counseling 3

Existential therapy

philosophy or way of thinking about therapy rather than a particular style of practicing psychology

Existential philosophers

Friedrich Nietzsche, Soren Kierkegaard, Martin Heidegger, Simone de Beauvoir

Existential writers

Jean Paul Sarte, Fyodor Dostoevsky, Albert Camus, Franz Kafka

Roots of existential therapy

born from philosophy, questions are sources of existential angst

Philosophy roots

clients are searching for meaning in their subjective worlds

humans are in a constant state of transition, evolving and becoming

Common questions/sources of existential angst for clients

“who am I?”

“what does it all mean?”

“how am I going to get to where I want to be in my life?”

Viktor Frankl

neurologist, philosopher, author, Holocaust survivor, founder of logotherapyl

logotherapy

focus on finding meaning and purpose

main themes of logotherapy

life has meaning in all circumstances

will to meaning is central motivation for living

we must have freedom to find meaning in everything

we must integrate body, mind, and spirit to be fully alive

Rolly May

brought existentialism from Europe to the US

believed psychotherapy should be aimed at problems of being rather than problem solving

Existential therapy rejects… and focuses on…

the deterministic model of traditional psychoanalysis and behaviorism; choices

Six propositions about the human condition

the capacity for self awareness increases

freedom and responsibility

striving for identity and relationship to others

the search for meaning

anxiety as a condition for living

awareness of death and nonbeing

How do problems develop in existential therapy?

Confrontation of 4 ultimate concerns (fear, death, meaninglessness, isolation)

a state of inauthenticity

anxiety (normal/existential vs. neurotic)

How does change occur in existential therapy?

Clients are assisted in identifying and clarifying their assumption about the world (rapport and relationship)

Clients are assisted in more fully examining the source and authority of their present value system (internal values, life worth living)

Clients are assisted in translating what they have learned into meaningful action

Goals of existential therapy

Helping clients accept their freedom and responsibility to act

assisting people in coming to terms with the crises in their lives

encourage clients to recognize the ways in which they are not living fully authentic lives

inviting clients to be more honest with themselves

broadening clients’ awareness of their choices

facilitating the clients’ search for purpose and meaning in life

assisting clients in developing a deep understanding of themselves and the ways they can effectively communicate with others

roles of the therapist in existential therapy

understand the subjective world of the client and help the client come to new understandings and options, to find meaning

Therapeutic relationship is key → authenticity and confronting the client honestly

Roles of the client in existential therapy

Responsible for how they are choosing to be in their world at the present moment

Active: decide what fears/feelings/anxiety they want to explore

Confront ultimate concerns rather than coping with immediate problems

focus on removing roadblocks to meaningful living

Existential therapy techniques

De-emphasis of specific techniques: paradoxical intention, de-reflection, socratic questions, write your own eulogy

Therapeutic relationship is most effective technique!

Pros of Existential therapy

humanizes therapy

provides a perspective on basic human conditions

relevant in multicultural contexts

Cons of existential therapy

concepts are abstract and ambiguous

lacks empirical support

not applicable to lower functioning clients/clients concerned about basic needs

highly focused on self-determinism and may ignore other factors (systematic oppression)

Gestalt Psychology

emphasizes how people function in their totality

reaction against reductionism and determinism

Frederick (Fritz) Perls

Gestalt view of human nature

self actualizing tendency (process of being, not striving to become)

the whole is mroe than a sum of its parts (striving to coordinate various parts into a unified whole)

Law of Pragnanz

people will perceive and interpret ambiguous or complex images as the simplest form(s) possible

Law of closure

we tend to see complete figures even when part of the information is missing

Law of Similarity

we tend to perceive things that physically resemble one another as part of the same object

Law of Continuity

when a shape is not complete, but enough of the shape is shown, our minds will fill in the blanks and construct the whole of the shape

following the curve of lines

Law of proximity

objects that are placed close together are perceived as being more related than those spaced farther apart

Law of Symmetry

elements that are symmetrical to each other tend to be perceived as a unified group

Law of Common Fate

humans perceive visual elements that move in the same speed and/or direction as parts of a single stimulus

Major beliefs of Gestalt therapy

stresses individual responsibility and individuality (actors not reactors)

believes in the “power of the present”

promotes direct experiencing

How do problems develop in gestalt therapy?

lack of awareness (unaware of current feelings, thoughts, and behaviors/lack of integration between different parts of self)

from inordinate focus on the past and future rather than the present (“unfinished business”)

not living in the “here and now”

unfinished business

unexpressed feelings that interfere with current psychological functioning (associated with distinct memories and fantasies, linger in the background)

results in preoccupation, distress, self-defeating behaviors, cognitive distortions

How do problems develop in Gestalt therapy?

