Theories of Counseling Midterm

Psychoanalytic/dynamic view of human nature

• Deterministic

• Driven by dynamics b/t id, ego, and superego

• Personality develops during psychosexual stages ages 0-6 or psychosocial stages

Psychoanalytic/dynamic cause of psychological suffering

• Anxiety is caused by repressed feelings/desires/thoughts/memories surfacing to awareness.

  • Neurotic anxiety= fear of instincts (id) taking over and causing moral/social punishment (superego)

  • Lack of resolution/impairment during psychosexual or psychosocial development

Ego creates defense mechanisms:

• repression

• denial

• projection

• displacement

• rationalization

• reaction formation

• sublimation

• regression

Psychoanalytic/dynamic therapy goal

1. Make unconscious conscious

2. Strengthen the ego

Psychoanalytic/dynamic therapy techniques

• Free association

• Dream analysis

• Projection/transference onto therapist

• Analysis of resistance

Psychoanalytic/dynamic therapeutic relationship

Traditional: therapist uses blank screen approach to foster projection, offers psychodynamic interpretations

Psychoanalytic/dynamic contemporary theories

• Carl Jung- collective unconscious, dream work

• Object-relations theory

• Self psychology

• Relational psychodynamics

Adlerian view of human nature

• Individual parts are unified via goals. We move toward, against, aware from, or are ambivalent towards goals.

  • Goals/movements are determined by style of living= perception of past, private logic

Adlerian cause of psych suffering

Lack of preparation or confidence in ability to deal with demands of life and socially connect

• Faulty private logic of past or self

  • Overgeneralization, minimization of worth, impossible goals (fictional finalism)

Adlerian therapeutic goals

1. Holistic life investigation

   1. People fail to change because they don’t recognize errors in thinking.

2. Develop sense of belonging, usefulness, contribution to society

3. Build preferred lifestyle + psychological muscle

Adlerian therapeutic techniques

1. Holistic life investigation

   1. Subjective interview, The Question, objective interview and lifestyle assessment.

   2. Develop insight

2. Develop sense of belonging, usefulness, contribution to society

   1. Encourage social interest, acceptance of others.

3. Build preferred lifestyle + psychological muscle

   1. Create third-order change, develop psychological flexibility and adaptability.

Adlerian therapeutic relationship

Egalitarian

Person-Centered Therapy history

• Developed by Carl Rogers- 1st person to systematically study the counseling process

• Shaped by nondirective counseling (counselor does not know best), client-centered therapy, humanism, emotion-focused therapy

Person-Centered Therapy view of human natue

• People are trustworthy and capable of understanding themselves/solving their own-problems.

• Actualizing tendency= people will self-actualize naturally when their basic needs are met.

  • Maslow’s hierarchy of needs

  • Shifted focus away from pathology

Person-Centered Therapy cause of psych suffering

Basic needs are not met or emotional regulation skills are not present

Person-Centered Therapy therapeutic goal

Help the client to achieve independence and integration.

• Incongruency= mismatch between reality and goal

• Unacceptable feelings able to be explored in a safe setting

• Specific problem-solving is NOT focus

Person-Centered Therapy therapeutic techniques

• Client-therapist relationship is the key to outcomes

• Necessary & sufficient conditions must be met.

1. Two persons are in psychological contact

2. The client is in a state of incongruence, vulnerable or anxious

3. The therapist is congruent in the relationship

4. The therapist experiences unconditional positive regard for the client

5. The therapist experiences empathic understanding of the client's frame of reference

6. This empathic understanding and positive regard are communicated to the client

• Client self-assessment over official assessment/diagnosis

Person-Centered Therapy therapeutic relationship

Therapist is congruent (genuine), shows unconditional positive regard and an accurate empathic understanding of client’s subjective world.

Person-Centered Therapy applications

Shown to be just as effective as goal-directed therapies

Useful in group settings, crisis interventions, and work with children

Existential Therapy history

Developed in aftermath of WWII from philosophical movement

• Victor Frankl- logotherapy

• Rollo May- problems of being vs problem-solving

• Irvin Yalom- the Four Givens

• Bugental- resistance to the present

• Emmy van Deurzen- sick of life or “clumsy” at life

Existential Therapy view of human nature

Humans design their life path, there is no predetermined path. We are finite and fundamentally alone; anxiety and death are conditions of life.

