Midterms COUN311 - Person Centered Therapy, Gestalt Therapy, Behavioral (ONGOING)

PERSON-CENTERED THERAPY

Developed by Carl Rogers rooted in humanistic psychology.

PERSON-CENTERED THERAPY

Emphasizes the therapist's attitudes and the quality of the client-therapist relationship over techniques.

Congruence

During the session, Sarah mentions that she feels like a failure for not meeting her own expectations. Mark responds honestly:

"I want to share something with you, Sarah. I sometimes struggle with similar feelings of inadequacy in my own life. It's important for me to be genuine with you about my experiences because it shows that we all face challenges."

Unconditional Positive Regard

As Sarah expresses her feelings of inadequacy, Mark listens attentively. He responds with:

"Sarah, I want you to know that I accept you completely, just as you are. It's okay to feel overwhelmed, and I appreciate your honesty in sharing these feelings with me.

Accurate Empathic Understanding

As Sarah talks about a recent project at work that didn't go as planned, she reveals her fear of disappointing her colleagues. Mark responds:

"It sounds like you're feeling really anxious about how your team perceives you. I can imagine how stressful it must be to worry about letting them down."

➢ To provide a climate of safety and trust in the therapeutic setting.

➢ To assist in the growth process.

➢ Not setting goals for what clients need to change, yet they differ on the matter of how to best help clients achieve their own goals.

What is the Therapeutic Goals of Person Centered Therapy?

➢ A possible danger is the therapist who, by merely reflecting content, brings little of his or her personhood into the therapeutic relationship.

➢ The approach has limited use with nonverbal clients, and it tends to discount the significance of the past.

➢ This approach is limited due to the lack of attention on using empirically proven techniques for specific problems.

What is the possible danger in Person Centered Therapy?

Frederick (Fritz) Perls and Laura Perls.

GESTALT THERAPY

Founders:

The late Miriam Polster and Erving Polster

GESTALT THERAPY

Other Key Figures:

understanding individuals

An existential, phenomenological and process-based approach that emphasises ______ _____ within their ongoing relationship with the environment.

GESTALT THERAPY

Confrontational Style

GESTALT THERAPY

It promotes direct experience over abstract discussions.

GESTALT THERAPY

Key goals include self-acceptance, environmental awareness, responsibility for choices and dynamic engagement with interpersonal relationships.

Holism

Therapists focus on the entire person, including thought, feelings, behaviors, body sensations, memories and dreams.

Field Theory

The therapeutic field includes the client, therapist, and all interactions occurring between them.

Figure Formation Process

Describes how individuals organize their experiences moment-to-moment.

Organismic Self-Regulation

Refers to how individuals maintain equilibrium when needs or interests emerge.

The Now

Emphasizes the importance of fully experiencing the present moment.

Unfinished Business

- Refers to unresolved feelings (e.g., resentment, grief) that interfere with present experiences.

- To achieve closure and improve authentic relationships.

Contact and Resistance

- Healthy contact requires awareness, energy and self-expression.

- Coping mechanisms

Energy and Block to Energy

- Blocked energy can manifest as physical tension or restricted expression.

- Therapists help clients identify these blocks to ra

Gestalt therapy focuses on increasing client awareness rather than adhering to predetermined goals.

THERAPEUTIC PROCESS IN GESTALT THERAPY

Continuum of Experience

Exploring emotions as interconnected rather than isolated events.

Here and Now Focus

Present-moment awareness; encouraging clients to engage with their current thoughts and feelings rather than getting lost in past narratives or future anxieties.

Paradoxical Theory of Change

Accept themselves as they are, rather than striving to become someone else.

Experimentation

Role-playing or other interactive methods.

Authentic Encounter

Fosters genuine connection and trust.

Process-Oriented Diagnosis

Encouraging clients to explore how their actions affect their lives in real-time.

The Experiment

- Gestalt therapy emphasizes the importance of experiments as a core component of the therapeutic process.

- They are spontaneous and tailored to the client's current experience, promoting experiential learning.

Role of the Therapist

The therapist acts as a creative agent, fostering a safe environment for clients to explore their feelings and behaviors.

