Theories Flashcards
Cognitive Behavioral Therapy (CBT)
B.F. Skinner
effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness
emphasis on helping individuals learn to be their own therapists.
Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.
emphasize what is going on in the person’s current life, rather than what has led up to their difficulties.
CBT art therapy
art is a cognitive process that uses thinking, sensing, and identifying as well as understanding emotions
artist is uncovering mental images and messages, recalling memories, making decisions, and generating solutions
Art provides a concrete record of inner processes that can be discussed and altered
CBT concepts
stimulus-response
behavioral conditioning
behavioral modification
simple stimulus-response behaviors: first level behaviors like automatic habits
Second-level behaviors included language, imagery, thinking, and affect.
CBT strategies to change behaviors
Facing one’s fears instead of avoiding them.
Using role playing to prepare for potentially problematic interactions with others.
Learning to calm one’s mind and relax one’s body.
six basic steps in CBT:
(1) establishing a good therapeutic rapport
(2) having a problem focus
(3) identifying irrational thoughts
(4) challenging irrational thoughts
(5) testing the validity of thoughts
(6) substituting irrational thoughts with rational ones
Core principles of CBT
unifying goal of CBTs is behavioral adaptation
Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
Psychological problems are based, in part, on learned patterns of unhelpful behavior.
People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
three guiding principles:
(1) context engagement—re-examining problematic situations in order to imagine novel responses
(2) attention change— helping clients sustain or shift attention in order to better adapt to various situations
(3) cognitive change —gaining perspective or altering meanings of emotionally significant situations
CBT strategies to change thinking patterns
Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
Gaining a better understanding of the behavior and motivation of others.
Using problem-solving skills to cope with difficult situations.
Learning to develop a greater sense of confidence in one’s own abilities.
Trauma-informed therapy
The adoption of the PTSD diagnosis by the DSM III in 1980
no overarching definition
shifts focus from “whats wrong with you” to “what happened to you”
acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation
Realize the widespread impact of trauma and understand paths for recovery
Recognize the signs and symptoms of trauma in patients, families, and staff
Integrate knowledge about trauma into policies, procedures, and practices
Actively avoid re-traumatization.
Narrative Art Therapy
mantra of any trauma treatment program should be “Finish the story”
putting the fragments of the trauma into the context of the ITR, and change the story from present tense to past with a definitive end.
best to use simple, clear drawing materials—thick and thin felt-tip markers, oil pastels—and large sheets of white drawing paper (12” × 18”
8 drawings
“Before” and an “After” picture serve as bookends that set the story in time. Between these two are drawings that depict each aspect of the ITR, as well as the accompanying thoughts and feelings. Body sensations should be included in each drawing, but it is possible to do a separate one to show the response of various parts of the body, bringing the basic number to nine.
Often, the process of drawing is sufficient to keep a person grounded
Under no circumstances should the therapist let the client leave a session without making certain he or she is grounded and fully oriented
“And now, we see that this very important story in the life of (client’s name) is truly over—and we can finally say, ‘The end!’”
The Instinctual Trauma Response (ITR)
Tinnin and Gantt (2014)
startle
attempt to fight or flee
freeze
altered state of consciousness (ASC)
Automatic obedience
Efforts at self-repair
Body sensations accompany each aspect
Humanistic
umbrella term for client centered, existential, gestalt, logotherapy, and narrative therapy.
focuses on a person’s individual nature, rather than assuming that groups of people with similar characteristics have the same concerns
emphasis in sessions is on a person’s positive traits and behaviors and developing their ability to use their instincts to find wisdom, growth, healing, and fulfillment
since humanistic therapists may not focus on diagnosing a client, those with symptoms of certain personality disorders may not achieve success with this approach
therapist’s ways of being and attitudes are more influential, in terms of helping clients change, than are techniques or interventions designed to get clients to change
Humanistic art therapy
three primary tasks
(1) being present, accessible, and open to clients
(2) honoring clients’ thoughts and feelings in the immediate experience
(3) engaging in artistic self-expressive activity along with clients
Gestalt Techniques
Fritz Perls
art therapy - Janie Rhyne
hot seat
empty chair
role playing
psychodrama
here and now focus of time
Gestalt art therapy
individuals can deal effectively with their life problems
stresses assumptions of personal responsibility for the course of one’s life
Dreams are assumed to represent existential messages that reflect current ways of being in the world
perceiving and becoming aware of what is obviously there
Without pushing for interpretations, we explore the dimensions of the drawing and elaborate its impact, through active, present experiencing
focus on the active movement in the art done by clients.
