SECTION II: THE HELPING RELATIONSHIP I: Theory and Skills

1. Chapter 4: Individual Approaches to Counseling Chapter 5: Counseling Skills SECTION II:THE HELPING RELATIONSHIP I:Theory and Skills

2. Chapter 4: Individual Approaches to Counseling

3. Why Have a Counseling Theory? • Offers us a framework • Knowledge builds on knowledge (Paradigm Shifts) • See Box 4.1, p. 102 • Theories are heuristic • Based on our view of human nature • Helps us work in an organized manner • Today, hundreds of counseling theories, but only some have gained prominence

4. Four Conceptual Orientationsand Associated Theories • Psychodynamic Approaches • Existential-Humanistic Approaches • Cognitive-Behavioral Approaches • Post-Modern Approaches

5. Psychodynamic Approaches • Overview • Dominated early part of 20th century • Common elements • Unconscious and conscious affects person’s functioning • Early child-rearing has some affect on development of personality • Past, in interaction with conscious and unconscious, affects person’s development • Have tended to be longer term • Some approaches: psychoanalysis (Freud), analytical therapy (Jung), individual psychology (Adlerian)

6. Psychodynamic Approaches(Psychoanalysis: Freudian Therapy) • Developed by Sigmund Freud • First comprehensive approach to therapy • Psychic energy (instincts) drive behavior • Life instinct (Eros): love, intimacy, sex, survival • Death instinct (Thanatos): fear, hate, self-destructive behavior aggression • All life and death instincts = libido • Structure of personality: • Id (pleasure principle) • Ego (reality principle) • Superego (moral imperatives)

7. Psychodynamic Approaches(Psychoanalysis: Freudian Therapy) • Psychosexual Stages: Oral, Anal, Phallic, Latency, Genital • Parenting affects developmental through stages • Defense mechanisms reflect that development • Name some defense mechanisms! • Deterministic Approach • See Figure 4.1, p. 104 • Long term approach that relies on making a little more of the unconscious conscious

8. Psychodynamic Approaches(Psychoanalysis: Freudian Therapy) • Techniques • Free Association • Dream Analysis • Empathy • Developing transference relationship • Techniques • Interpretation of: • Resistance • Defense mechanisms • Parapraxes • Dreams (manifest and latent meanings) • Transference

9. Psychodynamic Approaches(Analytical Therapy: Jungian Therapy) • Developed by Carl Jung • Less pessimistic and less deterministic than Freud • 8 Psychological Types—include combinations of: • Extraversion and Introversion (E or I) with • Mental Functions: Thinking and Feeling (T or F); Sensing and Intuiting (S or N) • Information that matches psychological type goes into consciousness. Information that doesn’t, goes into personal unconscious. • Our collective unconscious is inherited. Contains archetypes —tendency to perceive things in ways we call “human” • Well known archetypes: persona, anima and animus, shadow

10. Psychodynamic Approaches(Analytical Therapy: Jungian Therapy) • Jung believed we can make almost anything conscious • If we understand our personal and collective unconscious, we are “whole” • Techniques: • Goal of techniques—to make unconscious conscious • Some techniques: • Examining our dreams • Meaning of symbols • Creative Techniques (working with clay) • Active imagination

11. Psychodynamic Approaches(Individual Psychology: Adlerian Therapy) • Developed by Alfred Adler • “Teleology”—we inherently are goal directed • We move to fulfill one drive—striving for perfection. • All other drives subsumed by this one • Part of being human: having feelings of inferiority • Feelings of inferiority lead us to our subjective final goal • Our private logic leads us toward our final goal • Drive toward our subjective goal results in development of behaviors that compensate for feelings of inferiority • You can tell how a person is driven toward his/her goal through his/her style of life

12. Psychodynamic Approaches(Individual Psychology: Adlerian Therapy) • Work through feelings of inferiority, and you will move toward social interest (Gemeinschaftsgefuhl) • Followers: Dreikrus and Dinkmeyer • Worked with children whose typical behaviors from feelings of inferiority yield: • Attention seeking, use of power, revenge seeking, and inadequacy • Sometimes seen as an early humanistic approach (through education and counseling one can change) • One of first approaches to work with families

13. Psychodynamic Approaches(Individual Psychology: Adlerian Therapy) • Phase of therapy • Building relationship • Assessing lifestyle • Insight and interpretation • Reeducation and reorientation • Techniques: • Exploring family constellation • Examining early recollections • Encouragement • Democratically held discussion groups • Limit setting • Acting “as if” spitting in client’s soup • Setting logical and natural consequences

