Final Exam Flashcards
3 C’s of Counselling
Challenges/Choices/Changes
Usually a combination. Challenges could require them to make a choice or a change.
OR
Adapting to the change that has been made.
5 Stages of Counselliing
- Rapport and relationship building—A first impression can be a lasting impression. We need to make people comfortable and be comfortable with them. This is the hardest part of counselling.
- Assessment or defining the problem. Counselling does not do as much assessment- more in psychotherapy. Instead, we help them define their problem. Talk therapy- help people talk through it. One can often figure it out just by talking thoroughly, but it helps to have someone there to listen.
- Goal Setting. (All these steps work together; the relationship must continue throughout.) Ask: Do you want to stay with your partner or leave? What is the goal?
- Initiating Interventions: What do they need to do? If something is debilitating, intervention may be necessary. For example, taking steps to overcome social anxiety—saying hi to someone in class—encourages them to do things. In the above example, go to a party.
- Termination and follow-up. The issue may return, and they may need to come back.
Factors for Effective Counselling, and the percentages.
- The client is the primary driver for success. There is room for advice, but the autonomy is with the client.
o Client factors (40%)
o Alliance factors (30%)
o Expectancy factors or realism (15%)
o Theoretical and Technical factors (15%)
Client Factors in Counselling
Mandated counselling is much less effective than when they chose to go. Does the client want to make changes?(Client Factors)
Alliance factors
Relationship between counsellor and client.
Clients place more value on the therapist’s personality than on the specific techniques used. If they feel that you don’t like them, it will likely not be a strong working alliance
Expectancy and realism
We need to set realistic goals, but sometimes clients set these themselves. We may need to ask, “How realistic is this?” and bring them to an achievable level.
Key Competencies of Counsellors.
- Beliefs and attitudes- who am I, and what can I contribute to this?
- Knowledge- understand different cultural worldviews and understand human behaviour.
- Reflect on the work with clients- ask them how they feel at the session’s end.
- Confer with other colleagues- discuss a case while maintaining confidence.
- Practice self-care. Vicarious trauma is real. Similar to burnout. It happens when working with disadvantaged clients- take on what the client is dealing with, which can affect us. It can be frustrating not to see the change you want to see.
Transference
The client responds to the therapist as if they are a significant figure in the client’s past or present life. The client is comfortable getting mad at them or being open with them. For example, don’t say that it reminds me of my father. This is a positive thing.
Countertransference
The therapist responds to the client as if they were a significant figure in the counsellor’s past or present life. For example, a counsellor (male) is going through a nasty divorce and ends up working with a client who is going through a divorce (female). He was triggered as the client said they were gonna take everything from their husband. Meanwhile, the counsellor is on the other side; he feels he is being taken for everything. He realized he could not do this and was not a good fit.
Forces of Counselling Theory Also called applications.
- Psychodynamic
- Behavioral
- Existential/humanistic.
- Systemic
- Neuroscientific.
What qualities are essential for counsellors?
- Active listening skills, solid worldview, mild-mannered self-control, patience, empathy (not sympathy), open-minded, approachability, communication, self-reflective, emotional stamina, curiosity, honesty, acceptance, problem-solving, problem-solving skills, rapport-building skills, flexibility, diversity awareness, competency.
Beneficence (Ethics)
Being proactive in promoting the best interests of clients.
Fidelity (Ethics)
Honouring commitments to clients and maintaining integrity in counselling relationships.
Nonmaleficence (Ethics)
Refraining from actions that risk harm and not willfully harming clients. Like not testing drugs on people who don’t know.
Autonomy (Ethics)
Respecting the rights of clients to agency and self-determination. If a client refuses a technique, they can. E.g. the empty chair technique.
Justice (Ethics)
Respecting the dignity of all persons and honouring their right to just treatment.
Societal Interest (ethics)
Upholding responsibility to act in the best interests of society. If someone is going to be a danger to society, this behaviour may need to be reported. Black and White: if they say they will hurt themselves or another person, that must be reported. However, there is subjectivity.
Ethical Considerations in Counselling Process:
- Informed Consent (right to know about their therapy)
- Confidentiality (and the limits)
- Privileged communication (varies from place to place.
- Assessment (must consider relevant factors and avoid personal bases)
- Diagnosis (counsellors do not diagnose mental illness)
Principle-Based Decision Making- Steps
- Step One – What are the key issues in this situation?
- Step Two – What ethical articles from the CCPA Code of Ethics are relevant to this situation?