Preparing Clients for Experiments

Clients should be oriented and prepared for experiments to enhance their willingness to engage.

Confrontation

Confrontation in Gestalt therapy is not about aggression but about gently challenging clients to examine their behaviors and attitudes.

1. Experiment

2. Empty Chair Technique

3. Internal Dialogue Exercise

4. Making the Rounds

5. Reversal Exercise

6. Rehearsal Exercise

7. Exaggeration Exercise

8. Staying with the Feeling

9. Dream Work

What are the 9 Gestalt Therapy Interventions?

Experiment

Spontaneous activities that arise from the therapeutic relationship and dialogue. They shift focus from merely discussing issues to engaging in experiential learning.

Empty Chair Technique

In this role-playing exercise, the client sits in front of an empty chair and imagines that a significant person or part of themselves is sitting there. The client engages in a dialogue with this imagined figure.

Internal Dialogue Exercise

Clients engage in a conversation with different parts of themselves, often using two chairs to represent conflicting aspects (E.g., "top dog" vs. "underdog").

Making the Rounds

In group therapy, participants are encouraged to interact with each member by expressing feelings or thoughts directly to them.

Reversal Exercise

Clients are asked to role-play the opposite of their usual behaviors or symptoms (e.g., someone who is typically shy may act confidently).

Rehearsal Exercise

Clients vocalize their internal rehearsals or scripts for social interactions out loud during therapy.

Exaggeration Exercise

Clients are encouraged to exaggerate specific movements or gestures associated with their emotions (e.g., shaking hands when feeling anxious).

Staying with the Feeling

Therapists encourage clients to remain present with uncomfortable emotions rather than avoiding them.

Dream Work

Instead of interpreting dreams, therapists guide clients to act out their dreams as if they are happening in the present moment.

BEHAVIOR THERAPY

focuses on observable behaviors and the current factors influencing them, emphasizing tailored treatment strategies and rigorous assessment.

Classical Conditioning

This involves learning through association, exemplified by Pavlov's experiments with dogs. Techniques like systematic desensitization illustrate clinical applications of this model.

Operant Conditioning

Focused on how behaviors are influenced by their consequences, operant conditioning employs reinforcement and punishment to shape behavior.

Social Learning Theory

Developed by Bandura, this approach emphasizes the interac;on between environment, personal factors, and behavior. It highlights the importance of self-efficacy in facilitating behaviour change.

Cognitive Behavior Therapy (CBT)

By the mid-1970s, CBT emerged as a dominant approach within behavior therapy, integra;ng cognitive processes into treatment strategies. This reflects a broader understanding of emo;onal and behavioral issues that considers cogni;ve factors alongside behavioral ones.

Scientific Basis

It relies on principles derived from the scientific method, applying empirically validated learning theories to facilitate behavior change. Treatment goals are clearly defined and agreed upon by both therapist and client, allowing for systematic evaluation of effectiveness.

Current Problem Focus

The therapy emphasizes addressing present issues and the factors influencing them rather than delving into historical causes. Behavior therapists conduct functional assessments to identify environmental factors maintaining problem behaviors.

Active Client Participation

Clients are expected to take an active role in their treatment by engaging in specific actions to address their problems. This includes monitoring behaviors, practicing coping skills, and comple;ng homework assignments, making the approach educational and action-oriented.

Change Without Insight

Behavior therapy operates on the premise that behavioral change can occur independently of insight into underlying issues. While understanding may enhance motivation, it is not a prerequisite for change.

Direct Assessment

The approach involves direct observation and assessment of both overt and covert behaviors. Therapists evaluate clients' social environments, including cultural influences and support networks, to inform treatment.

Individualized Interventions

Treatment strategies are tailored to the specific problems faced by each client. A critical question guiding therapy is determining which treatment is most effective for an individual's unique circumstances.

- primary objectives are to enhance personal choice and create new learning conditions.

- formal assessment identifies target behaviors for change, and ongoing evaluations track progress toward these goals.

What is the primary objective of Behavior Therapy

Applied Behavioral Analysis

Utilizes operant conditioning principles to modify behaviors by changing antecedents and consequences (the ABC model). Techniques include posi;ve reinforcement, nega;ve reinforcement, extinction, and punishment.

