Counseling and Helping Relationships Flashcards
helping relationship
considerable research evidence suggests that the relationship in counseling is the determining factor whether or not counseling is successful. theories of counseling provide the underlying philosophy and strategies for building and maintaining this relationship. four key elements of building this relationship are:
human relations core - empathy, respect, and genuineness as identified by carl rogers
social influence core - competence, power, and intimacy. expertness, attractiveness, and trustworthiness were identified by stanley strong in his social influence model.
skills core - allen ivey identified microskills - communication skill units such as attending, inquiry, and reflection
theory core - these help the counselor understand self and interpersonal relationships and skills. they also help to understand the problems of clients and help to choose interventions that are likely to be effective with the identified problems.
psychoanalytic (sigmund freud)
freud identified a structure of personality, namely, the id, ego, and superego. unconscious motivation or energy is the id ruled by the pleasure principle. the ego is controlled by the reality principle. the superego is internalized ethics.
therapy techniques include: free association, interpretation of dreams, and other client material.
transference (projections onto therapist) must be worked through.
countertransference consists of projections of the therapist onto the patient.
neo-freudians
a number of psychoanalysts moved away from freud’s emphasis on the id as the dominant force and placed more emphasis on the ego, including both psychodynamic and sociodynamic forces.
karen horney - security is each person’s major motivation and the person becomes anxious when it is not achieved. irrational ways to mend disrupted human relationships may become neurotic needs.
erich fromm - the individual must join with others to develop self-fulfillment - social character - otherwise they may become lonely and nonproductive. society offers opportunities to experience mutual love and respect.
harry stack sullivan - a social systems (interpersonal) approach can lead to understanding human behavior. behavior can best be understood in terms of social interactions, not as mechanistic and linear.
other neo-freudians include otto rank, wilheim reich, and theodore reik.
object relations theory
object relations theory is based on psychanalytic concepts.
object relations are interpersonal relationships as represented intrapsychically.
freud used the term object to mean a significant person or thing that is the object or target of one’s feelings or drives.
object relations are interpersonal relationships that shape an individual’s current interactions with people, both in reality and in fantasy.
four broad stages of development have been identified as important in the first three years of life:
a. fusion with mother - normal infantile autism (first 3-4 weeks of life)
b. symbiosis - with mother (3rd to 8th month)
c. separation/individuation (starts the 4th or 5th month)
d. constancy of self and object (by the 36th month)
progressing through these stages provides the child a secure base for later development. the child develops trust that their needs will be met.
attachment, borderline, and narcissistic disorders may occur when normal progression through these stages does not occur.
margaret mahler wrote psychological birth of the human infant. heinz kohut and otto kernberg are other writers in this area.
person-centered (client-centered, rogerian)
rogers reacted against the directive psychoanalytic approach which put the counselor in charge of giving advice, teaching, and interpreting. his focus was more on the person’s phenomenological world reflecting and clarifying their verbal and nonverbal communication.
the process of becoming, moving clients to self-actualization, and the relationship between client and counselor were critical concepts. the focus of counseling went from past to present and was on feelings. the counselor showed unconditional positive regard, genuineness/congruence, and empathetic understanding. these are the core or facilitative conditions of effective counseling.
rogers’ principal books are counseling and psychotherapy 1942, client centered therapy 1951, and on becoming a person 1961.
gestalt (frederick ‘fritz’ perls)
this approach is based on existential principles, has a here and now focus, and a holistic systems theory viewpoint.
individuals experiences needs. to the extent a need is in the forefront, it represents a figure and other needs are ground (in the background). as the need is met, it completes the gestalt and a new need takes its place. the goal for individuals in therapy is to become whole beings, to complete gestalts.
key concepts in the theory include personal responsibility, unfinished business, and awareness of the now.
this is an experiential therapy, encouraging the taking of responsibility by the client. the counselor uses confrontation and encourages the client to stay with feelings and to relive experiences and finish business.
