Counseling PSY Final Exam

what are some affective components of CBT?

• emotion awareness and identification

• feelings tracking

• neurobiology and physiology

• relaxation training (?)

What are some cognitive components of CBT?

• externalization

• identification of thoughts

• education on cognitive distortions

• cognitive restructuring

  • cognitive flexibility

  • social perspective taking

what is externalization?

being able to separate yourself from your feelings (EX: what is worry/sadness/anger telling you?)

What are some behavioral techniques of CBT?

• identification of behavioral patterns

• goal setting

• behavior tracking

• behavior change interventions

• differential reinforcement

• skills training

what are some examples of behavior tracking in CBT?

• what does worry tell you to do when it says there are germs on the door?

• what are the ways this behavior is getting in the way?

child development is…

• chronological

• orderly/reliable

• cumulative

• probabilistic

• directional

how do we shift kids to another path?

• check the map → know what’s normal so you know what’s not; how is this adaptive?

• look for ruts in the road → what’s keeping this behavior/issue in place?; risk and protective factors

• keep the wind at your back → work with developmental norms/tasks, not against

True or false: change can happen at any point within child development

True

What are some normative fears from the developmental period of infancy (0-2)?

Am I capable of surviving alone?

• separation

• stranger danger

• loud objects/noises

What are some normative fears from the developmental period of early childhood (3-6)?

what would happen if you wandered off and ate those bad berries? or pet that raccoon?

• the darkness

• separation

• bodily injury

• animals

• new foods

What are some normative fears from the developmental period of middle childhood?

you *can jump from the balcony into the pool now… but should you?

• thunder/natural events

• school performance

• injury/death

• getting sick (vomiting)

• peer acceptance

What are some normative fears from the developmental period of adolescence? (The Map)

what would’ve happened in caveman times if you get kicked out of the group?

• school performance

• health

• disaster/catastrophe

• social competence

• romantic relationships

The wind: developmental tasks for infancy

attachment, gross motor skills, language

The wind: developmental tasks for early childhood

autonomy, self-regulation of emotions, behaviors, and attention

The wind: developmental tasks for middle childhood

forming friendships, social skills, morality

The wind: developmental tasks for adolescence/emerging adulthood

independence, identity, development, romantic relationships, advanced social skills

What are some developmental considerations for cognitive development?

• knowledge/reasoning

• information processing

• memory

• metacognitive ability

• theory of mind

What are some developmental considerations for language development?

• expressive/receptive language

• communication skills

What are some developmental considerations for social development?

• perspective taking

• social skills

• normative social relationships

What are some developmental considerations for emotional development?

• self-regulation

• executive function

• emotional expression

What are some developmental considerations for the “o” factor: other people?

• parent-child relationships

• family system

• teachers and school staff

• parent involvement in treatment

• coach interactions

• accomodation

• motivation

Self-Determination Theory:

nobody likes doing things they’re bad at, for no clear reason, just because they’re told to

The 3 C’s: Kids do well…

• if they CAN (mastery)

• if they CARE (purpose)

• if they CHOOSE (autonomy)

Worry worldviews: Key Beliefs

• world as uncontrollable

• discomfort as dangerous

• child as incapable

CBT for pediatric anxiety, the tools: Affective components

• psychoeducation

  • affective education

  • false alarm feelings/neurobiology

• relaxation: turning off the alarm systems

CBT for pediatric anxiety, the tools: cognitive components

• name the bully → externalization

• tuning in → ID worry thoughts

• challenging worry thoughts

CBT for pediatric anxiety, the tools: behavioral components

• ID behavior patterns and goals

• building confidence via exposure

• differential reinforcement

• skills training

Catastrophization:

anxiety tells you that some horrible thing is going to happen… when in fact it is either highly unlikely or impossible

Magnification:

anxiety makes things out to be far worse than they really are

unhandleability:

anxiety tells you that if something bad happens, you will not be able to handle it

negative fortune telling:

anxiety makes negative predictions about what is going to happen

negative mind reading:

anxiety tells you that others are thinking negative things about you

3rd Wave

focus on changing relationship with thoughts and feelings using mindfulness and acceptance strategies

what is mindfulness?

• Sati

  • awareness, attention, remembering

• “awareness of present experience with acceptance”

• “the awareness that emerges through paying attention on purpose, and nonjudgmentally, to the unfolding of experience moment to moment”

Impermanence (1/3 Characteristics) for mindfulness:

everything is impermanent

• nothing lasts forever, things change

• holding onto the past is not accepting the inpermanence of life

Non-Self (1/3 Characteristics) for mindfulness:

everything arises interdependently (that is, nothing has an independent existence that is not predicated on other things; when applied to humans it implies that nobody has a stable, permanent self)

• we change as humans, the evolving view of human beings

Suffering (1/3 Characteristics) for mindfulness:

nothing in the physical or mental world can bring long lasting, unalloyed satisfaction

• pain is inevitable

• nothing will bring us endless happiness, pain will happen, but happiness will happen too.

