Counseling and Helping Relationships (4/6) Flashcards
Miscellaneous terms
The brain grows and differentiates because of
- genetics
- continuous interaction with environment
Since a person’s experiences with different environmental stimuli and events throughout life can promote re-mapping of different regions, so too the experience of therapy can restructure neural networks
Triune model of the brain
Surviving Brain
the stem and responds to danger and controls automatic functions (flight-fight)
Triune model of the brain
Feeling Brain
limbic system. emotion center, mediating feelings/thoughts, storing some memory
Triune model of the brain
Thinking Brain
cortex. executive functions, meaning-making, self-awareness
Neuroplasticity
brain’s ability to reproduce new neurons and reorganize itself as the individual experiences new situations and experiences (including psychotherapy)
Many counseling approaches result in formation of new neurons and connections. The production of neurotransmitters is promoted
Does CBT promote cognitive restructuring in clients with PTSD
Yes.
CBT promotes new connections within memory network leading to reduction of symptoms
Does EMDR help clients access new, more adaptive info?
Yes
Biofeedback (neurofeedback)
is useful for many client problems including sleep disorders, anxiety attacks, phobias, migraines
attempts to rewire neural networks
Cultural neuroscience
counselors help generate neurons and networks to assist diverse clients to lead more satisfying and empowered lives
Ways to increase production of positive neurotransmitters besides talk therapy:
- invovement in integrative therapies like art/music/physical movement/exercise
- relaxation exercises
- balanced nutrition
- yoga
- new/repeated emotional/verbal/interpersonal processes of learning that have become ingrained into brain structures
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
Council for Accreditation of Counseling and Related Educational Programs (CACREP)
standards require curricular experiences for all counselors in training to promote an understanding of theories of learning and personality develop to include current understanding of neurological behavior
CACREP definition of neurological behavior
relationship among brain anatomy, function, biochemistry, learning, behavior
Mindfulness components
- focus and attention on one’s current experience including environment, internal sensations, emotions, thoughts
- nonjudgmental, accepting attitude to whatever the client is experiencing externally/internally
Mindfulness
form of mental discipline with a focus on the here and now
may include:
- deep breathing exercises
- relaxation techniques
- meditation
Mindfulness-based cognitive therapy
assists client in stopping the self-perpetuating mental habits of ruminating on negative thoughts
- learn to pay attention to thoughts/body sensations in a nonjudgmental way
- accept them and let go of cycles and patterns of responding that are not useful
Purpose of mindfulness-based cognitive therapy
not to change these thoughts/body sensations as much as change the relationship to them in a reframing sort of way
Application of mindfulness counseling practices
- depression
- GADs
- stress
- anxiety
mindfulness may not be appropriate for:
- schizophrenia
- bipolar disorder
- PTSD
Counseling skills and conditions influencing counseling
Empathic understanding
the ability to experience the client’s subjective world including feelings/cognitions
Counseling skills and conditions influencing counseling
Congruence
AKA genuineness
counselor is authentic and integrated in the counseling session
can also mean an agreement between client’s behavior and their values/beliefs
Counseling skills and conditions influencing counseling
Unconditional positive regard
AKA acceptance
counselor is caring without condition and is neither evaluative nor judgmental
Counseling skills and conditions influencing counseling
Concreteness
the extent to which the client and the counselor deal with issues in specific terms rather than in vague generalities
Counseling skills and conditions influencing counseling
Immediacy
dealing with what is going on in the counseling process at the present time
Counseling skills and conditions influencing counseling
Interpretation
uncover and suggest meanings and relationships often underlying the apparent expression
Counseling skills and conditions influencing counseling
Self-disclosure
appropriate self-disclosure means that the counselor shares personal affect and experiences relative to the client’s issues
Counseling skills and conditions influencing counseling
Attending
several behaviors including listening, engaging in eye contact, and being psychologically present
Counseling skills and conditions influencing counseling
Restatement
repeating what the client has stated with emphasis on the cognitive message
Counseling skills and conditions influencing counseling
Reflection
repeating what the client has stated with emphasis on the affective or feeling portion of the message
Counseling skills and conditions influencing counseling
