Counseling Psych Exam 3

What was the main contributions of Viktor Franki

Founder of logotherapy

focus on finding meaning and purpose

translated existential philospohy into existential therapy

What was the main contribution of Rolly May

He brought existentialim from Europe to the US

Roots of Existential therapy

Clients are searching for meaning in their subjective worlds

Humans are in a constant state of transtion, evolving and becoming

Existential Therapy

Rejects the deterministic model of traditional psychoanalysis and behaviorism

Focuses on choices

Reacts against the identification of therapy with a set of techniques and instead bases practices on an understanding or what it means to be human

Believes that every person possess a health core belief

Six propostivions about human condition

The capacity for self-awareness increases

Freedom and responsibility

Striving fro 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 four ultimate concerns

Freedom

Death

meaningfulness

Isolation

A state of inauthenticity

Anxiety (normal/existential vs neurotic)

How does change occur in Existential therapy?

Three main phases

Clients are assisted in identifying and clarifying their assumption about the world

Rapport and relationship are key

Clients are assisted in more fully examining the source and authority of their present value system

Get better sense of what kind of life they think of as worth living and develop a clearer sense of their internal valuing process

Clients are assisted in translating what they have learnt into meaningful act

Action happens here- departure from psychodynamic

Goals Of Existential therapy

Helping clients to accept their freedom and responsibility to act

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

Encouraging clients to recognize the ways in which they are living fully authentic lives

Inviting clients to become 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

Role of Therapist in Existential Therapy

No uniform roles

To understand the subjective world of the client and help the client come to new understandings and options

To find meaning

Therapeutic relationship is key

Core of the therapeutic relationship

Authenticity

Confront clients honestly

Role of Client in Existential Therapy

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

Active-during the sessions, must decide which fear, guilt feelings, and anxiety they want to explore

Confront ultimate concerns, rather than coping with immediate problems

The focus is on removing roadblocks to meaningful living

Therapeutic techniques of Existential Therapy

General de-emphasis of specific techniques

Paradoxical intention

Dereflection

Socratic questions

Writing your own eulogy

Therapeutic relationship is most effective and powerful technique

Pros of Existential therapy

Humanize therapy

provides a perspective on basic human conditions

relevant in multicultural contexts

Cons of Existential Therapy

Concepts are abstract and ambiguous

Lack empirical backing

Limited applicability to

Lower-functioning

Clients concerned about basic needs

Highly focussed on self-determinism and may ignore other factor (systematic oppression)

What is Gestalt Therapy

Frederick (Fritz) Peris

emphasis : how people function in their totality

Reaction against reductionism and determinism

Gestalt view of Human Nature

Self-actualizing tendency

The process of being what one is and not a process of striving to become

The whole is more than a sum of its part

Striving to coordinate the various parts into a healthy, unified whole

what are the major beliefs of Gestalt therapy

Stresses individual responsibility & individuality

All individuals are actors, not just reactor

Anti-deterministic

Important to differentiate self from others & to connect self and other

Believes in the “power in the present”

The past is gone and the future has not yet arrived

Promotes direct experiencing

For example, rather than talk about a childhood trauma, the client is encouraged to become the hurt child

How do problems develop in Gestalt therapy

Lack of awareness

Being unaware of current feeling, thoughts, and behaviors

Lack of integration between different parts of the self inhibits people from self-regulation

From our inordinate focus on the past and future rather than the present (“unfinsished business”)

Feelings of alienation develop between the self and the objective world

Not living in the “here and now”

Unfinished Business

Unexpressed feelings that interfere with current psychological functioning

These feelings are associated with distinct memories and fantasies

Feelings not fully experienced linger in the background and interfere with effective contact

Possible results

preoccupation , distress, self-defeating behaviors, cognitive distortions

problems continued (Gestalt)

Resistance to contact

Defenses we develop to prevent us for experiencing the present fully

Introjection: accepting others’ views without reviewing them

Confluence: weak boundaries between self & 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 sb is polite instead of direct

What is emotion focused therapy?