role playing, two chair techniques, and dream work are used.
interpretation is done by the client not by the counselor.
perls wrote gestalt therapy verbatim and in and out of the garbage can.
individual psychology (alfred adler and rudolph dreikurs)
the belief in the uniqueness of each individual is influenced by social factors. each person has a sense of inferiority and strives for superiority. we choose a lifestyle, a unified life plan, which gives meaning to our experiences which include habits, family, career, attitudes, etc.
counseling goals are to help the client understand lifestyle and identify appropriate social and community interests. also, counseling strives to explain clients to themselves and for them to overcome inferiority.
techniques used are those leading to insight such as life histories, homework assignments, and paradoxical intentions.
transactional analysis (eric berne)
the personality has three ego states - parent, adult, and child.
a life script develops in childhood and influence a person’s behavior. many transactions with others can be characterized as games with the intent to avoid intimacy.
complementary transactions - adult to adult - lead to good communication
crossed transactions - adult to child and child to parent - lead to barriers to communication
the goal of therapy is to teach the client the language and ideas of TA in order to recognize ego state functioning and analyze one’s transactions.
techniques include teaching concepts, helping diagnose, interpretation, and use of contracts and confrontation.
berne wrote games people play
thomas harris wrote i’m okay - you’re okay
existential (rollo may, victor frankl, irvin yalom)
other existentialists include: sored kierkegaard, paul tillich, martin heidegger, and jean paul satre.
phenomenology is the basis of existential therapy.
phenomenology is the study of our direct experiences taken at their face value. we have freedom of choice and are responsible for our fate.
we search for meaning and struggle with being alone, unconnected from others.
anxiety and guilt are central concepts - anxiety is the threat of non-being and guilt occurs because we fail to fulfill our potential.
the goal of existential therapy is the understanding of one’s being, one’s awareness of who one is and who one is becoming.
awareness of freedom and choosing responsibility are other goals.
the authentic relationship is important in existential therapy. client-centered counseling techniques are appropriate.
logotherapy is the name of victor frankl’s counseling theory found in his book man’s search for meaning which followed his concentration camp experience.
the principles underlying his theory are individuals’:
a. motivation to find meaning in their life journey
b. freedom to choose what they do, think, and how they react
c. with freedom of choice comes personal responsibility
cognitive and behavioral counseling
the leading proponents of cognitive and behavioral counseling include joseph wolpe, donald meichenbaum, aaron beck, and albert bandura. albert ellis and his rational emotive behavior therapy, and arnold lazarus with multimodal therapy, are often included in this broad category.
the stimulus-response and stimulus-organism-response paradigms are at the basis of this theory.
the belief is that behavior is learn and, consequently, can be unlearned and relearned.
the goals of counseling are to identify antecedents of behavior and the nature of the reinforcements maintaining that behavior. the counselor helps create learning conditions and may engage in direct intervention. goals of therapy are likely to be behaviorally stated.
counseling techniques may include any of the following: operant and classical conditioning, social modeling, problem-solving, direct training, reinforcement, decision making
most counselors would establish a strong, personal relationship with the client.
dialectical behavior therapy (dbt)
marsha linehan developed this therapeutic approach for the treatment of borderline personality disorder. it is not used more widely with a variety of disorders including traumatic brain injury, eating disorders, as well as a range of mood disorders. dbt has been used with adolescents as well as adults. a group component usually complements individual work. used with adolescents, family members may be involved if available and willing.
a basic principle of dbt, in addition to the usual cognitive behavioral techniques, is helping clients increase emotional and cognitive regulation by learning the triggers that lead to their undesired behaviors. the dialectical principle of recognizing two sides to situations, such as the need for accepting change and recognizing the resistance to change, receives attention.
