Theories of Counseling and Psychotherapy, Lecture notes of Psychotherapy

Download Theories of Counseling and Psychotherapy and more Lecture notes Psychotherapy in PDF only on Docsity! Notes on Seligman “Theories of Counseling and Psychotherapy” Chapter 1 Development of Theories of Counseling & Psychotherapy First Force: Psychoanalysis/Psychodynamic Psychotherapy Freud  Past experiences as the source of people’s emotional difficulties in the present. Emphasizing unconscious processes and long-term treatment. Second Force: Cognitive & Behavioral Theories and Interventions BF Skinner, Albert Ellis, Aaron Beck, William Glasser, D. Meichenbaum, etc.  Behavioral treatment approaches (70s) have been integrated with cognitive approaches (80s) leading to Cognitive-Behavioral approaches in the 1990s  Emphasize the influence of thoughts and actions on emotions  Interventions generally focus on the present and seek to minimize dysfunctional cognitions and behaviors while replacing them with more helpful and positive thoughts and actions. Third Force: Existential-Humanistic Psychotherapy Carl Rogers, Fritz Perls, Victor Frankl, etc.  Emphasizes the importance of emotions and sensations and of people taking charge of and finding meaning in their lives.  Drew attentions to the importance of the therapeutic alliance. Fourth Force: Integrative  Elements of all previous three forces are integrated into a comprehensive and holistic effort to understand people as fully as possible.  Includes new approaches such as narrative therapy, positive psychology, and mindfulness. Treatment is Effective Martin Seligman, in 1995, conducted “the most extensive study of psychotherapy on record.”  Found that 87% of people who reported feeling “very poor” and 92% of people who said they felt “fairly poor” before therapy showed clear improvement by the end of treatment.  Improvement was long-lasting and reflected in changes in presenting concerns as well as improivement in occupational, social, and personal domains.  Long-term treatment was generally superior to short-term treatment. Common “Ingredients” that Promote Change  A therapeutic relationship characterized by collaboration, trust, mutual investment in the therapeutic process, shared respect, genuineness, positive emotional feelings, and a holistic understanding of clients and their backgrounds and environments.  A safe, supportive, and healing context.  Goals and a sense of direction, preferably explicit, but sometimes implicit.  A shared understanding about the nature of the problems and concerns to be addressed in treatment and the change processes that will be used to resolve them.  Therapeutic learning, typically including feedback and corrective experiences.  Encouragement of self-awareness and insight.  Improvement in clients’ ability to identify, express constructively, and modify their emotions and feelings.  Improvement in clients’ ability to assess and change dysfunctional behaviors as well as acquire new and more effective behaviors that promote coping, impulse control, sounds relationships, and good emotional and physical health. Understanding Mental Health Witmer and Sweeney (1992) advanced a holistic model for optimal health and functioning that delineates five important aspects of peoples’ lives:  Spirituality – Values, beliefs, ethics, purpose, direction, optimism, inner peace.  Self-Regulation – Sense of worth, mastery of one’s own life, spontaneity, emotional responsiveness, sense of humor, creativity, awareness of reality, psysical health.  Work – Paid employment, volunteer experiences, child rearing, homemaking, and education that provide psychological, social, and other rewards.  Friendship – Positive interpersonal relationships and social support that provide rewarding activities and interactions.  Love – Intimate, trusting, sharing, and cooperative long-term relationships. These five areas serve as a map of healthy functioning. They also delineate areas for assessment. Deficits in any of these five areas are likely to impair functioning, cause distress, require help, and be an appropriate focus for treatment. Remember the pie chart: 40% Extra-therapeutic Factors 30% Client-Therapist Relationship 15% Client’s Hope and Expectation of Positive Change 15% Specific Therapeutic Techniques Characteristics of Successful Clients  Maturity: Reasonably well-organized lives, responsible, knowledgeable about the world.  Capacity for Relationships: Interpersonal qualities such as good communication skills, an ability to invest energy and caring in personal relationships, and the capacity to form stable and close relationships are important client strengths. The client’s attachment style moderates the relationship between counseling experience and working alliance. Those clients who can form positive relationships and have a need for intimacy, trust in others, and fear of abandonment.  Ability to Establish Appropriate Interpersonal Boundaries: People who have good self- esteem, and a sense of control over their lives, are likely to establish appropriate boundaries both within and outside the therapeutic relationship. On the other hand, people who have inordinate needs for affiliation may seek an overinvolved and dependant relationship with the clinician. And people who have extreme needs for separateness and independence may reject Ethical Guidelines and Standards  Ethical standards give strength and credibility to the mental health professions.  