Intro to Counseling Midterm

Lecture Material

Counseling

a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, educational, work, and wellness goals.

Professional Counseling

Leverages a therapeutic relationship and reliable methods to nurture and encourage client flourishing

Flourishing

Having right relationships with God, oneself, other people, and the natural world

As Christians we have 6 presuppositions about our clients

• embodied

• unified in body, soul, and spirit

• image-bearers

• inherently relational

• agents who are capable of making choices

• fallen

What are characteristics of a “therapeutic” person? (6)

• empathetic

• present and future oriented

• stress responsibility and accountability

• appreciate biological constrains and social contexts

• are action and not solely insight oriented

• work on establishing purpose and meaningful goals

Bracketing

managing your personal values

Value imposition

directly defining a client’s values, attitudes, beliefs, and behaviors

Countertransference

any of our projections that influence the way we perceive and react to a client.

• Emotional reactivity

• Respond defensively

• Lose our ability to be present

According to Corey, where does a counselor start in a client relationship?

By discerning the goals of the client

If a client has no goals because they are a mandated client or minor, what can be done?

form a therapeutic alliance and if possible, help them to see some value in exploring their situation

Informed consent

The right of clients to be informed about their therapy and to make autonomous decisions pertaining to it

Includes:

• General goals

• responsibilities of the clients and counselor

• limitations and expectations of confidentiality

• Qualifications of the practitioner

• Fees

• Privacy issues of technology

Confidentiality

an ethical principle; legal duty of the counselors to not disclose info about a client

Privileged Communication

a legal concept that protects clients from having information about their cases discussed in a legal setting without their written permission

Exceptions to confidentiality

• When the therapist believes a client under the age of 18 is experiencing maltreatment

• When the therapist believes that a client of any age threatens to harm themselves or others

• When a counselor’s records are subpoenaed by a court of law

• When clients request in writing that their records be released to a third party

Dual relationships

Relationships that are either sexual or nonsexual that occur when a counselor assumes two or more roles with a client. This could be more than one professional role or combining professional and nonprofessional roles

How are therapists tools for client improvement?

• The alliance: high cohesion of the relationship is good

• The relationship: trust, etc

• The interpersonal skills: body language, authenticity, warmth*

Client Agency

The client has to be motivated in order for progress to be made

Humans have the potential for healing and growth. What is the evidence for this? (4)

• People frequently overcome problems without professional help

• The placebo effect

• Many people demonstrate resilience whether they receive treatment or not

• The higher levels of distress predict better counseling outcomes

What 3 things must be true of clients in order for counseling to be effective?

1. must be open to change, cooperative, and collaborative

2. select from therapy what they need to get better

3. must relate therapy to their daily lives

What are 4 practical implications of the importance of the client?

1. Promote client strengths and agency

2. Believe that clients are capable of proactive change

3. Privilege the client’s experience and ideas

4. See clients as “active self-healers” and not passive participants

Telic congruence

religious claims that the purpose of life involves rejecting parts of ourselves and pursuing another goal such as becoming like Christ

Organismic congruence

psychological value of embracing what we already are

Common factors

factors required for successful therapeutic practice regardless of treatment type

What are the three pathways of the common factors contextual model?

1. Real relationships

2. The creation of expectations

3. Enactment of health promoting actions

How is psychotherapy an unusual social relationship?

1. The interaction is confidential

2. Disclosure of difficult material does not disrupt the social bond

What factors characterize ineffective psychotherapy?

• poor alliances, collaboration, consensus, and empathy

• Lack of feedback on client profess

• Ignorance of alliance ruptures

• Unaware of countertransference

What things should practitioners avoid?

• confrontations

• negative processes

• assumptions

• therapist-centricity

• rigidity

• cultural arrogance

What are the 2 most statistically significant common factors?

1. Therapeutic alliance

2. Empathy

What three components form a therapeutic alliance

the bond, agreement about goals, and agreement about the tasks of therapy

Empathy

a complex process by which an individual can be affected by and share the emotional state of another, assess the reasons for another’s state, and identify with the other by adopting his or her perspective

Therapist effects

the most effective therapist can form strong alliances across a range of patients, demonstrate strong interpersonal skills, express appropriate professional self-doubt, and engage in time outside of actual therapy practicing various therapeutic skills.

How can a correct doctrine of sin aid therapeutic practice

by promoting empathy; it understands that we are all sinners and experience temptation

How do most counseling models differ from Christian counseling models?

Most counseling models emphasize dignity in ever person and learning skills to express empathy.

Christian counseling however integrates an understanding of sin into the model which naturally promotes empathy

What are the 3 dimensions of sin that we discuss?

1. Sin is an inherent condition

2. We make sinful choices as a result of our conditions

3. There are consequences of sin

   1. People are influenced by other people’s sin as we live in a broken world

An expansive view of sin leads to…

an expansive view of grace

• We avoid the language of sin because we feel weak. We need the deep convicting feeling to understand grace.

How does grace better the therapeutic relationship?

A grace-filled relationship makes people feel safe to express the sinful areas of their life thus allowing for growth.

What are Christian counseling view related to anger?

