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THEORIES OF COUNSELING

WHAT IS A THEORY
n

Patterson (1986): Theory is a (a) set of


stated assumption regarding a certain
field, (b) set of definitions of the ideas
and concepts in the theory, (c)
concepts that bear certain
relationship to one another, and (d)
hypothesis constructed from these
assumptions, definitions and
relationships Guidance and

Continuum of theories
n
n

n
n

Frank Parsons
1909-1940s: developing better means
of assessing people aptitudes and
interest
Directive counselling heavily on
advising and also known as traitfactor
1942 - Carl Rogers: Non-directive as
helper is not adviser
Directive vs non-directive?

Key points in different theories


n
n
n
n
n
n
n
n

Nature of human being


Basic assumptions
Goals
Key concept/construct
Personality development
Adaptive/maladaptive behavior
Learning process/change
Techniques
Guidance and

The Five Schools of Thought


n

Psychodynamic

Human beings are basically determined by


psychic energy and by early experiences.
Unconscious motives and conflicts are
central in present behavior. Irrational forces
are strong and the individual is driven by
impulses.
These impulses as solely sexual and
aggressive.
Early development is of critical importance
as later personality problems are rooted in
repressed childhood conflicts.

n
n

Guidance and

Behavioral
n
n

Humans are shaped and determined


by socio-cultural conditioning.
The view is basically one that is
determinist as all behaviors are a
product of learning through
conditioning and reinforcement
What was learnt can be unlearnt
Guidance and

Humanistic
n
n

n
n

Humans are viewed positively as we have a


basic inclination to become fully functioning.
The context of counselling is often focused
on the affective world of the client, moving
towards self-actualization, gaining trust,
spontaneity and focusing on the human
condition.
Humanistic approaches take a
phenomenological, here-and-now approach.
The relationship is thought to be fundamental
to successful therapy.
Guidance and

Cognitive-Behavioral
n
n

What we think is the root of our


emotional and behavioral life.
Consequently a change in cognition
will inevitably cause a change in our
behaviors and emotions.
Dysfunction and maladjustment are
problems of faulty or irrational
thoughts.
Guidance and

Emerging Approaches
n
n

As information on counseling is
collected new theories emerge.
Emerging approaches often include
aspects of previously founded
theories.
Contemporary emerging approaches
tend to focus heavily on
phenomenology, uman uniqueness,
multicultural concerns and client
empowerment.

Theory and Practice of Counseling


and Psychotherapy
Psychoanalytic Approach

Transparency

The Structure of Personality


n

THE IDThe Demanding Child


u Ruled by the pleasure principle

THE EGOThe Traffic Cop


u Ruled by the reality principle

THE SUPEREGOThe Judge


u Ruled by the moral principle
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (1)

Conscious and Unconscious


Conscious:
Whats on the surface
i.e. logic, reality

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (2)

Transparency

Unconscious:
What lies deep,
below the surface
i.e. drives, instincts

The Unconscious
n

Clinical evidence for postulating the unconscious:


u Dreams
u Slips of the tongue
u Posthypnotic suggestions
u Material derived from free-association
u Material derived from projective techniques
u Symbolic content of psychotic symptoms
NOTE: consciousness is only a thin slice of the total mind
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (3)

Anxiety
n

Feeling of dread resulting from repressed feelings, memories and


desires
u Develops out of conflict among the id, ego and superego to control
psychic energy

Reality Anxiety

Neurotic Anxiety

Moral Anxiety

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (4)

Transparency

Ego-Defense Mechanisms
n

Ego-defense mechanisms:
u Are normal behaviors which operate on an unconscious level and tend
to deny or distort reality
u Help the individual cope with anxiety and prevent the ego from being
overwhelmed
u Have adaptive value if they do not become a style of life to avoid facing
reality

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (5)

The Development of Personality


n

ORAL STAGE

First year

u Related to later mistrust and rejection issues


n

ANAL STAGE

Ages 1-3

u Related to later personal power issues


n

PHALLIC STAGE

Ages 3-6

u Related to later sexual attitudes


n

LATENCY STAGE

Ages 6-12

u A time of socialization

GENITAL STAGE

Ages 12-60

u Sexual energies are invested in life


Theory and Practice of Counseling and Psychotherapy - Chapter 4 (6)

Transparency

Transference
u The client reacts to the therapist as he did to an earlier significant other
This allows the client to experience feelings that would otherwise be
inaccessible
ANALYSIS OF TRANSFERENCE allows the client to achieve insight into
the influence of the past

Countertransference

Copyright 2009 Wadsworth Group. Brooks/Cole is an imprint of the


Wadsworth Group, a division of Cengage Learning, Inc.