client-centered treatment
requires the therapist to be empathic, open, honest, congruent, and caring
every person has worth, dignity, the capacity for self-direction, and an inherent impulse toward growth
therapists genuineness
complete acceptance
Person-Centered Expressive Arts Therapy
- Natelie Rogers
- believe in ability of individuals to find appropriate self-direction
- psychological climate is empathic, honest, and caring
- use the arts to let go, to express, and to release
- All people have an innate ability to be creative.
- Personal growth and higher states of consciousness are achieved through self-awareness, self-understanding, and insight
- Self-awareness, self-understanding, and insight are achieved by delving into our emotions.
- Our feelings and emotions are an energy source
- The expressive arts lead us into the unconscious.
- Art modes interrelate in what I call “the creative connection.”
- A connection exists between our life force—our inner core, or soul—and the essence of all beings
- as we journey inward to discover our essence or wholeness, we discover our relatedness to the outer world
- Finding spirit, soul, the ability to laugh at oneself, new wisdom, or the knowledge that with each struggle in life there are major lessons to be learned.
Humanistic techniques
Congruence: being authentic, open, and genuine as they interact with the individual who is in therapy.
Empathetic understanding: not only understanding what the client is feeling and saying, but also communicating that understanding to the client. The individual should feel heard, seen, and understood.
Reflective listening: actively listening to the individual and then summarizing what the client has said in their own words. This strategy can help reinforce what the client is saying, allow them to reflect back on their own words, and clear up potential misunderstandings.
Unconditional positive regard: accepting the individual without judgment. It is characterized by a caring attitude that plays an important role in fostering self-worth, personal growth, and self-awareness.
Existential
Friedrich Nietzsche and Soren Kierkegaard
focuses on concepts that are universally applicable to human existence including death, freedom, responsibility, and the meaning of life
focus on individual not symptoms
All people have the capacity for self-awareness.
Each person has a unique identity that can be known only through relationships with others.
People must continually re-create themselves because life’s meaning constantly changes.
Anxiety is part of the human condition.
emphasizes a person’s capacity to make rational choices and to develop to their maximum potential
Existential art therapy
- Bruce Moon
- primary thrust of therapy is engaging the client in a creative struggle with the ultimate concerns of human existence
- one of the underlying realities of human existence is that we are ultimately alone
Who existential therapy is good for
treating psychological concerns that are thought to result from an inhibited ability to make authentic, meaningful, and self-directed choices
Interventions often aim to increase self-awareness and self-understanding.
Symptoms: excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair, depression, guilt, anger, rage, resentment, embitterment, purposelessness, psychosis, and violence
life-enhancing experiences: relationships, love, caring, commitment, courage, creativity, power, will, agency, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence, and awe.
Existential Approaches
responsibility and freedom focus
find meaning in the face of anxiety
confronting negative internal thoughts rather than focusing on external forces like societal pressures or luck.
Fostering creativity, love, authenticity, and free will
The goal: To make more willful decisions about how to live, drawing on creativity and love, instead of letting outside events determine one’s behavior.
Transpersonal Therapy
Abraham Maslow and associates in the 1960 - stemmed from Carl Jung
emphasis on role of healing spirit
spiritual traditions and rituals
positive influences and role models
focus on a broader conception of how a person achieves meaning, purpose, and happiness
increase sense of empowerees
“reaching beyond humanistic concerns.”
