Chapter 13: Integrative Theories of Counseling and Psychotherapy Flashcards
Two Contraindications in Psycotherapy and Counseling
Psychotherapists have a strong commitment to a particular psychotherapy approach
Little evidence of the psychotherapy approaches is more effective than another
Societies, institutes, centers, and journals devoted to particular therapy apporaches dominate the field of psychotherapy
Mijority of practicing therapists do not identify themselves as adhering to one particular approach but refer to themselves as eclectic or integrative
Sources of Theoretical and Practical Diversity in Psychotherapy
Individuality
Cultural Specificity
Human Conflict
Individuality
Adler emphasized that every child born into the same family is at the same time born into a different family; Every perspective is unique; Integrational and eclectic approaches to therapy may allow greater latitude in addressing each client as a unique individual being
Cultural Specificity
Some individuals and groups are systematically treated differently, often discriminated against, throughout the world; Many factors distinguish individuals from one another, these factors might determine not only whether someone seeks therapy but also whether they even have access to therapy; Integrational and eclectic therapy approaches must address cultural backgrounds, values, and needs
Human Conflict
Conflict should not abe avoided because it can potentially lead to positive transformations
Conflict in the field of Counseling and Psychotherapy
Freud was ostracized for suggesting that sexual abuse was at the roots of hysteria;
Adler suggested that women’s psychopathology was at least generated and maintained by social factors, Freud sent him packing from the Vienna Psychoanalytic society
Jung and Freud finalized their theoretical divorce
Adler dismissed Frankl from his study group, Frankl emerged after WWI and championed meaning as central in psychotherapy and human development
Fritz Perls was rebuffed by Freud and became influential and productive
Carl Rogers and BF Skinner had great debates
Feminist therapists have reshaped theories and techniques
Staunch behaviorists threatened tnal Cognitive Therapy and Research
Francine Shapiro’s approach Eye Movement and Desensitization Reprocessing (EMDR) was criticized
Micheal Mahoney et al developed into leading constructivist thinkers
Options open to Ethical, Theory-Based Counseling and Psychotherapy
Ideological Purity
Theoretical Integration
Focus on Common Factors
Technical Eclecticism
Ideological Purity
Studying and learning one theoretical approach to therapy and applying it ethically and competently; allows the therapist to become a master of one approach; focusing on one approach can ease the ambiguity inherent in practicing therapy
Theoretical Integration
Involves the combining of two or more theoretical approaches to maximize therapeutic effectiveness; based on the idea that two heads are better than one
Dollard and Miller
Published Personality & Psychotherapy: An Analysis in Terms of Learning, Thinking, and Culture; early effort at integrating psychoanalytic and behavioral principles
Wachtel
Published Psychoanalysis and Behavior Therapy: Toward an Integration; his intent was to develop an open and evolving theoretical framework; goal was not designed to be a specific hybrid theory; wanted to develop a system that might change as learning theory and psychoanalytic theory continued to change and develop
Alexander and French
Articulated the concept of corrective emotional experience; in all forms of psychotherapy, the basic therapeutic principle is the same: To re-expose the patient, under more favorable circumstances, to emotional situations which he could not handle in the past; The patient, in order to be helped, must undergo a corrective emotional experience suitable to repair the traumatic influence of previous experiences
Common Therapeutic Principles
Roger’s Certain Type of Relationship, many theorists integrate Rogers’s concepts of unconditional positive regard, congruence, and accurate empaty into their therapeutic approaches, although some do it more formally and systematically than others
Jerome Frank
Developed a comprehensive common factors model of psychotherapy
Comprehensive Common Factors Model of Psychotherapy
All psychotherapeutic methods are elaborations and variations of age-old procedures of psychological healing. These incloude confession, atonement and absolutions, encouragement, positive and negative reinfocements, modeling, and promulgation of a particular set of values. These methods become embedded in theories as to the causes and cures of various conditions which often become highly elaborated
Components that continue to be relevant to practicing therapists
The Demoralization Hypothesis
Shared Therapeutic Components
The Demoralization Hypothesis
People who come for therapy are also experiencing a common form of distress; he refers to common distress as the demoralization hypothesis; Demoralization occurs when, because of lack of certain skills or confusion of goals, an individual becomes persistently unable to master situations which both the individual and others expect him or her to handle or when the individual experiences continued distress which he or she cannot adequately explain or alleviate. Demoralization may be summed up as a feeling of subjective incompetence, coupled with distress
Demoralization Symptoms
Low self-esteem, anxiety, sadness, and hopelessness; initial target of effective therapy
Shared Therapeutic Components
An emotionally charged, confiding relationship with a helping person.