Transference and Countertransference

u The reaction of the therapist toward the client that may interfere with
objectivity

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (7)

Transparency

Not always detrimental to therapeutic goals; can provide important means


of understanding your clients world
Countertransference reactions must be monitored so that they are used to
promote understanding of the client and the therapeutic process.

Free Association
u Client reports immediately without censoring any feelings or thoughts

Interpretation
u Therapist points out, explains, and teaches the meanings of whatever is
revealed

Copyright 2009 Wadsworth Group. Brooks/Cole is an imprint of the


Wadsworth Group, a division of Cengage Learning, Inc.

Psychoanalytic Techniques

Dream Analysis

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (8)

Transparency

u Therapist uses the royal road to the unconscious to bring


unconscious material to light
u Latent content
u Manifest content

Resistance
u Anything that works against the progress of therapy and prevents the
production of unconscious material

Analysis of Resistance
u Helps the client to see that canceling appointments, fleeing from
therapy prematurely, etc., are ways of defending against anxiety

Copyright 2009 Wadsworth Group. Brooks/Cole is an imprint of the


Wadsworth Group, a division of Cengage Learning, Inc.

Resistance

These acts interfere with the ability to accept changes which could lead
to a more satisfying life
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (9)

Group work provides a rich framework for working through


transference feelings
u Feelings resembling those that members have experienced toward
significant people in their past may emerge
u Group members may come to represent symbolic figures from a clients
past

Competition for attention of the leader provides opportunities to


explore how members dealt with feelings of competition in the past
and how this effects their current interactions with others.

Projections experienced in group provide valuable clues to a clients


unresolved conflicts

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (10)

Transparency

Copyright 2009 Wadsworth Group. Brooks/Cole is an imprint of the


Wadsworth Group, a division of Cengage Learning, Inc.

Application to Group Counseling

Limitations of Classical Analysis


This approach may not be appropriate for all cultures or socioeconomic
groups

Deterministic focus does not emphasize current maladaptive behaviors

Minimizes role of the environment

Requires subjective interpretation

Relies heavily on client fantasy

Lengthy treatment may not be practical or affordable for many clients

Theory and Practice of Counseling and Psychotherapy - Chapter 4 (11)

Transparency

Theory and Practice of Counseling


and Psychotherapy
Indivdual Psychology

Transparency

Alfred Adlers Individual Psychology


Based on the holistic concept

A phenomenological approach

Teleological explanation of human behavior

Social interest is stressed

Birth order and sibling relationships

Therapy as teaching, informing and encouraging

Basic mistakes in the clients private logic

The therapeutic relationshipa collaborative partnership

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (1)

Transparency

The Phenomenological Approach


n

Adlerians attempt to view the world from the clients subjective


frame of reference
u How life is in reality is less important than how the individual believes
life to be
u It is not the childhood experiences that are crucial
it is our present interpretation of these events

Unconscious instincts and our past do not determine our behavior

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (2)

Social Interest
n

Adlers most significant and distinctive concept


u Refers to an individuals attitude toward and awareness of being a part
of the human community
u Embodies a community feeling and emphasizes the clients positive
feelings toward others in the world
u Mental health is measured by the degree to which we successfully
share with others and are concerned with their welfare
u Happiness and success are largely related to social connectedness

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (3)

Lifestyle
n

A life movement that organizes the clients reality, giving meaning


to life
u fictional finalism or guiding self ideal
u Psychiatric symptoms are failed attempts at achieving our lifestyle
u Adlerian therapy helps clients to effectively navigate lifestyle tasks

Lifestyle is how we move toward our life goals


private logic
Values, life plan, perceptions of self and others
Unifies all of our behaviors to provide consistency
Makes all our actions fit together

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (4)

Transparency

u
u
u
u

Inferiority and Superiority


n

Inferiority Feelings
u Are normal
u They are the wellspring of creativity.
u Develop when we are young--characterized by early feelings of
hopelessness

Superiority Feelings
u Promote mastery
u Enable us to overcome obstacles

Related Complexes
u Inferiority Complex
u Superiority Complex

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (5)