Resistances to contact: defenses we develop to prevent us from experiencing the present fully

Introjection, confluence, retroflection, deflection

Introjection

accepting others’ views without reviewing them

confluence

weak boundaries b/w self and environment

retroflection

we do to ourselves what we want to do to someone else OR

doing things for ourselves that we want others to do for us

deflection

avoiding of contact or awareness by turning aside, such as being polite instead of direct

Emotion focused therapy

greater emphasis on emotions, emotions are connected to needs

focusing on emotions can lead to therapeutic change

short term (~8-20 sessions)

What are the main emotions?

primary adaptive emotions (initial emotional response, beneficial value)

primary maladaptive emotions (initial emotional response, not beneficial)

secondary reactive emotions (reaction to initial)

instrumental emotions (expressed because they have an effect on others)

How does change occur in Gestalt therapy?

increasing awareness of all parts of self

contact inner and external world without losing sense of self (individuality)

help clients take ownership and increase coping strategies

Gestalt techniques

internal dialogue: “empty chair”

enactment (exaggerate feelings/thoughts/behaviors to feel more intensely)

focusing (focus on present awareness, where do you feel sadness in your body?)

rehearsal: role play and reverse role play

Role of the therapist in Gestalt therapy?

creates an atmosphere that promotes growth and self-actualization

uses immediacy skills

identifies avoidance patterns

uses techniques to increase clients’ awareness

strives for person-to-person relationship

Roles of the client in Gestalt therapy

actively engaged in therapy as experts of their own experiences

make interpretations and meaning out of their experiences

Pros of Gestalt therapy

deemphasizes abstract intellectualization of problems

recognizes working with the past as it relates to the present

emphasizes doing (action oriented)

heightens awareness

helps individuals integrate polarities within themselves

Cons of Gestalt therapy

potential for abuse

not useful for clients who have difficulty abstracting and imagining/focusing on emotions

cross cultural relevance: heavy emphasis on developing separateness from one’s social circle

fewer studies

Post modern view of human nature

Realities are socially constructed, there is no absolute reality. Clients are healthy, competent, and resourceful. People have the ability to construct solutions and alternative stories to enhance their lives.

Postmodern Beliefs

The client is the expert (therapist takes a “not knowing” stance)

Dialogue is used to elicit perspective, resources, and unique client experiences

Questions empower clients to speak and express their diverse positions

Pros of postmodern therapy

Depathologizing, strengths based, empowerment of client.

Draws upon strengths of other approaches- collaborative, cognitive, attention to past experiences, future oriented

Social constructionism is congruent with philosophy of multiculturalism

Cons of post modern therapy

Few rigorous empirical research studies

may not be appropriate for very specific, concrete, behavioral concerns, severe psychopathology, cognitive impairment

therapist’s “not knowing” stance may compromise client’s confidence in the therapist as an expert

Narrative therapy assumptions

people make meaning out of their lives through the construction of narratives or stories

when stories are problem saturated, we experience distress

How do problems develop in narrative therapy?

clients get stuck in living out dominant stories that are problem saturated

they adopt stories in which they and their problems are fused (they are the problem)

How does change occur in narrative therapy?

Client must rewrite their story/narrative

First, identify or name the problem and how it has contributed to this story

Separate the person from the problem

search for exceptions to the problem

ask clients to speculate what kind of future they could expect

create an audience to support the new story

narrative therapy techniques

interviewing the problem

externalizing the problem

search for exceptions

supporting the new story

What can be externalized?

feelings, thoughts, cultural practices, behaviors

Role of the therapist in narrative therapy

demonstrate care, interest, respectful curiosity, openness, empathy, and fascination

adopt a not knowing position that allows being guided by the client’s story

helps clients construct a preferred alternative story

to create a collaborative relationship with the client being the senior partner

solution focused brief therapy (SFBT) assumptions

problem itself may not be relevant to finding effective solutions (emphasis on present and future)

shift from problem oriented to solution focused

people can create their own solutions

small changes lead to large changes

SFBT roles of therapist

collaborative partnership because client is expert

ask skillful questionsSF

SFBT techniques

pre-therapy change → what have you done since you made the appointment that has made a difference in your problem?

exception question -→ is there a time in your life when the problem did not exist?

miracle question: if a miracle happened and the problem was solved, what would be different in your life?