Ethical guidelines help clinicians make sound decisions.  Providing clients with information on when clinicians can and cannot maintain confidentiality, as well as other important ethical guidelines, affords client safety and predictability and enables them to make informed choices about their treatment.  Practicing in accord with established ethical standards can protect clinicians in the event of malpractice suits or other challenges to their competence.  Demonstrated knowledge of relevant ethical and legal standards is required for licensure and certification as a counselor, psychologist, or social worker. Clinicians are responsible not only for acting in ethical ways themselves but also for helping their colleagues to become aware of and adhere to these standards. Clinicians who believe that a colleague is acting unethically should first discuss the matter with the colleague and provide any needed information. Review of Ethical Standards:  Autonomy: Clinicians help people develop the skills and strengths they need to make wise choices for themselves. Inherant in this guideline is the mandate that clinicians understand, respect, and appreciate diversity.  Nonmaleficence (do no harm) and beneficence: Clinicians should always keep in mind the importance of actively promoting the well-being of their clients and acting in the best interests of their clients.  Justice: Fairness is an essential ingredient of clinicians’ professional relationships and interactions, whether they are with clients, colleagues, students, or others.  Fidelity: Clinicians “maintain their commitments to their profession and to their clients.” They are reliable and responsible, nurture and sustain trust in their relationships, value and protect the therapeutic alliance, and are truthful and congruent in their communications. In addition to the above principles, the following ethical guidelines from the ACA Code of Ethics are among the most important: The Counseling Relationship: Clinicians always act in the best interest of their clients. They competently develop treatment plans and use approaches and interventions that are likely to be helpful. If they believe their services are no longer beneficial to the client, they refer them. They avoid potentially harmful dual relationships (eg client and student, client and family member) and do not engage in sexual intimacies with current or former clients. They provide clients with written information about their services and charge fees consistent with common practice in their area. Confidentiality: Clinicians inform clients about the clinician’s obligation to maintain confidentiality, as well as about exceptions to that guideline. If clinicians work with minors, with people who present a danger to themselves or others, or who engage in abuse of children, the elderly, or people with disabilities, clinicians may need to break confidentiality but always do so with thought and care. Professional Responsibility: Clinicians practice only within their areas of competence. They engage in professional development to maintain and improve their skills and are active in professional associations. They have sound relationships with other professionals and never exploit clients or employees. Teaching, Training, and Supervision: Educators and supervisors maintain standards similar to those of clinicians. They have clear policies and ensure that their students and supervisees are informed of those policies and procedures. Research and Publication: Writers and researchers in mental health fields are also subject to ethical guidelines. They must be sure not to harm research participants. They provide opportunity for voluntary consent whenever possible, make available to participants and colleagues clear information on their work, and follow guidelines for submission of manuscripts of professional journals. They appropriately acknowledge any help their receive from colleagues and students. Role Induction The process of orienting people to treatment so they are more likely to become successful clients who understand and can make good use of the therapeutic process. Clients who informed of what to expect have a better understanding of treatment and their role in the process, seem more optimistic about making positive changes, and demonstrate greater willingness to self-disclose and talk about their concerns. Role induction typically entails discussing the following topics with clients early in the therapeutic relationship and ensuring that clients understand and are comfortable with the information that has been discussed:  The nature of the treatment process  How treatment promotes positive change  The kinds of issues and concerns that usually respond well to counseling and psychotherapy  The collaborative nature of the relationship  The roles and responsibilities of the clinician  The roles and responsibilities of the client  The importance of honesty and self-disclosure on the part of the client  Ethical aspects of the therapeutic relationship, especially guidelines for maintaining and breaking confidentiality  Ways to contact the clinician and what to do in the event of a client emergency  Obtaining their-party payments (eg from managed care, health insurance)  Clinician’s fees and appointment schedules  The kinds of changes people can realistically expect from treatment  Risks inherent in treatment Skill Development: Encouragers One of the most important and challenging roles of the clinician is to facilitate client self- disclosure.  