A healing setting
A rationale, conceptual scheme, or myth
A ritual
Factors that Selection of Particular Therapy Technique is Based On
Relevant or empirical outcomes research
Pragmatics of the Situation
Clinical Intuition
Syncretism
Choosing what to do with a client in a whimsical, unreasoned, or even impulsive manner
Eclecticism
Selecting what appears to be best in various doctrines, methods, or styles
Behavioral Theory and Therapy
Most flexible of all theoretical orientations; behaviorists contend that they practice a form of therapy based on scientific research and observable processes; their interest is not in a static theory but in what has been tested in the laboratory and in what has been demonstrated as effective
Gordon Paul
What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances, and how does it come about (who-how-whom question)
Primary purpose of the Diagnostic system of the DSM
To identify specific disease entities that are best ameliorated through the application of specific (often pharmacological) treatments
Main Eclectic or Integrative Forms of Therapy
Multimodal Therapy Eye Movement Desensitization Reprocessing Interpersonal Psychotherapy Process-Experiential Psychotherapy Dialectic Behavior Therapy Acceptance and Commitment Therapy Cognitive-Constructivist Psychotherapy The Transtheoretical Change Model The Last Best Therapy Dialectic
Preparing Your Client for Eclectic or Integrative Therapy
Avoid the word eclectic or define it simply.
Indicate reasons for not adhering to a certain theory or set of techniques.
Explain how you will choose the kinds of techniques you will use
Discuss your overall theory of human change and why you think your services might be of help.
Mention the theoretical origins of any techniques you might commonly use.
Indicate a willingness to discuss the reasons for choices you might make during the course of the client’s work with you
Arnold Lazarus
Coined the term Technical Eclecticism; noted the following: to attempt a theoretical rapprochement is as futile as trying to picture the edge of the universe. But to read through the vast amount of literature on psychotherapy, in search of techniques, can be clinically enriching and terapeutically rewarding.
Lazarus’ Opinion about why Techinical Eclecticism is preferable to Theoretical Purity
The most essential ingredients for an effective psychotherapist are flexibility and versatility. This implies an ability to play many roles and to use many techniques in order to fit the therapy to the needs and idiosyncrasies of each patient. By contrast, therapists with pet theories or specially favored techniques usually manage, in their own minds at least, to fit their patients’ problems within the confines of their particular brand of treatment
Mutimodal Therapy
Applies specific techniques and adopt specific interpersonal styles in an effort to help clients obtain their goals.
Primary Foci of Multimodal Therapy
Assessment
Technical Applications
Therapist Interpersonal Style
Assessment
Multimodal orientation is predicated on the assumption that most psychological problems are multifaceted, multidetermined, and multilayered, and that comprehensive therapy call for careful assessment of parameters of modalities
Modalities of Multimodal Orientation; Areas of Functioning
Behavior Affect Sensation Imagery Cognition Interpersonal Relationships Drugs
Technical Applications
Multimodal therapists consider using any therapy technique that seems appropriate based on empirical research or a logical or practical rational; multimodal therapists also use their intuition when determining what therapy approach to use
Therapist Style
Because every client is different, it is essential for therapists to change their style based on each new client; a flexble therapist has no fixed pattern of approaching new patients; usually perceives what his patient needs and then tries to fit the role
Becoming an Authentic Chamelion
Shifting one’s therapeutic style
Interpersonal Variables Therapists should consider varying depending on their clients’ needs, preferences, or expetations
Level of formality or informality Amount of personal disclosure How much or how often a new topic of conversation is initiated Level of directiveness Level of supportieness Level of relectiveness
Eye Movement Desensitization Reprocessing (EMDR)
Specific treatment approach developed by Francine Shapiro; originally designed to address trauma smptoms in general and to alleviate distributing traumatic memories in particular
Why EMDR is considered to be an interative treatment
It includes principles from the following theoretical perspectives:
Psychodynamic - there is a focus on past events and traumas that form the foundation for dysfunction
Behavioral- there is a focus on present stimuli, with specific behaviors expected of the client
Cognitive - there is a focus on negative and positive beliefs, as well as utilization of an information-processing model
Person-centered - EMDR therapists follow the client’s lead rather than always dictating the course or direction therapy
Physiological or body-centered - there is a focus on physical-affective links associated with trauma experiences
Phases of the Standard EMDR Procedure
History Preparation Assessment Desensitization Installation Body Scan Closure Reevaluation
Interpersonal Psychotherapy (IPT)
New therapeutic approach that integrates principles of traditional psychodynamic therapy (Harry Stack Sullivan) with more pragmatic, empirical formulations of depression;
Gerald L. Klerman
Developed IPT
Main Characteristics of IPT
It is time-limited
It focuses on one or two interpersonal problem areas
It focuses on current, rather than past, interpersonal relationships
It has an interpersonal, rather than intrapsychic, emphasis
It addresses cognitive-behavioral issues but wmphasizes these factors only in terms of how they affect important social relationships
It recognizes, but does not focus on, personality variables
It is based on a medical model in which the client is viewed as having clinical depression, a specific medical disorder for which a specific treatment is most appropriate
Main Foci of IPT is to help clients do the following:
Recognize the relationship between depressie symptoms and interpersonal problems
Find ways to deal more effectively with interpersonal problems, thereby alleviating depressive symptoms
Treatment Phases of IPT
IPT is a time-limited (acutely, 12-16 weeks) treatment with three phases: a beginning (1-3 sessions), middle, and end (3 sessions). The initial phase requires the therapist to identify the target diagnosis (MDD) and the interpersonal context in which it presents.
