques
Use most of standard behavior therapy procedures especially operant conditions, self-management principles, systematic sensitization, relaxation techniques, and modeling. Behavioral homework in real life situations are very important.
CT/RT
WDEP System Key procedures in reality therapy W - help clients explore their "wants" (and needs and perceptions) D - possible things they can "do" (direction and doing) E - opportunities for self-evaluation P - "plans" for improvement
CT/RT
Wants, Needs, and Perceptions- "what do you want?" assist clients in discovering their wants and hopes related to 5 basic needs, exploring QW and picture album. Direction and Doing-focus on the present is characterized by the key question "what are you doing?" Self-Evaluation - "does your present behavior have a reasonable chance of getting you what you want now, and will it take you where you want to go?' Planning and Action-identify specific ways to fulfill their wants and needs. "What is your plan?"
REBT - Relationship between therapist and client
Warm relationship is not required but may enhance the process for some. REBT therapists strive to unconditionally accept all clients and to teach them to unconditionally accept others and themselves. Therapist takes the mystery out of the process. Insight alone does not typically lead to psychotherapeutic change, action is also required. Therapist acknowledges progress clients make.
REBT view of emotional disturbance
We learn irrational beliefs from significant others during childhood, then recreate these beliefs throughout our lifetime.. Reinforce self-defeating beliefs through process of autosuggestion and self-repetition. We then behave in ways consistent with these beliefs, and this keeps dysfunctional attitudes alive and operative.
Choice Theory/Reality Therapy
William Glasser and Robert Wubbolding
CT/RT
Wubbolding added a new idea to choice theory. He believes that behavior is a language and that we send messages by what we are doing. The purpose of the behavior is to influence the world to get what we want.