dbt is viewed a a long-term therapeutic intervention in part because it requires the learning, practicing, and acquiring of a number of skills by the client. the skills are conceptualized in the following four modules:
a. mindfulness - paying attention to the present moment nonjudgmentally, and experiencing one’s emotions and senses fully
b. distress tolerance - accepting and tolerating oneself and the current situation, often painful and negative, in a non-evaluative way
c. interpersonal effectiveness - developing effective strategies for asking for what one needs, saying no as appropriate, and coping with interpersonal conflict
d. emotion regulation - identifying emotions and obstacles to changing them, reducing vulnerability, and increasing positive emotions
the dbt practitioner might also use such tools as diary cards (tracking interfering behaviors), chain analysis (analyzing sequential events that lead to behaviors), and the dynamics of the milieu or culture of the client’s group. for effective use of dialectical behavior therapy, the counselor must obtain training in order to teach the required skills and facilitate the application of these skills on an individual and group basis with a variety of clients.
rational emotive behavior therapy - rebt - albert ellis
rebt is based on the philosophy that it is not the events we experience that influence us, but rather it is our interpretation of those events that is important.
individuals have the potential for rational thinking. in childhood, we learn irrational beliefs and re-indoctrinate ourselves on a continuing basis. this leads to inappropriate affect and behavior.
belief system, self-talk, and crooked thinking are major concepts. therapy follows and a-b-c-d-e system as follows:
a - external event, activity, or action
b - belief in the form of a self-verbalization
c - consequent affect which may be rational or irrational
d - disputing of the irrational belief which is causing the affect/behavior
e - effect (cognitive) - which is a change in the self-verbalization
emotive techniques in therapy include role playing and imagery. this theory teaches that self-talk is the source of emotional disturbance.
multimodal therapy - arnold lazarus
this is a comprehensive, holistic approach sometimes classified as eclectic. it has strong behavioral ties.
this multimodal model addresses seven interactive yet discrete modalities summarized in the acronym basic id. these seven modalities are:
b - behaviors (acts, habits, and reactions)
a - affective responses (emotions and moods)
s - sensations (five senses as touch, smell, sight, hearing, and tast)
i - images (how we see selves, memories, dreams)
c - cognitions ( insights, philosophies, ideas)
i - interpersonal relationships (interactions with people)
d - drugs which is to signify, more generally, biology including nutrition
assessment covering all seven modalities is necessary to determine total human functioning.
counseling techniques from a variety of theoretical perspectives are used. these include anxiety-management training, modeling, positive imagery, relaxation training, assertiveness training, biofeedback, hypnosis, bibliotherapy, and thought stopping.
reality therapy (william glasser)
although it is based on choice theory, glasser continued to refer to the therapy as reality.
individuals determine their own fate and are in charge of their lives.
our perceptions control our behavior and we behavior (appropriately or inappropriately) to fulfill our needs. we have five genetically-based needs - survival, love and belonging, power or achievement, freedom or independence, and fun.
choice theory means we act to control the world around us and the real world is important to the extent it helps us satisfy our needs. we may not satisfy our needs directly.
taking responsibility is a key concept.
characteristics of reality therapy include:
a. emphasize choice and responsibility
b. reject transference - by being yourself as the therapist
c. keep the therapy in the present - the past is not critical
d. avoid focusing on symptoms - focus on how to meet needs
e. challenge traditional views of mental illness - take a more solution-focused approach
robert wubbolding has developed a system for helping counselors learn and use reality therapy. the acronym, wdep, represents:
w - exploring the client’s wants as these relate to perceived needs
d - encouraging clients to discuss actions and feelings
e - self-evaluation by clients concerning their behaviors
p - planning in order to effect change
feminist therapy
feminist therapy origins can be traced back to the women’s movement in the 1960s but no specific individual is associated with its development and nurturance.
basic perspectives include gender as central to therapeutic practice, awareness and understanding of the role of sociocultural influences as they manifest themselves in therapy, and the need to empower women and address societal changes.