What are the 4 noble truths?

• suffering exists

  • dissatisfaction arises in part because we condition things that are impermanent to be permanent when they aren’t

  • everything is temporary

• suffering arises from attachment or craving

• suffering may be extinguished by extinguishing attachment

• attachment may be extinguished by following the noble eightfold path

The Noble Eightfold Path

• correct understanding

• correct intention

• correct speech

• correct action

• correct livelihood

• correct effort

• correct mindfulness *

• correct concentration

what is the Buddhist concept of mindfulness (sati)?

awareness of or alertness to the body, mind, and environment in the present moment

what caused problems for mindfulness based therapy?

• insufficient attention to the present moment

  • excessively oriented towards the past or future or being caught up in one’s own internal mental world

• a lack of equanimity towards one’s experience

  • overly attached to pleasant things or becoming overly adverse to unpleasant things

How are problems alleviated (mindfulness)?

• return the mind to the present time and place

  • helps one gain insight into one’s emotions and behaviors, allowing greater self-regulation

• try to develop greater equanimity (“an attitude of curiosity, openness, and acceptance” or “this too shall pass”) to current experience which reduces suffering

what is the role of the therapist (mindfulness)?

to teach techniques and coach the client in their use, also may serve as a model of mindful living.

what is the clients role in therapy (mindfulness)?

learns and practices mindfulness techniques

• usually involves applying techniques in difficult situations

What is ACT? (mindfulness)

• 3rd Wave cognitive behavioral therapy developed by Steven Hayes in 1970s

• goal is to foster psychological flexibility

  • acceptance: willingness to experience

  • commitment: living in line with values

Assumptions in ACT

• psychological pain is normal, it is important, and everyone has it

• one can’t deliberately get rid of psychological pain, although one can take steps to avoid increasing it artificially

• one can live a valued life

Goals of ACT

• acceptance of unwanted private experiences that are out of personal control

• committed action towards living a valued life

• psychological flexibility: facilitates change

  • being psychologically present

  • direct behavior to serve valued ends

True or false: for mindfulness based therapy → goals do not equal symptom reduction

true → the outcome is the process by which the process becomes the outcome

What are the 6 core processes of mindfulness therapy?

1. contact with present moment (mindfulness)

2. acceptance

3. defusion → looking at thoughts, rather than from thoughts

4. self-as-context; the observing self

5. values

6. committed action

core process of mindfulness: acceptance

opening up and making room for painful feelings, sensations, urges, and emotions

• looking at our thoughts instead of from our thoughts

• thoughts are the things that pop up it doesn’t mean they’re correct

• ex: i’m having a thought that people don’t like me and I don’t know if that’s true so i’m just going to let it be

core process of mindfulness: cognitive diffusion

• looking at thoughts rather than from thoughts

• noticing thoughts rather than being caught up and giving into them

core process of mindfulness: contact with the present moment

consciously connecting with and engaging in whatever is happening in the present moment, non-judgmentally

core process of mindfulness: self as context, the observing self

you are a person that can be a variety of things, not just one type of person, sometimes we hold onto stories about ourselves to be literally true.

core process of mindfulness: values

knowing and clarifying desired qualities of ongoing actions, or chosen life directions

• clarifying who we want to be and what we want to be about

core process of mindfulness: committed action

taking effective action, guided by our values, even in the face of pain and discomfort

Mindfulness Therapeutic strategy: confronting the agenda

• what have you tried to get rid of your symptoms?

• did you succeed in permanently getting rid of them?

• what has this cost you?

Mindfulness Therapeutic strategy: acknowledging control is the problem

• illusion of control

  • if you’re unwilling to have an emotion, you will have it; these feelings/thoughts are a part of life, you can’t control them

• psychoeducation around why control persists

  • short-term effects seem useful and promising

  • society encourage and models

  • belief that emotions and thoughts cause or control belief (vs. influence)

• unworkable with costs

Mindfulness Therapeutic strategy: willingness is the alternative

• willingness = defusion, acceptance, contact with the present moment

• defusion techniques

  • leaves on a stream (helps to see thoughts as temporary mental events, not facts or commands)

  • I notice that I have the thought that…

  • thank your mind

• acceptance techniques

  • unwelcome party guest

  • passengers on a bus or demons on a boat

Defusion techniques: leaves on a stream

A mindfulness technique that helps individuals perceive their thoughts as temporary mental events rather than permanent truths or commands, often visualizing them as leaves floating downstream.

