Final Overview: The Helping Relationship

Question 1

Eclectic or Integrative

Answer 1

There are over 400 approaches to psychotherapy and counseling
worldwide. Most counselors claim they use several approaches and
thus would be classifi ed as eclectic or integrative.

Question 2

Sigmund Freud’s Psychodynamic Psychoanalysis

Answer 2

Psychoanalysis is a theory of personality and a form of psychotherapy.
It is a long term form of treatment often lasting three to five years or
more. In classical analysis the patient (the analysand) is seen four of five times per week. This form of therapy is said to be historic since it focuses on the past.

Question 3

Sigmund Freud’s Psychodynamic Psychoanalysis

Answer 3

Patient is asked to engage in free association which is saying
whatever comes to mind.

Dreams are very important.

Unconscious material is examined.

Freud emphasized ego defense mechanisms: repression
(most important)— something that is too painful to face, is
totally forgotten;

displacement—taking your anger out on a
safe target rather than the source of your anger;

projection—
you can’t accept a quality about yourself so you attribute it to
others (i.e., you think that you are looking out a window but you
are really looking in a mirror);

reaction formation—you deny
an unacceptable unconscious impulse by acting in the opposite
manner;

sublimation (often cited with career counseling)—you
express an unacceptable impulse in a socially acceptable manner;

rationalization—when a person overrates or underrates a
reward or outcome;

identification—Joining a feared person
(such as a gang) to relieve your anxiety;

suppression or denial (not unconscious or automatic)—occurs when you purposely
don’t think of a situation.

Transference is also a key principle. The analysand (client)
behaves as if the analyst is a parent or caretaker from the past.
The discharge of repressed emotions is called abreaction or
catharsis.

According to Freud’s structural theory the personality has three
systems, a superego (the moral seat of the mind housing two
entities the conscience and the ego ideal);

the ego or reality
principle that balances the id and the superego;

and the id which houses biological forces, especially sex and aggression.
The id operates on the pleasure principle striving for immediate
gratifi cation and tension reduction.

Eros is the life instinct,

Thanatos the death instinct.

Critics charge he used only case studies to test analysis rather
than using true scientific experiments.

Question 4

Carl Jung’s Analytic Psychology

Answer 4

Carl Jung broke away from Freud in 1914 because he felt Freud overemphasized the role of sexuality. His approach, like Freud’s is psychodynamic.

The unconscious has two parts: a personal unconscious
(very similar to what Freud postulated) and the collective
unconscious (an unconscious that one inherits which is common
to all individuals). The collective unconscious is composed of
archetypes passed down through the ages.

Archetypes include the persona: a social mask the person wears.
To explain gender Jung cites the animus or the masculine side
of the female and the anima or feminine side of the male.
Individuals are said to be androgynous, having both male and female characteristics. He also speaks of the shadow or the so called dark side of the personality related to animal instincts.

The self is symbolized via a mandala (a magic circle in Sanskrit)
or a balance between the personal unconscious and the collective
unconscious.

Jung created the extroversion/introversion typologies. Jung
felt that we possess both, however, one is dominant. The Myers-Briggs Type Indicator (MBTI) has its roots in his work. Individuation was Jung’s term for becoming a unique human
being.

Question 5

Alfred Adler’s Individual Psychology

Answer 5

Alfred Adler broke away from Freud to create his own theory. Adler’s individual psychology is a psychodynamic approach that focuses on the fact that behavior is one’s unconscious attempt to compensate for feelings of inferiority. An individual constructs a lifestyle which is chosen.

Adler stressed the “will to power” to generate feelings of
superiority.
The theory adheres to the principle of fictional finalism or
the notion that behavior is motivated primarily by future
opportunities rather than the past.
Adler felt birth order (also called place in the family constellation)
was important. First-born children are conservative leaders.
Second-born kids tend to be more competitive and rebellious.
Sibling interaction can have a greater impact than parent–child
interaction.

Question 6

Behaviorism, Behavior Modification, and Behavior Therapy

Answer 6

John B. Watson coined the word behaviorism while Arnold Lazarus
created the term behavior therapy. Counselors who use these approaches assume that behavior is based on learning rather than insight into the unconscious mind. The criticisms of behavior therapy are that it does not yield insight, it treats symptoms not the root cause, and it can be manipulative and often changes behavior but not underlying feelings.

Question 7

B.F. Skinner’s

Answer 7

B.F. Skinner’s radical behaviorism purports that behavior is
molded solely by its consequences. This paradigm is known as
operant or instrumental conditioning.