the basic principles of feminine psychology which underlie feminist therapy are (from corey 2017):
a. the personal is political and critical consciousness - the problems of the client have societal and political roots which often result in marginalization, oppression, subordination, and stereotyping
b. commitment to social change - therapy is not only for the individual but to advance a transformation in society. therapists must also take action for social change
c. 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 - women’s perspectives are considered central rather than using the male experience as the norm against which women often appear deviant
d. the counseling relationship is egalitarian - clients are experts on themselves and their oppression is recognized; therapy is a collaborative process
e. a focus on strengths and a reformulated definition of psychological distress - intrapsychic factors are only a part of the explanation for the pain experienced; psychological distress is reframed as a communication about unjust systems; symptoms can be reframed as survival strategies
f. all types of oppression are recognized along with the connections among them - all clients can be best understood in the context of their sociocultural environments. in addition to helping clients mage changes in their lives, feminist therapists work toward societal change.
therapeutic processes and techniques which may be used in feminist therapy include gender role analysis and intervention, bibliotherapy, assertiveness training, reframing and re-labeling, groups, and social action.
relational-cultural theory
the central premise of this approach is that human growth develops in connection with others rather than through separation and individuation.
this applies to the growth and development of men as well as women. relational-cultural theory addresses how people respond to relational and cultural adversity. issues in counseling may include power, privilege, marginalization, and acceptance rather than pathology.
connections are central and powerful in peoples’ lives. neuroscience appears to corroborate this. the brain changes through connections and relationships with others or with a therapist.
judy jordan (wellesley center for women) is one of the early scholars of relational-cultural theory. she believes we need to move from a human growth mode of separation to a relationship one. as social beings, cultural vaules and connections are paramount and individuals thrive in relationships.
solution-focused brief therapy - sfbt
solution-focused brief therapy does not address the history of past experience of a problem. understanding the nature of the problem is not necessary to generating solutions to a problem.
one focus of solution-focused brief therapy is to maintain a positive orientation believing that the client can construct solutions. stress is placed on what is working for the client, the exceptions that exist to the problem pattern. some principal therapeutic techniques and procedures include:
a. exceptions question - what were the circumstances when the problem did not exist, these circumstances represent news of difference
b. miracle question - if a miracle happened, how would you know and what would be different?
c. scaling questions - using a scale from 1 to 10, identify changes in the client’s affect, anxiety, etc. focus is on any positive change and then duplicate or increase that change.
brief therapy models are becoming more important with the need to meet health maintenance and employee assistance program needs for services. the number of sessions may be limited to six or eight or fewer. even in college counseling centers, limits to the number of counseling sessions are common.
brief therapy dictates setting specific goals early in the counseling relationship. the focus may be on resolving the immediate problem which led to the counseling intervention and the development of coping skills to assist counselees in managing current and future problems.
a related therapeutic approach is intermittent counseling. a client sees a counselor on and off as problems arise sometimes over several years. not all client problems will be addressed adequately using brief therapy models. the counselor and client must identify those circumstances when additional sessions are necessary and do what is possible to meet the client’s needs appropriately. using brief therapy procedures with certain client problems may raise ethical questions of professional competence and abandonment.
narrative therapy
as one of the strengths-based therapies, narrative therapy’s philosophical basis is social constructionism. this post-modern approach beliefs that independent, objective reality exists through subjective experiences, and the client’s perception of reality is valid. this reality is based on the language and words clients use to represent their situation and circumstances in which people live. consequently, their realities are socially constructed.
narrative therapy believes that clients’ lives are stories in progress and these stories can be told and explored from a variety of perspectives. stories used words and language to give meaning to experiences and help determine feelings and attitudes. they are subjective and constructed by the individual living within a context made up of family, culture, face, ethnicity, gender orientation, etc.
in narrative therapy, the client tells the often problem-saturated story and the therapist encourages other perspectives and interpretations. the story might be deconstructed and new meanings and variations may be substituted. after deconstruction, the focus is on helping the client rewrite their story.