Greater emphasis on emotions

Short term therapy (8-20)

Emotions are connected to needs

Focusing on emotions can lead to therapeutic change

Primary adaptive emotions

Initial emotional response; clear beneficial value

Primary maladaptive emotions

Initial emotional response; not beneficial

Secondary reactive emotions

Reaction to the initial emotional response

Instrumental emotions

Emotions expressed because they have an effect on others

How does change occur in Gestalt Therapy

Awareness

Increasing awareness of all parts of the self

Contact

Making contact with one’s inner anf external world without losing sense of self and individuality

Greater choice

Helping clients assume ownership of their experience, increasing internal coping strategies

Outcome= reowning

Identification with all vital function of the individuals, including ideas, emotions, anf actions

What are Gestalt therapy techniques

Internal dialogue - empty chair

Enactment- exaggeration a person is asked to exaggerate some feelings, thoughts or behavioral moments in order to feel it more intensely

Focusing: encourages clients to continually focus on their present awareness or experiences and stay with the feeling

sadness - where do you feel that in your body

rehearsal : role play

reversal: role play, but take others’ role

What is the role of the therapist in gastalt therapy

Creates an atmosphere that promotes growth and self-actualization

Uses immediacy skills regularly

Identifies patterns, particularly related to avoidance

Uses techniques in the service of increasing clients’ awareness

Strives for a person-to person relationship

Role of the client in Gestalt therapy

Actively engaged in therapy as experts of their own experiences

Make interpretations anf make meaning out of their experiences

Pros of Gestalt therapy

Deemphasizes abstract intellectualization of one’s problems

Recognizes working with the past as it relates to here and now

Emphasizes doing

Heightens awareness ina novel way

Helps individuals integrate polarizes within themselves

Cons of Gestalt therapy

Potential for abuse

May not be useful client who have difficulty abstracting and imagining or focusing on emotions

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

Fewer studies on this approach

What are two major types of postmodern therapies?

Nsrrative therapy

Solution-focused brief therapy

View of nature for Postmodern Therapies

Postmodern therapists assume that realities are socially constructed there is absolute reality

PM therapists see people as healthy, competent, resourceful

PM therapists believe that people have the ability to construct solutions and alternative stories to enhance their lives

Postmodern Beliefs

• The client not the therapist 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 to express their diverse positions 

• The  therapist supplies optimism and the process

Strengths of postmodern therapy

Depathologizing strength-based empowerment of the client

Draw upon strengths of other approaches: collaborative, cognitive, attention to past experiences, future orientated

Social constructionism is congruent with the philosophy of multiculturalism

Critques of postmodern

Few rigorous empirical research studies

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

For some individuals the therapist's not knowing the clients confidence in the therapist as an expert

How do problems develop in narrative therapy

Clients get stuck in living out dominant stories that are problem-satuated

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

Have a limited perception of their capacities

How does change occur in narrative therapy

• The client must rewrite their story 

• Identify or name the problem

  • Give the problem a life of its own 

  • Identify how the problem has contributed to the client’s problem-saturated story

• Separate the person from their problem

• Search for exceptions to the problem saturated story 

• Search for exceptions to the problem-saturated story 

• Ask client to speculate about what kind of future they could expect frok the competence person that is emerging 

• Create an audience to support the new story

NT techniques

Interviewing the problem

Externalizing the problem

Search for exceptions

Supporting the new story

interviewing the problem

• Hello (feeling). It seems like you’ve craved out a nice space for yourself in (client’s name) life.

• What purpose are you serving?

• What in (client’s) life scares you? Who seems to want you gone?

• What does (client) do that makes you think they don’t want you around?

• What are some things that you do in (client’s) life to make sure you stick around?

• What do you hope to do to (client) over the long term? What is your goal?

Externalizing the problem

Separate person from problem

I am a depressive person → Depression has made your life difficult

She is an anorexic → She is a person fighting against anorexia

What can be externalized?

e.g., Feelings, thoughts, cultural practices, behaviors

search for exceptions

• Unique outcome questions 

  • Describe a time that anger showed up on your life, but you resided 

  • Tell me about a time that you chose a healthy coping skill and rejected the alcohol influence. What was this like for you? How did you do it 

Supporting the story

Aimed at reinforcing the new story that has developed

Sharing the new story with an audience

An appreciative audience helps new stories to take root

NT role of therapist

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

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

To help clients construct a preferred alternative story

To create a collaborative relationship—with the client being the senior partner

Solution Focused brief therapy assumptions

The problem itself may not be relevant to finding effective solutions

Thus, the past is downplayed, while present and future are highlighted

A shift from “problem-orientation” to “solution-focus”

People can create their own solutions

A therapist’s “not knowing” affords the client an opportunity to construct a solution

Small changes lead to large changes

SFBT roles of therapist

• Create a collaborative partnership because the client is the expert on their own life

• Ask skillful questions because they:

  • Allow people to utilize their resources

  • Imply change (especially “how” questions)

  • Focus attention on solutions

  • Help people pay attention to what they are doing and can open up possibilities for them to do something more/different

SFBT techniques

• Pre-therapy change

  • What have you done since you made the appointment that has made a difference in your problem?

