Counseling Theory and Practice Midterm Flashcards
REBT
A short-term therapy developed by Albert Ellis that helps clients identify and change defeating thoughts and feelings
Goal of REBT
Help people reduce their underlying symptom-creating propensities. Minimization of musturbation, perfectionism, grandiosity, and low frustration tolerance
ABCDE Model
- Activating Events/ Adversity
- Irrational Beliefs about the events at “A”
- The emotional and behavioral Consequences
- Disputes/ arguments against irrational beliefs
- New Effect or the new, more effecive emotions and behaviors that result from more reasonable thinking about the original event
ABCDE
Activating events (A’s) in people’s lives contribute to their emotional and behavioral disturbances or consequences (C’s) largely because they are intermingled with or acted upon by people’s beliefs (B’s) about these activating events (A’s)
What Makes a Thought Irrational?
Irrational beliefs or dysfunctional attitudes that constitute people’s self-disturbing philosophies have two main qualities:
- They have at their core explicit or implicit rigid, powerful demands and commands, usually expressed as musts, shoulds, ought to’s, have to’s, go to’s. (“I absolutely must have my important goals fulfilled!”)
They also have derivatives of these demands:
Irrational Thoughts
Emptional upsets as distinguished from feelings of sorrow, regret, annoyance, and frustration – stem from irrational beliefs
REBT View of Neuroses
Neurotic thinking is the result of unrealistic, illogical, self-defeating thinking, and that is disturbance-creating ideas can be disputed
What does REBT do?
A cognitive-emotive-behavioristic method of psychotherapy uniquely designed to enable people to observe, understand, and persistently dispute their irrational, grandiose, perfectionistic shoulds, oughts, and musts and their awfulizing
Distraction (REBT Technique)
- Adult demanders can be transitorily sidetracked by distraction
- Therapist who sees someone who is afraid of being rejected (one who demands that significant others accept him) can try to divert him into activities such as sports, aesthetic creation, a political cause, yoga exercises, meditation, or preoccupation with the events of his childhood
- While the individual is diverted, he will not be so inclined to demand acceptance by others and make himself anxious
- Distraction techniques are mainly palliative, given that distracted people are still demanders and that they will probably return to their destructive commanding once they are not diverted
Satisfaction of Demands (REBT Technique)
If a client’s insistences are always catered to, she or he will tend to feel better (but will not necessarily get better)
- To arrange this kind of “solution,” a therapist can give her or his love and approval, provide pleasurable sensations (for example, put the client in an encounter group to be hugged or massaged), teach methods of having demands met, or give reassurance that the client eventually will be gratified
Magic and Mysticism (REBT technique)
- Adolescent and adult demanders can be led to believe (by a therapist or someone else) that their therapist is a kind of magician who will take away their troubles merely by listening to what bothers them
- A boy who demands may be assuaged by magic (ex: parents saying that a fairy godmother will satisfy his demands)
Minimization of Demandingnes
Best solution = to help individuals become less demanding
- As children mature, they normally become less childish and less insistent that their desires be immediately gratified
REBT encourages clients to achieve minimal demandingness and maximum tolerance
Temporary, palliative techniques may be used in REBT with clients who refuse more permanent resolution
Benefits/ What does REBT do?
- REBT assists patients in seeing how giving up perfectionism improves their lives
- REBT teaches patients to differentiate between desires and “musts.”
