Counselling Flashcards 8-12

Schema Therapy Origins

Origins of Schema Therapy:

1. Origins

   • Developed by Jeffrey E Young for personality disorders and chronic Axis I disorders

   • Created for patients who didn’t respond or relapsed after standard therapies

2. An Integrative Approach

   • Combines CBT, attachment and object relations theories

   • Includes Gestalt and experiential methods

3. Focus

   • Goes beyond symptoms; targets childhood-based schemas

   • Aims for deep, long term change in self and relationships

Who it helps and how it is delivered:

Who it helps:

• Most effective for Borderline Personality Disorder (BPD) and other personality disorders

• Also useful for:

  • Depression

  • Anxiety

  • Eating disorders

  • Substance abuse

  • PTSD

  • OCD

• How it is delivered:

  • Individual therapy: deep personalized work on schemas

  • Group therapy: learn from others, build healthier relationships

Goals of Schema Therapy:

Goals of Schema Therapy:

• Identify and change maladaptive behaviour

  • Recognise deep-rooted negative patterns (I'm unlovable) and transform them

• Meet core emotional needs adaptively

  • Help clients find healthy ways to fulfill needs for safety, love, autonomy and self worth

• Reduce maladaptive coping responses

  • Replace avoidance, surrender and overcompensation with healthier strategies

• Strengthen the Healthy Adult mode

  • Build resilience, self-compassion, and balanced decision making to improve daily life and relationships

Assumptions of Schema Therapy

• Everyone has universal core emotional needs

  • Safety, stability, nurturance, acceptance, autonomy, competence, identity, expression, play and realistic limits

• Schemas develop in childhood and persist into adulthood

  • They form when needs are unmet (interacting with temperament)

• Schemas shape perception and behaviour

  • They act like mental shortcuts - helping us interpret the world, but sometimes in biased or inaccurate ways

• Schemas can be adaptive or maladaptive

  • Adaptive schemas support healthy functioning

  • Maladaptive schemas cause recurring emotional and relational problems

• Coping styles maintain schemas

  • Avoidance, surrender or overcompensation keep maladaptive schemas alive, even when they cause suffering

• Schemas can be changed

  • Through cognitive, experiential, behavioural, and relational techniques, therapy can weaken maladaptive schemas and build healthier patterns

Unmet core needs

• Certain types of experiences lead to the early development of maladaptive schemas such as:

  • When the child's environment is missing something important such as love, stability or understanding

  • When the child is harmed or victimised

  • When the child is coddled, indulged or overprotected and did not receive suffient freedom or autonomy

  • When the child selectively identifies with the thoughts, feelings, experiences, and behaviours on influential adults (parents)

Schemas

• A broad, pervasive theme or pattern

• Composed of memories, emotions, cognitions and bodily sensations

• Regarding oneself and ones relationships with others

• Developed during childhood or adolescence; elaborated throughout ones lifetime; and

• Dysfunctional to a significant degree

 

Schemas (continued)

• Schemas keep themselves going by making us notice and remember things that fit with them, and by pulling us back into familiar situations, even if they are unhealthy

• Because of this, schemas can block us from getting our needs met, even in adulthood

• Maladaptive schemas cause problems by keeping us in unhealthy relationships, behaviours, or environments, and by making us see danger or rejection where it doesn’t really exist

Schema Domain 1: Disconnection and Rejection - AEDMS

• Domain 1: Disconnection and Rejection

  • Schemas related to violations of the basic universal needs for security, safety, stability, nurturance, empathy, sharing of feelings, acceptance and respect. Schemas in this domain often emerge when early family environment is detached, withholding, cold, rejecting, violent, explosive, unpredictable or abusive

• Five schemas ties to this domain:

  • Abandonment/Instability

  • Mistrust/Abuse

  • Emotional Deprivation

  • Defensiveness/Shame

  • Social Isolation/Alienation

Schema Domain 2: Impaired Autonomy and Performance - DEFV

• Schemas related to violations of the basic need for autonomy and competence; impact ones perceived ability to function independently and perform successfully

• Schemas in this domain often emerge when early family life is enmeshed, undermining confidence, overprotective, or failing to reinforce the child for preforming competently.

