Theories 2.0

Role of theory in counseling

• Cannot operate atheorthetically

• Need to be aware of assumptions, principles, and beliefs in order to be purposeful in practice

• Being theoretically grounded increases intentionality as a counselor

• Separates professionals from informal helpers

Case conceptualization importance

• Considered the most practical tool

• Starting point for most effective practice

• Sistinguishes between professional helper from natural helper

• Allows for understanding of client with maximum flexibility

• It’s ongoing and dynamic, requires continual revision and refinement

Evolution of counseling theories

1. Psychoanalysis: human actions determined by internal drives and unconscious processes; Freud and followers dominated first half of 20th century

2. Behaviorism: behavior determined by environment and punishment; found psychoanalysis too philosophical, focus should be external

3. Humanism: emphasized free will and change; found psychoanalysis too pessimistic, behaviorism too mechanistic; believe technique is not important, but the way the counselor relates to the client

4. Psychodynamic/Interpersonal: teach an appreciation of the complexity of the human psyche and the power of human relationships

5. Behavioral/Cognitive: remind the value of staying grounded in what can be observed while remembering that actions are shaped by thoughts that cannot be seen

6. Humanistic/Experiential: stress a recognition of feelings as an essential part of human experience and the importance of exploring the lived experience of clients

7. Family and systemic approaches: emphasize the way an individual is shaped is by family and other social groups; argue that individual cannot be understood outside of context of other groups

8. Feminist and multicultural therapy: emphasize direct impact of culture on individual experience; have become expected part of ethical practice

9. Biopsychosocial and health psychology: address client, social context, and systems used to deal with illness; bridge gap between medical treatment and therapy

10. Constructivist approaches: based on notion of social construction of meaning; include narrative therapy and solution focused therapy

Therapeutic relationship

• Strong predictor of treatment success

• Most important ingredient of therapy

• Poor outcomes linked to negative interpersonal process;

• High failure to return rate among minority clients

Empirical research strongly and consistently supports the centrality of the therapeutic relationship as a primary factor contributing to psychotherapy outcomes.

Characteristics of effective counselors

1. Employs specific methods

2. Offers strong relationships

3. Customizes treatment methods and relationship stances to client and condition

4. Compassionate

5. Self aware

6. Self-respecting

7. Open to change

8. Authentic

9. Sincere, honest

10. Humility

11. Humor

12. Able to maintain healthy boundaries

13. Human

Values as a counselor

Influence how we think and act, however, our ethical obligation is to not impose our values onto clients

2 Types:

1. Personal

2. Cultural

Bracketing

ability to assist clients in understanding what their values are and finding answers that are most congruent with their own values without imposing our own

Culturally responsive counseling

We must embody cultural awareness, cultural humility, cultural knowledge, and cultural skills — acknowledge intersectionality!

Intersectionality: dynamic interplay between various cultural identities within a person

Ruptures in therapeutic relationships

a break, strain, or tension between a therapist and a client.

Negative progress, ruptures, and strains are inevitable and help us better understand a client’s relational schemas. Repairing a rupture is an important part of the therapeutic alliance.

• Withdrawal Markers include denial, minimal response, shifting the topic, intellectualization, storytelling

• Confrontation Markers include complaints about therapist as a person, therapist’s competence, activities of therapy, being in therapy, parameters of therapy, progress in therapy

If a client expresses a desire for you to give them answers, you should…

NOT give them answers.

Counselors who leave their reactions and selves out of their clinical work are likely to be effective/ineffective counselors.

Ineffective counselors and merely technical experts.

Conscious

the region of the psyche that contains thoughts, feelings, perceptions, and other aspects of mental life currently in awareness; the content of the conscious is continuously changing as the person shifts their attention.

Preconscious

the level of the psyche that contains thoughts, feelings, and impulses not presently in awareness but that can be readily called into consciousness.

Unconscious

the level of the psyche that cannot be studied directly but is inferred from behavior, dreams, Freudian slips and forgetting, post hypnotic suggestions, material from free-association and projective techniques, symbolic content of psychotic symptoms

Psychoanalytic view of human nature

Viewed human nature as determined by irrational forces, unconscious motivations, biological and instinctual drives, and life and death instincts. The goal of life is to gain pleasure and avoid pain.

