Counseling & Helping Relationships Flashcards
Re Helping Relationships, what does research say is the determining factor of counseling success?
the counseling relationship
What are the ‘core’ elements to building a counseling relationship?
4 core elements:
- Human: Carl Rogers identified respect, empathy, genuineness (Rogers’ rrrrreg)
- Social: competence, power, intimacy. Stanley Strong identified trustworthiness, attractiveness, and expertise in his social influence model
- Skills: Allen Ivey identified attending, inquiry, reflection (“Allen Iverson in the AIR”)
- Theory: helps counselors understand self with relationship and skills; helps them identify client problems and effective interventions
Neo-Freudians
A number of psychoanalysts who moved away from Freud’s theory on the id as the driving psychological force. No id or superego, no sex driver
- Emphasized the ego instead - including psychodynamic and sociodynamic forces
(think: What the HEK? re freud’s theory)
Harry Stack Sullivan (think We stack each other on each other)
- a social systems (interpersonal) approach helps us understand human behavior. Behavior best understood via social interactions, not as mechanistic or linear.
Erich Fromm (think 2Ms joining together)
- one must join w/others to develop self-fulfillment (social character). Otherwise–>becomes lonely, nonproductive. Society offers oppty’s to practice mutual love & respect
Karen Horney
- security is major motivation and one feels anxious when not achieved.
- Irrational ways to mend disrupted reln’s–>becomes neurotic needs
Other Neo Freudians (think “3Rs in TOW”)
Theodore Reik
Otto Rank
Wilheim Reich
Gestalt
- overview
- concepts
- counselor’s role
- techniques
- books
-frederick ‘fritz’ perls
- based on EXISTENTIAL PRINCIPLES, here and now focus, holistic systems viewpoint
Premise: ppl have needs. When a need is in the forefront it represents the “figure,” while others are the ground (ie background). As the need is met, it completes the ‘gestalt’ and a new need takes its place. Goal is to become a whole person, completing the gestalt.
Key concepts: personal responsibility, unfinished business, awareness of the now
Counselor encourages client to stay w/feelings and finish business
Techniques: role playing, chair techniques, dream work
Interpretation is done by the client, not the counselor
Books by Perls:
Gestalt Therapy Verbatim
In and Out of the Garbage Can
Person-Centered
- Premise
- Critical concepts
- focus of counseling
- counselor’s role
client focused (Rogerian)
Rogers was against the therapist-as-expert model and instead emphasized the client’s phenomenological (experiential) world
Critical concepts: process of becoming, moving to self-actualization, reln’p bw client and counselor
Focus of counseling: on feelings, from past to present
Counselor’s role: showing unconditional positive regard, genuineness (congruence), empathic understanding–these are the core or facilitative conditions of effective counseling
Books
Counseling & Psychotherapy (1942)
Client Centered Therapy (1951)
On Becoming a Person (1961)
What were Carl Rogers’ main books?
Counseling & Psychotherapy (1942)
Client Centered Therapy (1951)
On Becoming a Person (1961)
Object-Relations Theory
Based on psychoanalytic concepts
- are interpersonal relnp’s as represented intraphysically
- freud used the term ‘object’ to mean a significant person or thing that’s the target of one’s feelings or drives (ie seeing a person as ‘good’ or ‘bad’)
- object relations are interpersonal reln’ps that shape one’s interactions w/ppl both in reality and fantasy
4 Stages of Development Important in first three years of life:
- autism/Fusion w/mother: normal infantile autism (3-4 weeks)
- Symbiosis: w/mother (3-8 months)
- Separation/Individual: starts at 4th or 5th month
- Constancy of self and object: by 36months
Progressing through the stages provides basis for secure development and trust that needs will be met
Attachment, borderline, and narcissistic disorders may occur w/abnormal progression through stages
Books
Margaret Mahler
- wrote ‘Psychological Birth of Human Infant
Heinz Kohut
Otto Kernberg
Authors associated with object relations theory?
Think Mho; we Mahl objects
Margaret Mahler
- wrote ‘Psychological Birth of Human Infant
Heinz Kohut
Otto Kernberg
Individual Psychology
- overview
- goals
- techniques
Alfred Adler, Rudolph Dreikurs
- belief in individual uniqueness
- influenced by social factors
- ea person has a sense of inferiority and strives for superiority
- we choose a lifestyle, a unified life plan, that gives meaning to our experience, which includes habits, family, career, attitudes
Counseling Goals
- Help client understand lifestyle and identify social and commty interests
- explain clients to themselves
- overcome inferiority
Techniques
- those leading to insight (ie, life stories, homework assignments, paradoxical intentions)
Transactional Analysis
- overview
- types of transactions
- goal of TA
- techniques
- books
Eric Berne
(BURNing yourself on the stove is a tx; when we complete a transaction we move on to the next; games are transactions)
- personality has 3 ego states that are hypothetical constructs: parent, child, adult that explain the function of the personality
- life script develops in childhood and influences one’s behavior.