Transparency

Birth Order
n

A concept that assigns probability to having a certain set of


experiences based on ones position in the family

Adlers five psychological positions:

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (6)

Transparency

u 1) Oldest child receives more attention, spoiled,


center of attention
u 2) Second of only two behaves as if in a race, often opposite to first
child
u 3) Middle often feels squeezed out
u 4) Youngest the baby
u 5) Only does not learn to share or cooperate with other children, learns
to deal with adults

Four Phases of Therapy


n

Phase 1: Establishing the Proper Therapeutic Relationship


u Supportive, collaborative, educational, encouraging process
u Person-to-person contact with the client precedes identification of the problem
u Help client build awareness of his or her strengths

Phase 2: Exploring the Individuals Psychological Dynamics


u Lifestyle assessment
Subjective interview
Objective interview

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (7)

Transparency

Family constellation
Early recollections
Basic Mistakes

Four Phases of Therapy


n

Phase 3: Encouraging Self-Understanding/Insight


u Interpret the findings of the assessment
u Hidden goals and purposes of behavior are made conscious
u Therapist offers interpretations to help clients gain insight into their
lifestyle

Phase 4: Reorientation and Re-education

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (8)

Transparency

u Action-oriented
u Useful vs. unhelpful

Encouragement
n

Encouragement instills self confidence by expecting clients to


assume responsibility for their lives and embrace the fact that they
can make changes

Encouragement is the most powerful method available for


changing a persons beliefs

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (9)

Transparency

u Helps build self-confidence and stimulates courage


u Discouragement is the basic condition that prevents people from
functioning
u Clients are encouraged to recognize that they have the power to choose
and to act differently

Application to Group Counseling


Group provides a social context in which members can develop a
sense of community and social-relatedness

Sharing of early recollections increases group cohesiveness

Action-oriented strategies for behavior change are implemented to


help group members work together to challenge erroneous beliefs
about self, life and others.

Employs a time-limited framework

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (10)

Transparency

Limitations of the Adlerian Approach


n

Adler spent most of his time teaching his theory as opposed to


systematically documenting it
u Hence, some consider Adlerian theory simplistic

Many of Adlers theoretical constructs (i.e. lifestyle) are difficult to


measure and require empirical testing

Research on treatment efficacy is limited


Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 5 (11)

Theory and Practice of Counseling


and Psychotherapy
Person Centered
Transparency

Person-Centered View of Human Nature


n

At their core, humans are trustworthy and positive

Humans are capable of making changes and living productive,


effective lives

Humans innately gravitate toward self-actualization


u Actualizing tendency

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (1)

Transparency

Given the right growth-fostering conditions, individuals strive to


move forward and fulfill their creative nature

Person-Centered Therapy

(A reaction against the directive and psychoanalytic approaches)


n

Challenges:
u The assumption that the counselor knows best
u The validity of advice, suggestion, persuasion, teaching, diagnosis,
and interpretation
u The belief that clients cannot understand and resolve their own
problems without direct help
u The focus on problems over persons

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (2)

Person-Centered Therapy
n

Emphasizes:
u Therapy as a journey shared by two fallible people
u The persons innate striving for self-actualization
u The personal characteristics of the therapist and the quality of the
therapeutic relationship
u The counselors creation of a permissive, growth-promoting climate
u People are capable of self-directed growth if involved in a therapeutic
relationship

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (3)

Therapy is a Growth-Promoting Climate


n

Congruence
u Genuineness or realness in the therapy session
u Therapists behaviors match his or her words

Unconditional positive regard


u Acceptance and genuine caring about the client as a valuable person
u Accepting clients as they presently are
u Therapist need not approve of all client behavior

Accurate empathic understanding

The therapist need not experience the situation to develop an understanding of it from
the clients perspective
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (4)

Transparency

u The ability to deeply grasp the clients subjective world


u Helper attitudes are more important than knowledge

Six Conditions

(necessary and sufficient for personality changes to occur)


u 1. Two persons are in psychological contact
u 2. The first, the client, is experiencing incongruence
u 3. The second person, the therapist, is congruent or integrated in the
relationship
u 4. The therapist experiences unconditional positive regard or real caring
for the client
u 5. The therapist experiences empathy for the clients internal frame of
reference and endeavors to communicate this to the client
u 6. The communication to the client is, to a minimal degree, achieved
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (5)