• Exception questions

  •  Is there a time in your life when the problem did not exist?

• Miracle question

  • If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?

• Scaling questions

  • On a scale of 0 to 10, where are you with respect to ____ ?

What is the integrative/Eclectic approach

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

4 types of integrative appraches

1. Technical eclecticism 

2. Common factors

3. Theoretical integration

4. Assimilative integration

Technical eclecticism

• Therapist selects and uses techniques from different approaches

  • Working from a “toolkit” of different approaches

• Most common & least complex form of integration 

• Strength: can draw on variety of approaches to meet different client needs

• Weakness: may be atheoretical 

  • Does not require an underlying theory of how problem develop or  how change occurs

  • Using techniques without understanding what is helping the client 

Common factors

Extratherapeutic factors- qualities of the client ot qualities of their environment that aid in recovery regardless of their participant in therapy 

Common factors- shared factors across a variety of therapeutic approaches, such as empathy and the therapeutic relationship 

Specific techniques- factors unique to specific therapies and tailored to treatment of specific problems

Expectancy factors- clients expectations of helo or beleif in the rational or effectiveness of therapy (placebo, hope)

• Findings that different theorretical orientations do not show differences in effectiveness 

• Some exceptions 

• Idea that all approaches to psychotherapy share certain effective ingredients 

• Maximizing use of change processes common across theoretical orientations (common factors)

Theoretical integration

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

• Most difficult & sophisticated form of integration

• Example: Dialectical Behavioral Therapy

  • An integration of behavioral therapy and mindfulness

  • In DBT, the dialectical framework allows for the synthesis and integration of mindfulness and behavioral theories—radical acceptance on one hand and the need for changes on the other

• Acceptance: mindfulness, distress tolerance

• Change: emotion regulation, interpersonal effectiveness

Assimilatative integration

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

• Between technical eclecticism and theoretical integration

• Example: Mindfulness-based cognitive therapy (MBCT)

  • Cognitive therapy as the main theoretical approach

  • Incorporate mindfulness techniques

Pre-contemplation

unaware of problems or consequences

increase insight (validate nurture/explore)

Contemplation

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

increase insight (listen,encourage)

preparation

Making plans to take action; can take “baby steps”

focus on action; behavioral change (smaller steps)

Action

Actively making signifcant changes to behavior;experiences and environment

Focus on action behavioral change (larger steps)

Maintenance

prevent relapse of beahvior;consolidate gains

Anticipate/prepare for challenges; celebrate progress

Relapse/termination of behavior

change process complete zero temptation high self-efficacy

Virginia Satir

Founder of experimetnal appraches of family therapy

focused oo the communication thst families engage in

Murray Bow

founded famiily system theroy (Bowen Theory)

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

System Theory

• Generic term for conceptualizing a group of related elements (people) that interact aas a whole entity (family or couple)

• The system is more than the sum of its parts: The different components interact with and influence each other 

Assumptions of family system theory

Client behaviors can:

• Serve a function in the family 

• Be unintentionally maintained by family processes

• Be a funcion of family’s inability to operate productively 

• Be a symptom of dysfunctional patterns

  • Intergenrational

How does problems develop in Family therapy

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 (undifferentiated)

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 therapy

Do trigangulate

The 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?

What is the most common problem addressed in couples therapy

Communication- Excessive demands,Withdrawing expecting partner to read mind, Not listening to the other person, Yelling, arguing, shouting

What are four types of problematic communication that are focused on in couple therapy?

Criticism

One partner attacks person’s character usually with the intent of making someone right/wrong

Contempt

Attack partner’s sense of self with intention to insult

Defensiveness

Making excuses, “yes… but”

Stonewalling

Withdrawing from the relationship as way to avoid conflict

Ingrative behavioral couple therpay

• Involves negotiation, problem-solving, and communication skills training

  • “I” statement

• Integrative because it involves making changes and accepting realities about the other person 

Emotional focused couples therapy

• Focus on identifying and expressing primary emotions rather than secondary emotions 

• This leads to rebuilding attachment bonds

good practices in couples counseling

• Don’t take side-showing favoritism can compromise your credibility

• Provide structure

  • Don’t let spouses interrupt and talk over each other

  • Energetic conservations ≠ learning or change

• Suggest changes to the couple’s day-to-day relationship

  • Insight alone is often not enough

  • Empirically supported form of couple therapy requires active interventions aimed at teaching couples new way to interact 

• Differ in situation of abuse 

• Have the couple talk to each other, not to you

3 types of Group Therapy

Support: focuses on providing support for specific issues and offering comfort and connectedness to others; focus on the clients supporting and validating each other

Psychoeducational: focuses on providing information about particular topics and developing skills. It is more information based, less personal sharing, less self-disclosure.