– Are there policies, case law, statutes, regulations, bylaws or other related articles that are relevant to this situation? - Step Three – Which of the six ethical principles are of major importance in this situation? (This step also involves securing additional information, consulting with knowledgeable colleagues or the CCPA Ethics Committee, and examining the probable outcomes of various courses of action.)
- Step Four – How can the relevant ethical articles be applied in this circumstance?
– How might any conflict between ethical principles be resolved?
– What are the potential risks and benefits of this application and resolution? - Step Five – What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)
- Step Six – What plan of action will be most helpful in this situation?
– Follow up to evaluate the appropriateness, adequacy, and effectiveness of the course of action taken. Identify any adjustments necessary to optimize the outcome.
Virtue Based Decision Making.
- What emotions and intuition am I aware of as I consider this ethical dilemma and what are they telling me to do?
- How can my values best show care for the client’s wellbeing?
- How will my decision affect other relevant individuals in this ethical dilemma?
- What decision would I feel best about publicizing?
- What decision would best reflect who I am as a person and practitioner within cultural/intercultural contexts?
Founder of Person Centered Therapy (About)
Carl Rogers
* Even with modern-day theories, Rogers’s contributions are probably the most significant.
* No theory excludes things Rogers said—a great place to start integrating therapies.
* Particularly in education.
“A courageous pioneer”
His work began in the 40s but he was not embraced until much later.
Sets the foundation for externalism.
*believes in the hierarchy of needs.
Features of the 3rd Force of Counselling
- 1960’s and 1970’s –not just alternatives to psychoanalytic and behavioral approaches but an extension of the importance of relationality in the therapeutic alliance.
- All propose an optimistic view that suggests each of us has the natural potential to self-actualize and find meaning in our lives.
- It doesn’t end with self-actualization
Humanism vs. Existentialism- Similarities
- Humanism and Existentialism BOTH:
- Respect for client’s experience and trust in clients’ ability to change
- Believe in freedom, choice, values, personal responsibility, autonomy, meaning
- Client strength/s versus client deficit/s and de-empasize notions of pathology
a focus on respect and trust for the client
Humanism vs. Existentialism- Distinction
- Existentialism = help people find meaning.
- Humanism = helping people get to self-actualization.
Existentialism
* Clients come into counseling because they are facing anxiety trying to construct an identity in a world without intrinsic meaning. Focus is often on realities of existence (life, death, isolation)
Humanism
* Less focus on anxiety
* Clients can suffer from anxiety in trying to create an identity
* Clients need to believe they have the natural potential to self-actualize
* Rogers was a problem solver.
* Reflecting- the most commonly used counselling technique.
Person Centered Therapy 1940s
– non-directive counselling
* Took power away from the counsellor and focus was on inherent power of the client
* Caused great concern and outrage amongst some of the more traditionalist theorists
* Focused mainly on reflecting and clarifying the clients’ communication
Person Centered Therapy 1950s
- 1951 – wrote “Client Centered Therapy”
- Reflected more on client than ‘non-direct’ methods
- Focused on clients’ internal frame of reference
- Self-actualizing (becoming more aware of self) is the motivation that leads to client change
Person Centered Therapy 1960s
- 1961 – wrote “On Becoming a Person”
- Focused on clients’ trust in one’s experience
- Studied the qualities of the counselling relationship
- Expanded his theory to education which became known as ‘student-centered’ teaching
Person Centered Therapy 80s and 90s
- Considerable expansion to other domains than just counselling
- Change of name to “person’ centered approach (PCT)
- Each period showed a progression in his belief that the counsellor and client relationship was central to therapy
Abraham Maslow
- Large influence on Carl Rogers
- Proponent of humanistic psychology or relational psychology
- Maslow criticized Freudian psychology for what he saw as pathologizing the client
- Self-actualizing people - key belief
- Self-actualizing people are self-aware, free, honest, caring, trusting and autonomous
- A hierarchy of needs is the basis toward self-actualization
Maslow - Hierarchy of Needs
- Physiological needs
- Belonging and Love
- Safety needs (security and stability)
- Self-esteem
- Fun and Humor
We achieve actualization as these basic needs are met. If we get stuck at any stage, we cannot get to the point of complete self-actualization
Self Actualization.
- Is a directional process of moving forward in one’s life – becoming a ‘whole’ person
- Includes greater personal self-awareness, freedom, honesty, caring, and autonomy
- Overall – being the person one wants to be and not living to the expectations of others
Person Centered View of Human Nature
- Positive view of human nature
- People have the inherent ability to change and live more happy lives
- Relationships are the driver to this process
Person Centered: The Counselling Process
- The goal is to assist clients in their growth process so they can better cope with problems they identify
- Clients come to realize that there are more authentic ways of being (and living)
- How can I discover myself?