The Therapist
Focuses on the quality of the therapeutic relationship

Provides a supportive therapeutic environment in which the client is the agent


of change and healing

Serves as a model of a human being struggling toward greater realness

Is genuine, integrated, and authentic, without a false front

Can openly express feelings and attitudes that are present in the relationship
with the client

Is invested in developing his or her own life experiences to deepen selfknowledge


move
self-actualization
Theory
and Practice of and
Counseling
and toward
Psychotherapy
- Chapter 7 (6)
n

Transparency

Application to Group Counseling


n

Therapist takes on the role of facilitator


u
u
u
u
u

Creates therapeutic environment


Techniques are not stressed
Exhibits deep trust of the group members
Provides support for members
Group members set the goals for the group

Group setting fosters an open and accepting community where


members can work on self-acceptance

Individuals learn that they do not have to experience the process of


change alone and grow from the support of group members

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (7)

Transparency

Person-Centered Expressive Arts


Therapy
n

Various creative art forms


u promote healing and self-discovery
u are inherently healing and promote self-awareness and insight

Creative expression connects us to our feelings which are a source of life


energy.
u Feelings must be experienced to achieve self-awareness.

Individuals explore new facets of the self and uncover insights that transform
them, creating wholeness
u Discovery of wholeness leads to understanding of how we relate to the outer world.

The clients inner world and outer world become unified.

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (8)

Transparency

Conditions for Creativity


Acceptance of the individual

A non-judgmental setting

Empathy

Psychological freedom

Stimulating and challenging experiences

Individuals who have experienced unsafe creative environments feel held


back and may disengage from creative processes

Safe, creative environments give clients permission to be authentic and to


delve deeply into their experiences

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (9)

Transparency

Limitations of the Person-Centered


Approach
n

Cultural considerations
u Some clients may prefer a more directive, structured treatment
u Individuals accustomed to indirect communication may not be comfortable with
direct expression of empathy or creativity
u Individuals from collectivistic cultures may disagree with the emphasis on internal
locus of control

Does not focus on the use of specific techniques, making this treatment
difficult to standardize

Beginning therapists may find it difficult to provide both support and


challenges to clients

Limits of the therapist as a person may interfere with developing a genuine


therapeutic relationship

Theory and Practice of Counseling and Psychotherapy - Chapter 7 (10)

Transparency

Theory and Practice of Counseling


and Psychotherapy
Gestalt Therapy
Transparency

Gestalt Therapy
n

Existential & Phenomenological it is grounded in the clients here


and now

Initial goal is for clients to gain awareness of what they are


experiencing and doing now
u Promotes direct experiencing rather than the abstractness of talking
about situations
u Rather than talk about a childhood trauma the client is encouraged to
become the hurt child
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (1)

Principles of Gestalt Theory


n

Holism:
u The full range of human functioning includes thoughts, feelings, behaviors, body,
language and dreams

Field theory:
u The field is the clients environment which consists of therapist and client and all that
goes on between them
u Client is a participant in a constantly changing field

Figure Formation Process:


u How an individual organizes experiences from moment to moment
Foreground: figure
Background: ground

Organismic self-regulation:
u Emergence of need sensations and interest disturb an individuals equilibrium
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (2)

Transparency

The Now
n

Our power is in the present


u Nothing exists except the now
u The past is gone and the future has not yet arrived

For many people the power of the present is lost


u They may focus on their past mistakes or engage in endless resolutions
and plans for the future

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (3)

Unfinished Business
n

Feelings about the past are unexpressed


u These feelings are associated with distinct memories and fantasies
u Feelings not fully experienced linger in the background and interfere
with effective contact

Result:
u Preoccupation, compulsive behavior, wariness oppressive energy and
self-defeating behavior

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (4)

Contact and Resistances to Contact


n

Contact
u Interacting with nature and with other people without losing ones
individuality

Boundary Disturbances/ resistance to contact


u The defenses we develop to prevent us from experiencing the present
fully
u Five major channels of resistance:

Deflection
Confluence

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (5)

Transparency

Introjection
Projection
Retroflection

Six Components of Gestalt Therapy


Methodology
The continuum of experience

The here and now

The paradoxical theory of change

The experiment

The authentic encounter

Process-oriented diagnosis

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (6)