- Behavioral techniques are used in REBT to change habits as well as cognition
- REBT helps clients acquire a more realistic, tolerant philosophy of life
- REBT practitioners often employ a rapid-fire, active-directive-persuasive-philosophical methodology
Mechanism of REBT
No matter what feelings (which, by the way, do not distract the therapist) the patient discusses, the focus is on the patient’s irrational beliefs
Mechanism of REBT
Therapists do not hesitate to contradict a patient’s beliefs and are often one step ahead while showing acceptance
Mechanism of REBT
Therapists may do more talking than their patients
Mechanism of REBT
Therapist doesn’t just tell the patient his or her beliefs are irrational, but also attempts to encourage the patient to see this for him- or herself
Basic Personality Theory of REBT
Humans largely create their own emotional consequences
- They appear to be born with a distinct proneness to do so, and they learn through social conditioning to exaggerate (rather than minimize) that proneness
Client-Centered Therapy
Carl Rogers –> an orderly process of client self-discovery and actualization occurs in response to the therapist’s consistent empathic understanding of, acceptance of, and respect for the client’s frame
The therapist sets the stage for personality growth by reflecting and clarifying the ideas of the client, who is able to see himself or herself more clearly and come into closer touch with his or her real self
As therapy progresses, the client resolves conflicts, reorganizes values and approaches to life, and learns how to interpret his or her thoughts and feelings, consequently changing behavior that he or she considers problematic
3 Essential Therapist-Offered Conditions of Therapeutic Personality Change
- Congruence
- Unconditional Positive Regard
- Empathic understanding of the client’s internal frame of reference
6 Necessary and Sufficient Conditions for Change (Client-Centered)
1) Two persons are in psychological contact
2) The client is in a state of incongruence, being vulnerable or anxious
3) The therapist is congruent or integrated in the relationship
4) The therapist experiences unconditional positive regard for the client
5) The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client
6) The communication to the client of therapist’s empathic understanding and UPR is to a minimal degree achieved
Unconditional Positive Regard
A nonposessive caring and acceptance of the client as a human being, irrespective of the therapist’s own values
Warm acceptance
Non-judgmental openness to the client as a person and his/her behaviors, beliefs, and values
Empathic Understanding
The ability to absorb the expressed meanings of the client as if the therapist were seeing the world as the client sees; and to feel along with the client in their pain or joy
Congruence
A state of wholeness and integration within the experience of the person (hallmark of psychological adjustment)
Becoming more congruent, whole, and integrated, is a predictable outcome and can be observed in all relationships that provide therapeutic conditions
Incongruence
A discrepancy between the cleint’s self-image and actual experience leaves him or her vulnerable to fears and anxieties
Clients is unaware of this state
Actualizing Tendency
Organisms are motivated to maintain and enhance themselves
People do the best they can under the circumstances they perceive and that is acting on them
Unconditional Positive Regard
Therapist accepts the client’s thoughts, feelings, wishes intentions, theories, and attributions about causality as unique, human, and appropriate to their current experience
Acceptance does not mean agreeing with client
Psychological Contact (client-centered)
Therapist must be present in the room; two people that may influence each other
Incongruence (client-centered)
Client must be vulnerable (fearful, anxious, distressed)
Incongruence between self and experience
Congruence or Genuineness (client-centered)
Therapist must be genuinely themselves
Openness to experience the client
Express feelings
Empathy (client-centered)
Therapist must be able to enter into and experience client’s world (while not getting enveloped)
Empathic understanding of the client’s internal frame of reference
Active, immediate, continuous process involving the therapist’s cognitive processes, affective responses, and expressive behavior
Implies openness to the client’s communications including:
- Negative or critical reactions to the client
- A willingness to suspend one’s own opinions, prejudices, and theories
Places the client’s own expression and meanings at the center of the process as the therapist follows with understanding
Goals of Person-Centered Psychotherapy
Assist client in becoming congruent, self-accepting people
- Client specifies specific goals
- Therapist provides setting & relationship to allow client to increase positive self-regard and be fully functioning
Client-Centered Theory of Personality
Psychological development –> Grow from unique infant to self-aware children in need of positive regard from others (being emotionally & physically touched, valued, cared for)
Perception of received positive regard influences self-regard
Children find satisfaction through meeting needs of others
Conditional Positive regard (theory of personality in person-centered)
- Conditions of worth
- Evaluate one’s own experience based on beliefs, values of others