Transpersonal Approaches
honesty, open mindedness, self-awareness
draw from a variety of different religions and spiritual practices for tools and methods
Meditation
Guided visualization
Hypnotherapy
Dream work
Art-marking
Music therapy
Journaling
Holotropic breathwork
Spiritual Therapy
part of a holistic approach to treating mental health symptoms and diagnoses
integrates spiritual or religious beliefs and practices into the therapeutic process.
acknowledges that you have unique spiritual and existential beliefs, values, and experiences about what it means to be human, that influence your understanding of yourself, others, and the world around you
the spirit is the most powerful and most important factor in a complete healing
techniques:
mindfulness
sacred texts
prayor
rituals
Psychodynamic
psychoanalytic understanding helps the therapist to know where a person is “stuck” (developmentally), what is being defended against (feared impulses), and how (favored coping and defense mechanisms)
Oedipal crisis was so overwhelming that it overrode all that went before
Sigmund Freud (Ego Psychology)
Self Psychology (Kohut)
Object Relations (Winnicott)
Edith Kramer
less focused on the patient-therapist relationship and more focused on the patient’s relationship with their external world
Individuals who have the capacity to be self-reflective and are looking to obtain insight into themselves and their behavior are best suited to this type of therapy.
longer term than CBT
our behavior and feelings as adults are rooted in our childhood experiences
Object Relations
- Melanie Klein
- the “object” in object relations theory refers to the who and what in which a person’s libidinal energy is invested.
- “libidinal energy”: constitutional reservoir of energy and life that is part sexual, part aggressive, but is more than either.
- human behavior is conceptualized within a tripartite system of id, ego, and superego, which, when unbalanced, creates the conflicts manifesting themselves in the range of defenses and symptoms characteristic of the neuroses.
- The therapist cannot actually be that which the patient lost, yet the therapist’s presence and actual living with the patient’s problems serve to repair the original damage and problem
- When a “good enough” mother (Winnicott, 1958) is sensitively attuned to the infant, she facilitates the child’s eventual capacity to self-regulate emotional states through a secure attachment.
Psychodynamics
Uncovering traumatic events that had been repressed (“making the unconscious conscious”) thought to be the key to recovery from neurotic illness
conscious
unconscious
defense mechanisms:
projection
displacement
sublimation
dream symbolism
transference
transference (psychodynamic)
symbolic ways in which the patient perceives and responds to the therapist
helps to identify distorted perceptions, which are assumed to be based on unresolved conflicts from the past
countertransference (psychodynamic)
symbolic ways in which the therapist perceives and responds to the patient
clue to what is being evoked in the therapist by the patient
Ego
The “compromise” effected by the “ego” consists of finding some way to satisfy or discharge the impulse, without offending either the environment (reality) or the individual’s moral code (“superego”)
Id (psychodynamic)
source of repressed (forbidden) wishes (impulses, ideas).
These impulses (the “instinctual drives”) constantly strive for discharge (satisfaction) and are expressed in a disguised form, because only in that way can they bypass the “censor” (the force serving to keep unwelcome ideas out of awareness)
Psychodynamic Approaches
therapist helps the patient to understand and gain control over previously unknown sources of distress through questions, clarifications, confrontations, and other forms of intervention—especially interpretations, in which possible connections may be tactfully proposed.
free association
dream analysis
focus on recognizing, acknowledging, understanding, expressing, and overcoming negative and contradictory feelings and repressed emotions
helping the patient understand how repressed emotions from the past affect current decision-making, behavior, and relationships.
help those who are aware of and understand the origins of their social difficulties but are not able to overcome problems on their own.
Patients learn to analyze and resolve their current difficulties and change their behavior in current relationships through deep exploration and analysis of earlier experiences and emotions.
dream analysis / dream work
(psychodynamics)
Only idiosyncratic associations to the manifest content can lead to the hidden significance of the dream
Thanatos (psychodynamic)
aggressive drive
Psychodynamic effective for
depression
those who have lost meaning in their lives and have difficulty forming or maintaining personal relationships
social anxiety disorder
eating disorders
problems with pain
relationship difficulties
borderline personality disorder
*less used in instances of psychosis, post-traumatic stress disorder, and obsessive-compulsive disorder.
Family Systems
Dr. Murray Bowen.