Acceptance techniques: passengers on a bus/demons on a boat

• you are the driver of the bus (your life)

• all the passengers (your thoughts, feelings, and emotions)

• some passengers are loud, threatening, or unpleasant

• if you stop to fight or argue with them the bus (your life) stops

• if you allow them to be there you can keep driving towards what matters

Purpose: encourages allowing thoughts/emotions to be there without trying to get rid of them

ACT Therapist role

• less confrontational manner and less directive forms of verbal interaction such as metaphor, paradoxes, and experimental exercises, to loosen the entanglement of language/thoughts and the self

• identify unworkable behaviors and develop suitable metaphors

• homework exercises that highlight the cost of unworkable solutions in respect to valued living

Mindfulness view of human nature:

• humans are naturally inclined towards psychological complexity

• emphasizes the holistic nature of human experiences and the importance of understanding and accepting emotions and thoughts

Strengths of ACT

• emphasizes acceptance and mindfulness strategies

• flexible and adaptable to diverse populations and a range of psychological issues

weaknesses of ACT

• may require more time for some individuals to grasp and apply its concepts

• limited empirical evidence for certain populations or specific disorders

Feminist Therapy assumptions about human nature

• we exist in a political and social system that is male dominated (patriarchy)

• for women to experience changes in personal lives, political changes (to social institutions) must occur

• gender schemas/sex-role stereotypes limit development

  • in society, men have more power than women

  • women are taught to rely on men

  • men may feel pressure to suppress emotions

Principles of Feminist Therapy

• empowerment and strengths-based

• honor clients voice (they’re an expert of their own life)

• address power and privilege (eradicate oppression)

• commitment to social change

  • it is assumed that individual change will best occur through social change

Feminist: How do problems develop?

• larger cultural context of patriarchy and oppression is pathological

  • problem is located outside the individual

• distress arises from internalized oppression

  • can include: microaggressions, trauma, interpersonal betrayal, and other forms of powerlessness

• symptoms are signs of resistance to experiences of oppression and attempts to solve the problem of powerlessness (not all attempts are helpful)

• acknowledges biological underpinnings of symptoms

“distress, not pathology” in feminist therapy

The client's suffering is understood as a normal reaction to oppressive/unequal social conditions rather than a personal failing or disorder.

Feminist: role of assessment and diagnosis

• diagnoses are based on the dominant culture’s view of normalcy and cannot account for cultural differences

• therapists have been sharply critical of the DSM classification system

• critique is based on research indicating that gender, culture, and race may influence assessment of clients symptoms

Feminist therapy goals

• attention to personal and social identities, awareness of own gender role socialization

• consciousness-raising

  • differentiate between the parts of their problems that are d/t harmful social structures and what they contribute/change

  • replace these messages with self-enhancing beliefs

• develop a sense of personal power (empowerment), identify power of relationships

• trust their own experience and intuition

• understand the impact of sexist and oppressive societal beliefs and practices

• develop a wide range of behaviors that are freely chosen (internally chosen)

Feminist: therapists role

• awareness of own biases and distortions

• commitment to understand oppression of all forms

• collaborate with clients to create positive change

• empowerment of client

  • identify and accept strengths/limitations client brings to a situation

  • identifying possible solutions to concerns, making an informed choice, and then creating change

  • provide a safe space for clients to address difficult topics

• help to free clients from roles that have hindered them from achieving potential

Feminist: Therapeutic Relationship

• Egalitarian in nature → no one set of knowledge seen as more highly valued than the other

• transparency → client involvement at any level; decisions with the client not for the client

• use of self-disclosure → therapist may talk about their own personal experiences to help normalize the client’s experience and provide hope that things can be better

Feminist: Treatment Planning

• identify identities

• consciousness-raising

• identification of strengths

• set up of therapeutic environment

• awareness of therapist privilege

Feminist: “Technically Eclectic”

any therapy can be feminist if it supports feminist practice (feminist consciousness, egalitarian relationship, client empowerment)

Feminist Intervention Strategies: gender-role analysis and intervention

• to help clients understand the impact of gender-role expectations in their lives

• provides clients with insight into the ways social issues affect their problems

Feminist Intervention Strategies: Power analysis and power intervention

• emphasis on the power differences between men and women in society

• clients helped to recognize different kinds of power they possess and how they and others exercise power

Feminist Intervention Strategies: Bibliotherapy

reading assignments that address issues such as:

• coping skills

• gender inequality

• gender-role stereotypes

• ways sexism is promoted

• power differential between men and women

• society’s obsession with thinness

• sexual assault

Feminist Intervention Strategies: Reframing

changes the frame of reference for looking at an individuals behavior

Feminist Intervention Strategies: self-disclosure

• to help equalize the therapeutic relationships and provide modeling for the client

• values, beliefs about society, and therapeutic interventions discussed

• allows the client to make an informed choice

Feminist Intervention Strategies: assertive training

• women become aware of their interpersonal rights

• transcends stereotypical sex roles

• changes negative beliefs

• implement changes in their daily lives

limitations of Feminist Therapy

• may be hard to measure improvement vs. traditional methods since feminist therapy may initially increase distressing feelings like anger but is ultimately empowering