Relaxation Training

Aims to help clients cope with stress through muscle and mental relaxation techniques. Progressive muscle relaxation, developed by Jacobson, is a foundational method that can be combined with other behavioral strategies.

Systematic Desentization

Developed by Joseph Wolpe, this technique involves gradually exposing clients to anxiety-provoking stimuli while practicing relaxation techniques. It is effective for treating anxiety-related disorders and phobias.

In Vivo Exposure and Flooding

These exposure therapies involve direct confrontation with feared stimuli. In vivo exposure entails real life encounters with anxiety-inducing situations, while flooding involves prolonged exposure to these stimuli without engaging in avoidance behaviors.

Eye Movement Desensitization and Reprocessing

A specialized form of exposure therapy that combines imaginal flooding, cognitive restructuring, and bilateral stimulation (e.g., eye movements) to address traumatic stress. EMDR is used for various populations but requires proper training for effective implementation.

Social Skills Training (SST)

This therapeutic approach aimed at enhancing interpersonal competencies, enabling individuals to interact effectively in various social situations. This training is particularly beneficial for those experiencing psychosocial issues stemming from interpersonal difficulties.

Psychoeducation

educating clients about social skills and their importance.

Modeling

demonstrating appropriate social behaviors for clients to observe and imitate.

Reinforcement

providing positive feedback to encourage desired behaviors

Behavioral Rehearsal

practicing new skills in a safe environment through role-playing.

Feedback

offering constructive criticism to help clients improve their social interactions..

Assertion Training

this specialized form of SST focuses on teaching individuals how to assert themselves appropriately in social situations. It aims to help those who struggle with expressing their feelings, saying no, or standing up for their rights without being aggressive. The training emphasizes the right to express oneself while being sensitive to others' feelings.

Anger Management Training

Designed for individuals with aggressive behaviors, this variation helps clients manage and express anger constructively.

Self-modification Programs

Self-modification techniques empower individuals to manage their own behavior changes and are more cost-effective than traditional therapy.

Self-monitoring

keeping track of one's own behavior and triggers.

Self-Reinforcement

rewarding oneself for achievement goals.

Stimulus Control

modifying the environment to reduce triggers undesirable behaviors.

Multimodal Therapy

Developed by Arnold Lazarus, multimodal therapy integrates various behavioral techniques tailored to individual client needs. It focuses on seven modalities of functioning (Basic ID.: Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal Relationships and Drugs) to create a comprehensive treatment plan.

Mindfulness and Acceptance-Based Approaches

The "third wave" of behavior therapy incorporates mindfulness and acceptance strategies. Techniques such as Dialectical Behavior Therapy (DBT). Mindfulness-Based Stress Reduction (MBSR), and Acceptance and Commitment Therapy (ACT) emphasize present-moment awareness and acceptance of experiences as central to promoting psychological well-being.

Opening

- The therapist welcomes Sarah and establishes a comfortable atmosphere.

- Brief check-in on how Sarah has been feeling since the last session.

Identifying Behaviors

- Behavior Discussion: Sarah reports feeling anxious about attending a friend's birthday party, describing physical symptoms such as sweating and racing heart when thinking about social interactions.

- The therapist asks Sarah to identify specific thoughts and behaviors that occur when she anticipates social situations

Intervention Activity Planning

- The therapist introduces the concept of behavioral activation, explaining how engaging in activities can help improve mood and reduce anxiety.

Role-playing Exercise

to prepare for the party, they role-play potential scenarios that might occur, such as starting conversations or handling awkward moments. This helps Sarah practice responses in a safe environment.

Response and Reflection

- Sarah expresses mixed feelings about the planned activities; she is excited yet apprehensive about attending the party.

- The therapist validates her feelings and encourages her to reflect on the past experiences where social interactions went well, emphasizing her strengths.

Plan for Next Session

- The therapist outlines the plan to review Sarah's experiences at the birthday party and other scheduled activities in the next session.

- They agree to discuss any challenges she faced and explore cognitive restructuring techniques to address negative thoughts that may arise from these experiences.