14. Existential-Humanistic Approaches • Overview • Loosely based on existential philosophy • Deals with struggles of living and how we construct meaning in our lives • Tends to be optimistic and not deterministic • Phenomenological perspective • Focus on consciousness and the relationship • Help people “self-actualize” • Three approaches: Existential Therapy, Person-Centered, Gestalt Therapy

15. Existential-Humanistic Approaches(Existential Therapy) • A number of theorists developed this approach: Frankl (Logotherapy); May, Bugental, Yalom • Central tenets of most existential approaches • Born into a world with no inherent meaning • We make our meaning • Struggle throughout life to be “human” • Most people live a life of limited self-reflecton • We are born alone, die alone, and mostly live alone • Choice about who we are • Can gain awareness about choices we made • See Box 4.4, p. 110

16. Existential-Humanistic Approaches(Person-Centered Counseling) • Developed by Carl Rogers (“client-centered therapy”) • We all have need to be regarded • Conditions of worth placed on us by significant others • Help people become more congruent and gain a more realistic sense of ideal self • "Necessary & sufficient conditions" (pp. 110-111) • “Techniques”: • Congruence/genuineness • Unconditional positive regard • Empathic understanding • See Box 4.5, p. 111

17. Existential-Humanistic Approaches(Gestalt Therapy) • Developed by Fritz Perls • Based on Gestalt psychology, phenomenology, & existentialism • More directive • Self-regulation, need identification, and need-fulfillment • Only aware of needs in “foreground” • “Blockages” or “impasses” yield “unfinished business” • Now = experience = awareness = reality • Anti-deterministic • Techniques “push” one into awareness (pp. 114-115)

18. Cognitive-Behavioral Approaches • Overview • Pavlov (1848-1936): Classical Conditioning • Skinner (1904-1990): Operant Conditioning • Bandura: Modeling or Social Learning (1940s) • Recent Years: • Cognitive Structures • illogical Ways of Thinking • See common assumptions (p. 116) • Approaches: Modern-Day Behavior Therapy, Rational Emotive Behavior Therapy, Cognitive Therapy, Reality Therapy and Choice Theory

19. Cognitive-Behavioral Approaches(Modern-Day Behaviorism) • Developed by Many Different Indivdiuals • Based on an understanding of classical condition, modeling, and operant conditioning • Therapeutic stages • Building the relationship • Clinical Assessment • Focusing on Problem Areas and Setting Goals • Choosing Techniques and Working on Goals • Assessment of Goal Completion • Closure and follow-up • Some techniques: See Box 4.8

20. Cognitive-Behavioral Approaches(Rational Emotive Behavior Therapy: REBT) • REBT: Developed by Albert Ellis • Complex interaction between thinking, feeling, & acting • Mostly, focus on Rational vs. Irrational Thinking • People have cognitive distortions • People often driven by 1 or more of 3 core irrational beliefs (see Box 4.9, p. 120) • ABCs of feeling and behaving • Relationship important, but not critical (see Box 4.10, p. 120)

21. Cognitive-Behavioral Approaches(Cognitive Therapy) • Developed by Aaron Beck • Continuity hypothesis: older emotional responses continue into modern day world • Diathesis-stress model: biological/genetic/environmental model—under stress, our (unique) disorders are shown • Rational, pragmatic, antideterministic, educative, empirical • We all have “core beliefs” that drive us—embedded beliefs often out of our awareness • We can have negative core beliefs (see Box 4.11)

22. Cognitive-Behavioral Approaches(Cognitive Therapy) • Cognitive Therapy (cont’d) • Core beliefs lead to intermediate beliefs (“attitudes, rules, and expectations”) • Intermediate beliefs lead to automatic thoughts • Automatic thoughts related to certain “cognitive distortions (see Table 4.1, p. 123) • Automatic thoughts lead to possible reactions to certain situations (see Figure 4.2, p. 124) • Treatment: focus on automatic thoughts, get to intermediate beliefs, then get to core beliefs—change core beliefs through thinking and acting differently

23. Cognitive-Behavioral Approaches(Reality Therapy and Choice Theory) • Developed by Glasser—originally called Reality Therapy • Five genetically based needs: survival, love and belonging, power, freedom, and fun • Unique “need-strength profile” • We can only satisfy our needs and control our behaviors in the present • Since birth, we create a “quality world” to determine how to satisfy our needs • Some quality worlds lead to destructive behaviors