- many transactions characterized as games to avoid intimacy (think “ea transaction writes a new part of one’s life script”)
Complementary transactions
- Adult: adult, leads to good communication
Crossed transactions
- adult: child or child: parent, leads to barriers to comms
Goal of TA: teach the client the language and ideas of TA to recognize ego state functioning and analyze one’s transactions
Techniques: teaching concepts, helping diagnose, interpretation, use of contracts and confrontation
Books
Games People Play (Berne)
I’m Okay, You’re Okay (Thomas Harris)
Existential Therapy
- Premise
- Concepts
- Goal
- Techniques
(Think “VIR –>VERY existential”)
Victor Frankl, Irvin Yalom, Rollo May
- based on phenomenology, which is the study of direct experience (~person centered)
Premise
- we search for meaning
- we have freedom of choice and are responsible for our fate
- we struggle with being alone, unconnected from others (we EXIST w/others)
Main Concepts
-anxiety: the threat of non-being
- guilt: occurs when we fail to fulfill our potential
Goal: to understand one’s being, one’s awareness of who one is and who one’s becoming (Very similar to Person-centered in this sense)
- awareness of freedom and choosing responsibility are other goals
Techniques
- authentic reln’p important
- client centered
Logotherapy
Type of existential therapy developed by Victor Frankl
3 principles:
- motivation to find meaning in life
- freedom to choose (what to do, think, react)
- w/freedom of choice comes personal responsibility
Book by Margaret Mahler
‘Psychological Birth of Human Infant
Cognitive and Behavioral Therapy
- pioneers
- basis of theory
- goals
- counselor role
- techniques
(think
Pioneers:
Aaron Beck
Albert Bandura
Donald Meichenbaum
Joseph Wolpe
Albert Ellis (REBT)
Arnold Lazarus (Multimodal)
Basis of theory:
- stimulus-response and stimulus-organisim-response paradigms are basis of theory
- behavior is learned and can be unlearned and relearned
Goals:
-identify antecedents of behavior and reinforcements maintaining that behavior
- goals are typically behaviorally stated
Counselor Role
- create learning conditions, direct intervention
Techniques
- operant and classical conditioning
- social modeling
- problem solving
- direct trng
- reinforcement and decision making
Dialectical Behavioral Therapy
- background
- principles
- skills
- techniques
Marsha Linehan
developed initially to treat borderline personality disorder
- now used widely to treat TBIs, eating disorders, mood disorders
- used w/adolescents (and families, if applicable) and adults
- A group component typically complements individual work
Basic Principles
- include typical cognitive behavioral principles
- helping clients increase cognitive and emotional regulation by learning their triggers
- dialectical principle of learning 2 sides of situations. Eg: need to accept change and recognizing resistance to change
- Long term intervention b/c it requires the learning, practicing, and acquiring of new skills
DBT Skills
- Mindfulness
- Distress Tolerance: accepting and tolerating oneself and the situation, despite the pain, without evaluation
- Interpersonal Effectiveness: strategies for asking for what one wants, saying no, dealing with personal conflict
- Emotion Regulation: identifying emotions and obstacles to changing them, decreasing vulnerability, increasing positive emotions
Techniques
- Diary Cards (tracking interfering emotions)
- Chain Analysis (analzying sequential events that lead to behavior)
- The dynamics of the milieu or culture of the client’s group
Rational Emotive Behavior Therapy
- basis
- major concepts
- techniques
Albert Ellis
- It’s not the events themselves but one’s interpretation of them
- Ppl have potential for rational thinking. In childhood, we learn irrational beliefs and then constantly re-indoctrinate them–>leads to inappropriate affect & behavior
- teaches that (-) self talk is the source of emotional disturbance
Major Concepts
- belief system
- self-talk
- ‘crooked thinking’
- ABCDE system
A: external event (activity/action)
B: belief (self-verbalization/self-talk)
C: consequence (may be rational or irrational)
D: dispute the irrational belief causing the affect/behavior
E: effect (cognitive)–a change in the self-talk
Techniques
- role playing
- imagery
Reality Therapy
- basis
- key concept
- characteristics
William Glasser (seeing reality through glass)
based on choice therapy but he referred to it Reality
- assumes we need quality reln’ps to be happy
- psych. problems are the result of 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 relnp’s.