- Leads to anxiety
Client-Centered Therapists
- Respect clients
- Listen without prejudice
- Are open to either positive or negative feelings to either speech or silence
Mindfulness
Clear, objective awareness of experience
Being aware, attentive, and observant to all experiences and emotions in the present moment
Mindfulness
A psychological state of awareness, the practices that promote this awareness, a mode of processing information and a character trait
A state
Why Practice Mindfulness
- Helps to increase our ability to regulate emotions, decrease stress, anxiety and depression
- Can help focus our attention and observe our thoughts and feelings without judgment
Mindfulness can…
- Help relieve stress
- Treat heart disease
- Lower BP
- Reduce chronic pain
- Improve sleep
- Alleviate gastrointestinal problems
Goal of Mindfulness
Achieve a state of alert, focused relaxation by deliberately paying attention to thoughts and sensations without judgment
Goal of Mindfulness
Draw your attention to the world around you and redirect your attention away from your worries
Collectivistic
Those cultures in which individuals’ identity is associated with their relationships to others
Members endorse relational values, prefer interdependence, encourage sharing resources, value harmony, tolerate the views of significant others, and prefer communication that minimizes conflicts
Valuing connection, persons frequently contextualize and have a holistic orientation
Individualistic
Individuals who frequently view themselves independently from others are denominated
Ideal personal characteristics include being direct, assertive, competitive, self-assured, self-sufficient, and efficient
Western societies tend to be identified this way because their members define themselves primarily in terms of internal features such as traits, attitudes, abilities, and agencies
Worldview
Those ideas and beliefs, shaped by one’s culture, that influence the way an individual interprets the world and interacts with it
Worldview
Negotiation of client-therapist is crucial for effective psychotherapy
Clash of Worldviews
Individualistic psychotherapists can violate personal and family norms by asking collectivistic clients to reveal intimate personal information, by soliciting the expression of emotion and affect, and by requesting individuals to air family disputes, all before earning their clients’ trust and establishing a positive therapeutic alliance
Steps to becoming culturally competent
- Become aware of your worldview
- Examine your attitude toward cultural differences
- Learn about different worldviews/ cultures
- Develop multicultural skills
Culturally Competent Therapists the capacity to…
- Value diversity
- Manage the dynamics of difference (of working with different cultures)
- Acquire and incorporate cultural knowledge into their interventions and interactions
- Increase their multicultural skills
- Conduct self-reflection and assessment
- Adapt to diversity and to the cultural contexts of their clients
Cognitive Therapy
Developed by Aaron Beck
Based on a theory of personality that maintains that people respond to life events through a combination of cognitive, affective, motivational, and behavioral responses
Aims to adjust information processing and initiate positive change in all systems by acting through the cognitive system
Collaborative Empiricism (CT strategy)
Views the patient as a practical scientist who lives by interpreting stimuli but who has been temporarily stopped by his or her own apparatus that gathers and integrates information
Therapist asks questions to understand the patient’s POV
-Patient plays an active role in describing how they would like things to be different and what they can do to help make changes
Guided Discovery (CT strategy)
Directed towards discovering what threads run through the patient’s current misperceptions and beliefs and linking them to relevant experiences in the past
Notion that the therapist does not provide answers to the patient but is curious about what the two of them will discover as they gather data, examine the data in different ways, and ask the patient what to make of new perspectives
Socratic Dialogue
A style of questioning that helps uncover the patient’s views and examines his or her adaptive and maladaptive features
Collaborative empiricism and guided discovery are implemented using this
“How does this new information fit with your belief that you can’t do anything right?”
Socratic Dialogue Steps
- Asking informational questions
- Listening
- Summarizing
- Asking synthesizing or analytical questions that apply discovered information to the patient’s original belief
Socratic Questions (Actual questions asked)
- What is the evidence for this thought? Against it?
- Am I basing this thought on facts or on feelings?
- Is this thought black and white, when in reality, it’s more complicated?
- Could I be misrepresenting the evidence? Am I making any assumptions?
- Might other people have different interpretations of this same situation? What are they?
- Am I looking at all the evidence, or just what supports my thought?
- Could my thought be an exaggeration of what’s true?
- Am I having this thought out of habit or do the facts support it?
- Did someone pass this thought/ belief to me? If so, are they a reliable source?
- Is my thought a likely scenario, or is it the worst-case scenario?
