Transcript Chapter 4_PowerPointx

SECTION II:
The Helping Relationship I: Theory and Skills
 Chapter 4: Individual Approaches to Counseling
 Chapter 5: Counseling Skills
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Chapter 4
Individual Approaches to Counseling
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Why Have a Counseling Theory?
 Offers us a framework
 Knowledge builds on knowledge (Paradigm Shifts)
 See Box 4.1, p. 100
 Theories are heuristic
 Based on our view of human nature
 Helps us work in an organized manner
 Today, there are hundreds of counseling theories, but only
some have gained prominence
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Four Conceptual Orientations
and Associated Theories
 Psychodynamic Approaches
 Existential-Humanistic Approaches
 Cognitive-Behavioral Approaches
 Post-Modern Approaches
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Psychodynamic Approaches
 Overview
 Dominated early part of 20th century
 Common elements
 Unconscious and conscious affects person’s functioning
 Early child-rearing has some affect on development of personality
 One’s past, in interaction with the conscious and unconscious, affects
person’s development
 Have tended to be longer term therapeutic approaches
 Some approaches: psychoanalysis (Freud), analytical therapy
(Jung), individual psychology (Adlerian)
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Psychodynamic Approaches
(Psychoanalysis: Freudian Therapy)
 Developed by Sigmund Freud
 First comprehensive approach to therapy
 Psychic energy (instincts) drive behavior
 Life instinct (Eros): love, intimacy, sex, survival
 Death instinct (Thanatos): fear, hate, self-destructive
behavior aggression
 All life and death instincts = libido
 Structure of personality
 Id (pleasure principle)
 Ego (reality principle)
 Superego (moral imperatives)
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Psychodynamic Approaches
(Psychoanalysis: Freudian Therapy)
 Psychosexual Stages: Oral, Anal, Phallic, Latency, Genital
 Parenting affects developmental through stages
 Defense mechanisms reflect that development
 Name some defense mechanisms!
 Deterministic Approach
 See Figure 4.1, p. 105
 Long term approach that relies on making a little more of the
unconscious conscious
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Psychodynamic Approaches
(Psychoanalysis: Freudian Therapy)
 Techniques
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 Techniques
 Interpretation of:
 Resistance
 Defense mechanisms
 Parapraxes
 Dreams (manifest and
latent meanings)
 Transference
Free Association
Dream Analysis
Empathy
Developing transference
relationship
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Psychodynamic Approaches
(Analytical Therapy: Jungian Therapy)
 Developed by Carl Jung
 Less pessimistic and less deterministic than Freud
 8 Psychological Types—include combinations of:
 Extraversion and Introversion (E or I) with
 Mental Functions: Thinking and Feeling (T or F); Sensing and Intuiting
(S or N)
 Information that matches psychological type goes into consciousness;
information that doesn’t match goes into personal unconscious.
 Our collective unconscious is inherited. Contains archetypes —tendency to
perceive things in ways we call “human”
 Well known archetypes: persona, anima and animus, shadow
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Psychodynamic Approaches
(Analytical Therapy: Jungian Therapy)
 Jung believed we can make almost anything conscious
 If we understand our personal and collective unconscious, we
are “whole”
 Techniques:
 Goal of techniques—to make unconscious conscious
 Some techniques include: examining our dreams, meaning of
symbols, creative techniques (e.g., working with clay), and active
imagination
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Psychodynamic Approaches
(Individual Psychology: Adlerian Therapy)
 Developed by Alfred Adler
 “Teleology”—we inherently are goal directed
 We move to fulfill one drive—striving for perfection.