24. Cognitive-Behavioral Approaches(Reality Therapy and Choice Theory) • Reality Therapy (cont’d) • Can change the pictures in our quality worlds and our behaviors • Total behavior: We can only choose our actions and thoughts • Use internal-control language, not external control language • Techniques: see WDEP system (Figure 4.3, p. 127) • Anti-deterministic

25. Post-Modern Approaches • Overview • Based on post-modernism, social constructionism, post-structuralism • Post-modernists: Questions modernism and many assumptions and beliefs we take for granted • Social Constructionism: Values are transmitted through language via social milieu (family, culture, society) • Post-structuralism: Questioning of “inherent truths” or “structures” we have believed • Two approaches: Narrative Therapy and Solution-Focused Brief Therapy

26. Post-Modern Approaches(Narrative Therapy) • Developed by White and Epston (and others) • Four basic tenets: • Realities are socially constructed • Realities are constituted through language • Realities are organized and maintained through narrative • There are no essential truths • Anti-deterministic and anti-objectivist • Deconstruct older, negative narratives. • Construct new narratives

27. Post-Modern Approaches(Narrative Therapy) • Narrative Therapy (cont’d) • We all are multistoried • Look at “thin” and “thick” stories • Look for exceptions to stories (see Fig. 4.4, p. 129) • Be respectful, curious, show awe, ask questions • Phases: joining, examining patterns, re-authoring, moving on • Use journaling, retelling new stories, symbols to reinforce new stories

28. Post-Modern Approaches(Solution-Focused Brief Therapy: SFBT) • SFBT: Developed by Berg and de Shazer (and others) • Developed at BFTC of Milwaukee • Rejected “disease model” believed that clients could work quickly to reach goals • Pragmatic, optimistic, anti-deterministic, future-oriented • Miracle Question • Questions: evaluative, coping, exception-seeking, solution-focused • Find exceptions • Often, under 6 sessions

29. Post-Modern Approaches(Solution-Focused Brief Therapy: SFBT) • Six Stages • Stage 0: Pre-Session Change • Stage 1: Forming a Collaborative Relationship • Stage 2: Describing the Problem • Stage 3: Establishing Preferred Goals • Stage 4: Problem-to-Solution Focus • Stage 5: Reaching Preferred Goals

30. Extensions, Adaptations, and Spinoffs of the Major Theories more Popular of hundreds of therapies more Popular of hundreds of therapies Eye Movement Desensitization Therapy (EMDR) Motivational Interviewing Gender-Aware Therapy Positive Psychology and Well-Being Therapy Complementary, Alternative, and Integrative approaches • Erikson’s Psychosocial Theory • Object-Relations Theory • Relational and Subjectivity Theory • Dialectical Behavior Therapy (DBT) • Acceptance and Commitment Therapy (ACT) • Constructivist Therapy

31. Integrative Counseling and Psychotherapy(Eclecticism) • Four stages: • Stage 1: Chaos • Stage 2: Coalescence • Stage 3: Multiplicity • Stage 4: Metatheory

32. Multicultural/Social Justice Focus • Bias in Counseling Approaches • Many theories developed by White men, European heritage • Their values impacted their theories • Some of these values included: • Individualism • Expression of feelings • Uncovering “self” • If you work hard, you’ll succeed • Mind-body dualism • Truth can be found • External factors not important

33. Multicultural/Social Justice Focus • It’s time to take into account other cultures • It’s time to become more multicultural sensitive in our theories • Many of the theories can be adapted to address these issues • Sometimes, new theories will need to be undertaken • And, let’s not forgot our own biases and how they interplay with bias in theories

34. Ethical, Professional, and Legal Issues • Some common issues related to Sections A and B of ACA ethics code: Section A: The Counseling Relationship, and Section B: Confidentiality, Privileged and Privacy • Section A • Welfare of clients • Informed Consent • Clients being seen by other professionals • Roles and relationships with clients (including sexual relationships)

35. Ethical, Professional, and Legal Issues • Section A (cont’d) • Roles and relationships at individual, group, institutional, and societal levels • Multiple clients • End-of-life care for terminally ill clients • Section B • Respecting client rights (including foreseeable harm and life-threatening diseases) • See “Tarasoff Case and Foreseeable Harm (Duty to Warn) Box 4.13, p. 142

36. The Counselor in Process • Embracing a Theory but Open to Change • Theory development is an ongoing process • Be open to changing your approach over your career • How do you think your approach might change?