Theories: Approaches to Counselling

Question 1

Psychoanalytic Theory – Sigmund Freud

Answer 1

PSYCHOANALYTIC – SIGMUND FREUD

THINK: Make unconscious conflicts conscious so the client (ego) can resolve these conflicts.

BASIC VIEW

• Key concepts:
  
  • Conscious vs. unconscious
    
    • Goal is to make the unconscious conscious
  • Personality structure – id. Ego. Superego
    
    • Goal is to allow the ego to solve problems from unconscious conflicts
  • Defense mechanisms and facing anxiety
    
    • Interpretation of resistance and working through transference
  • Look into past for clues into current problems
• Newer/contemporary theories
  
  • More focus on ego
  • Social and cultural factors
  • Defense Mechanisms

DEFENSE MECHANISMS help reduce conflict between id and ego by means of disguise

• REPRESSION – Pushing anxiety-producing information into the unconscious
• REACTION FORMATION – Repressed thoughts appear as mirror opposites
• REGRESSION – Tendency to go back to an earlier stage of personality
• RATIONALIZATION – Real motive for behavior is not accepted by ego
• DISPLACEMENT – Motive not acceptable in one form is acceptable in another form.
• PROJECTION – Perceiving the external world in terms of one’s own personal conflicts.

STAGES/PHASES

• Freud’s Psychosexual Development Theory
• Age Stage Characteristics

Birth-1½ yrs oral gratification through activities

1½ -3 yrs anal adapt to societal demands

3-6 yrs phallic recognize sex differences

6-12 yrs latency sexual urges quiet

13-adulthood genital deal with the opposite sex

• Process of Psychotherapy
• The goal of psychoanalysis is to help the patient achieve a resolution of internal conflict through understanding his subconscious conflicts and dealing with them in a more mature manner.
• Psychoanalytic situation is the name for the technique procedure of studying the mind in psychoanalysis.
• Client should be strongly motivated, willing to commit time, money, and energy to self-scrutiny.
• Analyst attempts to create a set of conditions in which the patient’s thoughts and associations come from persistent dynamic internal pressure of the drives.
• Length of sessions is normally at least 45 minutes, four times a week is considered optimal.
• Strict adherence to confidentiality is crucial.
• Therapy may run for several years.

Mechanisms of Psychotherapy – (Therapeutic Treatment Process)

1. The Opening Phase
   
   1. Everything the patient says and does is noted.
   2. Formalized history taking is not encouraged, and priorities in relating materials are left to patient.
   3. Analyst gains broad outline and nature of patient’s conflicts and studies characteristic resistance, eventually to detect a continuous thread of themes.
   4. Ordinarily, the opening phase lasts from three to six months.
2. The Development of the Transference
   
   1. The patient unconsciously reenacts a version of forgotten childhood memories and repressed unconscious fantasies, distorting the relationship with the analyst.
   2. TRANSFERENCE can be understood as a form of memory in which repetition in action replaces recollection of events.
      
      • TRANSFERENCE occurs when a client projects feelings about someone else, particularly someone encountered in childhood, onto her therapist. Frequently spoken about in reference to the therapeutic relationship.
        
        • EX: of sexual transference is falling in love with one’s therapist.
   3. Analysis of transference helps the patient understand how one misperceives, misinterprets, and relates to the present in terms of the past.
   4. The patient begins to evaluate the unrealistic nature of impulses and to make more appropriate decisions.
3. Working Through
   
   1. This phase continues through with the analysis transference.
   2. One time through insight is not enough to bring about changes, so it must be continued many times and ways.
   3. WORKING THROUGH acts as a kind of catalyst between analysis of transference and the overcoming of the amnesia for crucial childhood experiences.
   4. Recall of crucial childhood experiences facilitates insight and consolidates the corrective interpretations made in the course of therapy.
4. Resolution of the Transference
   
   1. This is the termination phase of psychoanalysis.
   2. Both the analyst and the patient are satisfied that the major goals of the analysis have been accomplished and the transference is well understood.
   3. Technically, the analyst’s aim is to resolve the patient’s unconscious neurotic attachment to him.
   4. Frequently there is a dramatic and sudden aggravation of the very symptoms for which the patient is being treated. (This can be understood as a last ditch effort to convince the analyst that he is not yet ready to leave treatment).
   5. Hitherto repressed memories confirming interpretations made earlier frequently emerge.
   6. Fantasies of becoming magically transformed by therapy emerge and need to be addressed.
   7. Finally, one must deal with the fantasies and expectations of what life will be like after treatment.