 All other drives subsumed by this one
 Part of being human: having feelings of inferiority
 Feelings of inferiority lead us to our subjective final goal
 Our private logic leads us toward our final goal
 Drive toward our subjective goal results in development of behaviors
that compensate for feelings of inferiority
 You can tell how a person is driven toward his/her goal through
his/her style of life
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Psychodynamic Approaches
(Individual Psychology: Adlerian Therapy)
 Work through feelings of inferiority, and you will move toward
social interest (gemeinschaftsgefühl)
 Followers: Dreikrus and Dinkmeyer
 Worked with children whose typical behaviors from feelings
of inferiority yield:
 Attention seeking, use of power, revenge seeking, and inadequacy
 Sometimes seen as an early humanistic approach (through
education and counseling one can change)
 One of first approaches to work with families
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Psychodynamic Approaches
(Individual Psychology: Adlerian Therapy)
 Phase of therapy
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 Techniques:
Building relationship
Assessing lifestyle
Insight and interpretation
Reeducation and
reorientation
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Exploring family constellation
Examining early recollections
Encouragement
Democratically held discussion groups
Limit setting
Acting “as if”
Spitting in the client’s soup
Setting logical and natural
consequences
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Existential-Humanistic Approaches
 Overview
 Loosely based on existential philosophy
 Deals with struggles of living and how we construct meaning in
our lives
 Tends to be optimistic and not deterministic
 Phenomenological perspective
 Focus on consciousness and the relationship
 Help people “self-actualize”
 Three approaches:
 Existential Therapy, Person-Centered, Gestalt Therapy
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Existential-Humanistic Approaches
(Existential Therapy)
 A number of theorists developed this approach
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Frankl (Logotherapy), May, Bugental, Yalom
 Central tenets of most existential approaches
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Born into a world with no inherent meaning
We make our meaning
Struggle throughout life to be “human”
Most people live a life of limited self-reflection
We are born alone, die alone, and mostly live alone
Choice about who we are
Can gain awareness about choices we have made
See Box 4.4, p. 111
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Existential-Humanistic Approaches
(Person-Centered Counseling)
 Developed by Carl Rogers (“client-centered therapy”)
 We all have need to be regarded
 Conditions of worth placed on us by significant others
 Help people become more congruent and gain a more realistic
sense of ideal self
 "Necessary & sufficient conditions" (pp. 112)
 “Techniques”
 Congruence/genuineness
 Unconditional positive regard
 Empathic understanding
 See Box 4.5, p. 112
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Existential-Humanistic Approaches
(Gestalt Therapy)
 Developed by Fritz Perls
 Based on Gestalt psychology, phenomenology, & existentialism
 More directive and confrontational
 Self-regulation, need identification, and need-fulfillment
 Only aware of needs in “foreground”
 “Blockages” or “impasses” yield “unfinished business”
 Now = experience = awareness = reality
 Anti-deterministic
 Techniques “push” one into experiencing the “now”
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Cognitive-Behavioral Approaches
 Overview
 Pavlov (1848-1936): Classical Conditioning
 Skinner (1904-1990): Operant Conditioning
 Bandura: Modeling or Social Learning (1940s)
 Recent Years:
 Cognitive Structures
 illogical Ways of Thinking
 See common assumptions (p. 117)
 Approaches:
 Modern-Day Behavior Therapy, Rational Emotive Behavior Therapy,
Cognitive Therapy, Reality Therapy and Choice Theory
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Cognitive-Behavioral Approaches
(Modern-Day Behaviorism)
 Developed by many different individuals
 Based on an understanding of classical condition, modeling, and
operant conditioning
 Therapeutic stages
1.
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3.
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6.
Building the relationship
Clinical Assessment
Focusing on Problem Areas and Setting Goals
Choosing Techniques and Working on Goals
Assessment of Goal Completion
Closure and follow-up
 Some techniques: See Box 4.8
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Cognitive-Behavioral Approaches
(Rational Emotive Behavior Therapy: REBT)
 REBT: Developed by Albert Ellis
 Complex interaction between thinking, feeling, & acting
 Mostly, focus on Rational vs. Irrational Thinking
 People have cognitive distortions
 People often driven by 1 or more of 3 core irrational beliefs (see
Box 4.9, p. 120)
 ABCs of feeling and behaving
 Relationship important, but not critical (see Box 4.10, p. 120)
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Cognitive-Behavioral Approaches
(Cognitive Therapy)
 Developed by Aaron Beck
 Continuity hypothesis: older emotional responses continue into
modern day world
 Diathesis-stress model
 Biological/genetic/environmental model—under stress, our
(unique) disorders are shown
 Rational, pragmatic, antideterministic, educative, empirical
 We all have “core beliefs” that drive us—embedded beliefs often
out of our awareness
 We can have negative core beliefs (see Box 4.11)
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Cognitive-Behavioral Approaches
(Cognitive Therapy)
 Cognitive Therapy (cont’d)
 Core beliefs lead to intermediate beliefs (“attitudes, rules, and
expectations”)
 Intermediate beliefs lead to automatic thoughts
 Automatic thoughts related to certain “cognitive distortions” (see Box
4.9, p. 121)
 Automatic thoughts lead to possible reactions to certain situations (see
Figure 4.2, p. 125)
 Treatment: focus on automatic thoughts, get to intermediate beliefs,