Paraphrasing
restating the message of the client to show or to gain understanding
Counseling skills and conditions influencing counseling
Summarizing
counselor or client brings together several ideas or feelings usually following a lengthy interchange
Counseling skills and conditions influencing counseling
Silence
may have many meanings:
- quietly thinking
- boredom
- hostility
- waiting for the counselor to lead
- preparing the next thrust
- emotional integration
Counseling skills and conditions influencing counseling
Confrontation
occurs when the counselor identifies and presents discrepancies between a client’s verbal and nonverbal behaviors or between counselor’s and client’s perceptions
Clinical Interventions
the treatment plan outlines the counseling interventions
Interventions are influenced by:
- diagnosis
- client characteristics
- counselor therapeutic orientation
Evidence-based interventions
should know and apply evidence-based research findings in selecting therapeutic interventions
- particular issues/problems consistent with particular client characteristics may thus be dealt with most effectively
- quality standards of care are the goal and consistent with ethical practices
Dual-diagnosis interventions
integrate practices with other mental health specialists including doctors
- ex. co-occurring mental disorders and substance use issues - need additional professional interventions
ensures an appropriate level of care is provided
Structuring
defining the nature, limits, goals of the counseling process
- roles of client and counselor may be described
Robert Carkhuff
five point scales to measure empathy, genuineness, concreteness, respect
- counselor responses may be viewed as additive, interchangeable, subtractive
Carl Jung - Analytic Psychology
Collective unconscious
determined by evolutionary development of the human species and contains brain patterns for the most intense emotional responses that humans experience
There is also a personal unconscious (similar to Freud’s)
Carl Jung
Archetype
operant for collective unconscious
response pattern occurring universally in the human experience and is characterized by an emotional charge to the existential issue of identity, meaning, purpose
- ex. anima, animus (female/male traits)
- androgynous (having both male and female characteristics)
- dark side of the personality relates to animal instincts
- extroversion/introversion (MBTI has roots in Jung)
the self is symbolized as a mandala or a balnce between the personal unconscious and collective unconscious
Carl Jung
Goals of Jungian therapy
- transformation of self including gaining knowledge of self
- recognition
- integration of self
Carl Jung
Therapy is viewed as
a healing process
Carl Jung
Jung introduced
introversion/extraversion concepts
Carl Jung
Which assessment is based on Jung’s theory
Myers-Briggs Type Indicator
Alfred Adler - individual psychology
Two important concepts
Birth order, family constellation
Alfred Adler
Techniques of counseling:
- counselor is egalitarian with client - it’s a collaborative effort
- neuroses are a failure in learning which results in distorted perceptions
- stress is on client responsibility
- will to power: generates feelings of superiority
- fictional finalism: behavior is motivated primarily by future opportunities than the past
Teleological theory - focused on future
Alfred Adler
Counseling should examine
- family constellations - birth order
- dreams
- early memories
Alfred Adler
Asks the question
What would be different if you were well?
- focuses on counseling process
Alfred Adler
Birth order implications
children in the same family have different psychological environments because of differences in birth order
Alfred Adler
Birth order implications
Oldest child:
- gets much attention
- tends to be dependable, hard-working, achievement oriented
- when another child (intruder) comes, oldest may fear losing love
Alfred Adler
Birth order implications
Second child:
- shares attention
- sees self as if in a race to compete with first child
- often succeeds where older fails
Alfred Adler
Birth order implications
Middle child:
- often feels left out
- may see life as unfair
- “poor me” attitude
- may develop problems
Alfred Adler
Birth order implications
Youngest child:
- baby in family
- pampered
- special role to play
- influenced by all others
- tends to go own way
- often develops in directions no one else thought of
Alfred Adler
Birth order implications
Only child:
- does not learn to share/cooperate
- often deals with adults well
- wants center stage even as adult and if does not get any, may have difficulties
Alfred Adler
Childhood experiences influences ____
our adult interactions and family dynamics
Gordon Allport and Kurt Lewin
Gordon Allport
acknowledged that individuals with their personalities exist within systems
- behavior of an individual must be viewed as fitting any system of interaction including culture, situational context, field theory
Gordon Allport and Kurt Lewin
Kurt Lewin
field theorist