1. Anger is morally neutral and should be explored

2. Anger is tainted with sin so counselors should bring people to repentance

3. Anger is tainted but still worth exploring because the greatest sources of evil in our life often have yet to be discovered

According to the sin and grace thesis, what three principles does counseling need to hold together?

Spirituality, theological, and psychological

Spiritual principles of counseling

functions more intuitively and is based on stories and experiences

• provides a framework for understanding life as difficult and offers companionship

Theological principles of counseling

functions by logic and analysis

• engages the intellect in understanding the divine

• provides a view of truth

Psychological principles of counseling

provides a view of human defensiveness

• much more prone to see faults in others than ourselves

• growth requires a gradual discovery of our defensive styles

4 types of integration

1. Worldview

2. Applied

3. Role

4. Personal

Worldview

beliefs about ultimate questions

• people are often worldview blind; exception during suffering

Worldview integration

a position that places professional methods within a cognitive frame that is embedded in Christian thought and premised by Christian assumptions

3 dominant worldviews

• Naturalism

• Secular humanism

• Christian deism

Naturalism

material existence

• faith is just a myth

• free will is non existent

• non-teleological

Secular humanism

emphasis on progress; technology can alleviate suffering; human are the source of goodness

Applied integration

The attempt to either

1. Adapt or accommodate secular interventions for use within a Christian population

2. The develop interventions explicitly derived from Christian thought and practice

Implicit applied integration

When a counselor chooses between a range of clinical decisions and techniques that lie within standard secular practice because those options are more consistent with Christian values

Examples of implicit integration

• Religiously sensitive clinical approaches

• Inquiry about spiritual beliefs

• Taking a spiritual assessment

• Counselor-clergy collaboration

Explicit applied integration

When an aspect of the Christian faith is formally and consciously included in clinical practice

Examples of explicit integration

• prayer

• forgiveness

• meditation

• spiritual mourning

Intentional integration

prayerfully depending on the Holy Spirit to lead and guide the therapeutic session, using implicit or explicit integration in a professionally competent way

Role integration

to live out in integrity role expectations and patterns that arise from a counseling vocation in a particular context in a way that is simultaneously faithful to one’s Christian identity.

De jure

stated explicitly and monitored by an authority

De facto

not stated explicitly but arise from common conduct patterns that characterize a profession

Functioning under a license

entering a government regulated profession or serving as a fiduciary of public trust

Personal integration

Organic wats that people integrate as a function of their personality and other individual characteristics in their relationship with God

Behaviorism

Consequences and rewards motivate our behavior

Tenets of behavioral therapy (8)

1. Derived from principles related to learning

2. Centers around targeted behaviors

3. Goals are concrete but often incremental

4. Focuses on the present

5. Agency of the client

6. Not focused on the origins of a problem

7. Individualized

8. Strong empirical base

A behaviorist must conduct a functional assessment (behavior analysis) of a client. Explain the ABC model of analysis

A: antecedent (What triggers a behavior)

B: behavior

C: consequence of the behavior

Positive reinforcement

adding something of value that encourages a behavior

Negative reinforcement

removing an unpleasant stimuli to encourage a behavior

Extinction

the result of removing a reinforcement

Positive punishment

Adding a consequence to decrease the frequency of a behavior

Negative punishment

Removing a positive stimuli to decrease frequency of a behavior

Systematic desensitization

based on classical conditioning; learning to stay calm while imaging anxiety promoting scenarios

In vivo exposure

exposing some to the anxiety producing event or object

Social skills training

modeling, behavior rehearsing, role play

Mindfulness

focusing on the present experience without judgement and with acceptance

Dialectical Behavior Therapy (DBT)

Marsha Lineham (1993)

• used with borderline personality disorders

• Draws upon mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance

• 1 year of intensive individual and group psychotherapy

Cognitive behavioral therapy

seeks to alter distorted beliefs

Tenents of CBT (4)

• Seeks to modify emotions and behaviors by altering distorted cognitions (thoughts)

• Says that all psychological problems have dysfunctional thinking in common

• When people think in adaptive ways, their emotions and behaviors improve

• Seeks to adapt schemas for enduring change

All or nothing thinking

looking at things in absolute, black and white categories

Overgeneralization

viewing negative events as a never ending pattern of defeat

Jumping to conclusions

Mind reading: you assume that people are reacting negatively to you when there is not definite evidence for this

Fortune telling: predicting things will turn out badly

Personalization and blame

blaming yourself for something you weren’t entirely responsible for, or you blame other people and overlook ways that your own attitudes and behavior might contribute

Schemas

deeply held beliefs about oneself and the world

What is the key idea of CBT

changes in belief lead to change in behavior and emotion

Pros of CBT

• present focused

• Creates distance between thoughts and feelings

• small steps

• focuses on reality

• homework

• places individuals on a path

• easy to understand

Basic components of CBT (5)

• solid, therapeutic alliance

• goal oriented

• time limited

• structured

• client education and empowerment

Applied behavior analysis

• considered an evidence based best practice treatment

• many techniques focus on antecedents and consequences

• intensive and long term therapy improve outcomes for many children with autism

• gains in intellectual functioning, language development, daily living skills, and social functioning

Functional behavior analysis

a process for gathering information about behaviors of concern, whether the behaviors are academic, social, or emotional