Minimal Encouragers: Brief interventions, in which clinicians demonstrate that they are listening, encourage clients to keep talking, and perhaps focus the clients’ words. 1. Umm-hmmm. A supportive murmur from the clinician accompanied by a nod of the head and an attentive posture. If clients are talking easily about themselves and using their time productively, thus may be all they need to continue that process 2. Repetition of a word. Here, the clinician repeats or underscores a client’s spoken word or phrase. This narrows the client’s attention and generally encourages the client to elaborate further. Although this intervention is very brief, it can have a considerable impact on the direction of treatment. 3. How so? Although this brief phrase is really a question, it functions like a minimal encourager in that is prompts the client to hone in on a particular point and explore it in greater depth.  Restatement: Restatement involves repeating or underscoring a longer phrase or sentence that the client has spoken. It can be thought of as an expanded version of a minimal encourager and serves the same purpose: focusing the client’s attention and promoting self-expression without adding to, changing, or interpreting the client’s words.  Paraphrase: In a paraphrase, clinicians feed back to clients the essence of what they have said. Although clinicians use different words from those of the client, they not seek to interpret, analyze, or add depth to a client’s statement. Rather, they simply give clients an opportunity to hear what they have said. Paraphrases let clients know that the clinician is listening and understanding them, and encourages clients to keep talking.  Summarization: A summarization pulls together and synthesizes a group of client statements. They are useful for focusing a session, bringing closure to a topic, wrapping up a session, and helping clients reflect on what they have said. Like paraphrases, summarizations are nor interpretive or analytical but simply feed back in a concise and coherent way what clients have said. Chapter 2 – Overview of Background-Focused Treatment Systems All of our experiences have shaped and continue to shape us. Most clinicians agree that we cannot fully understand our clients and their concerns unless we learn about their backgrounds and contexts. However, clinicians disagree on the amount of time they spend exploring clients’ histories, on the importance of past experiences in determining present functioning, and on the ways clinicians should focus on those past experiences in relieving present concerns and promoting mental health. Importance of Past Experiences in Treatment  Incorporating the discussion and processing of past experiences into treatment can greatly enhance its impact. Content of an Intake Interview:  Demographic and identifying information, including age relationship status, and living situation  Presenting problems, including reasons for seeking help now, symptoms, onset and duration of difficulties, the impact of concerns on the person’s lifestyle, and previous efforts to obtain help.  Prior and additional emotional difficulties.  Current life situation, including important relationships, occupational and educational activities, social and leisure activities, stressors, and sources of gratification.  Ethnic, cultural, religious, and socioeconomic information.  Family background, including information on the composition of family of origin and current families, relationships within families, parenting styles, parental role models and messages, family values, family strengths and difficulties.  Developmental history.  Career and educational history.  Medical history, including significant past and current illnesses, medical treatments and medications.  Health-related behaviors, including use of drugs and alcohol, diet, exercise, and overall self-care. Chapter 3 – Freud and Classic Psychoanalysis Freud and the development of Psychoanalysis  Freud’s early work focused on the study of neurology.  During the 1880s he became interested in the work of Josef Breuer who used hypnosis and verbal expression to treat emotional disorders.  His famous case of Anna O., a woman who experienced conversion symptoms (paralysis of limbs, disturbances of sight, eating, and speech) and dissociative symptoms captured Freud’s attention.  He became increasingly interested in psychological disorders and their treatment.  Freud sometimes used hypnosis, and experimentation led him to what he called the concentration technique, in which patients lay down with their eye closed while Freud placed his hand on their foreheads and urged them to say whatever thoughts arose.  He used questions to elicit material and promote self-exploration.  Although Freud later stopped touching his patients because of erotic possibilities, he continued to emphasize the importance of patient self-exploration and free association.  First used the term psychoanalysis in an 1896 paper.  His writings in the 1890s reflected growing awareness of the importance of sexuality in people’s lives. He initially believed that symptoms of neurosis and hysteria were due to childhood sexual experiences, perhaps sexual abuse.  