Socratic Dialogue
Implies that the patient arrives at logical conclusions based on the questions posed by the therapist
Questions enable the therapist to understand the patient’s point of view and are posed with sensitivity so that patients may look at their assumptions objectively and nondefensively
Therapists use Socratic Dialogue to…
- Explore approaches to problems
- Help the patient weigh advantages and disadvantages of possible solutions
- Examine the consequences of staying with particular maladaptive behaviors
- Elicit automatic thoughts
- Demonstrate EMSs and their consequences
CT Teaches patients to…
- Monitor their negative, automatic thoughts (cognitions)
- Recognize the connections among cognition, affect, and behavior
- Substitute more reality-oriented interpretations for these biased cognitions
- Learn to identify and alter the beliefs that predispose them to distort their experiences
Goal of Cognitive Therapy
Reduce cognitive distortions and biased judgments, thereby shifting information processing to a more “neutral” condition so that events will be evaluated in a more balanced way
Correct faulty information processing
Help patients modify assumptions that maintain maladaptive behaviors and emotions
Cognitive Therapy’s View of Neurosis
CT maintains that psychological distress results from several factors
- Although people may have biochemical predispositions to illness, they respond to specific stressors because of their learning history
Individuals experience psychological distress when they perceive a situation as threatening their vital interests
- Their perceptions and interpretations of events are highly selective, egocentric, and rigid
Cognitive Distortions
Systematic errors in reasoning are evident during psychological distress
Arbitrary Interference
Drawing a specific conclusion without supporting evidence or even in the face of contradictory evidence
Ex: the working mother who concludes that after a busy day “I’m a terrible mother.”
Ex: a young woman with anorexia nervosa believes that she is fat even though she is dying from starvation
Selective Abstraction
Conceptualizing a situation on the basis of a detail taken out of context, ignoring other information
(Dwelling on a single negative detail taken out of context)
Ex: a man who becomes jealous on seeing his girlfriend tilt her head toward another man to hear him better at a noisy party (thinking she’s cheating)
Ex: While on a date, you say one thing you wish you could have said differently and now see the entire evening as a disaster.
- Or I stumble over my words when meeting someone new and then I tell myself they will think I’m a fool
Overgeneralization
Abstracting a general rule from one or a few isolated incidents and applying it too broadly and to unrelated situations
(A single negative event is viewed as a never-ending pattern of defeat)
Ex: After a discouraging date, a woman concluded, “All men are alike. I’ll always be rejected.”
Ex: You have a negative experience in one relationship and develop a belief that you just aren’t good at relationships
Ex: You get a low score on a math test and you conclude that you are hopeless at math in general
Ex: “I was anxious about saying my name on the first day of school. I am going to anxious about talking in school all the time.”
Ex: Following a job interview, an accountant does not receive the job. He or she begins thinking that he or she will never find a job position despite his or her qualifications
Magnification and Minimization
Seeing something as far more significant or less significant than it actually is
Ex: A student catastrophized, “If I appear the least bit nervous in class, it will mean disaster.”
Ex: Another person, rather than facing the fact that his mother is terminally ill, decides that she will soon recover from her “cold.”
Ex: Example: An employee believes that a minor mistake will lead to being fired.
Ex: An alcoholic believes he or she doesn’t have a problem.
Personalization
Attributing external events to oneself without evidence supporting a causal connection
(Assuming personal responsibility for something for which you are not responsible)
Ex: A man waved to an acquaintance across a busy street. After not getting a greeting in return, he concluded, “I must have done something to offend him.”
Ex: “It’s all my fault that the meeting ran on so long.”
Dichotomous Thinking
Categorizing experiences in one of two extremes
(Things are seen as black and white; there is no gray or middle ground)
Ex: as complete success or total failure. A doctoral candidate stated, “Unless I write the best exam they’ve ever seen, I’m a failure as a student.”
Mind Reading
Assuming someone is responding negatively to you without checking it out
Ex: If your husband is in a bad mood, you assume it is your fault and don’t ask what is wrong.