Interpersonal process: focuses on the “process” of being in the group, guiding the clients to note how they interact with other group members and how that mirrors their lived experiences. Attention is paid to feelings, thoughts, and experiences that arise in the group—there will be opportunities to explore the meaning of these behaviors

Who benefits? Who is excluded?

• People who have difficult time in relationships may benefit significantly from process groups 

• Almost anyone can benefit from a group 

• Usually form a group by creating exclusion criteria

• Acute situational crisis 

• Suicidal clients 

• Members who are unable to attend regularly 

• Clients with Antisocial Personality Disorder

Considerations of group therapy

• Group Size: varies from 3 tos everal hundred members depending upon the type of group. Process group usually work best with 6-8 members 

• Duration of session: group sessions usually range from 1-2 hours

• Group structure: varies from open (allows members to enter and leave the group as needed) to closed  (only the group members who started at the beginning are in the group at the end)

• Ethics: confidentiality cannot be guaranteed

Therapist role in group therapy

• Expresses concern, acceptance, genuineness, and empathy towards all group members 

• Facilitates dialogue

• Serve as a role model of how to give and receive feedback to group members 

• In psychoeducational groups, offers instruction, education, and examples 

process components of group therapy

Who communicates? How long & how often? To whom? Who interrupts whom? Any speaker patterns related to gender, age, race?

What roles are people taking in the discussion (leader, antagonist, the silent one, wise person, clown)?

How does conflict surface: what is it about, who is involved,resolution?

What is the emotional content of the discussion?

What are some of the unstated assumptions underlying the discussion?

Tecchniques in Group therapy

• Creation & maintenance of the group

  • Group screening interview

• Culture building 

  • Norms of process 

  • Models desired behavior

• Using the here and now 

  • Process illumination ( help group members figure out what’s going on inside of them)

  • Self-reflection 

Stage 1: forming

• Orientation stage 

  • Typically polite, limited interactions

  • Members are getting to know their role

  • Greater dependency on therapist 

• Therapist role 

  • Provide structure and direction at this point 

Stage 2: storming

• Conflict stage 

  • Ideas are criticsized and challenged , coalitions begin to form

  • Members may be judgmental of one another

  • Power struggle amongst members 

• Therapist role 

  • Distinguish between an attack on your person and an attack on your role/ ideas

  • Unpleasant stage for most therapist

Stage 3: Norming

• Structure stage 

  • Agreement on procedures

  • “We” feeling amongst group members 

  • Cohesion 

• Concerns amongst group members 

  • Not being liked 

  • Not being close enough with others’

• Therapist role 

  • Foster group cohesion so group can be optimally effective

Stage 4: performing

• Work stage 

  • High task orientation 

  • Emphasize performance and cooperation

  • Full expression of positive and negative emotions

  • Most productive therapy at this stage 

• Therapist role 

  • Look out for  subgrouping, conflict, and self-disclosure

Stage 5:

• Dissolution/termination stage

  • Completion of tasks; increased independence and emotionality

  • Termination

• Therapist role

  • Assist in termination process

  • Guide client conclusions 

Pros of Group therapy

• Group dynamics can replicate outside the group and thus help the group members work out those issues 

• Accountability

• Skill building

• Members receive feedback/support/challenge that encourage or facilitate change

• Group offer diversity of perspectives

• Cost-effective

Cons of group therapy

• Not everyone can be in a group 

• Confidentiality more difficult to maintain 

• Can be harder to build trust and safety 

• Group leaders are not always properly trained 

• Group leader have less control than individual therapy 

• Concerns regarding what a disruptive person could do 

Career Counseling

• Focuses on issues such as career exploration, career change, career maladjustment, and other career issues over the lifespan

• Often utilizes assessment, classes,workshops, and other resources

Most common concern addressed in career counseling

Career dissatification

Person evironment fit

career satisfaction and success occurs when there is fit between individual characteristics and recruitment of the job

What are two major theories from person-environment fit approach

Theory of work adjustment

Holland’s theory of vocational personalities in Work Environments

Development perspectives

theories describe career development occurs over the life span and is infleuced by one’s self-concept, societal expectations, and feedback from others

Types of developmental perspective approaches

Self-Concept Theory: Super’s Life Span,

Life Space Perspective

– Social Cognitive Career Theory (SCCT)

Theory of Work adjustment

View career choice and development as continual processes of adjustment and accommodation

What are four adjustment styles that explain how both the person and environmentcontinuously achieve and maintain correspondence according to TWA?