Transparency

Therapeutic Techniques
The experiment in Gestalt Therapy

Internal dialogue exercise

Rehearsal exercise

Reversal technique

Exaggeration exercise

Staying with the feeling

Making the rounds

Dream work

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (7)

Transparency

Application to Group Counseling


Encourages direct experience and action

Here-and-now focus allows members to bring unfinished business to the


present

Members try out experiments within the group setting

Leaders can use linking to include members in the exploration of a


particular individuals problem

Leaders actively design experiments for the group while focusing on


awareness and contact

Group leaders actively engage with the members to form a sense of


mutuality in the group

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (8)

Transparency

Limitations of Gestalt Therapy


The approach has the potential for the therapist to abuse power by
using powerful techniques without proper training

This approach may not be useful for clients who have difficulty
abstracting and imagining

The emphasis on therapist authenticity and self-disclosure may be


overpowering for some clients

The high focus on emotion may pose limitations for clients who
have been culturally conditioned to be emotionally reserved

Theory and Practice of Counseling and Psychotherapy - Chapter 8 (9)

Transparency

Theory and Practice of Counseling


and Psychotherapy
Behavior Therapy

Transparency

Behavior Therapy
n

A set of clinical procedures relying on experimental findings of


psychological research
u Based on principles of learning that are systematically applied
Treatment goals are specific and measurable

u Focusing on the clients current problems


To help people change maladaptive to adaptive behaviors

u The therapy is largely educational - teaching clients skills of selfmanagement

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (1)

Exposure Therapies
n

In Vivo Desensitization
u Brief and graduated exposure to an actual fear situation or event

Flooding
u Prolonged & intensive in vivo or imaginal exposure to stimuli that evoke high
levels of anxiety, without the opportunity to avoid them

Eye Movement Desensitization and Reprocessing (EMDR)


u An exposure-based therapy that involves imaginal flooding, cognitive
restructuring, and the use of rhythmic eye movements and other bilateral
stimulation to treat traumatic stress disorders and fearful memories of clients
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (2)

Four Aspects of Behavior Therapy


n

1. Classical Conditioning
u In classical conditioning certain respondent behaviors, such as knee
jerks and salivation, are elicited from a passive organism

2. Operant Conditioning
u Focuses on actions that operate on the environment to produce
consequences

If the environmental change brought about by the behavior is


reinforcing, the chances are strengthened that the behavior will
occur again. If the environmental changes produce no
reinforcement, the chances are lessened that the behavior will
recur
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (3)

Four Aspects of Behavior Therapy


n

3. Social-Learning Approach
u Gives prominence to the reciprocal interactions between an individuals
behavior and the environment

4. Cognitive Behavior Therapy


u Emphasizes cognitive processes and private events (such as a clients
self-talk) as mediators of behavior change

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (4)

Functional Assessment of Behavior


n

A-B-C model
u Antecedent(s)
u Behavior(s)
u Consequence(s)

Antecedent

Behavior

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (5)

Consequence

Therapeutic Techniques
Relaxation Training to cope with stress

Systematic Desensitization for anxiety and avoidance reactions

Modeling observational learning

Assertion Training learning to express ones self

Social Skills Training learning to correct deficits in interpersonal skills

Self-Management Programs giving psychology away


Theory and Practice of Counseling and Psychotherapy - Chapter 9 (6)

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Therapeutic Techniques
n

Multimodal Therapy a technical eclecticism

Applied Behavior Analysis training new behaviors


u Particularly effective in working with developmentally delayed
individuals

Dialectical Behavior Therapy-- learning emotional regulation and


mindfulness
u Designed for the treatment of Borderline Personality Disorder

Mindfulness-Based Stress Reduction Therapy meditation and yoga

Acceptance and Commitment Therapy - learning acceptance and nonjudgment of thoughts and feelings as they occur

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (7)

Transparency

Application of Behavior Therapy to Group


Counseling
n

Treatments
u rely on empirical support
u emphasize self-management skills and thought restructuring
u Are typically brief

Leaders
u use a brief, directive, psychoeducational approach
u conduct behavioral assessments

Leaders and members

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (8)

Transparency

u create collaborative, precise treatment goals


u devise a specific treatment plan to help each member meet goals
u objectively measure treatment outcome