Fortune teller error
Creating a negative self-fulfilling prophecy
Ex: You believe you will fail an exam so you don’t study and fail
Emotional Reasoning
You assume that your negatove feeling results from the fact that things are negative
Ex: If you feel bad, then that means the world or situation is bad. You don’t consider that your feelings are a misrepresentation of the facts
Should Statements
Use words such as should, must, ought, rather than “it would be preferred” to guilt self
Labeling and Mislabeling
Name-calling (“he’s a jerk”) rather than just criticizing the behavior
Decatastrophizing (CT Technique)
What-if Technique
Helps patients prepare for feared consequences
- Helpful in decreasing avoidance, particularly when combined with coping plans
- If anticipated consequences are likely to happen, these techniques help identifying problem-solving strategies
- Often used with a time-projection technique to widen the range of information and broaden the patient’s time perspective
Reattribution
Techniques test automatic thoughts and assumptions by considering alternative causes of events
- Especially helpful when patients personalize or perceive themselves as the cause of events
- In the absence of evidence, it is unreasonable to conclude that another person or single factor is the sole cause of an event
- Encourage reality testing and appropriate assignment of responsibility by requiring examination of all the factors that impinge on a situation
Decentering
Primarily used in treating anxious patients who wrongly believe they are the focus of everyone’s attention
Cognitive Therapy Maintains
The modification of dysfunctional assumptions leads to effective cognitive, emotional, and behavioral change
Change can occur only if the patient experiences a problematic situation as a real threat
Psychodynamic Therapy
A general term for a variety of therapies that evolved from psychoanalysis
Key Mechanism of Change in Psychoanalysis
Theorized to involve the process of gaining insight into one’s own unconscious conflicts
Specific Therapeutic Stance of Psychodynamic
- An emphasis on helping clients become aware of their unconscious motivation
- Refraining from giving the client advice or being overly directive
- Attempting to avoid influencing the client by introducing one’s own beliefs and values
- Maintaining a certain degree of anonymity by reducing the amount of information provided about oneself/ their feelings of the session
- Attempting to maintain the stance of neutral and objective observer rather than a fully engaged participant in the process
- Seating arrangement in which the client reclines on the couch and the therapist sits upright and out of the client’s view
Defense Mechanism
Function: To cope with anxiety caused by conflict between the Id and the Superego (typically unconscious)
Defenses
Unconscious mental mechanisms mobilized by the ego to protect oneself from inner and outer threat
Repression
Distressing thoughts are barred from conscious expression
Unconscious forgetting to the point that they do not know it exists
Defense Mechanism
Excludes painful memories and experiences
Ex: A dog in childhood bit an individual. This develops into a phobia of dogs, but the person does not remember where this fear originated from
Ex: An individual has a Freudian slip, saying, “I’m in love with Mark,” her ex-boyfriend when she meant to say the name of her current one
Denial
Defense Mechanism
Distorting or not acknowledging thoughts and feelings
Ex: Someone denies that they have an alcohol or substance use disorder because they can still function and go to work each day.
Ex: After the unexpected death of a loved one, a person might refuse to accept the reality of the death and deny that anything has happened
Reaction Formation
Defense Mechanism
Someone denies a threatening feeling and proclaims she feels the opposite
Act in the opposite extreme as true feelings
Ex: A drug addict loudly preaches against substance abuse and for abstinence from them
Ex: A mother who bears an unwanted child, for example, may react to her feelings of guilt for not wanting the child by becoming extremely overprotective to convince both the child and herself that she is a good mother
Projection
Defense Mechanism
Attributing to others unacceptable personal thoughts, feelings, or behaviors
In which a person attributes a threatening feeling or motive he is experiencing to another person
Ex: If you strongly dislike someone, you might believe that they strongly dislike you
Ex: a person who realizes that they are being aggressive during an argument may accuse the other person of aggression
Displacement
Defense mechanism
Place angry, discontented feelings on safe objects
Ex: mad about something that happened at work (can’t express feelings there), so you yell at your SO when you get home
Sublimation
Defense mechanism
Socially unacceptable impulses are transformed into socially acceptable behavior
- Modification of drive into acceptable behavior
Ex: playing football to release aggressive urges
Ex: when I’m feeling frustrated or angry I let out my aggression through boxing
Rationalization
Defense Mechanism
Making excuses for a failure or loss
Ex: saying “everyone else does it” to make yourself feel better about doing something that you know is wrong
Ex: Someone who is passed over for a promotion might rationalize the disappointment by claiming to not have wanted so much responsibility after all
Regression
Defense Mechanism
Ex: When we are scared, our behaviors often become more childish or primitive
Ex: College student sucks his thumb when stressed
Identification
Taking on characteristics of others to increase positive feelings (sports team, mentor)