Bowen believed that the personalities, emotions, and behaviors of grown individuals are a result of their birth order, their role within their family of origin and the coping mechanisms they have developed for dealing with emotional family difficulties
helps individuals resolve their problems in the context of their family units
work individual and together
8 interlocking concepts
family systems people
Nathan Ackerman
Jay Haley
Salvador Minuchin
Murray Bowen
Hanna Kwiatkowska
societal emotional process (family systems)
Broader social and cultural forces can influence family relationships.
sibling position (family systems)
Birth order can affect the dynamics between children, siblings, and parents.
emotional cutoff (family systems)
Family conflict with no resolution may lead some people to sever a relationship entirely.
multigenerational transmission process (family systems)
Small differences in differentiation between children and parents can lead to large differences among extended family members over time.
family projection process (family systems)
Parents may displace their feelings or anxieties onto their children, who then may displace their own feelings or anxieties onto others.
nuclear family emotional process (family systems)
Relational patterns that occur in the family, including marital conflict, dysfunction in a spouse, impairment of one or more children, and emotional distance.
differentiation of self (family systems)
The sense of individuality a person develops, rather than relying on others in their family or social groups.
Triangles (family systems)
The relationship dynamic between three people, which may influence relationships with others in the family.
family systems effective for
family conflict
Substance use disorder
Alcohol use disorder
Depression
Anxiety
Bipolar disorder
Personality disorders
Eating disorders
Coping with physical disabilities and disorders
Positive Psychology
Martin Seligman
emphasizes traits, thought patterns, behaviors, and experiences that are forward-looking and can help improve the quality of a person’s day-to-day life
goal is to minimize negativity in one’s thinking and behavior and to develop a more optimistic and open attitude that will enhance rather than disrupt one’s social, professional, and spiritual life
optimism
spirituality
hopefulness
gratitude
happiness
creativity
perseverance
justice
meaning and purpose
free will
Positive Art Therapy
promote well-being by building upon what is good in our lives.
negativity bias— an evolutionary mechanism that naturally commands our attention and propels us to channel resources toward correcting what is not functioning in our environment
Recent research demonstrates that experiencing high levels of well-being leads to greater physical health and longer life, improved work performance, good citizenship, and stronger social networks and societies
PERMA
Positive Emotions
Engagement
Relationships
Meaning
Achievement
just the process of doing art evokes positive emotions.
-Depict three positive events that happened during the day and what about you or the situation made them happen
-represent a positive memory
-identify the things that you value and give your life meaning
-depict a door that closed and a door that opened
-visualize and make symbols for people and creatures who matter to you or someone who you admire
Seligman’s Perma model
P Is for Positive Emotions: The pursuit of positive emotions will not necessarily improve your well-being. However, the experience of positive emotions through savoring your day-to-day moments may well boost well-being.
E Is for Engagement: Being engaged with life is important for well-being. Otherwise, your mind and body will run on automatic and you may suffer tedium and little meaning.
R Is for Relationships (Positive Ones): We thrive when we are connected in meaningful relationships.
M Is for Meaning: A sense of meaning and purpose is essential to well-being.
A Is for Accomplishment and Achievement: We each need to succeed and accomplish the goals we set. This quest for self-improvement is essential.
Solution Focused
Insoo Kim Berg, Steve de Shazer, and their colleagues in the late 1970s
focus on clients present and future goals
finding solutions in the present and exploring one’s hope for the future in order to find a quick and pragmatic resolution of one’s problems
Solution focused techniques
Goal setting
positive, respectful, and hopeful outlook on the part of the clinician.
the solution to a problem is found in the “exceptions,” or those times when one is free of the problem or taking steps to manage the problem
specific questioning techniques
0-10 scale
empathic support
compliments to help a person recognize the virtues and strengths that have previously gotten the patient through hard times and are likely to work in the future
Attachment Theory
John Bowlby 1960s
brief, process-oriented form of counseling
client-therapist relationship is based on developing or rebuilding trust and centers on expressing emotions
looks at the connection between an infant’s early attachment experiences with primary caregivers, usually with parents, and the infant’s ability to develop normally and ultimately form healthy emotional and physical relationships as an adult
secure attachment
strong early attachment led to safety, security, and support, which then led children to develop healthy connections with others
anxious attachment
insecure, threatened, suspicious, and fearful of being rejected
avoidant attachment
develops during early childhood, particularly in those who do not experience sensitive responses to their needs or distress
causes a low tolerance for emotional or physical intimacy and, sometimes, struggles with building long-lasting relationships
disorganized attachment
can often lead to inconsistent behavior in relationships
want to be close to another person but then pull away out of fear
often the result of maltreatment, abuse, or trauma by a parent or caregiver when you’re young