Limitations of Behavior Therapy


Heavy focus on behavioral change may detract from clients experience of
emotions

Some counselors believe the therapists role as a teacher deemphasizes the


important relational factors in the client-therapist relationship

Behavior therapy does not place emphasis on insight

Behavior therapy tends to focus on symptoms rather than underlying causes


of maladaptive behaviors

There is potential for the therapist to manipulate the client using this
approach

Some clients may find the directive approach imposing or too mechanistic

Theory and Practice of Counseling and Psychotherapy - Chapter 9 (9)

Transparency

Theory and Practice of Counseling


and Psychotherapy
REBT
Transparency

Rational Emotive Behavioral Therapy


(REBT)
n

Stresses thinking, judging, deciding, analyzing, and doing

Assumes that cognitions, emotions, and behaviors interact and


have a reciprocal cause-and-effect relationship

Is highly didactic, very directive, and concerned as much with


thinking as with feeling

Teaches that our emotions stem mainly from our beliefs,


evaluations, interpretations, and reactions to life situations
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (1)

The Therapeutic Process


n

Therapy is seen as an educational process

Clients learn
u To identify the interplay of their thoughts, feelings and behaviors
u To identify and dispute irrational beliefs that are maintained by selfindoctrination
u To replace ineffective ways of thinking with effective and rational
cognitions
u To stop absolutistic thinking, blaming, and repeating false beliefs
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (2)

View of Human Nature


We are born with a potential for both rational and irrational thinking

We have the biological and cultural tendency to think crookedly


and to needlessly disturb ourselves

We learn and invent disturbing beliefs and keep ourselves


disturbed through our self-talk

We have the capacity to change our cognitive, emotive, and


behavioral processes

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (3)

Transparency

The A-B-C Theory of Personality


n

activating
event

belief

consequence

disputing
intervention

effective
philosophy

New feeling

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (4)

Transparency

Irrational Ideas
n

Irrational ideas lead to self-defeating behavior

Some examples:
u I must have love or approval from all the significant people in my life.
u I must perform important tasks competently and perfectly.
u If I dont get what I want, its terrible, and I cant stand it.

Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (5)

Application of CBT to Group Counseling


Tailored for specific diagnoses such as anxiety, panic, eating
disorders and phobias

Treatments are standardized and based on empirical evidence

Use of homework allows lessons learned in group to generalize to


the clients daily environment

Help members gain awareness of how their self-defeating thoughts


influence what they feel and how they behave

Heavy emphasis on psychoeducation and prevention of symptoms

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (6)

Transparency

Aaron Becks Cognitive Therapy (CT)


n

Insight-focused therapy

Emphasizes changing negative thoughts and maladaptive beliefs

Theoretical Assumptions
u Peoples internal communication is accessible to introspection
u Clients beliefs have highly personal meanings
u These meanings can be discovered by the client rather than being
taught or interpreted by the therapist
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (7)

Theory, Goals & Principles of CT


n

Basic theory:
u To understand the nature of an emotional episode or disturbance it is
essential to focus on the cognitive content of an individuals reaction to the
upsetting event or stream of thoughts

Goals:
u To change the way clients think by using their automatic thoughts to reach
the core schemata and begin to introduce the idea of schema restructuring

Principles:

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (8)

Transparency

u Automatic thoughts: personalized notions that are triggered by particular


stimuli that lead to emotional responses

CTs Cognitive Distortions


Arbitrary inferences

Selective abstraction

Overgeneralization

Magnification and minimization

Personalization

Labeling and mislabeling

Polarized thinking

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (9)

Transparency

Becks Cognitive Triad


n

1.

Pattern that triggers depression


Clients hold negative views of themselves
u

2.

Selective Abstraction
u
u

Client interprets life events through a negative filter


The world is a negative place where bad things are bound to happen
to me

Client holds a gloomy vision of the future


u

The world is bleak and it isnt going to improve

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (10)

Transparency

3.