Question 8

A positive reinforcer

Answer 8

Is a stimulus that raises the probability
that a behavior will be repeated. The reinforcer must come after
the behavior (or operant).

Question 9

Negative reinforcers

Answer 9

Also raise behavior. For example, a recruit in the military makes a bunk bed to avoid being yelled at by a drill instructor. All reinforcers, whether positive or negative raise behavior. All reinforcers are said to follow or come after a behavior (e.g., a youngster gets a prize after she completes a math problem).

Question 10

Albert Bandura

Answer 10

speaks of social learning theory. Here the
person’s own behavior increases when he or she sees somebody
else getting reinforced for it; also referred to as vicarious learning
or modeling.

Question 11

Punishment

Answer 11

Is intended to lower behavior.

Question 12

Behaviorists champion role playing (e.g., assertive behavior).

Answer 12

Behaviorists champion role playing (e.g., assertive behavior).

Question 13

Extinction

Answer 13

(such as time-out) will lower behavior after an initial

extinction burst or response burst.

Question 14

Ratio schedules of reinforcement

Answer 14

Rely on work output

whereas interval schedules rely on time.

Question 15

Continuous reinforcement

Answer 15

Occurs when each behavior is

reinforced.

Question 16

Intermittent reinforcement

Answer 16

Occurs when some, but not all of
the desired behaviors are reinforced (e.g., a child gets a treat for
every third math problem he completes).

Question 17

Shaping with successive approximations

Answer 17

Is reinforcing small

chunks of behavior that lead to the desired behavior.

Question 18

Differential reinforcement of other behaviors (DRO)/

differential reinforcement of alternative behavior (DRA)

Answer 18

takes place when the helper reinforces behaviors other than
the dysfunctional behavior to reduce the dysfunctional target
behavior (e.g., you want a child to quit talking in class so you give
him a gold star only when he is doing his work and not talking).

Question 19

Skinnerian operant conditioning,

Answer 19

In Skinnerian operant conditioning, the behavior is affected

by the consequences that come after the behavior.

Question 20

Ivan Pavlov

Answer 20

Ivan Pavlov popularized what is now known as classical
conditioning. Behavior modifi cation is generally based on
Skinner, while behavior therapy usually has its roots in Pavlov.

Question 21

Joseph Wolpe’s systematic desensitization

Answer 21

can be conducted
individually or in a group to curb fears and abate anxiety. His
technique of counterconditioning is based on Pavlov and relies
on relaxation and imagining feared stimuli.

Question 22

Biofeedback devices

Answer 22

are used to enhance the client’s selfcontrol
(such as muscle tension) and are a form of operant
conditioning.

Question 23

Criticisms of behavior therapy:

Answer 23

It does not yield insight; it is
mechanistic; it treats symptoms and not the cause; it can be
manipulative; generally ignores developmental stages; and
it often changes behavior but not underlying feelings. This
approach deals with behaviors rather than the whole person.

Question 24

Hint: A great way to determine whether a question is referring to reflexive classical conditioning or Skinner’s operant conditioning

Answer 24

Ask yourself a simple question: Would the conditioning
work with every member of the species who is not disabled? If
the answer is yes, then it is most likely Pavlovian conditioning
(e.g., all dogs salivate when they eat meat, so it’s Pavlov).

Question 25

Carl R. Rogers’s Person-Centered Humanistic Therapy

Answer 25

This approach has also been called client-centered, Rogerian, nondirective,
or self-theory. The basic notion (a very positive one) is that
human beings can self-actualize and reach their full potential in a
therapeutic setting that fosters growth; classifi ed as an optimistic form
of therapy.

Question 26

Carl R. Rogers’s Person-Centered Humanistic Therapy

Answer 26

Three conditions for effective helping: The therapist must
show empathy; be genuine/congruent; and display unconditional
positive regard (UPR).

Empathy is not sympathy! It is the ability to subjectively
understand the client’s world in the here-and-now—to
walk in his or her shoes—and convey this to the client.
Robert Carkhuff created a five-point empathy scale with a
level fi ve response as the best response.

The counselor must be genuine/congruent. The counselor
cannot be a phony. Words must match (i.e., be congruent) with
actions.

The counselor accepts the client regardless of his or her behavior.
This does not imply that you necessarily agree with the client.
This is called unconditional positive regard.

The counselor will often use reflection or open-ended
questions.