• can be culturally biased

• “f-word” may evoke many stereotypes that are negative and mostly inaccurate

• limited empirical research

• therapists do not take a neutral stance

Contributions to feminist therapy

• acknowledges and normalizes the impact of social forces on mental health and ability to make positive change

• client as co-expert

• orientation to social justice and multicultural considerations

• focus on working with victims/survivors of relationships violence, more recently with perpetrators

• called attention to child abuse, incest, rape, sexual harassment, and domestic violence

Postmodern view of human nature

• assume that realities are socially constructed, there is no absolute reality

• see people as healthy, competent, resourceful

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

Postmodern Stance/Beliefs

• the client is the expert → therapist takes a “not knowing” stance

• dialogue is used to elicit perspective, resources, and unique client experiences

• questions empower clients to speak and to express their diverse positions

• therapist supplies optimism in the process

Postmodern: Social Constructionism therapy goals

• generate new meanings in the lives of clients

• co-develop with clients solutions that are unique to the situations

• enhance awareness of the impact of various aspects of the dominant culture on the individual

• help people develop alternative ways of being, knowing, and living; re-write their script

Postmodern: Assumptions of Solution-Focused Brief Therapy

• brief and focusing on solutions, rather than on problems

  • emphasizes what is working

• the problem itself may not be relevant to finding effective solutions

  • past is downplayed, present and future are highlighted

• therapy grounded on a positive orientation; people are healthy and competent

• people can create their own solutions

• small changes lead to large changes

Postmodern: role of therapist (SFBT)

• create a collaborative partnership because the client is the expert in 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 different

types of relationships in SFBT (postmodern): customer-type relationship

client and therapist jointly identify a problem and a solution to work toward

types of relationships in SFBT (postmodern): complainant relationship

a client describes a problem, but is not able or willing to take an active role in constructing a solution

types of relationships in SFBT (postmodern): visitors

clients come to therapy because someone else thinks they have a problem

Techniques (questions) used in SFBT

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

• exception questions → direct clients to times in their lives when the problem did not exist; there are always times when the problem is less severe or a sense for the client

• scaling questions → on a scale of zero to 10 (0 the worst you have been, 10 represents the problem being solved) where are you in respect to ______?

• the miracle question → a hypothetical scenario where the client imagines how their life would change if a miracle occurred and the problem was resolved overnight.

Postmodern: goals of SFBT

• emphasis is on constructing solutions rather than problem solving

• construct a concrete vision of a preferred future for themselves

• change clients focus away from the past and toward their present and future

• focus on keeping therapy simple and brief

Narrative Philosophy

• people make meaning out of their lives through the construction of narratives

• narrative is like a thread that weaves events together, forming a story

• client as expert of their life

• non-pathologizing, competency/strength focused, collaborative, motivation and agency enhancing

• collaboration: family members, friends, associates, professionals

Narrative: life stories in the therapeutic context

• clients lives are multi-storied, occuring at the same time

• dominant vs. alternative stories

• stories are situated within a broad social context

Narrative: how do problems develop?

• clients are often stuck in a pattern of living a problem-saturated story (stories are characterized by problems)

• clients adopt stories in which them and their problem are fused (the person is the problem) → clients only think of themselves in terms of these problems

• clients have limited perception of their capacities d/t engaging in problem-saturated thinking

Goals of Narrative Therapy

• to deconstruct problem-saturated stories and to re-author narratives that support preferred outcomes

• invite clients to talk about their lives in a fresh language which support preferred outcomes

• aims to empower the clients to change the ways people view their realities

Narrative: the therapeutic process

• collaborate with the client in identifying the problem

• separate the person from their problem

• investigate how the problem has been disrupting or dominating the person

  • ex: when did depression come into your life?

• search for exceptions to the problem

  • unique outcome questions: the client identifies times in the past when the problem did not exist

• ask clients to speculate about what kind of future they could expect from the competent person that is emerging

• create an audience to support the new story

  • the clients may express their new personal narrative with others or writing in a journal

Postmodern Approaches: Strengths and Contributions

• depatholgizing, strengths based, empowerment of the client

• draws upon strengths of other approaches: collaborative, cognitive, future oriented

• social Constructionism is congruent with the philosophy of multiculturalism

• brief-format

Post Modern: Challenges and Limitations

• highly verbal, linguistic

• may not work for very specific, concrete, behavioral concerns, severe psychopathology, cognitive impairment

• “not knowing stance'“ may compromise the clients confidence in the therapist as an expert

• few rigorous empirical research studies

what is the broad goal for couples counseling?

help partners understand and resolve conflicts and improve their relationship