Id

untamed drives or impulses at birth; ruled by pleasure principle, unconscious; part of personality

• “I WANT” → pleasure, impulses, immediate gratification

Ego

organize and mediate between id and external world; logical thinking, planning, ruled by reality principle; part of personality

• “I SHOULD” → morality, ideals, rules, guilt

Superego

last part of personality to emerge, internalized social component, expectations of parental figures, moral code, ideal, reward and punishment, inhibits id, persuades ego

• “WHAT CAN I REALISTICALLY DO?” → negotiates between id, superego, and reality

Eros

life instincts; serve the purpose of survival; growth, development, creativity, procreation, relationships, romantic love — psychoanalythic theory

Thanatos

death instincts; aggressive drive, unconscious wish to do or hurt ourselves or others; leads to risky behavior and destructive urges— psychoanalythic theory

Anxiety in psychoanalytic theory

• Result from conflict among id, ego, superego

• Freud viewed it as a feeling of dread that results from repressed feelings, memories, and desires

• Can induce a state of tension that motivates us to do something

What are the 3 types of anxiety?

Reality, neurotic, and moral ← existential isn’t included because this is Freud

Reality anxiety

the fear of danger from the external world; the fear is proportionate to the threat

Neurotic anxiety

fear that the instincts will get out of hand and cause the person to do something for which they will be punished

Moral anxiety

fear of one’s own conscience; when the ego cannot control anxiety by rational and direct methods, it relies on indirect ones, like ego-defense behavior

Defense mechanisms

adaptive behaviors (can become maladaptive) that help us cope with anxiety and either deny or distort reality; operate unconsciously, unintentionally, and not purposefully.

Follow a developmental pattern for their emergence and decline.

Compensation (defense mechanism)

Disliking an aspect of ourselves and making efforts to compensate for it (defense mechanism)

Denial (defense mechanism)

Refusing to accept a painful reality, facts, or something about ourselves (defense mechanism)

Displacement (defense mechanism)

Directing strong feelings/emotions onto a person or object that doesn’t feel threatening (defense mechanism)

Identification (defense mechanism)

(Un)conscious modeling of another person’s values, attitudes, or behaviors (defense mechanism)

Introjection (defense mechanism)

Conforming/accepting standards to be true to avoid scrutiny (defense mechanism)

Projection (defense mechanism)

Projecting faults and negative self-beliefs or concepts onto others (defense mechanism)

Reaction formation (defense mechanism)

Adopting behaviors or feelings that are exactly the opposite of one’s true emotions (defense mechanism)

Rationalization (defense mechanism)

Justifying a behavior by presenting reasons which sound logical (defense mechanism)

Regression (defense mechanism)

Retreating to infantile defenses and behaviors so life feels less threatening (defense mechanism)

Repression (defense mechanism)

(Un)consciously pushing feelings or thoughts away in order not to feel them (defense mechanism)

Ritual and undoing (defense mechanism)

Trying to undo a negative behavior by masking it with a positive one (defense mechanism)

Sublimation (defense mechanism)

Satisfying an impulse or a negative behavior with a socially acceptable one (defense mechanism)

Humor (defense mechanism)

Making light of darker experiences to make them more digestible (defense mechanism)

Transference

client carries over their feelings from past relationships into the client/therapist relationship

Countertransference

the therapist’s strong emotional reactions to a client

Resistance

any idea, attitude, feeling or action that fosters status quo and gets in the way of change

Goals of psychoanalytic/psychodynamic therapy

• Aim of psychoanalytic theory is to make unconscious motives conscious

• Treatment outcomes are reached when an individual uncovers the meaning of their symptoms and gains insight into the causes of their behavior and repressed material that interferes with functioning

• Person’s tendency to cling to old patterns is confronted by working through transference distortions

Role of the therapist in psychoanalytic therapy

• Anonymous nonjudgmental stance (blank screen approach)

• Foster transference relationship for clients to make projections onto therapist

• Establishing therapeutic alliance is key (safety for client) 

• Infers meaning from reported dreams, free associations, etc.