APPLICATION of THEORY

1. Client must be strongly motivated to overcome their difficulties by honest self-scrutiny.
2. Patients must be willing to commit considerable time and money and accept the discipline necessary to complete psychoanalysis.
3. Since it is arduous and costly, it is not recommended for minor problems.

Question 2

Adlerian Theory

Answer 2

ADLERIAN THEORY – ALFRED ADLER

THINK: The GOAL is to help the patient overcome feelings of inferiority.

BASIC VIEW

• Alfred Adler, believed that much of who we are is the result of family and social interactions throughout early childhood.
• Believed BIRTH ORDER had a major influence on the development of personality.
• Adlerians believe that if people can understand the purposefulness of their behavior, they have a much better chance of changing behaviors that are not useful or helpful.
• Adlerian therapy focuses on the development of individual personality while understanding and accepting the interconnectedness of all humans.
• TELEOLOOGY – meaning Goal-Directed – Adler believed that human behavior is goal-oriented (teleological) and that humans can best be understood in terms of how they go about trying to achieve their goals
  
  • Explanation of something by its purpose (goal) or function and not so much by the cause

Feelings of inferiority

• The overarching goal of Adlerian psychotherapy is to help the patient overcome feelings of inferiority.
  
  • According to Adler, feelings of inferiority can result in neurotic behavior but, in the right setting, can also be used as motivation to strive for greater success.
• We are completely dependent on adults for survival
• Common to all humans
• May develop from birth order – especially experiences of devaluation in childhood, physical limitation, etc.
• Primary motivation force behind all accomplishments – Since people don’t want to feel inferior, there is an avoidance motivation that drives them to do better.
• If overwhelmed then we can develop an INFERIORITY COMPLEX
• Striving for Superiority
• “Fundamental fact of life”
• Initially focused on individual superiority
• Later changed to striving for a superior or perfect society
• Can develop superiority complex if a person ignores others and society
  
  • Life-style
• Means by which an individual attempts to gain superiority
• Gives an individual an identity
• Four Types:
  
  • Socially useful (This is the only correct lifestyle to live by)
    
    • Healthy, not overbearing
    • Can give to others
  • Ruling-Dominant (Mistaken lifestyle)
    
    • generally aggressive and dominant over others
    • Turn energy inward and harm themselves (e.g., alcoholic
  • Getting-Leaning (Mistaken lifestyle)
    
    • Sensitive, rely on others to go through challenges
    • Prone to anxiety disorders and dissociation
  • Avoiding (Mistaken lifestyle)
    
    • Low energy, recoil within themselves
    • Avoid life in general
    • Prone to psychosis

**Last three are called MISTAKEN LIFESTYLES – a Person exhibiting a mistaken lifestyle is avoiding the attempt to solve life’s problems, thereby escaping possible defeat. Such a person lacks adequate social interest.

• Three childhood conditions can create a mistaken life-style
  
  • Physical inferiority
  • Spoiling/pampering
  • Neglecting
• Safeguarding Strategies
  
  • Used to protect the illusion of superiority a mistaken life-style generates
  • Excuses
  • Aggression
    
    • Depreciation
    • Accusation
    • Self-accusation
  • Distancing
• Birth Order
• First Memories

APPLICATION of THEORY

Adlerian theory – Depression

• Recovery is usually dramatic—client can deny suicide intent even after a few hours or days
• Externalized anger—preoccupied with others
• Powerlessness is prominent and motivation is to assert power over others
• Drug and alcohol abuse common
• Poor problem-solving skills—immediate gratification desired
• Defense mechanisms—projection, denial, intellectualization, regression, rationalization
• DSM-IV Diagnosis: Adjustment Disorder—Cluster B Personality Disorders, Antisocial, Borderline, Histrionic, Narcissistic

Adlerian Psychotherapy

• Major Goals
  
  • Increase client’s social interest
  • Reduce inferiority feelings and overcome feelings of discouragement
  • Help clients feel a sense of equality
• Counseling Relationship
  
  • Based on equality
  • Mutual respect is vital
  • Provides information and guides client

STAGES/PHASES

• PHASES:
• ENGAGEMENT – Establishing the client-therapist Relationship
  
  • Listening skills
  • Offering hope
  • Encouragement
• ASSESSMENT – Assessment of your personal history, with an emphasis on birth order and early childhood memories.
  