• Four schemas are tied to this domain:

  • Dependence/Incompetence

  • Vulnerability to Harm or Illness

  • Enmeshment/Underdeveloped Self

  • Failure

Schema Domain 3: Impaired Limits - EI

• Schemas related to deficiencies in internal limits, responsibility toward others, or long-term goal orientation; leading to difficulties respecting the rights of others, cooperating with them, making commitments, or setting and meeting realistic personal goals

• These schemas often emerge when early family environment is characterised by permissiveness, overindulgence, lack of direction, or a sense of superiority

• Two schemas are tied to this domain:

  • Entitlement/Grandiosity

  • Insufficient Self-control/Self-discipline

Schema Domain 4: Other-Directedness - ASS

• Schemas related to not fulfilling the need for self directness/ expression and awareness or own needs ad desires; leading to an excessive focus on the desires, feelings, and responses of others, at the expense of ones own needs, to gain love and approval or avoid retailisation; also leads to lack of awareness regarding ones own needs and difficulties in asserting oneself

• Often emerge when children brough up in an atmosphere of conditional positive regard or conditional acceptance, where the child needed to suppress important aspects of the self in order to gain love, attention or approval

• Three schemas are tied to this domain:

  • Subjugation

  • Self- sacrifice

  • Approval seeking/ Recognition-seeking

Schema 5: Overvigilance and inhibtition - EUPN

• Schemas related to unmet needs for spontaneity and playfulness, results in an excessive emphasis on supressing ones spontaneous feelings or choices, and a perpetual focus on meeting rigid, internalised rules and expectations about performance and ethical behaviour

• These schemas often emerge from a family atmosphere that is grim, demanding, punitive; where performance, obligations, etc. predominant over pleasure, relaxation or playfulness

• Four schemas are tied to this domain:

  • Negativity/Pessimism

  • Emotional Inhibition

  • Unrelenting Standards/Hyper criticalness

  • Punitiveness

Self-report assessment tools used in Schema Therapy:

• young schema questionnaire (YSQ)

• Schema Mode (Inventory)

Maladaptive Coping Styles: - SSS

• There are 3 types of maladaptive coping styles

  • Schema Surrender, which involves giving in to ones schemas

  • Schema Avoidance, which means avoiding situations or people which trigger our schemas

  • Schema Overcompensation, which means doing the opposite of ones schemas

Modes:

• Schemas are enduring patterns; modes are temporary stats that cluster schemas and coping responses

• People may switch between modes throughout the day

• Four main types of modes:

  • Child modes

  • Maladaptive coping modes

  • Dysfunctional parent modes

  • Healthy adult mode (capable, strong, balanced)

Techniques: Cognitive/Behavioural

Psychoeducation:

• Teaching clients about their schemas and case formulation is a key first step

Cognitive Techniques:

• Schema Diary: similar to CBT thought records but includes schema triggers and responses

• Flashcards/Affirmations: Healthy Adult statements used to counter maladaptive schema modes

Behavioural Techniques:

• Assertiveness Training: helps challenge the compliant surrenderer

• Empathy Training: used for clients with entitlement schemas

• Exposure Tasks: support clients in facing avoided situations or emotions

Techniqes Experiential:

Role play:

• Often used in group therapy

• Group members act out different modes for one client - Vulnerable Child, Healthy Adult

Chair work:

• The client moves between two chairs, speaking from different parts of the self (Detached Protector vs Healthy Adult)

Imagery Rescripting:

• Revisiting painful childhood memories in imagination

• Therapist or client steps in to meet unmet needs, soothing the Vulnerable Child and reshaping the emotional memory

Imagery Rescripting:

• Client asked to visualise an upsetting memory, then guided through the specifics of the memory

• Guided to connect with the feelings associated with the memory, and explore what needs were not met and what maladaptive messages were internalised

• The client is then guided to choose a safe person to enter the memory to meet their needs - can be anyone, but often powerful when choosing their present-day healthy adult self

Imagery Rescripting Steps:

• Select a memory linked to a maladaptive schema or mode to focus on

• Revisit the memory in a safe, supportive way to access emotions and bodily sensations

• Reshape the experience

  • Develop compassion for the child self

  • Provide comfort, protection, and meet unmet needs

  • Allow this healing to flow into the adult self

• Prepare the client: plan the IR session together, start with cognitive restricting so the client feels safe and in control

• Safe Place Imagery: use first to create an emotional anchor before starting

Techniques Interpersonal:

Therapeutic Relationship:

• The therapist-client relationship provides a corrective emotional experience

Limited Reparenting:

• Therapist responds to the clients modes much like a good parent

  • Offers warmth, reassurance and nurturance to Vulnerable Child mode

  • Sets limits with Avoidance or Overcompensating modes

  • Challenges Punitive or Demanding modes

• May also include appropriate firmness, self-disclosure, playfulness, and limit-setting

• Empathetic Confrontation:

  • Therapist compassionately but firmly challenges negative or maladaptive behaviours

  • Links these behaviours back to the clients childhood schemas and coping patterns

  • Helps the client see alternatives and practice healthier responses

Limited Reparenting:

• Model the Healthy Adult Mode by offering corrective guidance and support

• Focus on empowerment, not blame; therapy is about meeting current needs, not critizing past caregivers

