COUNSELING THEORIES CHAPTER 7

1. COUNSELING THEORIES CHAPTER 7

2. I. INTRODUCTION** A. Definition of and Need for Counseling • Counseling is a helping relationship that involves one party who needs help, another party that provides help, and a setting that allows the process to occur. • Frequently, we are helping people deal with the feelings or emotions surrounding a communication disorder • We are also providing guidance

3. Often, I have found that: • As the SLP, I am the key person parents turn to when they need to vent their emotions or talk over their worry, fear, and stress • As a student, I was never ready for this—I thought my job ended with assessment and treatment

4. B. Guidance, Counseling, and Psychotherapy** • Psychotherapy is concerned with the treatment of psychological abnormality • This is the province of trained counselors and psychotherapists

5. Counseling: • Does not deal with major personality changes • Deals with personal adjustment • Helps otherwise normal people make adjustments in their behaviors and cope with difficult circumstances

6. Guidance: • Less formal than psychotherapy or counseling • Method of influencing another person’s thoughts or behaviors • Advice is dispensed and information given

7. II. THEORIES OFCOUNSELING** A. Psychodynamic Theory • based on psychoanalytic theory • created by Freud • behavior is the product of conflicts between the id, ego, and superego • 5 psychosexual stages

8. B. Client-Centered Theory • Also called person-centered theory • Carl Rogers • Foundation: empathic relationship between the client and therapist that will allow the client to freely experience and express all his/her emotions in a completely accepting climate

9. (Luterman, 2008) The counselor (you, the SLP) needs to be fully present:** • You have to be in touch with your own needs and experiences • You enter into a therapeutic alliance with the client so as to release the client’s self-actualizing drive • With the right therapeutic environment, the client’s self-actualizing drive will bubble up and they will actively choose to make changes

10. Step 1: • Step 2:

11. Step 3: • Step 4:

12. Some multicultural clients might not like this… • They often expect advice and specific solutions, not just a shoulder to cry on • The more educated the client, the more they will want the list of action steps

13. C. Behavioral Theory** • Scientists could not measure and document outcomes of psychoanalytic and client-centered approaches; wanted measurement • Behaviorists focus on what is observable, with an emphasis on environmental, external influences

14. All behavior is caused by environmental stimuli • human behavior is the product of external reinforcement • behavior is shaped and maintained by immediate consequences • reinforcement must be given immediately after a particular behavior has occurred

16. Rather than focusing on feelings, the clinician focuses on specific outcomes • Goal: emphasize client’s identifiable behaviors and make positive changes • Danger: “fruit loop therapy” • May be most effective after a client-centered approach, esp. in the beginning where clients have strong emotions

17. Many multicultural clients appreciate this • Behavioral therapy does not rely on having people get in touch with and express their feelings • Provides specific and practical steps for positive change

18. D. Cognitive-BehavioralTheory** • Belief: client’s thoughts are key to his or her feelings and actions • Counseling is a 3-step process: • change the client’s thinking • change the belief system • change the behavior

19. Luterman (2008) states that:

20. There are some irrational thoughts that can cause pain to clinicians and clients: • I must be universally liked • It is awful when things are not just the way I want them to be • Or, as Mark McKibbin said in Europe, “I don’t believe this. In the States, the customer is always right.” • To be worthwhile, a person must be competent and high-achieving in all areas

21. Mistakes are not OK, and I must be stupid to have done this—it’s awful!** • This attitude severely limits people’s personal and professional growth • Remember: It is only a mistake if you do it a second time

22. A person’s past history is an all-powerful determinant of his present behavior; because something once strongly affected his life, it should continue to do so • A person should become very upset over other people’s problems and disturbances • There is always a perfect solution to problems, and it is catastrophic if this solution is not found

23. A cognitive therapist… • Is not directly interested in the person’s emotions • S/he assumes that “how you think is how you feel,” so the interest is in changing the person’s thoughts • If your thinking gets straightened out, so will your feelings—and there are 4 steps for this

24. 1) • 2) • 3) • 4)

25. For example: hearing impaired client:** • 1. “So you don’t want to wear your hearing aid because you’re afraid people will avoid you at social gatherings.” • 2.”When you go to the party Sat. PM, see if you think this is true. Observe people’s reactions to you.” • 3. (next session) “How did people react? Oh, no one avoided you? You had fun?” • 4. “Now that we know this, would you be willing to wear your hearing aid more often?”

26. Explore discrepancies between a client’s thoughts and reality • Help the client develop new thoughts so they can deal constructively with their situation • Limitation: may cut short the expression of strong emotions that need to come out • Good for adults who have such negative beliefs that tx progress is impeded

27. E. Reality Therapy (Okun & Krantrowitz, 2008)** • This is a branch of the cognitive-behavioral theory • It was developed by psychiatrist William Glasser • It is rational, logical, and learning oriented

28. Like a breath of fresh air….  • This approach involves helping people take more effective control of their lives Accomplished by helping them choose effective, responsible behaviors • SLP confronts inconsistencies openly and directly • 8 steps

29. 8 Steps • 1. • 2. • 3.

30. 4. • 5. • 6.

31. 7. • 8. • This approach is quite popular in Asian and Middle Eastern countries • It is practical and helps clients to assume responsibility

32. F. Eclectic Approach** • 1) accept and listen to client nonjudgmentally--let them express their emotions • 2) if feelings are accompanied by negative thoughts that are preventing progress, help client test experimentally the validity of those thoughts • 3) help clients implement constructive behaviors to deal with their communication disorder

33. Again, remember… • Clients do not change unless they assume some responsibility

34. III. DEALING WITH CLIENTS’ COGNITIVE DISTORTIONS • 1. • 2. • 3.

35. 4. • 5.

36. 6. “Should” statements

37. 7. Catastrophizing** • People believe the worst that can happen, and that it will happen to them • If my child is retained in 4th grade, he’ll become a behavior problem and maybe eventually turn to a life of crime

38. Mindsets that Inspire Procrastination • Helplessness— • Feeling overwhelmed-- 3. Perfectionism —

39. Fear of failure/disapproval/criticism — 5. Low frustration tolerance —

40. Many Americans have low frustration tolerance… • Because our society emphasizes instant gratification • The LA-Z boy culture • Everything should be easy, fast, effortless, and comfortable!

41. IV. REACHING RESOLUTION** • Sometimes people cannot come to a conclusion or agree upon a course of action • In these cases, I use a little “Roseberry magic”

42. A technique I have sometimes used:** • First present a solution that’s really unpalatable • “We could not enroll Neil for stuttering therapy, and just let him go. Of course, the danger is, that when he gets to junior high, the other kids might really make fun of him and ostracize him.”

43. Next…** • Present another unpalatable extreme • “I could see Neil daily for 20-30 minute sessions, but he would always miss social studies and probably fall behind.”

44. Lastly…** • Present a “middle of the road” option that is very palatable • “A third option is that I could see Neil twice a week for 20 minutes, and send home brief assignments for you to do with him. In this way, he wouldn’t miss too much class and we could work on strategies for him to be more fluent, especially as he goes into junior high.” • “Which one of these sounds best to you?”