Counselor strives to improve congruence so that the person is more like his or her ideal self.

Rogerians are not big fans of traditional diagnosis and testing. Moreover, they do not believe in the unconscious. Humans can control their own behavior. Critics are concerned that this approach is too optimistic and may not be the treatment of choice
for severely disturbed individuals or very young children.

Question 27

Albert Ellis’s Active-Directive Rational Emotive Behavior

Therapy (REBT)

Answer 27

Previously known as RET. This is a cognitive behavioral (CBT) form of
therapy. Change your thinking (cognitions) and you can change your
life. Essence of the treatment captured in the saying of Epictetus, a
fi rst century Stoic philosopher, “Men are disturbed not by things, but
of the view which they take of them.” Irrational beliefs (IBs) are replaced
by rational beliefs (RBs) via the counseling process.

Question 28

Albert Ellis’s Active-Directive Rational Emotive Behavior

Therapy (REBT)

Answer 28

Uses the ABC or ABCDE model of personality. A is an
activating event. B is the client’s belief system. C is the emotional consequence. At D the counselor disputes the irrational belief at B. E is a new emotional consequence that occurs when B becomes rational.

Humans have an innate tendency to think in an irrational, illogical, unscientific manner. Thought is referred to as self-talk or internal verbalizations.

Shoulds, oughts, musts, terriblizing, and awfulizing causes
irrational thought.

This is an active directive form of therapy utilizing lots of
homework, bibliotherapy and even rational imagery (RI).

Critics charge that the approach does not emphasize, feelings,
the counselor client relationship, and that REBT is mechanistic
or even sterile. May be too complex for those with psychosis or
thought disorders.

Question 29

Aaron T. Beck’s Cognitive Therapy

Answer 29

Beck’s cognitive therapy is similar to REBT emphasizing that the client
has automatic thoughts which are distortions of reality such as polarized black-or-white thinking, overgeneralizing based on a single
event, personalization— wrongly attributing an event to yourself,
and drawing conclusions without real evidence. Clients are urged to
keep a record of dysfunctional thoughts.

Question 30

Fritz Perls’ Gestalt Therapy

Answer 30

This experiential/existential approach focuses on the here-andnow
in an attempt to help the client become whole again. Gestalt is
an experiential form of therapy and it relies on dream work, role-playing,
confrontation, the top dog/underdog concept, hot seat, and the
empty chair technique. Modern gestalt therapists are not as abrupt
with clients as Perls. The therapy is now considered a softer gentler
treatment.

Question 31

Fritz Perls’ Gestalt Therapy

Answer 31

Gestalt is a German word that basically means “organized
whole.” The view of human nature is that humans want to be self-actualized and complete (whole).

Dreams are the royal road to integration. Counselor asks
client to recount the dream as if it is occurring in the present
moment.

What and how questions are used more than why questions
(e.g. “What is your foot doing now?”).

Goal is for the client to take responsibility and achieve awareness
in the here-and-now. Doing is emphasized over just talking
about problems.

Laura Perls (Fritz Perls wife) helped develop the approach and
made it more popular with women in therapy.

Critics charge that this approach is “gimmicky,” puts little or no
stock in diagnosis and psychological testing, and at times is “antitheoretical.”
On occasion, the approach can abet self-centeredness.

Question 32

Eric Berne’s Transactional Analysis (TA)

Answer 32

A here-and-now approach that took Freudian terminology and made
it fun and easy to understand. The theory took into account transactions
between individuals. It is often combined with Gestalt. Critics
charge this is like mixing water and oil since TA is cognitive and Gestalt
is experiential. Others say this is desirable since the two complement
each other. The person develops a life plan called a life script.

Question 33

Eric Berne’s Transactional Analysis (TA)

Answer 33

Ego states are the Parent, Adult, and Child (PAC). These
states roughly correspond to Freud’s superego, ego, and id.

Uses Tom Harris’ life positions. I’m Ok, You’re Okay, healthy;
I’m Ok, You’re not Ok, I’m not Ok, You’re Ok; and I’m not Ok,
You’re not Ok.

Games are played to avoid intimacy. Somebody is always hurt in a game.

Stephen B. Karpman’s drama triangle (aka Karpman’s
triangle). A person changes his or her position from victim to
persecutor to rescuer during the discussion.
Critics note that TA promotes game calling.