Possible specific Interpersonal Situation linked to a client’s depressive symptoms
Grief
Interpersonal Role Dispute
Role Transition
Interpersonal Deficit
Grief
Complicated bereavement folowing the death of a loved one
Interpersonal Role Dispute
Conflicts in an important social relationship
Role Transition
A change in life status, including the beginning or end of a relationship, retirement, graduation, medical diagnosis, and so on
Interpersonal Deficit
When a client lacks specific social skills that contribute to relationship problems
Process-Experiential Psychotherapy
Rooted in person-centered theory; emphasizes the formation of a relationsihp based on Rogers’s core conditions and then, from the trusting relationship foundation, seeks to explore and resolve the client’s affective problems.
Dialectical Behavior Therapy
Developed by Marsha Linehan et al at University of Washington Suicidal Behaviors Research Clinic
Dialectical Behavior Therapy
Developed as a specific treatment for women who were exhibiting parasuicidal behavior and suffering from BPD; blends cognitie-behavioral and Eastern meditation practices with elements of psychodynamic, person-centered, Gestalt, strategic, and paradoxical approaches
Parasuicidal Behavior
Includes all intentional self-injurious behavior, some of which is also characterized by suicidal intent
Functions Delivered in Various Modalities of DBT
Enhancing the client’s skills and capabilities
Improving the client’s motivation
Generalizing the client’s skills and capabilities from therapy to the client’s life outside therapy
Improving the therapist’s capabilities and motiation to treat BPD patients
Structuring hte client’s environment to support and validate the client’s and therapist’s capabilities
Acceptance and Commitment Therapy
Emphasize that current medically based therapy systems are operating ont he wrong paradigm; the assumption of healthy normality and the assumption that abnormality is a disease are both flawed and that the disease, disorder, or psychopathology model has fared quite poorly over the years
Transtheoretical Change Model
Focuses on how people change, proposed by James Prochaska; Emphasizes both common factors and theoretical integration
Transtheoretical Model Seeks to
Respect the fundamental diversity and essential unity of therapy systems
Emphasize empricism
Account for how people changei nside and outside of therapy
Address physical and mental health problems
Encourage therapists to be innovators and now simply borrowers from various systems
Dimensions of Change that the Transtheoretical Model Focuses on
Change processes
Stages of Change
Levels of Change
Common Change Processes
Consciousness Raising Dramatic Relief Self-Re-evaluation Environmental re-evaluation Self-liberation Social-liberation Counterconditioning Stimulus Control Reinforcement Management Helping Relationship
Consciousness Raising
Processes of personal insight and awareness that stem from feedback and education; rooted in Psychodynamic Theory and Feminist Theory
Dramatic Relief
Catharsis and expressive procedures; Gestalt Theory
Self-Re-evaluation
An examination of self, self-schema, and other variables; Cognitive therapy, constructivist, and Adlerian Theories
Environmental Re-evaluation
Information processing with environmental focus; cognitive and constructivist theory
Self-Liberation
A focus on personal freedom; Existential and Choice Theory
Social-Liberation
A focus on freedom from social oppression; Feminist, Existential, and Constructivist Theory
Counterconditioning
New learning that overcomes old learning; behavioral
Stimulus control
Management of environmental stimuli; behavioral
Reinforcement Management
Management of environmental contingencies; behavioral
Helping Relationship
The healing potential of a helping relationship; person-centered
Stages of Change
Precontemplation Contemplation Preparation Action Maintenance Termination
Precontemplation
During this stage, the individual has little or no interest in changing his behavior
Contemplation
During this stage, the individual is aware that a problem exists, but she has not yet made a clear commitment to making personal change
Preparation
During preparation, there may be some intention and effort made toward change; There may be occasional ventures forth into action, but mostly these individuals are so deep into contemplation that they’re beginning some minimal action toward change but are not yet into the action stage
Action
During action, people are plunging into the change process. These are the clients whom most therapists love to see because their motivation is so high that they quickly engage in the therapy process and often make considerable and imediate progress; the successful alteration of a problem behavior for a period from 1 day to 6 months
Maintenance
People continue with their action and deepen their commitment toward permanent change. There is continual work or action toward relapse prevention. This stage continues from 6 months to infinity, but relapse often occurs at some point durin gmaintenance
Termination
People have 100% confidence (self-efficacy) that they will not engage in the problem behavior again; Prochaska uses a 5-year criterion of symptom liberation, plus 100% confidence, for classification into this stage
Levels of Change
Symptom/Situational Problems Maladaptive Cognitions Current Interpersonal Conflicts Family-Systems Conflicts Intrapersonal conflicts