• Encourage balance: meeting ones own needs while respecting the needs of others

• Promote self-compassion and resilience through emotional validation, realistic self-discipline and positive self-talk

• Therapists as a model: clients learn from our example, and we help them strengthen their own Healthy Adult mode

Empathic Confrontation

• Maladaptive coping modes can trigger strong reactions in others (including therapists), often reinforcing the clients schemas

• Therapists must validate the schema and coping mode, but also point out their unhelpful impact in the present

• Balance is key: clients need empathy and confrontation

• Confront the mode, not the client

• Use empathic confrontation whenever coping modes interfere with connection or therapeutic progress

Origins of DBT

• Marsha Linehan

• DBT initially developed for chronically suicidal patients

Why was DBT better than CBT

• CBT focused heavily on changing thoughts and behaviours

• But when Linehan used it on suicidal patients, they often felt

  • Invalidated - You are saying my thoughts are wrong

  • Misunderstood - You don’t get how much I'm suffering

  • Or pushed to hard to change when they weren't ready

• This led many to drop out of treatment of escalate suicidal behaviours

Validation and Mindfulness

• Therapists communicates - You feelings make sense given your experience

• Doesn’t mean agreement, it means acknowledging the reality of the client's pain

• This built trust and helped patients feel safe enough to stay in treatment

• Mindfulness:

  • Borrowed from Zen practices, adapted to therapy

  • Helps client observe their thoughts and emotions without immediately reacting

  • Instead of trying to get rid of pain instantly, patients learned to sit with it and accept reality as it is in the moment

DBT for BPD

• This was the first DBT manual, and it officially poisoned DBT as a treatment for BPD

  • The manual laid out:

• The Biosocial theory (emotional sensitivity + invalidating environments = emotional dysregulation)

• The 4 DBT skill modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness)

• The structure of treatment (individual therapy, skill groups, phone coaching, consultation team)

DSM 5 for BPD

DBT House - SQPI

DBT theories: Biosocial Theory

• Biological Vulnerabilities:

• Emotion Sensitivity: Some individuals are biologically predisposed to react more intensely to emotional stimuli. They experience emotions more quickly, intensely, and for a longer duration compared to others

• Slow Return to Baseline: These individuals might take a longer time to return to their emotional baseline after an emotional reaction. This slower return contributed to prolonged emotional distress

• High Emotional Reactivity: A heightened emotional reactivity can lead to impulse behaviours, as individuals struggle to manage intense emotions effectively

DBT Theories: Invalidating Environment

• Lack of Emotional Validation: An invalidating environment is one where a person's emotional responses are consistently rejected, ignored or trivialized. This can happen in various setting, such as family, school, or even therapy

• Inconsistent Reinforcement: The lack of consistent reinforcement for adaptive behaviours and an overemphasis on negative behaviours can contribute to emotional dysregulation

• Punitive Responses: Punitive responses to emotional expression may discourage individuals from sharing their emotions openly, leading to a cycle of supressed emotions and increased distress

DBT Theories: Skills Deficit Model

1. Skill Gaps:

   • Many clients haven't learned effective behaviour for managing emotions, relationships or stress

2. Behaviour as Coping Mechanism:

   • Problem behaviours are usually maladaptive solutions to real problems

   • These are not attention seeking behaviours; they are attempts to cope in the absence of skills

3. Skills Acquisition:

   • DBT treatment = teaching new skills to replace maladaptive ones

   • Four main skills modules (Mindfulness, Distress Tolerance, Emotional Regulation, Interpersonal Effectiveness) fill in the missing tools

4. Focus on Learning, Not Blame:

   • Instead of blaming, pathologizing, or labelling clients as manipulative, DBT takes an educational approach

     • You have not learned the skills yet

DBT Formulation of BPD 5 POINTS

• Emotional Dysregulation

• Cognitive Dysregulation

• Behavioural Dysregulation

• Dysregulation of Sense of Self

• Interpersonal Instability

Key Concepts in DBT: Zen and Behavioural Approaches

• DBT combines two traditions:

  • Zen (Mindfulness and Acceptance): Being present in the moment, noticing thoughts and feelings without judgment, practicing acceptance

  • Behavioural (Change Strategies): Using behavioural principles (like reinforcement, exposure, problem solving) to help clients learn and maintain new skills

Key Concepts in DBT: Balencing Acceptance and Change

• This is the heart of DBT

• Clients often feel invalidated in therapy focuses only on change ("You need to stop cutting") But focusing only on acceptance can leave them stuck ("It's okay you cut, nothing changes")

• DBT teaches both:

  • You're doing the best you can - Acceptance

  • And you need to keep working towards change - Change

Key Concepts in DBT: Dialectics

• Dialectical means that two things that seem opposite can both be true at the same time. DBT helps clients move away from black-and-white thinking and find a balance between opposites.