Existential Therapy cause of psych suffering

Inauthenticity, surrender of responsibility to life circumstances, meaninglessness

Existential Therapy therapeutic goal

Build client’s ability to consciously shape their life.

6 propositions:

1. Self-awareness

2. Freedom and responsibility

3. Search for identity and relationship

   1. Relationships build out of fulfillment, not deprivation or reliance

4. Search for meaning

5. Anxiety as a condition of living

6. Awareness of death and nonbeing

Existential Therapy therapeutic techniques

More of a philosophy than set techniques.

1. Clarify assumptions of non-responsibility or inauthenticity

2. Restructure values

   1. Motivated by existential guilt, death/nonbeing

   2. Fills in existential vacuum

3. Take action

   1. Encourage freedom to take risks

Existential Therapy therapeutic relationship

Therapist is a “fellow traveler”, not a healer.

Shared decision-making

Existential Therapy application

Useful for developmental crises, major life changes/decisions, grief/loss

Can be overly individualistic/emphatic of subjectivity

Gestalt Therapy history

Developed by Fritz Perls

• Influenced by personality holism + field theory

• Perls used a confrontational approach

Gestalt Therapy view of human nature

Field theory practice= humans must be understood within their environment

Gestalt= the essence of a form cannot be separated into its parts

Individuals are able to self-regulate when they are aware of what is happening in their environment.

• Figure

• Ground

Gestalt Therapy cause of psych suffering

Contact boundary disturbances or resistances= avoidance of the present moment

• Introjection

• Projection

• Retroflection

• Dejection

• Confluence

Unfinished business= figures that do not resolve into the background and blocks contact with self and others

• Impasse= old coping mechanisms no longer exist + external support no longer available

• Paradoxical theory of change= the more you strive for inauthenticity, the more you feel stuck

Gestalt Therapy therapeutic goal

1. Increase awareness- engage with the present

2. Increase choice/freedom to choose differently

3. Ownership of experiences and their consequences

4. Acceptance and integration of all parts of self

5. Create contact

Gestalt Therapy therapeutic techniques

• Phenomenonological inquiry- bring attention to present using ‘How’ and ‘What’ questions

• Experiments

  • Empty chair technique

  • Future rehearsal

  • Exaggeration

  • Reversal exercise

  • Dream work

• Attendance to client’s ground (unconscious presentation)- body language, tone, metaphors, avoidance of statements or “I” language

Gestalt Therapy therapeutic relationship

Active partnership

Therapist accompany client through impasses, don’t rescue them

• Impasses must be fully experienced to get through them

Client is expert of their own experience

• Self-discovery over interpretations by therapist

Gestalt Therapy application

Holistic approach, challenges clients creatively, moves from talk to action and direct experience

Experiments should be based on rationale, not just novelty

Caution required when interpreting bodily sensations

Historical confrontational approach has been criticized

Feminist Therapy history

• No single founder; developed in response to white, male, European and American psychologists dominating counseling theory

• Based in feminist philosophy, social justice and multicultural concepts

Feminist Therapy view of human nature

• The personal is political

• We are socialized to accept gender roles and other forms of oppressive cultural norms

• Marginalized voices should be honored and valued

Feminist Therapy cause of psych suffering

• Oppression and marginalization

  • Reinforced via cultural norms

  • Internalized without our awareness

• Shifts focus from individual symptoms to social factors

Feminist Therapy therapeutic goal

1. Increase awareness of gender roles

2. Identify internalized oppression and replace with self-enhancing beliefs

3. Acquire skills to create social change

4. Develop sense of personal and social power

5. Recognize power of relationship and connectedness

Feminist Therapy therapeutic techniques

• Gender role/social identity analysis

• Power analysis

• Reframing and relabeling blame

• Bibliotherapy

• Assertiveness training

• Social action

Feminist therapy is strengths-based, focuses on sociopolitical factors over pathologizing/”dehumanizing” individual.

• Across lifespan

• Intersectionality of identities

Feminist Therapy therapeutic relationship

Egalitarian relationship- non-hierarchical, equal power between therapist and client.