  • Conducting a lifestyle analysis
  • Overall lifestyle patterns
• INSIGHT – wherein the therapist helps you view your situation from a different perspective
  
  • New ways of thinking about the situation
• REORIENTATION – wherein the therapist suggests active steps you can take outside of therapy to reinforce newly developed insights and perhaps learn even more about yourself and your capabilities

Question 3

Gestalt Theory – Fritz Perls

Answer 3

GESTALT THEORY – FRITZ PERLS

THINK: Help the clients INTEGRATE their ‘parts’ into a WHOLE, work through their UNFINISHED BUSINESS and bring CLOSURE.

BASIC VIEW

• An Existential approach based on the premise that people must find their own way in life** and **accept personal responsibility if they hope to achieve maturity – based on the “WHOLE” person (Greater than the sum of his parts), focuses on free will, self-determination, and the search for meaning—often centering on the client rather than on the symptom. The approach emphasizes the client’s capacity to make rational choices and to develop to their maximum potential.
• Therapy aims at the INTEGRATION of conflicting dimensions within the client.
  
  • INTEGRATION – refers to how these parts fit together and how the individual integrates into the environment.
    
    • Often people who come to therapy do not have these parts fitting together in their environment.
    • Gestalt Therapy is about facilitating clients to integrate themselves as whole persons and help restore balance in their environment.
• PHENOMENOLOGICAL APPROACH – is the psychological study of subjective experience. It’s about explaining the experience from the point of view of the subject, by analyzing the words that they have spoken or had written – it focuses on the client’s perceptions of reality.
• AWARENESS – simply being aware of a problem and the environment around them in general, they are able to self-regulate in their environment.
  
  • Simply being aware is therapeutic in and of itself
  • Can gain self-understanding and knowledge to change
• Only the client can effectively interpret his awareness
• Therapy provides the necessary intervention and challenge to help clients proceed to integration and more “authentic” existence.

There are two main causes lacking awareness:

1. Preoccupation with one’s past, fantasies, flaws and strengths that the individual becomes unaware of the whole picture.
2. Low self-esteem.

APPLICATION of THEORY

Gestalt Therapy

• Creates a therapeutic environment in which the client gets “in touch” with unfinished issues by re-experiencing, and integrating such experiences into current awareness.
  
  • UNFINISHED BUSINESS refers to people who do not finish things in their lives.
    
    • People with unfinished business often resent the past and because of this are unable to focus on the here and now. One of the major goals of Gestalt Therapy is to help people work through their unfinished business and bring about closure.

There are three ways people may achieve awareness through therapy:

1. Contact with the environment: This is through looking, listening, touching, talking, moving, smelling, and tasting. This enables the individual to grow in his or her environment through reacting to the environment and changing.
2. Individual Responsibility: This refers to the individual taking responsibility for his or her own life rather than blaming others.
3. HERE AND NOW: This is the individual living in and being conscious at the present moment (MINDFULNESS) rather than worrying about the past or the future.

• Nothing exists but the present – Emphasis on the “now”, the current interaction
• Any escape from the present is viewed as resistance
• To help the client make contact with the present moment, the therapist asks “what” and “how”, not “why”
• The therapist encourages dialogue in the present tense (e.g. empty chair, “I” talk, conversation between 2 parts)
  
  • “HOT SEAT” – a technique of gestalt therapy in which a client sits in a chair next to the therapist, who encourages the client through direct prompting and questioning to relive stressful experiences and openly express feelings of discomfort, guilt, or resentment.
    
    • The technique aims to generate a new, more vivid awareness, which leads the client to find his or her own solutions to problems or emotional difficulties.
    • An individual member expresses to the therapist an interest in dealing with a particular issue, and the focus moves away from the group into an extended interaction between the group member and therapist for a limited period of time.
    • During this one-on-one interaction, the other group members remain silent; afterward, they give feedback on how they were affected, what they observed, and how their own experiences are similar to those the individual member discussed.
  • “EMPTY CHAIR” technique – The empty chair technique is a “method of facilitating the role-taking dialogue between the patient and others or between parts of the patient’s personality.
    