Flexibility

Person’s level of tolerance for person-environment discorrespondence and whether they have a tendency to become easily dissatisfied with the environment

Activeness

The tendency to actively work on the environment to change discorrespondence and/or dissatisfaction

Reactiveness

The tendency to adjust the self to deal with discorrespondence without acting on the environment

Perseverance

The degree of resolve and persistence of a person to adjust and accommodate before choosing to leave an environment

What are 6 interest code according to Holland’s theory of vocational personalities in work environment?

Investigative, Artistic, social, enterprising, conventional, realistic

How your interest level is determined in Strong Interest Inventory (SII)? What are four components of SII?

comparing your scores against the average score for your gender

Components

General occupational themes

Basic interest scales

Occupational scales

Personal style scales

Self-concept theory: super’s life span, life space perspective

Self-concept theory view career choice and development as a process of developing and implementing a person’s self-concept in a vocational setting

Growth

Exploration’

Establishment

Maintenance

Disengagement

What is social cognitive career theory?

• Self-efficacy expectations: beliefs people have about their ability to successfully complete a task

  • Individuals develop their sense of self-efficacy from personal performance, social interactions, and how they feel in a situation

• Outcome expectations: beliefs related to the consequences of performing a specific behavior

  • Individuals develop outcomes expectations from past experiences, either direct or vicarious, and the perceived results of these experiences

Critques of career counseling

Generalizability

Major theories vocational psychology were all developed in the US

Mixed support in international studies

Vocational psychology has largely been based on work with middle-upper class white men

scientist Practioner

• Conducting research

• Being a good consumer of research

  • Critically evaluate research that you read

• Applying research findings to practice 

• Approaching clients with a scientifcic mindset 

  • Forming hypotheses about how the client’s problems are developed and how to address those problems

research cycle

identify research question, choose approapiate experimental model, conduct research, analyze data, publish your research findings

theory building and testing

make specific hypotheses, theory testing- do the research, revise theory, theory building

two major types of psychotherapy research

outcome

does therapy work

what specffic therpaies work

process

how does therapy work

for whom does therapy work

single group design

• Test treatment effectiveness by looking at an outcome variable before and after treatment- is there a significant change?

• Absolute efficacy (whether a treatment is effective at all)

randomized controlled design

Test treatment effectiveness by comparing one or more treatment groups against a control group

Two or more groups- individuals randomly assigned to a group

Are the groups’ scores on the DV significantly different from each other at post treatment?

Relative efficacy: comparing the efficacy of a treatment against other treatment (+ absolute efficacy)

considerations of RCT

• Must define the inclusion and exclusion criteria

• In RCT designs, researcher are trying to establish whether a treatment woeks for a specific population or disorder ( individuals with DSM 5 diagnosis of Major depressive disorder)

• Even within people who have a specific diagnosis, there is a lot of heterogeneity

  • How long have you had the disorder?

  • Family history? 

  • Previous treatment: Therapy? Medication? Both?

  • Comorbid disorders?

• Recruitment issues

• Must define control group

• Blinding: how do you make sure the participants don’t know what group they’re in?

  • Placebo effect

• “Supportive therapy”/ treatment as usual

• “Pure control” no intervention

• Wait-list control: receive intervention after the study 

• Must operationalize the therapy 

• Strictly define and standardize how the treatment will be delivered 

• Manualized treatment

  • A specific protocol explaining how to carry out the therapy 

therapist related factors of RCT

Therapist effects: some individual therapist may be more effective than others

Therapist adherence: therapists may differ in how closely they follow the manualized treatment

mediation

Third vatiable accounts for the assocation between two variables (how/why do the effects occur)

treatment → lower anxiety symptoms

Self-efficacy

moderation

A third variable effects the direction or strength of association between 2 variables

when/for whom does treatment work?

Treatment → lower anxiety symptoms social support