- individuals choose their own fate and are in charge of their own lives (~existential)
- we act to control the world around us and the world helps us satisfy our needs. we may not satisfy our needs directly.
- perceptions control behavior and we behave to fill our needs
5 Genetically-based needs:
- survival
- love and belonging
- power or achievement
- freedom or independence
- fun
Key Concept: taking responsibility
Characteristics of choice therapy:
- choice & responsibility
- reject transference by being oneself
- keep therapy in present (past not critical)
- focus on how to meet needs, not on symptoms
- solution-focused approach; challenge traditional mental illness model
- assumes we need quality relationships to be happy
WDEP
- developed by Robert Wubbolding to help learn Reality Therapy
W= exploring the clients’ WANTS related to perceived needs
D= DISCUSS actions and feelings
E= self-EVALUATION by clients of their behavior
P= PLANNING to effect change (following E)
Multimodal Therapy
- premise
- techniques
Arnold Lazarus
- holistic, sometimes considered eclectic approach
- strong behavioral ties
- address 7 interactive modalities. Assessing all 7 determines total human functioning
7 Modalities represented through BASIC ID:
B=behaviors (acts, habits, reactions)
A=affect
S= sensations
I=images (how we see ourselves, memories, dreams)
C= cognitions ( insights, philosophies, ideas)
I= interpersonal reln’ps
D= drugs (represents biology, including nutrition)
Techniques
- uses various theoretical perspectives
- anxiety mgmt trng
- modeling
- (+) imagery
- relaxation trng
- assertiveness trng
- biofeedback
- hypnosis
- bibliotherapy
- thought stopping
Famous books on TA
Games People Play (Berne)
I’m Okay, You’re Okay (Thomas Harris)
Robert Wubbolding
developed WDEP to help therapists learn Reality Therapy
W= exploring the clients’ WANTS related to perceived needs
D= DISCUSS actions and feelings
E= self-EVALUATION by clients of their behavior
P= PLANNING to effect change (following E)
Characteristics of choice therapy
- choice & responsibility
- reject transference by being oneself
- keep therapy in present (past not critical)
- focus on how to meet needs, not on symptoms
- solution-focused approach; challenge traditional mental illness model
Feminist Theory
No single author
started from women’s mvmt in 60s
Basic Principles: (starts with the person, what are they committed to? how are they heard? what characterizes the reln when they are (heard)? What is the focus?)
- Person is political and critical consciousness
- roots of oppression are political and societal–>leads to marginalization, oppression, stereotyping - Commitment to social change
- therapy is for society, not just for individual - Value women’s voices, knowledge, and (oppressed) experience.
- central perspective is female (vs male) - Counseling reln’p is egalitarian
- client is expert; oppression recognized; therapy=collaborative - Focus on strengths, redefining psychological distress
- intraphysical factors only part of the pain experienced. Psychological distress=communication about unjust systems; Oppressive systems reframed as survival strategies
Techniques (GESP BARGS)
gender-role analysis
empowering techniques
self-nurturance
power analysis and intervention
bibiotherapy
assertiveness trng
reframing and relabeling
groups
social action
Relational Cultural Theory
- main person
- premise
- common issues
Judy Jordan
- believes we need to move from a human growth mode of separation to a relationship one
Premise of RCT: we grow in connection with others, not as individuals (through (separation/individuation)
Issues may include:
power, privilege, marginalization, accceptancce
Solution Focused Brief Therapy (SFBT)
Steve deShazer
focuses on what works and seeks to duplicate/add more of it
history or nature of the problem not necessary to find solution
Characteristics
- few sessions (6-8)–>may be seen as unethical or abandonment
- warrants setting specific goals early on
- not applicable for all clients
Techniques (“send an EMS to solve”)
Exception Question - “what were circumstances when the problem didn’t exist?”–>news of difference
Miracle Question - If miracle happened, how would you know/whaat would be different?
Scaling question - on scale of 1-10, rate client’s anxiety. Focus on the (+) changes and duplicate/increasing them
Narrative Therapy
post modern
strengths based
rooted in social constructionism
Premise
Independent objective reality exists through subjective experiences; client’s view is valid
- this reality based on language & words client uses–>leads to reality that is socially constructed
Clients lives are stories in progress
Techniques
- Questions and clarifications: by therapist to understand and deconstruct
- Externalization & deconstruction: the problem is the problem, not the person. externalizing the problem helps deconstruct it
- Re-authoring: helping clients find an appropriate alternative story
- Documenting evidence through writing of letters: shown to be a powerful adjunct, increases gains
Integrative Counseling
A highly individualized theory based on synthesis of theories and practices. NOT simply borrowing of a theory/practice.