• DBT constantly looks for synthesis:

  • Emotion mind vs Reasonable mind Wise mind

  • Self-acceptance vs Self-improvement

  • Independence vs Connection with others

Validation as Emotional Regulation

• Validation means helping clients feel understood by acknowledging that their emotions make sense given their experience

• In DBT, validation is more than just being supportive, it's an important way to reduce emotional distress

• When people feel heard and understood, then often become less emotionally overwhelmed and more able to think clearly and use coping skills

Validation

• Level 1: Stay Awake and Pay Attention

• Level 2: Accurate Reflection

• Level 3: Reading a Person's Behaviour and Guessing what they might be feeling or thinking

• Level 4: Validating Using Past History or Biology

• Level 5: Normalizing

• Level 6: Radical Genuineness

Treatment: 4 modes

• Individual Therapy:

  • One to one sessions with a therapist

  • Focus: life threatening behaviours (suicidality, self-harm), therapy-interfering behaviours, and improving quality of life

• Skills Group:

  • Clients learn the core DBT skills (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness)

  • Taught in a group classroom format, more like "skills training" than traditional group therapy

• Phone Coaching:

  • Clients can contact their therapist between sessions (within agreed boundaries)

  • Purpose: get in the moment help using DBT skills instead of falling back on problem behaviours

• Consultation Team:

  • For Therapists, not clients

  • A weekly meeting where DBT therapists support each other, stay adherence to the model, and precent burnout

Length of DBT

• Compressive DBT is usually a 1 year program

  • The reason: The skills group cycle (Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness) is often taught over about 6 months, and then repeated once to consolidate learning

  • That makes it around 12 months total

• Some programs extent to 14 months (or longer) if:

  • There are breaks between skill modules

  • Clients need more time to complete both cycles

  • The service adapts the program to local needs or resources

Cognitive and Behavioural Strategies:

• Cognitive modification/challenging

• Exposure

• Contingency management

Group session

• Mindfulness

• Homework Review

• New Skills Based on Curriculum

• Class Rather than Therapy

Skills Training Mindfulness - WODP

• What it is: Learning to pay attention to the present moment, on purpose, without judgment

• Why it matters: Clients with BPD often get swept away by intense emotions or automatic reactions. Mindfulness creates a pause between urge and action

• Core Skills:

  • Wise Mind: balancing emotion mind and reason mind

  • Observe: notice sensations, thoughts, feelings without reacting

  • Describe: put words on the experience - I notice my heart is racing

  • Participate: fully engage in the moment

  • Non-judgmental, One-Mindfully, Effectively

Skills Training Distress Tolerance - ASIR

• What it is: Short-term tools for surviving emotional crises without making things worse

• Why it matters: Clients often resort to self-harm, substance use, or impulsive actions when distressed. DT skills provide safer alternatives

• Core Skills:

  • ACCEPTS: (Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations)

  • Self-Soothe (using the 5 senses)

  • IMPROVE the Moment (Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation, Encouragement)

  • Radical Acceptance: acknowledging reality as it is

Skills Training: Emotional Regulation - BBOPS

• What it is: Teaching clients to identify emotions, reduce vulnerability to emotional chaos, and increase positive emotions

  • Why it matters: BPD is marked by intense, rapidly shifting moods. ER helps prevent emotional rollercoasters

• Core Skills:

  • STOP: Stop, Taking a step back, Observe, Proceed mindfully

  • PLEASE: take care of Physical health, Eating, Avoid drugs, Sleep, Exercise

  • Build Mastery: do things daily that create a sense of competence

  • Opposite Action: act opposite to unhelpful emotional urges

  • Build Positive Experiences: small enjoyable activities to balance negativity

Skills Training Interpersonal Effectiveness: - DGF

• What it is: Tools to communicate effectively, maintain relationships, and respect self-respect

  • Why is matters: Clients with BPD often swing between clinging and pushing people away, which destabilises relationships

• Core Skills:

  • DEARMAN: Describe, Express, Assert, Reinforcement, stay Mindful, Appear confident, Negotiate

  • GIVE: Gentle, Interested, Validate, East manner (keeping relationships positive).

