© 2016. cengage learning. all rights reserved. chapter 4: individual approaches to counseling ...

© 2016. Cengage Learning. All rights reserved.

Chapter 4: Individual Approaches to Counseling

Chapter 5: Counseling Skills

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SECTION II: The Helping Relationship I: Theory and

Skills


Chapter 4Individual Approaches to

Counseling

2


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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Why Have a Counseling Theory?


Psychodynamic Approaches

Existential-Humanistic Approaches

Cognitive-Behavioral Approaches

Post-Modern Approaches

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Four Conceptual Orientationsand Associated Theories


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) 5

Psychodynamic Approaches


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 conscious7




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Techniques Free Association Dream Analysis Empathy Developing

transference relationship

Techniques Interpretation of:

Resistance Defense mechanisms Parapraxes Dreams (manifest and

latent meanings) Transference


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, shadow9

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 imagination10

Psychodynamic Approaches(Analytical Therapy: Jungian 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 11

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)


Psychodynamic Approaches(Individual Psychology: Adlerian

Therapy)

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Phase of therapy Building relationship Assessing lifestyle Insight and

interpretation Reeducation and

reorientation

Techniques: 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


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 Therapy14

Existential-Humanistic Approaches


A number of theorists developed this approach Frankl (Logotherapy), May, Bugental, Yalom

Central tenets of most existential approaches 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(Existential Therapy)


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. 11216

Existential-Humanistic Approaches(Person-Centered Counseling)


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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Existential-Humanistic Approaches(Gestalt Therapy)


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


Developed by many different individuals Based on an understanding of classical condition,

modeling, and operant conditioning Therapeutic stages

1. Building the relationship 2. Clinical Assessment3. Focusing on Problem Areas and Setting Goals4. Choosing Techniques and Working on Goals5. Assessment of Goal Completion6. Closure and follow-up

Some techniques: See Box 4.819

Cognitive-Behavioral Approaches(Modern-Day Behaviorism)


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) 20

Cognitive-Behavioral Approaches(Rational Emotive Behavior Therapy:

REBT)


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 differently22

Cognitive-Behavioral Approaches(Cognitive Therapy)


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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Cognitive-Behavioral Approaches(Reality Therapy and Choice Theory)


Overview Based on post-modernism, social constructionism,

post-structuralism 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 Therapy25

Post-Modern Approaches


Developed by White and Epston (and others) Underlying premises:

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(Narrative Therapy)


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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Post-Modern Approaches(Solution-Focused Brief Therapy: SFBT)


Extensions, Adaptations, and Spinoffs of the Major Theories

Erikson’s Psychosocial Theory

Object-Relations Theory Relational and Subjectivity

Theory Dialectical Behavior Therapy

(DBT) Acceptance and Commitment

Therapy (ACT)

Constructivist Therapy

Eye Movement Desensitization Therapy (EMDR)

Motivational Interviewing

Gender-Aware Therapy Positive Psychology and Well-

Being Therapy Complementary, Alternative,

and Integrative Approaches

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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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Integrative Counseling and Psychotherapy

(Integrative Approach)


Bias in Counseling Approaches Many theories developed by White men, European heritage Their values impacted their theories Some of these values included:

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 states32

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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Multicultural/Social Justice Focus


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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Ethical, Professional, and Legal Issues


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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The Counselor in Process

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