• Remains open and sensitive

Main therapeutic techniques in psychoanalysis

Free association, interpretation, dream analysis, analysis of resistance, analysis of transference

Free association (psychoanalytic technique)

clients are encouraged to say whatever comes to mind; flow with thoughts without censorship; nothing client says is taken for face value; therapists look for repressed material that may offer insight

Interpretation (psychoanalytic technique)

pointing out, explaining, and even teaching the meaning of behaviors that manifest in dreams, free association, therapeutic relationship, resistance, and defenses

Dream Analysis (psychoanalytic technique)

pathways to repressed material; connection to current struggles

Analysis of resistance (psychoanalytic technique)

analysis of any idea, attitude, feeling or action that fosters the status quo and gets in the way of change

Analysis of transference (psychoanalytic technique)

central technique in classical psychoanalysis; clients recognize relational dynamics/patterns and achieve insight into how past relationships are affecting present life

Jonathan Shedler’s psychodynamic model of therapy

1. Focus on emotions/affect: explore the full range of emotions – contradictory feelings, troublesome emotions, emotions that they can’t quite identify or articulate

2. Avoidance of distressing thoughts or feelings: exploring the ways that people avoid information and their own experience; how and why clients avoid distressing or threatening thoughts and feelings

3. Identification of recurrent themes or patterns: identifying recurrent patterns and themes that happen in people’s lives

4. Emphasis on past experiences, how the past lives on in the present: help clients understand the impact of early life experiences; free themselves of the limitations of the past to live more fully in the present

5. Focus on interpersonal experiences: the majority of mental health issues are rooted in problematic relationship patterns

6. Emphasis on therapeutic relationship (working relationships): focusing on counselor-client relationship; deep belief that is the relationship that is healing; transference offers a unique opportunity to rework some of it in that relationship

7. Exploration of wishes, dreams, and fantasies: take seriously the fantasy life of the client because it tells us something important about their experience

During psychoanalytic treatment, clients are typically asked to…

Clients are asked not to make radical changes in their lifestyle.

Analysis of transference is central to psychoanalysis because…

Analysis of transference allows clients to relive their past in therapy and to gain insight.

From the Freudian perspective, resistance is typically a conscious/unconsious process.

From the Freudian perspective, resistance is typically an UNCONSCIOUS process.

Directive procedures are/are not called for when clients feel that they are "stuck" in therapy.

Directive procedures are NOT called for when clients feel that they are "stuck" in therapy.

Individual Psychology

Adler's, original-yet-misleading name for his approach that stressed understanding the whole person

All dimensions of a person are interconnected, and all dimensions are unified by the person's movement toward a life goal

Views each person as an indivisible, goal-directed whole shaped by social context rather than biological drives

Adlerian view of human nature (teleological aspect)

People have a natural need for meaning and significance

All behavior is goal driven.

Goal is envisioned in early life (even earlier than age 5).

People move toward personally meaningful goals, and all ways of being are directed towards final goal.

Adlerian view of human nature (sociological aspect)

 Feeling of being at home in the world

People are best understood in the context of relationships.

People are social by nature. Social interest is nurtured (or not) in the family unit.

Well-developed social interest results in a sense of being capable of making worthwhile contributions to the world.

Community feeling is central to Adlerian therapy (connection/belongingness).

People need community and connection to feel whole.

Unity of personality in Adlerian therapy

people can only be understood as integrated and complete beings

The sum of an individual's thoughts, feelings, emotions, and behaviors are an indivisible, coordinated whole.

Inferiority feelings in Adlerian therapy

Early determining force in behavior

The source of human striving and the wellspring of creativity.

Attempts to compensate for both imagined and real inferiorities, which helps people overcome handicaps.

Sources of Inferiority:

• Childhood/upbringing

• Social experiences

• Feelings of incompleteness

Striving for superiority in Adlerian therapy

A strong inclination toward becoming competent, toward mastering the environment, and toward self-improvement.

The striving for perfection (and superiority) is a movement toward enhancement of self.

Striving for Superiority:

• Seeking complete wholeness

• Overcoming deficiencies

• Developing social interest

Private logic in Adlerian therapy

Thinking about self, others, and life as if the only that individual matters 

• Private fiction for how the world operates can lead to maladaptive responses; we operate as if the fiction were true

• When stress becomes distress, private logic occurs; develops from disconnection

• Adler believed private logic developed to preserve sense of worth and most of these biases are unconscious rather than conscious

Fictional finalism in Adlerian therapy

an imagined central goal that gives direction to behavior and unity to the personality— what people would be like if they were perfect and entirely secure.

Basic mistakes in Adlerian therapy

Faulty, self-defeating perceptions, attitudes, and beliefs that may have been appropriate at one time but are no longer useful.