  • FAST: Fair, no Apologies, Stick to values, Truthful (self-respect effectiveness)

Core Skills - DEARMAN

• DEARMAN: asking for what you want clearly and effectively

  • Describe: state the facts

  • Express: share feelings clearly

  • Assert: ask for what you need

  • Reinforce: explain the benefits of saying yes

  • Stay Mindful: don’t get pulled off track

  • Appear Confident

  • Negotiate: compromise if needed

Core Skills - Give

• Give: keeping relationships positive

  • Gentle: be kind, no attacks

  • Interested: listen actively

  • Validate: show understanding

  • Easy manner: use humour or warmth

Core Skills - Fast

• FAST: maintain self-respect

  • Fair: to yourself and others

  • Apologies: don’t over apologise if you haven't don’t anything wrong

  • Stick to your values

  • Truthful: don’t exaggerate or manipulate

Boundaries in DBT Phone Coaching

1. Time Limited:

   • Calls usually 5-10 mind only

2. Purpose-Bound:

   • Phone coaching is only for skills use, not for venting, storytelling or causal chat

   • The therapists role: Which DBT skill can you use right now to cope?

3. Availability and Access:

   • Therapists set clear rules about when they are available - not a nights, and weekends only for emergencies

4. The 24-Hour Rule:

   • If a client engages in self harm or a suicide attempt, they cannot call their therapist for 24 hours afterward

   • Why? To avoid reinforcing self-harm with therapist attention

5. No Crisis Rescue:

   • Phone coaching is not for full scale cris management - calling 000, suicide intervention

6. Generalisation, Not Dependency:

   • Coaching helps clients generalise DBT skills to daily life

   • But boundaries ensure they don’t become dependant on their therapist for everyday decision

Where is DBT Effective?

Modernism

• Modernism is a way of thinking that developed during the Enlightment (17th-18th centuries) and shaped Western thought up to the mid 1900s

It is based on the belief that:

• Truth is objective, it exists independently of personal opinions or feelings

• Reason, science, and logic can uncover the truth

• The world operates according to universal laws that apply to everyone

• There is one correct way to understand and explain reality

• A modernist view of mental health might say there's one scientific explanation for depression, a chemical imbalance, and once we discover and treat that cause, the problem is solved

Post Modernism

• Postmodernism is a way of thinking that challenges the idea of one single truth or objective reality

• It suggests that what we call truth is shaped by culture, language and social context, meaning there are many perspectives, not just one correct way to understand the world

• emerged in reaction to grand narratives of modern society tht claimed to explain everything

Freud: Example of Modernism

• Freud believed that there are universal truths about the human mind, like the id, ego and superego, that apply to everyone

• He thought the therapists job was to discover hidden truths in the unconscious and bring them to awareness

• This reflects modernism because it assumes

  • There is one truth to uncover

  • The therapist is the expert who can find and explain the truth

  • Human behaviour follows universal psychological laws

Postmodernism as a Social Philosophy 3 positions

1. A postmodern society has replaced the modern society

2. There is continuity from modernism to postmodernism

3. Modernism and postmodernism are both involved in ongoing relationship

3 pillars of postmodernist approach

• Three pillars that support the postmodernist approach:

  • Social constructionism

  • Constructivism

  • Poststructuralism

Social Constuctionism

• Argues that perceived reality is socially constructed by people in the same culture who interact with eachother

• The primary concern of social constructionism is to understand how we interpret the world around us and assign meaning to life events and social realities, and how these social meanings influence us

Constructivism

• Reality is personally constructed. Each individual authors their own meaning system to make sense of his of her perceived reality

• According to Rosen (1996) there ae as many realities as there are perceivers because realty is not unitary, objective phenomenon

Poststructralism

All phenomena including the self and mind are themselves nothing but texts and, therefore, all phenomena exist exclusively in linguistic or literary constructions created by readers/observers

•  suggesting that counsellors should share power and recognise that clients also create knowledge though their own language and experience

Postmodernism and Counselling

• Postmodernism is a way of thinking that explores how ideas, truth and meaning are shaped

• It suggests that peoples problems are influenced not only by personal factors but also by their social and cultural environment

• It has influenced approaches such as:

  • CBT: considers how culture, language, and context affect thoughts and behaviour

  • Narrative Therapy: helps clients re-author their life stories rather than viewing themselves as the problem

  • Feminist Therapy: explores how social power and inequality affect people's experiences

Hansen (2006) three primary links in postmodern philosophy and counselling

• Theories as narrative structures

• Theoretical truth as a tool

• An egalitarian counselling relationship

Theories as Narrative Structures

• All theories are based in culture, politics and language. Therefore, it is naïve to suggest that one theory is better than the other

• Theories are narrative structures for rhetorical purposes and can be used to persuade clients to view their experience from a different perspective

• Reorganising the elements of old storylines, constructing new meaning structures for making sense of life, and promoting mastery over experiences are not dependant on the truth of the narrative (or on the theory)

Theoretical Truth as a Tool

• Theoretical truth is a tool and can fit whatever interpretation is practical in a particular situation

• The best interpretation of events is always the most useful one

• This means, theory selection should be based on whether a theoretical orientation is helpful in meeting the goals of a particular counselling situation