I am a lousy person

Donald Meichenbaums Cognitive


Behavior Modification (CBM)
n

Focus:
u Clients self-verbalizations or self-statements

Premise:
u As a prerequisite to behavior change, clients must notice how they
think, feel, and behave, and what impact they have on others

Basic assumption:
u Distressing emotions are typically the result of maladaptive thoughts
Transparency

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (11)

Meichenbaums CBM
n

Self-instructional therapy focus:


u Trains clients to modify the instructions they give to themselves so that
they can cope
u Emphasis is on acquiring practical coping skills

Cognitive structure:
u The organizing aspect of thinking, which seems to monitor and direct
the choice of thoughts
u The executive processor, which holds the blueprints of thinking that
determine when to continue, interrupt, or change thinking
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Theory and Practice of Counseling and Psychotherapy - Chapter 10 (12)

Behavior Change & Coping (CBM)


n

3 Phases of Behavior Change


u 1. Self-observation
u 2. Starting a new internal dialogue
u 3. Learning new skills

Coping skills programs Stress inoculation training


(3 phase model)

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (13)

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u 1. The conceptual phase


u 2. Skills acquisition and rehearsal phase
u 3. Application and follow-through phase

Limitations of Cognitive Behavior Therapy


n

Extensive training is required to practice CBT

Therapist may misuse power by imposing their ideas of what


constitutes rational thinking on a client
u Therapists must take special care to encourage clients to act rationally
within the framework their own value system and cultural context

The strong confrontational style of Ellis REBT may overwhelm


some clients

Some clinicians think CBT interventions overlook the value of


exploring a clients past experiences

Theory and Practice of Counseling and Psychotherapy - Chapter 10 (14)

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Theory and Practice of Counseling


and Psychotherapy
Realty Therapy
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Reality Therapy Basic Beliefs


n

Symptoms are the result of choices weve made in our lives


u We can chose to think, feel and behave differently

Emphasis is on personal responsibility

Therapists function is to keep therapy focused on the present

We often mistakenly choose misery in our best attempt to meet our


needs

We act responsibly when we meet our needs without keeping


others from meeting their needs

Theory and Practice of Counseling and Psychotherapy - Chapter 11 (1)

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Basic Needs
n

All internally motivated behavior is geared toward meeting one or


more of our basic human needs
u
u
u
u
u

Belonging
Power
Freedom
Fun
Survival (Physiological needs)

Our brain functions as a control system to get us what we want

Our quality world consists of our visions of specific people,


activities, events, beliefs and situations that will fulfill our needs

Theory and Practice of Counseling and Psychotherapy - Chapter 11 (2)

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Procedures That Lead to Change:


The WDEP System

W
u

D
u

Wants - What do you want to be and do?


Your picture album

Doing and Direction - What are you doing?


Where do you want to go?

Evaluation - Does your present behavior have a reasonable


chance of getting you what you want?
n P Planning SAMIC3
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Theory and Practice of Counseling and Psychotherapy - Chapter 11 (3)

Planning For Change


S
A

Simple - Easy to understand, specific and concrete

Measurable - Are the changes observable and helpful?

M
I

Controlled - Can you do this by yourself or will


you be dependent on others?
- Can you do this on a continuous basis?

n
n
n

Attainable - Within the capacities and motivation


of the client

Immediate and Involved - What can be done today?


What can you do?

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Theory and Practice of Counseling and Psychotherapy - Chapter 11 (4)

Total Behavior

Our Best Attempt to Satisfy Our Needs


n

DOING active behaviors

THINKING thoughts, self-statements

FEELINGS anger, joy, pain, anxiety

PHYSIOLOGY bodily reactions

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Theory and Practice of Counseling and Psychotherapy - Chapter 11 (5)

Application of Reality Therapy to Group


Counseling
Group leaders and members jointly determine goals and plans of action

In group, members explore new courses of behavior that will bring them
closer to getting what they want out of life

Leaders challenge group members to evaluate for themselves if what they


are currently doing is working for them

Feedback from leaders and group members can help individuals design
realistic and attainable plans

Group setting encourages members to take an active stance in attaining


change in their lives

Theory and Practice of Counseling and Psychotherapy - Chapter 11 (6)

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Limitations of Reality Therapy


Some feel it does not adequately address important psychological concepts
such as insight, the unconscious, dreams and transference

Clinicians may have trouble viewing all psychological disorders (including


serious mental illness) as behavioral choices

There is a danger for the therapist of imposing his or her personal views on
clients by deciding for the client what constitutes responsible behavior

Reality therapy is often construed as simple and easy to master when in


fact it requires much training to implement properly.

More empirical support is needed

Theory and Practice of Counseling and Psychotherapy - Chapter 11 (7)

Copyright 2009 Wadsworth Group. Brooks/Cole is an imprint of the


Wadsworth Group, a division of Cengage Learning, Inc.

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