    • Two chairs are placed facing each other: one represents the patient or one aspect of the patient’s personality, and the other represents another person or the opposing part of the personality. As the patient alternates the role, he or she sits in one or the other chair.
    • The therapist may simply observe as the dialogue progresses or may instruct the patient when to change chairs, suggest sentences to say, call the patient’s attention to what has been said, or ask the patient to repeat or exaggerate words or actions.
    • In the process, emotions and conflicts are evoked, impasses may be brought about and resolved, and awareness and integration of polarities may develop – polarities or splits within the patient, between the patient and other persons, or between the patient’s wants and the social norms (Patterson, 1986).
  • Considerable psychological pain can be experienced as a result from these techniques.
  • Nonverbal Behavior is eliminated for the Client, allowing them to be:
    
    • Less subject to defensiveness
    • More revealing of their emotions
  • On the other hand, Therapists focus on the client’s nonverbal behavior to make them more aware of how they show different feelings with their bodies: An example of connecting a part of the body with what a person is saying is if he is expressing anger, but also smiling.
• I-THOU RELATIONSHIP – in which both the therapist and client are present in the here-and-now rather than focusing on the past or future.
  
  • Emphasis is on direct experience of therapist and client

Using Gestalt Therapy

• Asking members to talk to an empty chair or play the role of someone who they want to confront can be hard
• Pairing up could also be another alternative
• Use Specific Language
• Focusing on Nonverbal Behavior

Question 4

Person-Centered Theory – Carl Rogers

Answer 4

PERSON-CENTERED THEORY – CARL ROGERS

THINK: While showing the client UNCONDITIONAL POSITIVE REGARD, the counselor helps the client remove INCONGRUENCY and achieve their maximum potential.

BASIC VIEW

Basic Assumptions

• A person can direct their own life
• The client must fully experience the present, accept oneself and decide on how to change
• Mental health = incongruence between what an individual is currently and what he/she wants to become
• ACTUALIZING TENDENCY – The process of pursuing one’s full potential
  
  • From Rogers’ perspective, every person strives to be a creative, fully-functioning being who desires to reach their potential.
  • This pursuit of full potential is innate.
  • It is the “Forward thrust of life”
• PHENOMENOLOGICAL REALITY – All people live in their own subjective world, which can be known only to themselves. A person’s reality is known only to that person because they are the ones interpreting it.
• Need for UNCONDITIONAL POSITIVE REGARD – Says people are able to grow and fulfill their potential, and they must be valued as themselves. This means the therapist has a deep and genuine care of the person. The therapist must have a consistent, prevailing attitude of kindness and acceptance toward the person as he is–even in lieu of the fact that he may be displeased by the person’s actions.
  
  • The only way to not interfere with the actualizing tendency
• CONDITIONS OF WORTH – Occurs if children learn that they will only get positive regard if they do certain behaviors and perform.
  
  • Incredibly unhealthy for the child
• INCONGRUENCY– A discrepancy between the client’s self-image and his actual experience. This could leave him or her vulnerable to fears and anxieties.
  
  • The client is often unaware of the incongruence.
  • Occurs when people stop using their own frame of reference to evaluate what’s actualizing for them and use someone else’s

APPLICATION of THEORY

Necessary Conditions for Effective Therapy (Carl Rogers)

1. Therapist-Client Psychological Contact: The client and the therapist must be in psychological contact; that is, they both must make a difference in the phenomenological field of the other. (i.e. what one does must affect the other)
2. Client Incongruence or Vulnerability: The client must be in a state of incongruence and therefore vulnerable or anxious.
3. Therapist Congruence or Genuineness: The therapist must be in a state of congruency in relation to the client (otherwise, why should the client listen to him?). The therapist should be self-aware, genuine, and congruent. This does not imply that the therapist be a picture of perfection, but that he or she be true to him- or herself within the therapeutic relationship.
4. Therapist Unconditional Positive Regard (UPR): The therapist must give the client unconditional positive regard. The clients’ experiences, positive or negative, should be accepted by the therapist without any conditions or judgment. In this way, the client can share experiences without fear of being judged.
5. Therapist Empathy: The therapist must seek an empathic (i.e. from the other person’s perspective) understanding of the client’s internal frame of reference. The therapist demonstrates an empathic understanding of the clients’ experiences and recognizes emotional experiences without getting emotionally involved.
6. Client Perception: The client must perceive the fact that the therapist is giving him or her unconditional positive regard and is attempting to understand empathetically his or her internal frame of reference.