some specific therapeutic techniques and interventions may be:
a - questions and clarifications - by the therapist to discover and construct the story of the client’s experience
b - externalization and deconstruction - with the focus that the person is not the problem, the problem is the problem. externalizing the problem can help deconstruct it.
c - re-authoring - helping the client find a more appropriate alternative story. by finding strengths and exceptions, help the client write a new story more consistent with what they want their life to be like.
d - documenting the evidence through writing of letters - therapists can consolidate gains and advance therapy by writing letters to the client between sessions. these have been found to be powerful adjuncts to the sessions.
integrative counseling
integrative counseling goes beyond eclectic counseling which is the use of a variety of techniques from a variety of theories that best meet the needs of the client.
integrative counseling implies the creation of a model by synthesizing existing theories and practices, not the mere borrowing of useful techniques. integrative counseling begins with the counselor developing a personal theory based on values, worldview, education, and experience. from this personal perspective, the counselor fleshes out this integrative counseling theory to include the processes and techniques that fit from other theoretical perspectives. the result is a highly individualistic theory owned by the counselor, highly congruent, and yet flexible so that the counselor can address particular client problems and use counseling experiences to further develop this integrative theory.
psychoanalytic therapy - basic philosophy and key concepts
basic philosophy - human beings are basically determined by psychic energy and by early experiences. unconscious motives and conflicts are central in present behavior. early development is of critical importance because later personality problems have their roots in repressed childhood conflicts.
key concepts - normal personality development is based on successful resolution and integration of psychosexual stages of development. faulty personality development is the result of inadequate resolution of some specific stage. anxiety is a result of repression of basic conflicts. unconscious processes are centrally related to current behavior.
adlerian therapy - basic philosophy and key concepts
basic philosophy - humans are motivated by social interest, by striving toward goals, by inferiority and superiority, and by dealing with the tasks of life. emphasis is on the individual’s positive capacities to live in society cooperatively. people have the capacity to interpret, influence, and create events. each persona at an early age creates a unique style of life, which tends to remain relatively constant throughout life.
key concepts - key concepts include the unity of personality, the need to view people from their subjective perspective, and the importance of life goals that give direction to behavior. people are motivated by social interest and by finding goals to five life meaning. other key concepts are striving for significance and superiority, developing a unique lifestyle, and understanding the family constellation. therapy is a matter of providing encouragement and assisting clients in changing their cognitive perspective and behavior.
existential therapy - basic philosophy and key concepts
basic philosophy - the central focus is on the nature of the human condition, which includes a capacity for self-awareness, freedom of choice to decide one’s fate, responsibility, anxiety, the search for meaning, being alone and being in relation with others, striving for authenticity, and facing living and dying.
key concepts - essentially an experiential approach to counseling rather than a firm theoretical model, it stresses core human conditions. interest is on the present and on what one is becoming. the approach has a future orientation and stresses self-awareness before action.
person-centered therapy - basic philosophy and key concepts
basic philosophy - positive view of people; we have an inclination toward becoming fully functioning. in the context of the therapeutic relationship, the client experiences feelings that were previously denied to awareness. the client moves toward increased awareness, spontaneity, trust in self, and inner-directedness.
key concepts - the client has the potential to become aware of problems and the means to resolve them. faith is placed in the client’s capacity for self-direction. mental health is a congruence of ideal self and real self. maladjustment is the result of a discrepancy between what one wants to be and what one is. in therapy attention is given to the present moment and on experiencing and expressing feelings.
gestalt therapy - basic philosophy and key concepts
basic philosophy - the person strives for wholeness and integration of thinking, feeling, and behaving. some key concepts include contact with self and others, contact boundaries, and awareness. the view is nondeterministic in that the person is viewed as having the capacity to recognize how earlier influences are related to present difficulties. as an experiential approach, it is grounded in the here and now and emphasizes awareness, personal choice, and responsibility.