He subsequently focused more on infantile sexuality and fantasies rather than actual sexual experiences as instrumental in determining emotional difficulties. Important Theoretical Concepts Human Nature  Freud placed great emphasis on the influence of biology and of early childhood experiences.  He believed that people go through predictable stages of psychosocial development and must struggle to find a balance between their strong sexual drives and their need to behave in socially acceptable ways.  He viewed people as seeking to win love and approval by acting in ways that reflected the dictates of their families and societies.  Emphasized irrational and instinctual forces in shaping people, but also believed that people can use psychotherapy and other sources of help and personal growth to gain insight, lessen the power of the unconscious, and free ourselves to make conscious and healthy choices.  Understanding early development, and he pressures of the libido and the superego, and strengthening our egos can enable us to lead the sorts of lives and have the types of relationships that we desire. Personality Structure  According to Freud, the personality is composed of three structures: the id (biological component), the ego (psychological component), and the superego (social component).  These structures often overlap and intertwine--they are not discrete entities--although each has distinctive properties. They are separated only by artificial boundaries/constructs. o The Id:  First system of the personality. Present at birth, it encompasses all of the inherited systems, including instincts, and is largely unconscious.  The id derives its energy from bodily processes and is in touch with the needs and messages of the body, seeking to satisfy them when possible.  The id is subjective and emotional and, in its pure form, is not moderated by the external world. (Wants what it wants when it wants it)  The id (like the infant in which it originates) is intolerant of tension, pain, and discomfort and seeks to avoid them by pursuing pleasure and gratification (the pleasure principle).  The id has two strategies for obtaining pleasure: - Reflex actions: Include autonomic processes, such as coughing and blinking, that reduce tensions, especially those of a biological nature. - Primary process: Allows people to form a mental image of a remedy for their discomfort, a wish fulfillment. Believed that dreams serve this function.  Freud believed that people have both life instincts and death (or destructive) instincts. Life instincts, reflecting the needs of the id, lead us to pursue pleasure an avoid pain.  The libido, present at birth, is an important aspect of the life instinct (aren’t they one and the same?). This was initially defined by Freud as sexual desire, but its meaning has been broadened to refer to energy and vitality. o The Superego:  Can be thought of as the opposite of the id.  Like a rigid conscience that internalizes rules and guidelines of a person’s world. Messages from parents, teachers, and society as well as racial, cultural, and national traditions are important contributors to the development of a person’s superego.  The moral code of the superego is perfectionist, diligently discriminating between good and bad, right and wrong.  The formation of the superego allows self-control to take the place of parental control.  When people follow the idealistic dictates of their superego, they feel righteous and proud, but may sacrifice pleasure and gratification.  On the other hand, when they ignore the superego, shame, guilt, and anxiety may result.  The superego serves an essential function in curtailing the drives of the id; but like the id, the superego is too controlling and extreme in its directives. o The Ego:  The ego, like the superego, becomes differentiated from the id as the child develops, although energy from the id provides power for both the ego and the superego. The ego is not present at birth, but evolves as the baby realizes its separateness from the mother.  The ego is aware of both the pressures from the id and the constraints of the superego and seeks to moderate both while still meeting their needs.  The ego has been described as “the mental agent of rational and self-conscious selfhood.”  It is mediator and organizer. Guided by the reality principle or reality testing, the ego has considerable power: it can effect changes in the environment, postpone or suppress instinctual demands, and encourage sound moral judgment and flexibility.  Using logic, intelligence, objectivity, and awareness of external reality, a healthy ego considers, modifies, and integrates both internal and external pressures on a person, decides when and how to respond to those demands, and identifies the wise choices and behaviors that promote self-preservation. Stages of Development  Freud believed that people develop according to predictable stages, with those occurring during the first 5 years of life being the most important. The nature of a person’s development during those early years is a major factor in determining the later emotional health of that person. o The Oral Stage  First year of life (approx). The mouth is the most important zone of the body for the infant, with sucking and eating providing the nurturance to sustain life during the oral-incorporative phase.  Biting is a way to express aggression during the subsequent oral-aggressive period.  The mouth also becomes the child’s first erotic zone.