Therapeutic goals

• Provide a safe and trusting environment
• Self-exploration and awareness of what blocks their personal growth
• Genuineness, true empathy, unconditional acceptance, and caring
• Non-judgmental
• Active listening, reflection of feelings, and clarification

Question 5

Rational-Emotive Behavioral Therapy (REBT) – Albert Ellis and Cognitive Behavioral Therapy (CBT)

Answer 5

RATIONAL-EMOTIVE BEHAVIORAL THERAPY – ROBERT ELLIS – Thoughts Cause Feelings

THINK: ACTIONS trigger THOUGHTS that result in FEELINGS. The counselor helps the client to change negative thoughts to POSITIVE, RATIONAL thoughts, creating healthier FEELINGS.

BASIC VIEW

• One of the leading theories in the field, founded by Albert Ellis.

View of Human Nature

• We are born with a potential for both rational and irrational thinking
• We have the biological and cultural tendency to think crookedly and needlessly disturb ourselves
• We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk
• We have the capacity to change our cognitive, emotive, and behavioral processes

The Model

• ABC model
  
  • A=Activating event
  • B=Beliefs
  • C=Consequences
• Most people are unaware that the occurrence of the event is NOT what causes feelings.
• This theory is based on the premise that thoughts cause feelings.
• Counsellor helps client to focus on how they can change their feelings by looking at what they are telling themselves.

ABC’s of Rational-Emotive Therapy

Activating event >> Beliefs (“Self-Talk”) >> Consequences

EX: “Rejection letter from grad school” >> “I must succeed at everything I do” >> ”Depression and feelings of Incompetence”

Observed vs Actual causal relationship:

The A-B-C Theory

A B C

(activating event) (belief) (consequence – emotional and behavioral)

And the treatment… DEF…

D E F (disputing intervention) (effect—an effective (new feeling) philosophy is developed)

Rational Emotive Behavioral Therapy (REBT)

• Stresses thinking, judging, deciding, analyzing, and doing
• Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship
• Is highly didactic, very directive, and concerned as much with thinking as with feeling
• Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

Irrational Ideas

• Irrational ideas lead to self-defeating behavior
• Some examples:
  
  • “I must have love or approval from all the significant people in my life”
  • “I must perform important tasks competently and perfectly”
  • “If I don’t get what I want, it’s terrible, and I can’t stand it.

APPLICATION of THEORY

The Therapeutic Process

• Therapy is seen as an educational process
• Clients learn:
  
  • To identify and dispute irrational beliefs that are maintained by self-indoctrination
  • To replace ineffective ways of thinking with effective and rational cognitions
  • To stop absolutist thinking (all or nothing), blaming, and repeating false beliefs

Teaching REBT to the clients

• Two ways to introduce REBT to members.
• Write out a problem that the member brought up in the session.
• The second way is to ask “Where do feelings come from?”
• White board and handouts really help to get the ABC model across to members.
• Other creative techniques would include two chairs and using Elli’s list of irrational ideas that people tell themselves.
• Two lists, one for adults and one for children.
• Example of irrational beliefs for adults:
  
  • The world should be just and fair and if not I cannot stand it.
  • One should be comfortable without pain at all times
• For Kids:
  
  • If someone calls me names, it must be true and I can’t stand it
  • I should be the best at everything I do and if not, I am worthless

COGNITIVE BEHAVIORAL THERAPY (CBT) – is a talking therapy that can help you manage your problems by changing the way you think and behave.

THINK: Counselor takes client in incremental steps toward a behavior change, challenging irrational thinking and replacing those thoughts with rational thinking at each step.

• Changes dysfunctional emotions, thoughts, and behaviors
• Focuses on solutions
• Challenge distorted thinking patterns
• Changing destructive behavior patterns
• Cognitive Behavioral Therapy
• https://upload.wikimedia.org/wikipedia/en/1/1c/Depicting_basic_tenets_of_CBT.jpg
• Key concepts
  
  • Automatic thoughts (see handout)
  • Cognitive distortions (see handout)
    
    • Inaccurate thoughts that reinforce negative thought patterns and emotions

CBT - Techniques

• Journaling
• Unraveling cognitive distortions – requires awareness first
• Cognitive restructuring – challenge belief behind
• In most cases, CBT is a gradual process that helps a person take incremental steps toward a behavior change.
  
  • EX: Someone with social anxiety might start by simply imagining anxiety-provoking social situations. Next, they might start practicing conversations with friends and family, then with an acquaintance, then a stranger, and then step into a larger social setting. Etc.