Ego defense or mental mechanism through which an individual, in varying degree, makes himself or herself like someone else; he identifies with another person. This results in the unconscious taking over of various elements of another
Ex: a child developing the behavior of his or her parents without conscious realization of this process
Intellectualization
Defense Mechanism
An individual talks about something threatening while keeping an emotional distance from the feelings associated with it
involves a person using reason and logic to avoid uncomfortable or anxiety-provoking emotions
Turning emotion into abstract thought
Ex: if a woman’s roommate announced that she was moving out, the woman might conduct a detailed financial analysis of her new budget rather than confront her emotions of sadness, loneliness, or anger
Transference (PD Technique)
The client’s tendency to view the therapist in terms that are shaped by his/her experiences with important caregivers and other significant figures who played important roles during the developmental process
- Therapeutic relationship provides an opportunity for the client to bring the memory of the relationship with the significant figure from the past to life through relationship with therapist
Countertransference (PD Technique)
Activation of unconscious wishes and fantasies on the part of the therapist toward the patient
- Can either be elicited by and indicative of the patient’s projections or come from the therapist’s tendency to respond to patient as though they were significant figures in their life, history, or fantasy of the therapist
Totality of the therapist’s feelings and other spontaneous responses emerging in the context of the therapist-client relationship
Free Association (PD Technique)
Clients are encouraged to attempt to suspend their self-critical function and verbalize thoughts, images, associations, and feelings that are on the edge of awareness
- Related everything in awareness (all senses) – therapist listens for themes that may relate to unconscious material, which is assumed to affect current behavior and symptoms
Neutrality (PD Technique)
No self-disclosure, nothing in the office to influence the client
Empathy (PD Technique)
Empathic understanding of client’s experiences
Relational Psychoanalysis
Recognizes therapist as individual that will affect course & outcome of treatment
- Patient will also affect therapist
- Detached objectivity does not exist
- Neutrality difficult to sustain
- 2-person psychology
Resistance
Usually behavioral cues that resistance to treatment is occurring
- Late for/canceling appointments
- Difficulty free associating
Therapist chooses if/when to interpret
Interpretation
Therapist’s job is to interpret material presented by client & make it relevant to client
- Need to keep interpretation at an acceptable level to client
- Interpretation of dreams
Etiology of Psychopathology in Psychodynamic
- Neurosis on a continuum –> everyone could benefit from psychoanalysis or talking cure
- Conflict between Id and Superego = Anxiety
- Repressed sexual abuse = Hysteria
- Irregular or inattentive mother = Anxiety
- Overly controlling or degrading parent during anal stage = Obsessive compulsive traits
Unexpressed aggression turned inward = Depression
Conscious
Sensations and perceptions we are aware of
Preconscious
Memories of events that can easily be retrieved with little effort
Unconscious
Container for memories and emotions that are threatening to conscious minds, must be pushed away
Id
Aspect of the psyche that is instinctually based and present from birth
Pleasure principle
Ego
Gradually emerges out of the id and functions to represent the concerns of reality
Reality seeker
Although the id presses for immediate sexual gratification the ego evaluates the suitability of the situation for satisfying one’s instinctual desire, and it allows the individual to delay instinctual gratification or find other ways of channeling instinctual needs in a socially
Superego
Psychic agency that emerges through the internalization of social values and norms
Seeks perfection
Often becomes overly harsh and demanding and can lead to destructive feelings of guilt and rejecting stance towards one’s own instinctual needs and wishes
Assumptions
- Primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories
- The unconscious mind comprises mental processes that are inaccessible to consciousness but that influence judgment, feelings, or behavior
- Freud –> the unconscious mind is the primary source of human behavior
- Like an iceberg, the most important part of the mind is the part you cannot see
- Our feelings, motives, and decisions are actually powerfully influenced by our past experiences, and stored in the unconscious
Mechanism of Psychodynamic
Freud –> change involves becoming aware of our instinctual impulses and related unconscious wishes and then learning to deal with them in a reflective and rational fashion
Mechanism of Psychodynamic
Central notion → psychoanalysis works by making the unconscious conscious and that the primary vehicle for doing this through the verbal interpretations that give the client insight into the unconscious factors that are shaping his/her experience and actions
Emotional Insight (Psychodynamic)
Combining the conceptual with the affective so that the client’s new understanding has an emotionally immediate quality to it and is not relegated to the realm of intellectual understanding that has no impact on his or her daily functioning
Alliance Rupture and Repair
Inevitable that the therapist will ultimately fail the client by not being adequately attuned to their needs
When this happens → a retraumatization will occur for the client, and the process of working through this retraumatization in a conservative way allows the client to begin to bring split-off parts of the self into the therapeutic relationship