Question 34

William Glasser’s New Reality Therapy with Choice Theory

Answer 34

This therapy focuses on present behavior. Clients are taught that
they create their own personal reality with the behaviors they choose.
Glasser believes that “Behavior is the control of our perceptions”
and that a success identity is the result of being loved and accepted.
Glasser has been criticized for downplaying the role of the environment
in terms of impacting ethnic minorities. Reality Therapy has also
been deemed “weak” in terms of not dealing with dreams, the past,
or traumatic memories. According to Glasser psychiatric medicines
or “brain drugs” are not the answer. This paradigm challenges the
medical model of psychiatry.

Question 35

William Glasser’s New Reality Therapy with Choice Theory

Answer 35

The eight steps of reality therapy: build a relationship with the client; focus on present moment behavior; help the client to evaluate his or her current behavior; develop a contract with
an action plan; have the client commit to the plan; accept no
excuses; do not use punishment; and refuse to give up on your client. The approach emphasizes short term treatment and is very concrete.

Psychological needs include belonging, power, freedom, and
fun.

Critics charge that reality therapy is a bit too simplistic, does not take into account developmental stages, and has changed its focus over the years.

Question 36

Postmodern Social Constructivist Theories

Answer 36

Social constructionism emphasizes that realities are socially constructed.
Brief therapy and narrative therapy are constructivist approaches.

Question 37

Narrative Therapy (NT) by Michael White (Australia) and
David Epston (Auckland, New Zealand)

Answer 37

Narrative Therapy postulates that individuals construct their lives by stories they tell about themselves and stories others create about them. Stories create meaning and this becomes the client’s identity.
Therapy consists of the client describing his or her life experiences and then rewriting or reauthoring the narrative in a new way.
A narrative therapist externalizes the problem in his or her progress notes and sends it to the client as a letter between sessions.
Rather than saying “You are a cocaine addict,” a narrative
therapist will tell the client, “Cocaine has been trying to wreck your life.” Again, clients reauthor their lives with new stories and fresh language.
The narrative therapist sees him- or herself as a consultant
or collaborator with the client. Some cultures want an expert
therapist, and thus (at times) this can create a problem for
multicultural counseling.

Question 38

Solution focused brief therapy (SFBT) Steve DeShazer and

Insoo Kim Berg

Answer 38

SFBT focuses on solutions and not on an understanding of the problem. The focus is on exceptions to the rule—what is working.

Using so-called exception questions: a client who is depressed is asked: “When aren’t you depressed?”

Goals are small and realistic. The client is also asked the miracle question: “If a miracle took place while you were sleeping, how would you know the problem was solved? How would things be
different?”

SBFT also uses formula fi rst session task (FFST). This is a
homework assignment prescribed after the fi rst session.

Recently, this approach has gained popularity in group treatment
settings.

Question 39

Solution focused brief therapy (SFBT) Steve DeShazer and

Insoo Kim Berg

Answer 39

Brief therapy (BT) is becoming the norm in many instances since
managed care fi rms (hellbent on cutting costs!) often restrict the
number of sessions the client can attend. Most counselors dislike
managed care feeling that the managed care company is micromanaging
their practice. In some states managed care fi rms cannot be sued
for their actions. Insurance and managed care policies are responsible
for the fact that many counselors spend as much time dealing with
business issues as they do actually counseling their clients. On the
positive side, managed care forces counselors to look at outcome
measures such as the DSM GAF Scale that will demonstrate the effectiveness
of the counseling process.

Question 40

Psychotherapy Integration by Frederick Thorne

Answer 40

Psychotherapy Integration uses strategies from a number of counseling
schools. Instead of merely using techniques from the approaches
in eclecticism, the integrative approach assumes that using or integrating
two or more theories will often produce results that are superior
to a single school of therapy. Today support is mounting for this
approach.

Question 41

Family Counseling

Answer 41

Family counseling asserts that the pathology resides in the family system
and not in an individual. The client is the family and not the
identified patient. Family therapists believe in circular rather than
linear causality. First-order change occurs when a client makes a
superfi cial change to deal with a problem, but the change does not
alter the underlying structure of the family. Second-order change
alters the underlying structure and thus makes a difference that is
longer lasting.

Question 42

Case Integration

Answer 42

Case integration takes place when several helpers from the same
agency or different agencies work together without duplicating services
to help an individual client.

Question 43

Milieu Therapy

Answer 43

Milieu therapy urges helpers to change the client’s entire environment
(social and physical) to help the client. Hence, treatment is not
limited to counseling sessions. In most instances, this takes place in
inpatient treatment facilities.