• The usefulness of theories in counselling is seen in their equipping the counsellor with prepackaged narratives

• These narratives can be helpful to the meaning-making process

An Egalitarian Counselling Relationship

• The counsellor is expected to be an equal partner with the client rather than an expert that enlightens the client

• Together, the counsellor and client co-construct narratives

• Given that it is impossible to capture the absolute truth, the postmodern counsellor treats the client as an equal partner and as an expert in their own lives

• This egalitarianism will encourage the client to unpack their stories from their own perspective and will help the counsellor gain an empathic understanding of the client

• Doing so will engage the counsellor and the client to uncover the deeper meanings of the clients lived experience

Strengths of Postmodernism in Counselling

• An Egalitarian Counsellor-Client relationship

• An Emphasis on Phenomenological Understanding

• Freedom from Theoretical Bondage

• Contextualization

An emphasis on Phenomenological Understanding

• Multiple realities: Everyone experiences the world differently

• Focus on meaning: Explore what experiences mean to the client rather than applying labels

• Understanding the client's perspective: See the world through the client's eyes

• Use stories: Encourage clients to share their experiences and meanings

• Narrative Therapy: Helps clients rewrite unhelpful stories in more empowering ways

Freedom from Theoretical Bondage

• Freedom from theoretical bondage: means not being trapped or limited by one counselling theory (like CBT, psychoanalysis, or person-centred therapy). Instead, the counsellor can draw from different perspective depending on what best fits the client

• Avoiding preconceived ideas: helps the counsellor truly hear and understand the client's unique story, rather than interpreting everything through a single theoretical lens

• Being non-judgmental: means the counsellor doesn’t assume they already know what the client's problem is or how it should be solved. They stay curious, open and collaborative

Pros

• Openness and empathy: Without preconceptions, the counsellor can truly listen and understand the client's unique story without bias or judgement

• Client empowerment: it allows clients to define their own experiences and meanings, rather than being fitted into diagnostic categories

• Flexibility: The counsellor can adapt their approach to suit each individual rather than applying a one-size-fits-all model

• Stronger relationship: Clients often feel more accepted and understood when the sense the counsellor is open and curious rather than assuming

Cons

• Lack of structure: Without any guiding framework, the counsellor may feel uncertain about how to direct sessions or identify key issues

• Risk of missing patterns: Some preconceptions (like knowledge of psychological theory) can help identify underlying dynamics that might not be immediately visible

• Potential inefficiency: Too much openness without focus could make therapy progress slower

• Emotional strain: Constantly "starting from scratch" with every client can be mentally demanding for the counsellor

Contextualization:

• Reality is contextualised in socio-cultural, politico-economic and linguistic forces (as well as other forces) that shape personal views of reality

• Postmodern counselling can help clients identify the negative and oppressive effects of mainstream culture and dominant societal forces on their personal life with the goal of minimizing their self-blame and enhancing their self-esteem

• It can also enable the counsellor to consider all factors that might contribute to problems

Limitations of Postmodernism in Counselling

• Proneness to Relativism

• Overemphasis on the Relational Self

• Tendency towards Reductionism

• Deification of Non-Preconception

Proneness to Relativism:

Postmodernism's strength is openness to many perspectives, but it weakness is that everything is seen as equally true, it can make it difficult to find meaning, direction, or connection in counselling

Overemphasis on the Relational Self:

• Overemphasis on the relational self may turn us into a pawn of social factors (context) and a passive receptor of external stimuli

• It also delays addressing intrapersonal issues and diminishes the ultimate worth of a holistic person

Tendency towards Reductionism:

• Postmodernism can sometimes oversimply people's experiences by focusing mainly on language, stores, and social meanings

• This may overlook other important factors, such as biology, emotions, trauma, or life circumstances

• As a result, people can be viewed more as storytellers than as complex individuals

Deification of Non-Preconception

• Many postmodern counsellors claim that they bring no preconceived theory or approaches to the counselling encounter

• Heidegger (1962/1927) suggested "whenever something is interpreted as something, the interpretation will be founded essentially upon the fore-conception. An interpretation is never a pre-suppositionless apprehending od something presented to us

• This means a counsellor can only do counselling from their own perspective. The perspective of the counsellor is a personal theory that impacts the sense-making process of the client

• Furthermore, freedom from theoretical bondage does not mean that we do not need theory. It means that we should treat theory as a tool instead of the foundation of practice

The goal of narrative therapy

• Focuses on the interpretation of one's experience

• These process is to simplify these experiences into narrative structures or stories that provide a framework for understanding them

• Problems must be viewed from the context in which they are situated

• The goal is to help the client deepen the understanding of the experience

Narrative Therapy in changing behaviour

• Finding exceptions - collaboration: The counsellor helps clients notice times when they did have control or acted differently from their "problem story". This helps clients see the change is possible

• Challenging false beliefs: Many of our behaviours come from negative stories we've learned about ourselves like "I'm not good enough". These beliefs often come from how others or society have influenced us

• Creating new stories: By recognisisig these exceptions, clients can begin to rewrite their stories, focussing on strengths, successes and possibilities. These new narratives help them build confidence and make lasting changes in how they think, feel and behave.