This is a personalized theory based on values, worldview, education and experience
Highly congruent yet flexible
Behavior Therapy
Basic Philosophy and Key Concepts
Philosophy
- behavior is the result of learning
- we are both the product and producer of the environment
Concepts
- focus is on overt behavior
- precision in specifying treatment goals, development of specific treatment plans, objectively evaluating outcomes (METRICS!)
- based on learning theory principles
- Normal behavior is learned through reinforcement and imitation, abnormal behavior is result of faulty learning
Neurobiology & Psychotherapy
CACREP requires an understanding of the neurological behavior to underpin theories of learning and personality development.
CACREP defines neurological behavior as: the reln’p among the brain anatomy, functioning, and biochemistry, as well as learning and behavior
Premise of neurobiology & psychotherapy
- brain grows genetically but also by interacting with the environment, which means psychotherapy affords oppty to help w/brain restructuring
Triune Model of the Brain
- brain has 3 principal locations and functions:
1) Surviving brain - the stem; fight or flight
2) Feeling brain - limbic system, emotion; mediates feelings and behaviors; stores some memory
3) Thinking brain - cortex; executive functions, meaning making, self-awareness
CBT promotes neural networking, as does EMDR
Biofeedback: helpful for sleep disorders, anxiety attacks, phobias, migraines; attempts to rewire neural networks
CACREP’S defn of neurological behavior
the reln’p among the brain anatomy, functioning, and biochemistry, as well as learning and behavior
Biofeedback
helpful for sleep disorders, anxiety attacks, phobias, migraines
attempts to rewire neural networks
CACREP is acronym for what?
Council for Accreditation of Counseling and Related Education Programs
Mindfulness
2 major aspects of mindfulness for counseling:
1) focus on current experience (ie environment, thoughts, sensations, emotions)
2) nonjudgmental acceptance of experience–internal and external
Mindfulness-Based CBT
- helps client in stopping self-perpetuating mental habits of ruminating on negative thoughts
- purpose isnt to change thoughts but change the reln’p to them by reframing
May not work with schizophrenia, bipolar, or PTSD clients
Therapists may find minfulness useful no matter what theory they use
Counseling skill of: congruence
aka genuineness
counselor is authentic and integrated in the session
can also mean an agreement bw the client’s behavior and values/beliefs
Counseling skill of: Unconditional positive regard
Acceptance; counselor is caring and non-evaluative/judgmental
Counseling skill of: Concreteness
extent to which client and counselor deal with issues in specific vs vague generalities
Counseling skill of: Restatement
repeating what the client said w/emphasis on the cognitive message
Counseling skill of: Reflection
repeating what the client said w/emphasis on affective portion of message
treatment plan outlines _______, which are based on several factors, including __________
treatment plan outlines counseling interventions, and interventions are based on several factors, including the diagnosis
Client characteristics influence the treatment plan (culture, demographics like age, personality)
Counselor’s therapeutic orientation influences the intervention(s) chosen. For instance, a psychodynamic approach is different than a cogntive behavioral approach)l4
Main reason why people come to counseling?
Self disclosure
Carl Jung
founded analytic psychology
introduced concepts of intro- and extraversion
MBTI based on his work
believd in the collective unconscious, which is
- determinedd by the evolutionary development of the human species (most intense emotional responses that we experience)
- operated by archetypes
archetypes= universal response pattern in human experience, characterized by emotional charge to identity, meaning, purpose.
Ex of archetypes: anima (female) and animus
Goals of therapy
- transformation of self by gaining knowledge of self, recognition, and integration of self
Robert Carkhuff
developed a 5 pt scale to measure for empathy, genuiness, concreteness, and respect in counselor; L1=low, L5=high
Counselor responses are either additive, interchangeable, or subtractive
Eg (p. 114 of Helwig)
Structuring
refers to defining the nature, limits, and goals of counseling process, may include roles too.