believed behavior is a function of life space which is a function of the person and the environment
- challenged the linear, mechanistic view of behavior
Aaron Beck
Aaron Beck
developed a system of psychotherapy called cognitive therapy
Aaron Beck
Automatic thoughts
similar to the preconscious
Aaron Beck
Internal communication system
in depressed people, this system was negatively focused resulting in low self-esteem, self-blame, negative interpretations of experience
negative cognitive shift
Aaron Beck
Developed this assessment
Beck Depression Inventory
Joseph Wolpe
Theory of reciprocal inhibition
underlying principle states that a person cannot be both anxious and relaxed at the same time
Joseph Wolpe
Systematic desensitization
(based on theory of reciprocal inhibition)
behavioral intervention of counterconditioning
- goal: to reduce anxiety by associating negative stimuli with positive events
- - specifically, negative images are paired with muscle relaxation
Donald Meichenbaum
cognitive behavior modification
shift from self-defeating thoughts to coping ones
Donald Meichenbaum
Stress inoculation
practicing positive or reinforcing self-statements
Behavioral techniques
Token economy
use of tokens (points, rating, etc.) as a reinforcement in a behavioral treatment program
- shaping of behavior can occur through the use of these tokens
- privileges and goods can be purchased with tokens
Behavioral techniques
Paradoxical intention
clients are urged to ‘intend’ that which they fear or wish to change
- may work with a variety of unwanted behaviors like insomnia, smoking, arguing, etc.
Behavioral techniques
Implosive therapy
induces anxiety around the problem by presenting vivid images or cues (flooding)
- the anxiety is expected to diminish (extinguish) with repeated exposure and in the absence of any threat
Behavioral techniques
Thought stopping
inhibit recurring thought by consciously stopping it whenever it occurs
Johari Window
Looks like…
…………………..known to….not known
…………………..self……………to self
…………………..————————
known to…..|…………..|…………..|
others……….|…………..|…………..|
…………………—————————
not known..|…………..|…………..|
to others…..|…………..|…………..|
………………..————————–
Johari Window
Named after
Joe Luft and Harry Ingham
(Johari is a combination of their first names)
Johari Window
How it works
client brings material in this window to the counseling session; some is known, other info is not
Johari Window
Principles of change may be identified
- a change in one quadrant affects all other quadrants
- it takes energy to hide, deny, or be blind to behavior
- threat increases awareness; mutual trust tends to increase awareness
- the smaller the first quadrant (upper left), the poorer the communication
- there is universal curiosity about the unknown area but customs, social training, fears keep parts unknown
- the goal of counseling is to minimize the lower right quadrant and maximize the upper left
Johari Window
Helps explain
dynamics which occur in group therapy
- in productive groups, the quadrants not known to self and others may decrease in size and self-awareness and feedback from others increase
Consultation
voluntary, problem-solving process, initiated or terminated by the consultant or consultee, to help consultees develop attitudes or skills so they can function more effectively with individuals, groups, organizations
- work-related
may be client, consultee, system focused, and goal is to resolve issues that cause human problems and increase competence so future problems may be avoided
- has a preventative function
- not counseling
Consultation may be:
content oriented: transfer of knowledge or info from the consultant to the consultee
process oriented: looking at the process - may use communication theory, attribution, change, motivation theory
Models of consultation
Bergan
behavioral model with 4 stages:
1. problem identification
2. problem analysis
3. plan implementation
4. problem evaluation
Part of the focus of this consultation is on problem behaviors and their antecedents and consequences
- model emphasizes verbal interaction in consultation
Models of consultation
Bandura
social learning model
- dynamic interplay of behaviors, cognitions, enviornment and all three are assessed in problem identification
- many solutions revolve around modeling, rehearsing, changing cognitions
Models of consultation
Schein
- purchase model: buying the consultant expert’s knowledge or service
- doctor-patient model: stresses diagnosis and problem identification
- process model: consultee with the consultant in the diagnostic process and identification of interventions
Models of consultation
Caplan
mental health consultation model
- consultation occurs between two professionals and can be centered on the client, the consultee and client, the program, consultee and administration
Models of consultation
Splete
Nine-stage process of consultation
- pre-contract
- contract and exploration of relationship
- contracting
- problem identification
- problem analysis
- feedback and planning
- implementation of the plan
- evaluation of the plan
