Part IV Clinical Skills and Resources

1. Part IV Clinical Skills and Resources pp. 101 - 117

2. Clinical Models • Psychoanalytic concepts • Conscious and unconscious mind • Behavior from inner conflict and with biological and social forces • Personality • Psychic energy that drives survival and pleasure “instincts”: _____ • Conscience – moral judge and self ideals promoter: __ • Executive mediator: __ • Inner strivings and reality; monitor /master of drives

3. Psychoanalysis– cont’d • Motivation – biological drive to obtain ___ and avoid ____ - aka the ______ Principle. • Adult pathology – due to frustration of _____ gratification at developmental stage(s) Therapeutic Approach • CL: Free association – no agenda thoughts • TH: Follows, understands, uncovers defenses • E.g. repression, regression, reaction formation

4. Analytic psychoanalysis • Carl Jung • Added concept of “collective _________ “ to personal concept of mind – ancestral memories • Memories organized around archetypal images • Therapeutic approach • Dream analysis – to access the ___ • Reveals archetypes to be interpreted www.cgjungpage.org

5. Application of Psychoanalytic concepts to SA Counseling • Personality • Identifying traits/patterns helps client understand how they interact with others • The Myers-Briggs Indicator identifies traits • Helps identify core competencies needed (to support recovery) • Spirituality • Helping clients find strength for daily living to enhance recovery and health

6. Individual Psychology • Alfred Adler • Desire for superiority leads to pursuit of fictional goals (“unrealistic goals”) • Leads to discouragement and self-destructive behaviors Therapeutic Approach • Assessment – family, birth order, early memories • Costs – of unhealthy goals analyzed (to motivate) • Realistic goals, plan of action – helps to overcome discouragement, inferiority www.iaiponline.org

7. Person-centered Therapy • Carl Rogers • Philosophy: People are good, worthy, valuable and have internal resources to improve situation. Clients are guided (when potential emerges). Therapeutic Approach • TH “adheres to” core conditions: • responds to cl. with empathy, congruence and warm regard • Guides rather than directs www.centerfortheperson.org/organizations.html

8. Gestalt Therapy • Fritz Perls • Principle goal: __________ achieved by • Focus on present situation, current behaviors, cl’s perceptions and interpretations of experiences • No focus on underlying “causes” • Homework, life “experiments” (roleplay), working through “layers” of awareness to core Phony (stereotypical, inauthentic), phobic (avoiding pain an responsibility), impasse (stalling), implosive (questioning defenses), explosive – energy release from letting go of pretense (get “real”) www.gestaltri.com

9. Existential Psychotherapy • Irvin Yalom • Focuses on present, fundamental questions of being human (finding meaning in life) • And the struggles inherent in this existence • 4 ultimate concerns: • death (no escape), freedom (to define own world), isolation (gulf between self/other), meaninglessness (defining meaning, purpose)

10. Existential Psychotherapy – cont’d Therapeutic Approach • Explore the 4 ultimate concerns; paraphrase • Share (self-disclose) to provide alternatives and ask questions about internal struggle. www.yalom.com

11. Logotherapy • Victor Frankl • Freedom to determine meaning (with mind) more important than external circumstances, events • Cls have ability and responsibility for choices • No-choice is still a choice. Therapeutic Approach • Teach avoidance of “victim role” • Dereflection – attend to creative ways of coping • instead of problem situation • Paradoxical intentions – • Encouraging exaggerated form of undesired behavior http://logotherapy.univie.ac.at

12. Rational-Emotive Behavior Therapy • Albert Ellis Philosophy: Root of emotional problems is irrational thinking; rational thinking can be taught/learned. Therapeutic Approach ABC model: Activating event, Belief about A; Consequences (behavior and feelings from thoughts about A) DEF: Dispute – challenge thinking – homework, teaching Effect – on beliefs Feeling – appropriate to situation (neither anxious nor depressed) www.rebt.org

13. Choice Theory/Reality Therapy • William Glasser • Theory: Choose behavior to meet need(s): • Love and belonging, power, fun, freedom, survival • Behavior affects thoughts and feelings; “doing something different” changes emotional state Therapeutic Approach Focus is on building love and belonging relationships Questions: What (have) now that meets needs? What do you want? What are you doing to get what you want? Is it working? Learning to meet own needs; develop “caring habits”; eliminate “deadly habits”

14. Cognitive-Behavioral Therapy (CBT) • Aaron Beck • Thinking errors underlie negative thinking/feeling. Techniques: • Reduce anxiety – empathy, reframing • Uncover, monitor faulty processing, negative schema • Questioning, behavioral experiments to test beliefs • Behavioral strategies (journaling) reinforcing new skills • Works well with people free of delusions (live in reality). www.beckinstitute.org

15. Transactional Analysis • Eric Berne Personality made up of 3 ego states: each with own styles of feeling, thought and behavior: Parent, Adult, Child Therapeutic Approach Help to develop positive life view (“script”) of self/other (“I’m ok; you’re ok”) Explore “transactions” (what’s said between people), “games and cons”, “scripts” and “structures” Identify “strokes” - positive reinforcement of behavior www.itaa-net.org

16. Other approaches • Pavlov – classical conditioning • Behavior from conditioned reflexes • Skinner – operant conditioning • Behavior from rewards (pos. and neg.) • Bandura – social learning theory • Behavior learned by observing the environment All emphasize environment’s impact on behavior Therapy: Analyze behaviors and create plan for modifying it; monitor, follow up.

17. Techniques • Directive, moderately directive, nondirective • Directive • Openly confront and challenge cl. to take specific action • Nondirective • Empathic support of client • Moderate • Support and assistance given in taking action

18. Directive Techniques – exs.

19. Other Directive: Diversion, Encouragement, Exaggeration, Fruit basket, goal setting, graduated exposure, imagery, immediacy, language exercises, magic wand, offering options, paradoxical interv. Playing the projection push-button technique Reframing reinforcement self-help form (REBT) self-monitoring sharing hunches spitting in “soup” staying with a feeling systematic desensitization teaching ABC model

20. Non-Directive Techniques – exs.

21. Moderately-Directive Techniques – exs.

22. Other Moderately Directive: Brainstorming Cognitive modeling Counter-conditioning Extinction Feedback Self-disclosure Humor Jolting language (sarcasm) Role play Two-chair technique