- How can I become who I want to become?
- How can I remove the masks and be me?
- The client chooses their therapeutic goals
PCT: Masks
: you present yourself to people how you want them to see you. Perhaps not being your authentic self makes you not happy.
* Example: 17 year old. Trouble with peers. Drugs. She was selling her body. Came from a wealthy home and educated parents. She had the potential to be a good student. When asked ‘how would other people describe you”? she said ‘they describe me as crack whore’ and she also described herself as a crack whore. She was not ok with people calling her that. Then ask, do you like what you are doing and how you live? She said no. Then go back and say, is it correct for people to call you that? (insert reality therapy). She agreed as she is doing that. Challenging this is the humanistic part of helping her self actualize.
Key Aspect of PCT
- The therapeutic relationship and the client’s internal resources are the crux of successful therapy.
- The qualities and characteristics of the therapist are key to the success of therapy
PCT- The Role of the Therapist
- Presence is key to successful therapy
- Therapist sees themselves as an instrument of change
- Focus is on immediate experience – not delving into the past
- Therapist must be ‘real’ with the client
- A shared journey
- Counsellor does not need to be ‘perfect’ but must recognize their influence on clients
Rogers would say that you will never be a good counsellor if you don’t do these 3 things. (Necessary and Sufficient Conditions for Change)
- Congruence—genuineness, counsellor’s behavior is congruent with emotions
Congruence = Genuineness – being honest with the client. - Empathy—accurate ability to view the world from client’s perspective
Empathy = a deep understanding of the client/person. Really understanding what it would be like to be them – know what it would feel like to be in their shoes. - Accurate empathic understanding is thought to be the most powerful determinant of client progress
- Unconditional Positive Regard—acceptance, caring, confirmation of client. * Unconditional Positive Regard = a non-judgmental approach used with clients (people) to show respect for them as a human being and showing acceptance of a person’s right to their feelings, even in cases when we might not necessarily agree with them or like their opinion/actions.
Subjective empathy
When counsellors learn about an experience from a client and begin to internalize what that would be like
Interpersonal empathy
When counsellors understand an experience at a distance but can convey a sense of what it is like for the client
Objective empathy
When counsellors rely on outside frames of reference or similar experiences
Accurate Empathy
Rather than think of empathy as a particular type (Subjective, Interpersonal or Objective), it is more useful to think of it in an integrated manner and not to focus as much on how one might relate to a client’s experience, but rather, focus on being able to internalize that experience and be able to put oneself in the shoes of another person.
PCT Therapeutic Experience
grounded on the assumption that it is clients who heal themselves and create self-growth.
* Therapy will help individuals:
* Become open to experience
* Trust themselves
* Unmasking - evaluate themselves internally (not externally)
* Willing to continue to grow as a person
Goals of Person-Centered Therapy
- Increase the independence and integration of the client
- Focus on the person, not the problem
- Create the conditions necessary for positive growth
- Develop openness to new experiences, trust in themselves, internal source of evaluation, and willingness to continue growing
It should be noted… - A major aspect of person-centered therapy is the belief that the therapist should not choose the goals of the client, but instead help the client define and clarify their own goals
- Goals should be expected to change as the client progresses through counselling
PCT Important Points
- The relationship between client and therapist is KEY in person-centered therapy
- The relationship is characterized by equality
- Aside from presence, the therapist does not use any particular techniques or strategies although reflection is a common factor used in this approach
- Diagnosis and collecting background history is not necessary
- Skill is for the therapist to create a strong therapeutic relationship based on congruence, positive regard and empathy
Factors of PCT (7)
- No real techniques, aside from PRESENCE
- reflection, listening, immediacy, empathizing, understanding, and responding to the client
Contemporary Approaches to PCT
- Expressive Art Therapy; Creative Therapy; Creative Play Therapy
- Goal of these is for creative expression to unleash inaccessible feelings and emotions
- Motivational Interviewing (change talk)
- A more directive PCT approach which uses more counsellor intervention and includes questions to client
- Emotion-focused Therapy
- Helping clients accept and explore their emotions. We need to accept ourselves before we can change ourselves.