key concepts - emphasis is on the what and how of experiencing in the here and now to help clients accept all aspects of themselves. key concepts include holism, figure-formation process, awareness, unfinished business and avoidance, contact, and energy.
behavior therapy - basic philosophy and key concepts
basic philosophy - behavior is the product of learning. we are both the product and the producer of the environment. traditional behavior therapy is based on classical and operant principles. contemporary behavior therapy has branched our in many directions, including mindfulness and acceptance approaches.
key concepts - focus is on overt behavior, precision in specifying goals of treatment, development of specific treatment plans, and objective evaluation of therapy outcomes. present behavior is given attention. therapy is based on the principles of learning theory. normal behavior is learned through reinforcement and imitation. abnormal behavior is the result of faulty learning.
cognitive behavior therapy - basic philosophy and key concepts
basic philosophy - individuals tend to incorporate faulty thinking, which leads to emotional and behavioral disturbances. cognitions are the major determinants of how we feel and act. therapy is primarily oriented toward cognition and behavior, and it stresses the role of thinking, deciding, questioning, doing, and redeciding. this is a psychoeducational model, which emphasized therapy as a learning process, including acquiring and practicing new skills, learning new ways of thinking, and acquiring more effective ways of coping with problems.
key concepts - although psychological problems may be rooted in childhood, they are reinforced by present ways of thinking. a person’s belief system and thinking is the primary cause of disorders. internal dialogue plays a central role in one’s behavior. clients focus on examining faulty assumptions and misconceptions and on replacing these with effective beliefs.
choice theory/reality therapy
basic philosophy - based on choice theory, this approach assumes that we need quality relationships to be happy. psychological problems are the result of our resisting the control by others or of our attempt to control others. choice theory is an explanation of human nature and to best achieve satisfying relationships.
key concepts - the basic focus is on what clients are doing and how to get them to evaluate whether their present actions are working for them. people are mainly motivated to satisfy their needs, especially the need for significant relationships. the approach rejects the medical model, the notion of transference, the unconscious, and dwelling on one’s past.
feminist therapy
basic philosophy - feminists criticize many traditional theories to the degree that they are based on gender-biased concepts, such as being androcentric, gendercentric, ethnocentrist, heterosexist, and intrapsychic. the constructs of feminist therapy include being gender fair, flexible, interactionist, and lifespan oriented. gender and power are at the heart of feminist therapy. this is a systems approach that recognizes the cultural, social, and political factors that contribute to an individual’s problems.
key concepts - core principles of feminist therapy are that the personal is political, therapists have a commitment to social change, women’s voices and ways of knowing are valued and women’s experiences are honored, the counseling relationship is egalitarian, therapy focuses on strengths and a reformulated definition of psychological distress, and all types of oppression are recognized.
postmodern approaches
basic philosophy - based on the premise that there are multiple realities and multiple truths, postmodern therapies reject the idea that reality is external and can be grasped. people create meaning in their lives through conversations with others. the postmodern approaches avoid pathologizing clients, take a dim view of diagnosis, avoid searching for underlying causes of problems, and place a high value on discovering clients’ strengths and resources. rather than talking about problems, the focus of therapy is on creating solutions in the present and the future.
key concepts - therapy tends to be brief and addresses the present and the future. the person is not the problem; the problem is the problem. the emphasis is on externalizing the problem and looking for exceptions to the problem. therapy consists of a collaborative dialogue in which the therapist and the client co-create solutions. by identifying instances when the problem did not exist, clients can create new meanings for themselves and fashion a new life story.
family systems therapy
basic philosophy - the family is viewed from an interactive and systemic perspective. clients are connected to a living system; a change in one part of the system will result in a change in other parts. the family provides the context for understanding how individuals function in relationship to others and how they behave. treatment deals with the family unit. an individual’s dysfunctional behavior grows out of the interactional unit of the family and out of larger systems as well.