- conclusion and termination of relationship
Animal-assisted counseling
helps clients establish a relationship with an animal that facilitates communication, builds self-confidence, non-judgmental
- these positive interactions can be used to better understand oneself and generalize to others
- dogs/horses are most commonly used although many other animals have been found to be effective
- individuals who are physically/mentally challenged, victims of trauma, socially shy may be good candidates
Wilderness therapy
more clinically-oriented
outdoor behavioral mental healthcare approach for troubled adolescents and adults
- purpose: to identify/address emotional, behavioral, psychological problems through an outdoor, often unfamiliar environment
Adventure-based counseling
desired for children and younger/older adults as an experiential set of outdoor activities
- may range from camping to hiking to completing ‘challenge’ courses designed for individuals, pairs, small groups
possible outcomes:
- self-awareness
- self-confidence
- communication skills
- trust
- camaraderie
- diversity sensitivity
- multicultural skills
Distance counseling/Telehealth
encompasses webcounseling, e-counseling, telephone counseling
- may be info-giving, be assessment-focused, psychoeducational, deal with personal/therapeutic issues
Issues of distance counseling/telehealth
- security of communications
- imposters
- records maintenance
- trust building/transparency
- contacts for clients in case of crisis
Trauma/Disaster Counseling
- training is required to work with this population
- possible consequences for counselors working with clients impacted by trauma include: compassion fatigue, secondary traumatic stress, vicarious trauma
- displayed by lack of energy, prefer isolation, be irritable, have sleeping problems, self-medicate, cease self-care activities
Compassion fatigue
evidenced by counselors who work with difficult client issues and may result in lack of empathy and interest in the client’s concerns
- may occur even when working with clients who have not experienced trauma
Secondary traumatic stress
may result because of exposure to graphic material presented by traumatized clients
- may begin experiencing some of the same symptoms as the client
some think vicarious trauma is the same as secondary traumatic stress; others believe vicarious trauma includes change in counselor’s worldview, sense of self, beliefs
Neurolinguistic programming
Richard Bandler and John Grinder are the original proponents
Neurolinguistic programming
communications theory using the five sensory channels
- can be used to establish and maintain rapport and pace the client’s verbal cues
- examines the structure of language and how it is used to represent reality
Eye Movement Desensitization and Reprocessing (EMDR)
used to facilitate client’s accessing of memories of painful and traumatic experiences and reprocessing these experiences through eye movements similar to those found in REM sleep cycles
- has generated considerable positive research
Alcohol and Substance Abuse Counseling
substance abuse is often viewed as the number one problem in the US
Personality traits often found in alcoholics and drug users:
- low self-concept
- anxiety
- underachievement
- feeling of social isolation
- sexual dysfunctions
- dependence
- fear of failure
- suicidal impulses
Individual, group, family counseling are valuable components of treatment
- residential programs, often using behavior modification and soical learning theory, may be effective
- treatment of physical addiction is also necessary
Questionnaire that is useful in assessing signs of addiction
SASSI (Substance Abuse Subtle Screening Inventory)
Twelve Step programs
effective for many with drug or alcohol problems
Kinesics
nonlinguistic communication which occurs through body movements such as gestures and facial expressions
Proxemics
spatial features of the environment such as positioning of furniture, seating arrangements, etc.
- how we arrange space will have an impact on behavior
- each of us has a personal space
Tryptophan is an amino acid that is related to this in the brain
serotonin
when it is removed from diet, memory/anxiety/sleep/mood decrease and aggresssion rises
A meta-analysis by Smith, Glass,& Miller (idk what year)
found that psychotherapy has a strong/big effect at .85
(this is often quoted and you should know about this meta-analysis)
small assocation less than .2
medium association is .50 or less
big/strong/large assocation is over .80
Glasser
Reality-Choice Theory
focuses on present behavior. clients create their own personal reality with the behaviors they choose
- behavior is the control of our perceptions
- success identity is the result of being loved/accepted
- does not deal with dreams, the past, traumatic memories
eight steps:
- build a relationship
- focus on present moment behavior
- help client to evaluate current behavior
- develop contract with an action plan
- accept no excuses
- do not use punishment
- refuse to give up on client
psychological needs
- freedom
- belonging
- power
- fun