Limitations and Criticisms of PCT
- Many professionals feel PCT conditions are necessary but not sufficient for change to occur
- Many clients want more than just to be listened to, but rather, they want concrete techniques to help them change
- Many clients want more structure than what PCT provides for them
- Some cultures are more collectivist and PCT tends to be more individualistic
Existential: Using Reflection in Counselling
- Reflection is a commonly used counselling technique, but it is often used incorrectly when people simply repeat what the person has said to them.
- Reflection requires understanding a person’s feelings, hearing their messages, and reflecting deeper meanings they are attempting to communicate.
Using Reflection – Example - Woman, 42, tells you: “So often I feel that I’m alone, that nobody cares about me. My husband doesn’t seem to notice me, my kids only demand from me, and I just dread getting up in the morning. “
- What is this person experiencing?
- How might you respond to her using a reflective voice?
- What is this person experiencing?
- Ignored, unappreciated, taken advantage of, unloved, uncared for, a sense of hopelessness
- How might you respond to her using a reflective voice?
- “I’m hearing you say you are feeling lonely, and maybe even desperate for human connection.
- I sense that you are asking yourself – what’s the use of going on this way. “
Existential: Using Immediacy in Counselling
- Immediacy is: ‘the key skill of focusing attention on the here and now relationship of counsellor and client [person] with helpful timing, to challenge defensiveness and/or heighten awareness’.
- It is an advanced technique used ‘in the moment’ to point out how you are interpreting a client’s [person’s] actions or behaviour.
- It must be used carefully, sensitively, and timely or it can cause harm in the counselling relationship.
- Example: I notice when we talk about your mother, you seem to get quite agitated or uncomfortable with the discussion
Existentialism Defined
- A philosophy - more than a set of counselling techniques
- The goal of existential therapy is to assist clients in an exploration of their existence – the “givens of life”
- Existentialism strives to help clients define the nature of human existence
Existentialism Key Figures
Key figures in existential philosophy, which strives to define the nature of human existence, are Sϕren Kierkegaard, Friedrich Nietzsche, Martin Heidegger, Jean-Paul Sartre, Martin Buber, Ludwig Binswanger, and Medard Boss.
Four prominent developers of existential psychotherapy are Viktor Frankl, Rollo May, Irvin Yalom, and James Bugental
Existentialism Basic Beliefs
- We are free (unlike determinism of traditional theories of unconscious and past experiences)
- We are free to choose how we respond to events
- We are responsible for ourselves, and we design the pathways we follow
- We are not victims of circumstances (bad faith)
- Our values are what we choose
- Our existence is never fixed or finished
- Clients are not sick (but may be sick of life)
Existential Counselling
6 key propositions:
Capacity for self-awareness
We are free and must accept this and the responsibility that comes with this.
We must preserve our uniqueness and come to know us as who we are – not how others see us - but rather, how we interact with others
Our meaning of life is never fixed- we re-create ourselves.
Anxiety is part of the human condition
Death is part of the human condition, and awareness of it gives significance to living
central concerns of a person’s existence:
- Death
- Freedom
- Isolation
- Meaninglessness
Existentialism role of anxiety
- Anxiety is a part of life as we recognize our mortality and pain and suffering.
- Anxiety can be used as the motivation to change.
Goals of Existential Counselling
- Help clients recognize the ways in which they are not living fully authentic lives and to make choices that will lead to their becoming what they are capable of being.
- recognize factors that block freedom
- challenge clients to see how they might be responsible for their problems (their cognitions) rather than - this is happening to me.
- widen perspectives on choice
- accept the freedom and responsibility that go along with taking action
The goal of existential therapy is to assist clients in their exploration of the existential “givens of life,” how these are sometimes ignored or denied, and how addressing them can ultimately lead to a deeper, more reflective and meaningful existence.
Existential Counselling: Key Points
- Counsellor/Client relationship is key to process.
- Quality of relationship is more important than techniques used
- Techniques are ‘borrowed’
- Therapy is a collaborative & shared journey
- Techniques used from other theoretical approaches are always used with the overlying question – what does it mean to be human
- Most appropriate for those seeking personal growth or experiencing a developmental crisis – questioning the meaning of their life or life in general
Logotherapy
- Healing through meaning in Greek.
- Viktor Frankl.
- A psychologist, neurologist, and philosopher, he formulated his meaning-centred approach, which promotes freedom of choice and personal responsibility.
- Internationally recognized and empirically based.
- The quest for meaning is the key to mental health and human flourishing.
Existentialism and multicultural counselling
Existential therapy is useful in working with culturally diverse clients because of its focus on universality, or the common ground that we all share.