scaling questions: on a scale from 1-10…

Integrative/eclectic psychotherapy

a particular form of psychotherapy that draws its theoretical basis and clinical methods from two or more theoretical orientations

combination of THEORIES AND TECHNIQUES

Psychotherapy integration

developing novel and effective approaches to psychotherapy by combining elements of two or more therapies

every approach to psychotherapy has something positive to offer

combination of TECHNIQUES

Integrative approaches

technical eclecticism

common factors

theoretical integration

assimilative integration

technical eclecticism

therapist selects and uses techniques from different approaches (working from a toolkit of different approaches)

most common and least complex form of integration

strength of technical eclecticism

can draw on a variety of approaches to meet different client needsw

weakness of technical eclecticism

may be atheoretical

→ does not require an underlying theory of how problems develop or how change occurs, uses techniques without understanding what is helping the client

common factors

shared factors across a variety of therapeutic approaches, such as empathy and the therapeutic relationship (30% of client outcomes/improvement)

common factor basis

different theoretical orientations do not show differences in effectiveness (with exceptions) and all approaches to psychotherapy share certain effective ingredients

maximize use of change processes common across theoretical orientations

theoretical integration

bringing together theoretical concepts from different approaches to form a new model of therapy

most difficult and sophisticated form of integration

example of theoretical integration

dialectical behavioral therapy (DBT) is an integration of behavioral therapy (change = emotion regulation and interpersonal effectiveness) and mindfulness (acceptance = mindfulness and distress tolerance)

assimilative integration

maintaining one central theoretical position while incorporating (assimilating) techniques from other theories

between technical eclecticism and theoretical integratione

example of assimilative integration

mindfulness based cognitive therapy

cognitive therapy is the main theoretical approach and mindfulness techniques are incorporated

Transtheoretical model (stages of change)

precontemplation

contemplation

preparation

action

maintenance

relapse or termination

Precontemplation

unaware of problem or consequences

increase insight

contemplation

considering a change but not ready to take action; stuck between changing and not changing (ambivalence)

increase insight

preparation

making plans to take action, “baby steps”

focus on action, behavioral change

action

actively making significant changes to behavior, experiences, and environment

focus on action, behavioral change

maintenance

prevent relapse of behavior; consolidate gains

anticipate/prepare for challenges; celebrate progress

relapse/termination

change process complete; zero temptation; high self efficacy

considerations of transtheoretical model

people do not pass through stages in a linear fashion

a client’s readiness can fluctuate throughout the change process

limitations: less explicit consideration of social or economic context in which person is trying to make change

empirical support of integrative therapies

not a lot of research, but the existing research generally supports efficacy

integrative therapy practice considerations

solid grounding in theoretical orientation

client understanding of treatment

adapting to clients

drawing on clinical wisdom and experience

therapeutic relationship in integrative therapies

extremely important, contributes substantially to therapy outcomes and client improvement

Systems Theory

Generic term for conceptualizing a group of related elements (people) that interact as a whole entity T

the system is more than the sum of its parts

the different components of the system interact with and influence each other

Virginia Satir

considered a founder of experiential approaches to family therapy

focused on the communication that families engage in

Murray Bowen

Founded Family Systems Theory or Bowen Theory

Focused on how to conceptualize problems as a result of the family of origin

Family Systems theory

individuals are best understood through assessing the interactions between and among family members

Client behaviors in family systems theory can…

serve a function in the family

be unintentionally maintained by family processes

be a function of family’s inability to operate productively

be a symptom of dysfunctional patterns (intergenerational)

How do problems develop in family systems theory?

triangulation, fusion, emotional cutoff, multigenerational transmission process

triangulation

process in which two people who are in conflict involve a third person in order to reduce the tension and avoid conflict in the relationship

fusion

family members’ feelings, thoughts, and behaviors are merged (undifferenetiated)e

emotional cutoff

boundaries are too rigid and family members are not in emotional contact

multigenerational transmission process

dysfunctional patterns are passed from generation to generation

How does change occur in family systems therapy?

de triangulate

differentiation while remaining connected

de triangulate

therapist brings attention to the role that each person is playing

family members are then helped to communicate neutrality

differentiation while remaining connected

how do “I” feel?

Problems typically addressed in couples counseling

Communication 84%

Unrealistic expectations

Little affection/sex

power struggles

decision making issues

Problematic communication

criticism, contempt, defensiveness, stonewalling

criticism

one partner attacks partner’s character, usually with the intent of making someone right/wrongc

contempt

attacks partner’s sense of self with intention to insultd

defensiveness

making excuses, “yes…but”