• Therapist monitors personal biases and power dynamic.

• Incorporation of feminism, social justice, and sociocultural context

Feminist Therapy contemporary approaches

• Relational-cultural theory: relationships drive change; focus on relational resilience, mutual empathy, and social justice

• Transnational feminism: focus on diverse female experiences across the globe, consideration of positionality and reflexivity

Family Systems view of human nature

Individuals are best understood within their family systems/relationship dynamics.

• All families have unique culture and unspoken rules to maintain system balance.

• Change most effective within relationships- systemic processes have more power than individual ones.

Family Systems cause of psych suffering

Individual symptoms serve a function within family systems and are unintentionally maintained.

• Reflective of familial dysfunction, maybe generationally.

Family Systems therapeutic goal

Patterns within family/key relationships must be understood and challenged.

1. Decrease symptoms of dysfunction.

2. Change transactional roles.

3. Create more appropriate boundaries.

Family Systems therapeutic techniques

• Genogram of generational patterns

• Analysis of family culture, power, alignment, organization.

  • Parent and child subsystems and boundaries- what happens when crossed?

  • Use “How” ?s

• Inner parts work: firefighters, managers, exiled parts

• Untangle triangulations/triads

• Boundary setting

• Unbalancing power dynamics

• Enactments

  • Initiation > facilitation > closing.

  • Focus is on process, not content.

• HW between sessions

  • Must be co-created and understood by family

Family Systems therapeutic relationship

Therapist takes a curious, “not knowing” stance.

• Family is expert of their own experience.

• Asks permission and invites engagement when offering hypotheses.

Collaborates with all family members present, takes de-centered position within system to observe without taking over.

• Therapist is in charge during enactments and coaches family through process.

Family Systems contemporary approaches

Conjoint family therapy- intergenerational family sculpting and reconstructions, triad work

Structural-strategic therapy- change transactional patterns to create more healthy boundaries (joining, enactments, unbalancing, parent-child subsystems, etc)

Family Systems applications

Family must be understood within cultural context

• Who holds power? What is a healthy family? Who counts as family?

Therapist must consider how much influence they are willing to have in the family’s life.

Choice/Reality Therapy view of human nature

Love and belonging is our primary need, drives our behavior.

• Behavior is made up of acting, thinking, feeling, and physiology

• Chosen behavior attempts to meet our needs (our “quality world” or “picture album”)

Choice/Reality Therapy view of psych suffering

Symptoms/problems driven by a lack of satisfying relationships or lack of connection. Pain is seen as behavior (“anxiety-ing”, “depressing”), not pathological.

Choice/Reality Therapy therapeutic goal

1. Prioritize relationships

   1. How to connect to quality world, fulfill social needs

   2. Learn how to meet needs or long-term goals with better behaviors

2. Choice and responsibility for self only

   1. Focus on relationship-building, not symptoms

   2. Focus on present needs only

Choice/Reality Therapy therapeutic techniques

Self-evaluation questions

WDEP system:

• W= wants and needs

• D= direction and doing (present-based)

• E= evaluation (is current behavior helping or hurting?)

• P= planning and action, using SAMIC

  • Simple

  • Attainable

  • Measurable

  • Immediate

  • Controlled

Choice/Reality Therapy therapeutic relationship

Safe alliance allows clients to try new behaviors and re-evaluate in session

• Client decides what to try, goals

Therapist should be supportive and challenging

Therapist must reject transference

Therapist should fit into client’s quality world

Choice/Reality Therapy application

Short-term, action-oriented intervention

Seriously limited by not accounting for environmental forces

Behavioral Therapy history

BF Skinner= founder

• classical and operant conditioning

Bandura

• social-cognitive therapy

Behavioral therapy followed shift towards conditioning in the 50-60s

In the 1980s, emotions and biology came into focus

Behavioral Therapy core tenets

1. Scientific method

2. Concrete goals

3. Operationalization of present behavior

   1. Insight is not a prereq for change

4. Active clients: education, HW

Behavioral Therapy techniques

• Functional assessment: ABC model

• Progressive muscle relaxation

• Systematic desensitization

• In vivo exposure and flooding

• EMDR

• SUDs

• Behavior rehearsal and real-life practice

• Psychoeducation