Dual diagnosis intervention
counselors should integrate their practice w/other specialists (ie medical)
substance use co-occurs in ____ of ppl seeking mental health services
half
Alfred Adler
father of individual psychology
2 Main concepts
- birth order
- family constellation
Techniques
- counselor is egalitarian w/client–(cooperative effort)
- views neuroses as failures in learning–>leads to distorted perceptions
- focus is on client responsibility in counseling
- examines family constellation, dreams, early memories
Birth Order Implications:
- children in same family have different psychological environments b/c of birth order
*childhood experience influences adult interactions and family dynamics
implication of first born, per Adler
gets much attn
dependable
goal and achievement oriented
hard working
fears losing love when another child (intruder) enters
implication of 2nd born, per Adler
shares attn
competes w/1st born
succeeds where first born doesn’t
implication of middle born, per Adler
feels left out
may see life as unfair and develop a “poor me” attitude
may develop problems
implication of youngest child, per Adler
baby in family, pampered, special role to play; influenced by others but tends to go own way; dvlops in directions nobody anticipated
implication of only child, per Adler
doesn’t learn to share/cooperate
deals well w/adults
wants center stage as adult and has problems when they don’t get it
Gordon Allport
individuals and their personalities exist w/in a system (ie cultural, situational context)
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
developed cognitive therapy, in which client experiences a cognitive shift
-identified automatic thoughts (~preconscious)
- there is an internal communication system, and in depressed ppl it’s negatively focused
- cause of depression is any combo of factors (eg., biological, genetic, personality, stress)
- there is greater stability of results and fewer relapses with CT than anti-depressants
Joseph Wolpe
theory of reciprocal inhibition
- states that anxiety and relaxation cannot coexist
Systematic desensitization (based on reciprocal inhibition theory) is a behavioral intervention of counterconditioning.
- goal is to reduce anxiety by associating (-) stimuli w/positive events. (Eg., negative images paired with muscle relaxation)
Donald Meichenbaum
- spoke of cognitive behavior modification, which is a shift from self-defeating thoughts to coping ones
- introduced concept of stress inoculation, which is practicing positive or reinforcing self-statements
Other Behavioral Techniques
token economy
paradoxical intention
implosive therapy (imagination)
thought stopping
token economy
using tokens to reinforce behavior; shaping of behavior through tokens
privileges and goods can be purchased through tokens
paradoxical intention
clients urged to “intend” that which they fear or want to change
implosive therapy
induce anxiety via images/imagination or cues (called ‘flooding’). The anxiety is then expected to diminish (extinguish) w/repeat exposure and in the absence of any threat
thought stopping
behavioral technique to consciously stop recurring thoughts
Johari Window
Jon Luft & Harry Ingham
is a psychological tool to help individual better understand relationship w/oneself and others
- Top (horizontal, left to right(: known to self/not known to self
- Left (vertical, top to bottom): known to others/not known to others
top left quadrant: known to self/known to others
top right: not known to self/known to others
bottom left: known to self/not known to others
bottom right: not known to self/not known to others
Premise
- client brings material (stuff) into session, some of which is known and other info that isn’t.
Principles of Change Identified During Session:
goal of counseling is to minimize the lower right and maximize upper left
smaller the upper left quadrant–> worse the comms
there’s universal curiosity about the lower right (unknown) but customs, socialization and fears suppress it
change in one quadrant affects them all
requires energy to hide, deny, or be blind to behavior
threat increases awareness, mutual trust increases awareness
In Groups
- helps explain group dynamics
- lower right quadrant decreases in productive groups as awareness and feedback increase
Definition of consultation
a voluntary, problem-solving process, initiated by consultant or consultee, to help consultees devp attitudes or skills to increase functioning.
Consulting is similar to counseling except for what?
context, role, function
Consultation is preventative in nature, T/F?
True
2 types of consultation
Content - knowledge transfer bw parties
Process - examines the process
Names behind some of the consultation models
Bergan, Bandura, Schein, Caplan, Splete
Bergan model of consultation
- behavioral model emphasizing verbal interaction
4 stages:
- problem identification
- problem analysis
- plan implementation
- problem evaluation
(So, identify it, plan it, implement the plan, evaluate it)
Part of the focus is on problem behaviors and the antecedents and consequences (it IS a behavioral model))
Bandura model of consultation
social learning model
- there’s a dynamic interplay of behaviors, cognitions, and environment. these are assessed in problem identification
- soln’s revolve around modeling, rehearsing, changing cognitions
Schein model of consultation
Purchase model - buying consultant’s knowledge/service (“I buy”)
Doctor-Patient Model - stresses diagnosis and problem identification (“you tell me”)
Process Model - involves both parties in the diagnosis and interventions (“we do”)
Caplan model of consultation
mental health consulting model
- occurs bw two professionals and can be centered on the client, consultee and client, program, consultee and administration