key concepts - focus is on communication patterns within a family, both verbal and nonverbal. problems in relationships are likely to be passed on from generation to generation. key concepts vary depending on specific orientation but include differentiation, triangles, power coalitions, family-of-origin dynamics, functional versus dysfunctional interaction patters, and dealing with here-and-now interactions. the present is more important than exploring past experiences.
neurobiology and psychotherapy
the brain grows and differentiates not only because of genetics but continues this process through its continuous interaction with the environment. consequently, the person’s experiences with different environmental conditions and events throughout life can promote re-mapping of different regions of the brain. so, too, the experience of psychotherapy can restructure neural networks in the brain.
the triune model of the brain suggests three principal locations and functions:
- the surviving brain is the stem and response to danger and controls the automatic functions (fight or flight)
- the feeling brain (limbic system) is the emotion center, mediating feelings and thoughts, and storing some memory
- the cortex comprises the thinking brain including executive functions, meaning-making, and self-awareness
neuroplasticity is the brain’s ability to reproduce new neurons and reorganize itself as the individual experiences new situations and experiences (including psychotherapy) various counseling theoretical approaches, skills, and interventions result in the formation of new neurons and connections. the production of neurotransmitters is promoted.
research suggests that CBT promotes cognitive restructuring useful in working with clients who have experienced trauma such as PTSD. CBT promotes new connections within their memory network leading to a reduction of symptoms. EMDR is believed to help clients access new, more adaptive information.
biofeedback (or neurofeedback) has been found useful for a number of client problems such as sleep disorders, anxiety attacks, phobias, and migraine headaches. biofeedback procedures attempt to “re-wire” neural networks.
ivey, d’andrea, and ivey argue that most counseling relationships foster the development of new neurons and neural networks whether counselors know that or not. they also write of cultural neuroscience and how counselors help generate neurons and networks to assist diverse clients to lead more satisfying and empowered lives.
other ways to increase production of positive neurotransmitters besides talk therapy include involvement in integrative therapies such as art, music, physical movement and exercise, relaxation exercises, balanced nutrition, and yoga.
medication can reduce or control symptoms but there are no biochemical means to change faulty interaction patterns and behaviors that have led to a disorder. in addition to the processes listed above, change will come with new and repeated emotional, verbal, and interpersonal processes of learning that over time become ingrained into brain structures.
current standards of CACREP require curricular experiences for all counselors in training to promote an understanding of theories of learning and personality development to include current understanding of neurological behavior. separate courses in anatomy or neurobiology are not required. CACREP defines neurological behavior as the relationship among brain anatomy, function, and biochemistry, as well as learning and behavior.
mindfulness
the concept of mindfulness is appearing more frequently as an important aspect in many counseling approaches especially cognitively-oriented applications. there are two major aspects to mindfulness as applied to counseling. one component is a focus and attention on one’s current experience including one’s environment as well as internal sensations, emotions, and thoughts. the other important component of mindfulness is a nonjudgmental, accepting attitude to whatever the client is experiencing externally or internally.
mindfulness is viewed as a form of mental discipline wit ha focus on the here and now rather than the past or the future. most individuals need instruction and practice in order to implement mindfulness as defined here. instruction may include, deep breathing exercises, other relaxation techniques, and meditation. mindfulness-based cognitive therapy assists the client in stopping the self-perpetuating mental habits of ruminating on negative thoughts. clients learn to pay attention to their thoughts and body sensations in a nonjudgmental way learning to accept them and let go of cycles and patterns of responding that are not useful. the purpose is not to change these thoughts and body sensations as much as change the relationship to them in a reframing sort of way.
application of mindfulness counseling practices have been described with a variety of troubled clients such as those with depression, generalized anxiety disorders, as well as other clients experiencing anxiety and stress. a variety of studies suggest mindfulness may not be appropriate for individuals with schizophrenia, bipolar disorder, and posttraumatic stress disorder. many counselors might find mindfulness techniques useful no matter what counseling theory and techniques are used.