These are myths that are influential in shaping personality.

Social interest in Adlerian therapy

A sense of identification with humanity; a feeling of belonging; an interest in the common good.

High → greater degree of wellbeing; cooperation, creativity, contribution

Low → feeling useless, self-defeating behaviors; moving against or away from others

Lifestyle in Adlerian therapy

The core beliefs and assumptions through which we organize our reality and find meaning in life events.

Our perceptions of self, others, and the world and our characteristic way of thinking, acting, feeling, living, and striving toward long-term goals.

Adler considered this the largest aspect of personality.

An individual’s lifestyle includes… in Adlerian therapy

a life goal, personal law of movement, the individual’s assessment, opinion, and evaluation of self, unification of personality, and the life problem or task that must be faced

Conviction of lifestyle includes… in Adlerian therapy

Sense of self, ideal self, picture of the world, and ethical

Sense of self in Adlerian therapy (conviction of lifestyle)

(Conviction of lifestyle) What you believe about who you are right now, focused on your perceived strengths, weaknesses, identity, and capabilities

Ideal self in Adlerian therapy (Conviction of lifestyle)

What you think you should be, focused on the rules, standards, or obligations you believe you must meet to feel worthy and accepted (Conviction of lifestyle)

Picture of the world in Adlerian therapy (Conviction of lifestyle)

Your beliefs about the rest of the world and other people, focused on what you expect from the environment, how you view others, and what you think life demands of you (Conviction of lifestyle)

Ethical conviction in Adlerian therapy (Conviction of lifestyle)

Your personal code of right and wrong, focused on how you judge your own behavior and the actions of others (Conviction of lifestyle)

Style of life in Adlerian therapy

Individual’s way of looking at and interacting with the world; not uncovered without deliberate effort

• Healthy: psychological flexibility, errors in interpretation do not impair adaptability

• Disturbed: low psychological flexibility, errors generate difficulties in relationships, goal-achievement, social interaction expectations; difficulty adapting because of lifestyle rules

Family constellation in Adlerian therapy

The social and psychological structure of the family system; includes birth order, the individual's perception of self, sibling characteristics and ratings, and parental relationships. Each person forms a unique view of self, others, and life through the family constellation.

• Early experiences have strong influence; children learn by observation and modeling

• Influence of family and family roles are central to Adlerian understanding of individuals

• Family is the first social network: we find our place, sources of striving for superiority, rules/values are developed

Birth order in Adlerian therapy

Adler identified five psychological positions from which children tend to view life: oldest, second of only two, middle, youngest, and only. Actual birth order itself is less important than a person's interpretation of their place in the family.

• Birth position is an interpretation, increases the probability of certain experiences. Trends that begin in childhood because of sibling relationships can influence individuals through life.

Dreikurs 3 life tasks in Adlerian therapy

Work task, social task, and intimacy task

Early recollections in Adlerian therapy

Childhood memories (before the age of 10) of one time events. People retain these memories as capsule summaries of their present philosophy of life. From a series of early recollections, it is possible to understand mistaken notions, present attitudes, social interests, and possible future behavior.

Adler believed that early recollections were in a window into client’s thoughts and feelings about how they they have come to understand themselves, others, and life tasks

Encouragement in Adlerian therapy

Process of increasing one's courage to face life tasks; used throughout therapy as a way to counter discouragement and to help people set realistic goals.

Part of phase 4, adaptive reorientation and reeducation – stage is focused on promoting change through action; requires therapist encouragement

Courage in Adlerian therapy

the willingness to act, even when fearful, in ways that are consistent with social interest; part of phase 4, adaptive reorientation and reeducation

Lack of willingness to act can cause psychological difficulties: 

• Exaggerated sense of inferiority

• Insufficient feeling of community

And lead to anticipating failure, avoiding life tasks, and blaming, complaining, excuse making (largely unconscious).

Goal-directed behavior in Adlerian therapy

All human actions are inherently purposeful and oriented toward a future objective rather than merely driven by past causes

Movement in Adlerian therapy

how people evaluate themselves, others, and their world drives their law of movement; helps people handle life challenges and move towards their final goal

Movement toward in Adlerian therapy

Movement is in the service of connection and the feeling of belonging; aim at helping us to count, to feel capable, and to handle life’s challenges

• EX: A manager notices their team is burning out. Instead of blaming them, the manager organizes an open forum, listening to their struggles, and collaborating with them to restructure the workload.