How it works

• People live by stories: about themselves and their experiences

• The person is not the problem, the problem is the problem: The goal is to separate the person from the problem

• Look for exceptions: Identify times when the problem was less powerful or absent

• Rewrite the story: Focus on strengths, values, and successes to create a more empowering narrative

• Create new meanings: Help clients choose stories that better reflect who they are and who they want to be

Narrative Therapy: a session

• Storytelling: The client shares about their life and the problems they're facing. The counsellor listens closely for themes, languages, and meaning in those stories.

• Externalising the problem: the counsellor helps the client see that the problem is the problem and not the person

  • "Anxiety is trying to take over my life"

• Exploring alternative stories: together, the look for exceptions or unique outcomes, times when the client was strong, capable, or when the problem had less power

• Re-authoring: The client beings to rewrite their story with new meanings, focussing on their values, skills and hopes for the future.

• Witnessing and reflection: The counsellor may reflect back what they hear, helping the client see themselves in a new, more empowering way.

Ethics

Definition: A set of moral principles, especially ones relating to or affirming a specified group, field, or form of conduct

Advantages of General Guidelines

• Flexibility and Professional Judgement:

  • General codes allow counsellors to adapt ethical principles to diverse contexts, cultures and client situations

  • Counselling often involves complex, unique cases where rigid rules wouldn’t fit every circumstances

• Encourages Ethical Thinking:

  • Practitioners must engage in deeper ethical reasoning instead of merely following a checklist

  • Promoted personal moral development and professional integrity

• Broad Applicability:

  • General principles can apply across different counselling settings (schools, clinical, community, online)

  • They remain relevant even as new ethical challenges emerge (telehealth, AI- assisted therapy)

• Supports Cultural Sensitivity

  • Counsellor's can interpret and apply guidelines in culturally appropriate ways rather than adhering to inflexible rules that may not fit all cultural contexts

Drawbacks of General Guidelines

• Ambiguity and Inconsistency:

  • The same principle may be interpreted differently by different practioners

  • Can lead to inconsistent ethical decisions and confusion about what constitutes right action

• Risk of Ethical Misjudgement:

  • Without clear directives, inexperienced counsellors may make errors in ethical reasoning or fail to recognise a boundary violation

• Difficulties in Enforcement:

  • Regulatory bodies may struggle to determine whether a counsellors actions violated an ethical standard if the guideline is too vague

• Limited Protection in Legal or Disciplinary Contexts:

  • General statements like act in the clients best interest may not hold up well in court or hearings compared to specific actionable standards

Why do we have ethics codes:

• To protect clients:

  • Make sure people are treated safely, fairly, and with respect

• To guide counsellors:

  • Help counsellors understand what is right and expected in their work

• To hold people accountable:

  • If someone acts unethically, there are clear rules to deal with it

• To improve how we practice:

  • Encourage counsellors to keep learning and doing better

• To keep the profession independent:

  • So counsellors can set their own rules (instead of the government doing it for them)

• To reduce conflict:

  • Give everyone a shared understanding of what's okay and what's not

• To protect counsellors:

  • If something goes wrong, the code helps show they acted properly

Limitations of Codes of Ethics

• Too general or imprecise to yield specific solutions, leaving counsellors to rely on their own judgment when faced with complex or ambiguous ethical situations

• Knowledge of ethical codes has been found to be insufficient to guarantee ethical conduct

• Consumers are unlikely to be aware of ethical codes

• Not consistent across professions

• May not be consistent with the law

• May not be consistent with our views, attitudes and feelings

• Typically reactive rather than proactive

Respond to criticisms by using several strategies

• Provide Evidence-Based Outcomes:

  • Share research and statistics showing counselling improves mental health, academic performance, and overall wellbeing

• Use Case Examples (Anonymised):

  • Illustrate the benefits of counselling through real-life examples without revealing client identities

• Engage in Public Education:

  • Give talks, workshops, or write articles to explain what counselling involves and its positive impact

• Address Misconception Directly:

  • Acknowledge common myths and clarify the truth

• Collaborate with Stakeholders:

  • Work with schools, workplaces, or community groups to show how counselling integrates with broader social support systems

• Professional Advocacy:

  • Join professional associations, participate in policy discussions, or advise organizations to promote ethical and effective counselling practices

Reseacrh and Ethics:

• Ethically Important and Necessary:

  • Research in counselling helps improve interventions, understand client needs, and develop best practices. However, because it involves human participants, it carries ethical responsibilities to protect their rights, privacy and wellbeing

• Will Always Have an Impact on the Respondent:

  • Participating in research may evoke emotional responses, triggers past trauma, or cause stress for respondents. Counsellors must anticipate these effects and minimise harm

• Ethics and Consent as an Ongoing Process:

  • Consent is not a one-time formality; participants should be informed continuously about the research, their right to withdraw, and how their data will be used. This ensures that their participation remains voluntary and informed throughout

• Ongoing Consent in Training Materials:

  • When counsellor training uses videos or case studies of real clients, ethical practice requires ensuring clients have given informed consent for their material to be used. Even after initial consent, trainers should check that clients remain comfortable with how their information is presented

 

Psychotherapy and Counselling Federation of Australia (PACFA) Code of Ethics (2017)

• PACFA is the national peak body that represents counsellors and psychotherapists in Australia

• PACFA set the ethical standards, accredits training programs, and maintains a national register of qualified practitioners

PACFA Code of Ethics 2017

• Provides the ethical framework for all members, covering:

  • Clinical practice

  • Supervision

  • Education and training

  • Research

  • Professional conduct and self-care

PACFA ethics are grounded in:

• Values (Accountability, Client Focus, Competence, Diversity, Integrity, Justice, Empowerment, Human Rights)

• Ethical Principles (Trust, Autonomy, Beneficence, Non-malifence, Fairness, Self-respect)

• Personal Attributes (Authenticity, Care, Courage, Curiosity, Diligence, Empathy, Honest, Humility, Resilience, Respect, Sincerity, and Wisdom)

PACFA Core Ethical Principles: - PWBRPRW

1. Put Clients First:

   • Act with care, compassion and avoid harm

2. Work to High Professional Standards:

   • Only practice within your competence and training

   • Keep learning (professional development and supervision)

3. Build Relationship of Trust:

   • Honesty, openness, and reliability

   • Informed consent, clear contracts, and transparency about fees

4. Respect Diversity and Human Rights:

   • Value each person's dignity

   • Respect cultural, spiritual, gender, sexuality and lifestyle difference

5. Protect Confidentiality:

   • Safeguard client privacy

   • Explain limits of confidentiality

6. Respect Professional Boundaries:

   • Avoid dual or exploitative relationships

   • Maintain clear therapist client roles

   • Manage power dynamics carefully

7. Work Ethically with Colleagues:

PACFA + Decision Making

1. Who it applies to:

   • All PACFA members: counsellors, psychotherapists, educators, supervisors, researchers

2. Ethical decision-making:

   • Like PsyBA, PACAFA expects practioners to use the Code as a framework for making choices, not just a rulebook:

   • If faces with a dilemma:

     • Identify the ethical issue

     • Refer to the relevant principle

     • Consider client wellbeing first

     • Seek supervision if needed

3. Professional conduct procedures:

   • PACFA has a formal complaints process

   • If a practioner breaches the Code:

     • The Ethics Committee investigates

     • Sanctions can range from further training to suspension of membership

PsychBA Code of Conduct for Psychologists

• Sets out the standards of conduct expected of psychologists by the PsychBA

• Defines the core requirements for safe and effective professional practice in Aus

• Provides a framework to guide professional practice, judgment and decision making

• Promotes public protection, public confidence and trust in psychological services

• Establishes consistent, evidence based standards for the profession

• Provides a benchmark against which psychologists professional conduct may be assessed

• Helps the public understand the standards of behaviour they can expect from psychologists

• Serious or repeated failure to meet the code may lead to regulatory actions, including consequences for registration

What the code does not do

• It does not replace the law. Psychologists are responsible for understanding and complying with their legal obligations. If the Code conflicts with legislation or case law, the law takes over

• It does not replace organisation requirements. Psychologists must also follow relevant workplace, employer and funding-body policies. Where organisational requirements differ significantly from the Code, psychologists should realise these differences and seek to achieve appropriate alignment

• It is not a complete guide to every ethical issue. The Code should be considered alongside other relevant PsyBA standards, guidelines, legalisation and regulatory requirements

Expectations of Psychologists

1. Safe, effective and collaborative practice

2. ATSI health and cultural safety

3. Respectful and culturally reflective practice for all

4. Working with clients

5. Working with other practitioners and colleagues

6. Working within systems

7. Minimising risk to and by behaviours

8. Psychologists behaviour

9. Proactive management of health, wellbeing and work-related psychological risk factors

10. Teaching, supervising and assessing

11. Ethical research