counseling skills and conditions influencing counseling
empathetic understanding - the ability to experience the client’s subjective world including feelings and cognitions
congruence - also called genuineness, this characteristic implies that the counselor is authentic and integrated in the counseling session. congruence can also mean an agreement between a client’s behavior and their values and beliefs.
unconditional positive regard - also called acceptance, this characteristic implies the counselor is caring without condition and is neither evaluative nor judgmental
concreteness - this is the extent to which the client and the counselor deal with issues in specific terms rather than in vague generalities
immediacy - this is dealing with what is going on in the counseling process at the present time
interpretation - this is a therapeutic technique used to uncover and suggest meanings and relationships often underlying the apparent expression
self-disclosure - appropriate self-disclosure means that the counselor shares personal affect and experiences relative to the client’s issues
attending - this refers to several behaviors including listening, engaging in eye contact, and being psychologically present
restatement - repeating what the client has stated with emphasis on the cognitive message
reflection - repeating what the client has stated with emphasis on the affective or feeling portion of the message
paraphrasing - restating the message of the client to show or to gain understanding
summarizing - this is a process whereby the counselor or client brings together several ideas or feelings usually following a lengthy interchange
silence - silence may have many meanings such as quietly thinking, boredom, hostility, waiting for the counselor to lead, preparing the next trust, or emotional integration
confrontation - confrontation occurs when the counselor identifies and presents discrepancies between a client’s verbal and nonverbal behaviors or between a counselor’s and client’s perceptions
clinical interventions
the treatment plan outlines the counseling interventions. the interventions employed are based on several factors in addition to the diagnosis.
client characteristics influence the treatment plan. besides the presenting problem, factors such as cultural background, age, and personality may influence the interventions selected. for example, depression may manifest itself very differently for various cultures or age groups. not uncommonly in seniors, depression can co-occur with medical issues or losses suffered.
counselor therapeutic orientation also influences the counseling interventions selected. psychodynamic theoretical approaches, look different from cognitive behavioral methods.
evidence-based interventions
mental health counselors are encourages to know about and apply evidence-based research findings in selecting therapeutic interventions. particular issues and problems consistent with particular client characteristics may thus be dealt with most effectively. quality standards of care are the goal of consistent with ethical practices.
mental health counselors are encouraged to conduct their own pre and post assessments and to use such results in selecting or modifying their interventions.
dual-diagnosis interventions
clinical counselors should integrate their practice with other mental health specialists including those trained in medicine. the incidence of co-occurring mental disorders and substance use issues is an example where counselors need additional professional interventions for their clients. many estimates indicate that substance use co-occurs in as many as one half of individuals seeking mental health services. integrating counseling interventions with other professionals may assure an appropriate level of care is provided.
structuring
structuring refers to defining the nature, limits, and goals of the counseling process. the roles of the client and counselor may be described.
robert carkhuff
crakhuff developed 5-point scales to measure empathy, genuineness, concreteness, and respect. counselor responses may be viewed as additive, interchangeable, or subtractive. the counselor’s empathetic response may be:
level 1 - does not attend to or detracts significantly from the client’s affect
level 2 - subtracts noticeably from the client’s affect
level 3 - interchangeable with the client’s content and affect
level 4 - adds noticeably to the client’s affect
level 5 - adds significantly to the client’s affect and meanings
for example:
client (obviously distressed and anxious): “we had an argument last night and he got very angry, I was really afraid - then he stormed out and I haven’t seen him since.”
level 1 response - where do you think he went?
level 2 response - you seem a little worried about all this
level 3 responses - you’ve very anxious about what happened last night and his whereabouts
level 4 or 5 response - you’re very anxious about what happened last night but also afraid for your safety and wondering where this relationship is going