Movement against in Adlerian therapy

When individuals work against themselves, even to the point of being self-destructive; reacting with anger and the assertion of power and even seeking revenge

• EX: A sibling feels overshadowed by their successful older brother. To safeguard their self-esteem, they constantly move against their brother by mocking his achievements, starting arguments at family dinners, and trying to outdo him in a hostile, competitive way.

Movement away from in Adlerian therapy

Withdrawal movement is a safeguard or protection against loss and hurt; when survival is threatened, usually by abuse or neglect

• EX: An employee is assigned a high-profile presentation. Terrified that they will fail and look foolish, they move away from the challenge by calling in sick on the day of the meeting or ignoring emails from their supervisor.

Ambivalent movement in Adlerian therapy

Characterized by displays of inadequacy, in giving up when faced with life tasks and challenges, and with both anxiety and depression becoming everyday life experiences.

• EX: A person wants to propose to their long-term partner. They buy a ring (movement toward), but then focus heavily on small flaws in the relationship and postpone the proposal (movement away). They remain stuck in this loop for years, never fully committing nor breaking up.

Four counseling phases in Adlerian counseling

1. Establishing the relationship

2. Exploring the individual's psychological dynamics

3. Encouraging self-understanding and insight

4. Adaptive reorientation and reeducation (techniques)

1. Establishing the relationship (Four Adlerian counseling phases)

• Collaboration, Listening, and Empathizing

• Collaborative and caring relationships are hallmark of Adlerian approach

• Therapeutic process is only possible when there is an alignment between clearly defined goals

• Later phases of therapy hinge upon therapeutic alliance

• Focus on relationship rather than presenting problem

• Adlerian therapists focus on subjective experience more than techniques

• Understand client’s maladaptive patterns

(Four Adlerian counseling phases)

2. Exploring the individual's psychological dynamics (Four Adlerian counseling phases)

• Explain assessment and reason for obtaining personal info, especially family structure

• Strong therapeutic alliance needed for assessment phase

• Assessed through subjective interview, objective interview, and lifestyle assessment

(Four Adlerian counseling phases)

3. Encouraging self-understanding and insight (Four Adlerian counseling phases)

• Interpret findings of assessment as a way to promote self-understanding

• Goals of behaviors are made conscious

• Insight does not lead to change

• People can make significant changes without insight

• Adlerian interpretations are suggestions; open-ended, explored, and hunches

(Four Adlerian counseling phases)

4. Adaptive reorientation and reeducation (Four Adlerian counseling phases)

• Development of preferred life and lifestyle that supports it; ultimate goal of therapy

• Stage is focused on promoting change through action; requires therapist encouragement and use of client’s psychological muscle

(Four Adlerian counseling phases)

Subjective interview

Client tells life story, since clients are experts of their own lives; extract patterns, ways of coping, approach to life

Objective interview in Adlerian therapy

uncover holistic narrative, lifestyle assessment, private interpretations, family constellation, client’s evaluation of family conditions, early recollections, cast a light on “story of our life” and interpretation, striving for superiority

Lifestyle assessment in Adlerian therapy

informs the interpretation people develop that govern what they do (movement); various approaches like family constellation interview, asking the question, early recollections

Psychological muscle in Adlerian therapy

exercise of responsibility, cooperation, respect for self and others, and courage in the daily approach to life tasks

Reorientation in Adlerian therapy

the phase of the counseling process in which clients are helped to discover a new and more functional perspective and are encouraged to take risks and make changes in their lives.

Viktor Frankl in Existential therapy

explored meaning (logotherapy), freedom, responsibility, values in Existential therapy

Rollo May in Existential therapy

explored anxiety, courage to be, aloneness in Existential therapy

Irvin Yalom in Existential therapy

developed existential approach to therapy and death anxiety in Existential therapy

View of human nature in Existential therapy

Existential therapy believes — We need to make sense of our existence. The human experience is never fixed. Feelings of impermanence and uncertainty generate emptiness and anxiety. We must constantly recreate ourselves through projects (aka creativity). 

Six major propositions in Existential therapy

1. The capacity for self-awareness

2. Freedom and responsibility

3. Striving for identity and connection with others

4. The search for meaning, purpose, values, and goals

5. Anxiety as a condition of living

6. Awareness of death and nonbeing