Week 1 - intro Flashcards
Meta-analyses show that clients undergoing therapy are better off than how many % of a control group?
80%
x% of clients improve significantly:
After x amount of sessions or X months of treatment,
75% after 26 sessions or 6 months of tx
50% show improvement after 8-10 sessions
most gains are maintained in the long term
A certain proportion will relapse & require ongoing treatment
Maintenance of gains enhanced if clients attribute improvement to their own efforts
Specific Factors
Theoretical models of human behaviour & theory-based techniques aimed to alleviate symptoms
Models explain:
What causes symptoms/behaviour
What maintains symptoms/behaviour
What changes symptoms/behaviour techniques
Models provide a theoretical framework, structure & focus to counselling
Techniques are based on Models
eg Cog therapy > Downward arrow Behaviour therapy > exposure Gestalt > empty chair Psychoanalysis > free assoc ACT > Cog Defusion IPT > Communication Analysis Solution Focused Therapy > Miracle Question Dialectical Behaviour Therapy > Chain Analysis Family Therapy > Genogram Narrative Therapy > Reframing
Common Factors:
Common Factors: processes common to most (if not all) models:
Therapeutic alliance/relationship
Client factors
Hope/Expectations for change
Specific vs Common Factors:
What contributes most to change?
model and techniques (specific factors) : ~15%
Common factors ~85%
Extratherapeutic Factors
Expectancy
Therapeutic Alliance
The ‘Big 4 (lambert 92)
Therapeutic relationship: 30%
Extratherapeutic (client) factors: 40%
Hope & Expectancy: 15%
Models & Techniques: 15%
(1) Therapeutic Relationship: 30%
What is the therapeutic Rship and what aspects does it include?
Connection, rapport or bond between the client & counsellor
Aspects include:
Positive regard & acceptance (seeing the client as a human being with essential goodness)
Caring, warmth & genuineness
Purposefulness
Trust & confidence
Encouragement of risk taking (support for change)
Empathy
Empathy
What is it and why is it important?
The central ingredient that promotes reflection & change
To understand another person’s experience from their perspective
Involves putting your own opinions, judgements, interpretations to one side
Rogers: perceiving the internal frame of reference of another with accuracy as if one were the person, but without ever losing the “as if” condition.
“as if” – recognises that the client’s experience is always in some part a projection based on the counsellor’s experience – thus, true objectivity is very difficult
The most fundamental, vital & complex therapeutic skill
How is empathy misunderstood
Empathic responding does not involve direct expression of your own feelings
Empathy ≠ caring & being nice
Inaccurate empathy: when the counsellor presumes to know, or imposes his/her understanding on the client
Overinvolved: to experience identical feelings to the client
Sympathetic responding: the expression of care & compassion (these are still your own feelings
Counsellor self-awareness is essential in this process
What are the components of empathy?
Passive empathy: the counsellor’s unbiased understanding of the client’s experience
Active empathy: the counsellor’s communication of their understanding of the client’s experience, in a way which validates & supports the client
The client’s experience of being empathically received will allow them to share deep & personal feelings, facilitates self-exploration & letting go of defenses
Active empathy is achieved with microskills
Extra-therapeutic factors: 40%
What are they?
Factors within the client & their life context – exist ‘outside’ the normal therapeutic process, yet contribute to change
eg. social >quality of social support
individual > self awareness
Environment > Financial security
Extratherapeutic factors:
What is Readiness for Change?
Pre-contemplation: client does not see they have a problem, so not really open to change
Contemplation: sees there is a problem, knows something needs to be done, & intends to change eventually
Preparation: ready to take action soon (days/weeks, rather than months)
Action: implementing changes
Maintenance: client has achieved their goals, working to consolidate change & prevent relapse
Hope & Expectancy (3)
What is it? Why is it important?
Client forms certain expectations for improvement, which become self-fulfilling prophecies
Approx 15% of clients improve before tx begins
Influenced by degree to which the client and counsellor believes a solution is possible
Degree to which client & counsellor believes the client has the capacity, ability or skills needed for change
Developing & sharing a Conceptualisation provides pathway for change & can instil hope