- Assignment or homework for the next sessions.

Systematic Desentization

Example: A teenager who is afraid of elevators is taught relaxation techniques, then is gradually exposed to approaching, entering, and finally riding in an elevator with the therapist.

Token Economy

Example: A 7-year-old child with ADHD receives a star on a chart each time she completes homework without interruption. After earning 10 stars, she can exchange them for 30 minutes of video game time.

Habit Reversal Training

Example: A client with trichotillomania is taught to become aware of the urge to pull hair and immediately clasp her hands together or sit on her hands whenever the urge arises.

● Awareness training

● Recognizing the triggers and urges and competing with response training by performing an incompatible behavior.

● The competing response (clasp hands) physically prevents the problematic behavior (pull hair), while the urge passes.

Flooding

Example: A child fears dogs. Her therapist brings her to a park with dogs and remains with her until the fear diminishes after prolonged exposure.

● Intense and immediately exposed to the feared situation.

● Directly exposed to the feared object.

Flooding

Example: A client with a specific phobia of spiders is brought into a room filled with spiders and must remain there with the therapist for two hours until the anxiety naturally diminishes.

Modeling

Example: A manager wants his team to learn conflict resolution skills. He demonstrates effective negotiation in role-play exercises, encouraging team members to imitate his behavior.

● Observation and Imitation of the behavior.

Aversion Therapy

Example A woman wishes to quit smoking. Her therapist pairs each cigarette with a bitter-tasting solution to make smoking unpleasant.

Positive Reinforcement

Example: After successfully brushing her teeth each morning for a week, a child earns praise and her favorite breakfast.

Self-Monitoring (Self-Modification Program)

Example: In therapy, an adult is taught to monitor his daily mood and record details when depressive feelings occur, noting the setting and possible triggers.

Shaping

Example: A therapist works with a child who refuses to eat vegetables, gradually increasing the amount on the plate and offering praise for any attempt to try a bite, slowly building up over sessions.

Behavioral Activation

Example: A client who procrastinates at work is required to list specific tasks and set a timer for each, practicing these routines during sessions. Gradually, the client is exposed to longer periods of scheduled work.

Shaping

Example: A therapist works with a socially anxious adolescent by breaking down the skill of initiating conversation into simple steps and reinforcing each successful attempt before moving to more complex steps.

Extinction

Example: To reduce a child's temper tantrums, parents are taught to ignore outbursts and only give attention when the child is calm.

Behavioral Activation

Example: A 35-year-old man with depression rarely leaves his house and has stopped engaging in previously enjoyable activities. His therapist schedules specific activities for him each day—walking for 15 minutes, calling a friend, cooking a meal—and tracks his mood after each activity.

Response Prevention

Example: A therapist treats a client with obsessive-compulsive disorder who compulsively washes her hands 40 times daily. The therapist has the client touch a "contaminated" doorknob and prevents her from washing her hands increasing periods while staying with her until anxiety decreases.

Self-Monitoring (Self-Modification Program)

Example: A therapist with a client who has bulimia nervosa instructs her to keep a detailed food diary, recording what she eats, when, where, and her emotional state before and after eating.

Aversion Therapy

Example: A client who smokes cigarettes receives a mild electric shock each time she takes a cigarette from the pack during therapy session, creating an association between smoking and discomfort.

Modeling

Example: A therapist demonstrates assertive communication skills during a role-play, showing a socially anxious client exactly how to refuse an unreasonable request from a coworker. The client then observes and later imitates this behavior.

Imaginal Exposure

Example: A combat veteran with PTSD repeatedly describes the traumatic event in detail during therapy sessions while the therapist helps him remain present and process the emotions until the distress decreases.

Imaginal Exposure

Example: A client with agoraphobia practices entering a crowded mall repeatedly in imagination during therapy sessions, visualizing all the details while using relaxation techniques before attempting real-life situations.

Behavioral Rehearsal

Example: A therapist works with a client who engages in self-injurious behavior. They practice alternative coping strategies through role-play using ice cubes, drawing on the skin with red marker, or calling a support person until the client can perform these independently.