then get to core beliefs—change core beliefs through thinking and acting
differently
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Cognitive-Behavioral Approaches
(Reality Therapy and Choice Theory)
 Developed by Glasser—originally called Reality Therapy
 Five genetically based needs: survival, love and belonging, power,
freedom, and fun
 Unique “need-strength profile”
 We can only satisfy our needs and control our behaviors in the
present
 Since birth, we create a “quality world” to determine how to
satisfy our needs
 Some quality worlds lead to destructive behaviors
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Cognitive-Behavioral Approaches
(Reality Therapy and Choice Theory)
 Reality Therapy (cont’d)
 Can change the pictures in our quality worlds and our
behaviors
 Total behavior: We can only choose our actions and
thoughts
 Use internal-control language, not external control
language
 Techniques: see WDEP system (Figure 4.3, p. 128)
 Anti-deterministic
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Post-Modern Approaches
 Overview
 Based on post-modernism, social constructionism, poststructuralism
 Post-modernists: Questions modernism and many assumptions and
beliefs we take for granted
 Social Constructionism: Values are transmitted through language via
social milieu (family, culture, society)
 Post-structuralism: Questioning of “inherent truths” or “structures”
we have believed
 Two approaches
 Narrative Therapy and Solution-Focused Brief Therapy
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Post-Modern Approaches
(Narrative Therapy)
 Developed by White and Epston (and others)
 Underlying premises:
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Realities are socially constructed
Realities are constituted through language
Realities are organized and maintained through narrative
There are no essential truths
 Anti-deterministic and anti-objectivist
 Deconstruct problem-saturated stories (narratives)
 Construct new narratives
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Post-Modern Approaches
(Narrative Therapy)
 Narrative Therapy (cont’d)
 We all are multistoried
 Look at “thin” and “thick” stories
 Look for exceptions to stories (see Fig. 4.4, p. 130)
 Be respectful, curious, show awe, ask questions
 Phases:
 1) Joining, 2) Examining patterns, 3) Re-authoring, and 4) Moving on
 Use journaling, retelling new stories, symbols to reinforce
new stories
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Post-Modern Approaches
(Solution-Focused Brief Therapy: SFBT)
 SFBT: Developed by Berg and de Shazer (and others)
 Developed at Brief Family Therapy Center of Milwaukee
 Rejected “disease model” and believed that clients could work
quickly to reach goals
 Pragmatic, optimistic, anti-deterministic, future-oriented
 Miracle Question
 Questions: evaluative, coping, exception-seeking, solution-focused
 Find exceptions to client problems
 Often under 6 sessions
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Post-Modern Approaches
(Solution-Focused Brief Therapy: SFBT)
 Six Stages of SFBT
 Stage 0: Pre-Session Change
 Stage 1: Forming a Collaborative Relationship
 Stage 2: Describing the Problem
 Stage 3: Establishing Preferred Goals
 Stage 4: Problem-to-Solution Focus
 Stage 5: Reaching Preferred Goals
 Stage 6: Ending Therapy
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Extensions, Adaptations, and
Spinoffs of the Major Theories
 Eye Movement Desensitization
Therapy (EMDR)
 Erikson’s Psychosocial Theory
 Object-Relations Theory
 Motivational Interviewing
 Relational and Subjectivity Theory
 Dialectical Behavior Therapy (DBT)
 Acceptance and Commitment
Therapy (ACT)
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 Gender-Aware Therapy
 Positive Psychology and Well-Being
Therapy
 Complementary, Alternative, and
Integrative Approaches
Constructivist Therapy
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Integrative Counseling and Psychotherapy
(Integrative Approach)
 Combine varying theoretical approaches into helping clients
 Integrative Approach (formerly called “eclecticism)
 Four stages
 Stage 1: Chaos
 Stage 2: Coalescence
 Stage 3: Multiplicity
 Stage 4: Metatheory
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Multicultural/Social Justice Focus
 Bias in Counseling Approaches
 Many theories developed by White men, European heritage
 Their values impacted their theories
 Some of these values included:
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Importance of individualism
Expression of feelings
Search within “self” to discover truth
If you work hard, you’ll succeed
Mind-body dualism
Truth can be found or uncovered
Facts can be found, values are opinions
External factors of little impact on internal psychological states
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Multicultural/Social Justice Focus
 It’s time to take into account other cultures and become more
multicultural sensitive in our theories
 Many of the theories can be adapted to address these issues
 Sometimes, new theories will need to be undertaken
 And, let’s not forgot our own biases and how they interplay
with existing bias in theories
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Ethical, Professional, and Legal Issues
 Theory and the ACA Code
 Counselors should only practice in an area for which they
have been trained
 Importance of Using theory that is based on sound scientific
evidence
 Obtaining supervision so that counselors practice at their
optimal levels
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Ethical, Professional, and Legal Issues
 Working effectively with all clients
 Tarasoff Case and Foreseeable Harm
 “Duty to warn”
 Julea Ward v. Board of Regents of Eastern Michigan
University (EMU)
 Counselor referral of client in same sex relationship
 Sexual Orientation Change Efforts
 Conversion and Reparative Therapy
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The Counselor in Process
 Embracing a Theory but Open to Change
 Theory development is an ongoing process
 Be open to changing your approach throughout your career
 How do you think your approach might change?
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