Counseling Theories & Change Processes

Scientist-practitioner?

Evidence-based practice that uses research-supported theories and models (e.g., Transtheoretical Model).

Three course philosophies?

Scientist-practitioner, culturally competent, integrational (awareness + action processes).

Three ways theory helps in counseling?

(1) Conceptualize the nature of the problem, (2) show where you are with the client, (3) give directions for moving through the process (stage and level of change).

Stage of change = ? Level of change = ?

Stage = client readiness for change (when). Level = presenting problem (what to change and which theoretical approach).

5 stages of change?

Precontemplation, Contemplation, Preparation, Action, Maintenance.

Precontemplation: features, problems, strategy?

Unaware or no desire to change; cons > pros; often mandated or referred; may be hopeless; wants to change someone else. Build the relationship so they feel seen, then create dissonance.

Contemplation?

Admits a problem; pros = cons; ambivalent; limited insight; doubts ("Can I change?"); risk of drop-out.

Preparation?

Pros > cons; developing an action plan. Problems: vague plan, unsupportive others.

Action?

Actively changing and modifying the environment. Problems: coping with slips, changing too many things at once, unsupportive others.

Maintenance?

Sustaining change; maintenance sessions. Problems: streamlining the plan, coping with lapses, environmental change, incorporating change into lifestyle.

Common (non-specific) factors?

Therapeutic alliance, empathy/warmth, hope and positive expectations, client factors/resources, collaborative goals. They create the conditions for change.

Why understand common factors?

They account for much of therapy outcome regardless of theory; theory matters but is only part of the change process.

Common vs. specific vs. principles of change?

Common = "How am I creating conditions for change?" Principles = "What needs to happen for this client to move?" Specific = "How does this theory help me facilitate that?"

Three groupings of common factors (Class 2)?

Expectation (instilling hope, client's model of the problem), Attention (Hawthorne effect, counselor attention), Relationship (alliance, goals/tasks, counselor factors).

Principles of change?

Foster hope/motivation; build alliance; increase awareness/insight; facilitate corrective experiences; encourage reality testing and consolidate learning.

Counselor factors tied to better outcomes?

Good mental health, genuineness, non-judgmental, empathic. Meaning for you: self-care, self-awareness, and personal work matter.

Stage practice cases?

Malik ("can anything help?") = Contemplation. Ell (meds 2 months, mood stable) = Action. Chris (blames coworkers, referred) = Precontemplation. Mei (over a year, still uses grounding) = Maintenance. Kat ("can't imagine not having wine") = Contemplation. Mason (plan for gradual exposure, goals) = Preparation.

5 levels of change (and how organized)?

Symptom/situational → Maladaptive cognitions → Interpersonal → Family/systems → Intrapsychic/intrapersonal. Organized from surface/present-focused to deep/underlying causes.

Example for each level?

Fear of flying; "everyone is judging me"; difficulty with assertiveness; child's behavior problems with parental conflict; toxic relationship patterns from childhood relational trauma.

5 P's of case formulation?

Presenting problem (why now?), Predisposing (biopsychosocial vulnerability), Precipitating (recent triggers), Perpetuating (what maintains it), Protective (strengths, supports). They organize case conceptualization and treatment planning.

Processes of change?

Overt and covert activities people use to change thinking, feeling, behavior, and relationships (the how).

Inner-directed processes?

Consciousness raising (information, feedback, psychoeducation); Catharsis (therapeutic release, corrective emotional experience, dramatic relief); Choosing (self-liberation); Helping relationship (alliance, "creating the container").

Action-oriented processes?

Conditional stimuli (counterconditioning, stimulus control); Contingency control (contingency management, reevaluation); Choosing (social liberation/advocacy); Helping relationship (family, friends, therapeutic relationship).

Identify the process: Omar removes alcohol from home.

Stimulus control.

Maria cries and tells her trauma in group.

Catharsis.

Anna reads an article and realizes avoidance feeds depression.

Consciousness raising.

Priya earns Friday-night choice for attending therapy.

Contingency management.

Jordan trusts the counselor and feels believed in.

Helping relationship.

Fundamental assumptions of Humanistic-Existential approach?

Phenomenological (perceived reality); authenticity, choice, meaning; growth-oriented; the therapeutic relationship is central.

Major humanistic-existential theories?

Person-Centered, Existential, Experiential (Gestalt).

Person-Centered Therapy founder and works?

Carl Rogers; Counseling and Psychotherapy (1942), Client-Centered Therapy (1951).

PCT assumptions?

Humanistic (inherent worth), healthy person = fully functioning/congruent, central drive = actualization.

PCT path to distress?

Actualizing tendency → need for positive regard → conditional positive regard → conditions of worth → conflict with self-concept → incongruence → distress.

PCT path to growth?

Unconditional positive regard + empathy + congruence → reduced conditions of worth → openness to experience → increased congruence/self-trust → growth.

Conditions of worth?

Conditions we hold ourselves to in order to feel worthy of positive regard; they alienate us from our true self. Sources: dominating/overprotective/hostile environments, conditional messages ("You only count when..."), and valuation (valuing becomes a function of conditions of worth rather than our own experience).

How does need for positive regard interfere with self-actualization?

Conditional positive regard creates conditions of worth that block accepting the authentic self → incongruence.

Importance of incongruence + example?

It causes psychological distress from a gap between self-concept and experience. Example: "I never need anyone," yet severe loneliness and panic when alone.

Conditions for good outcome in PCT?

Collaborative relationship, unconditional positive regard, empathic understanding, genuineness, immediacy.

Goal of PCT?

Promote growth, empowerment, self-awareness, and congruence.

Reciprocal interpersonal reactions?

Clients pull reactions from us. Be self-aware, complement the client appropriately, notice transference, and use immediacy.

"Fix it" vs. "be with it"?

PCT emphasizes being with the client's experience, not fixing it.

PCT areas for contemplation work?

Consciousness raising (active listening, empathy, immediacy), catharsis (reflecting feelings), helping relationship (genuineness, UPR, accurate empathy).

Benefit of active listening?

Builds rapport and alliance, especially for precontemplators and contemplators.

Three areas immediacy can refer to?

Client's reaction to you, your reaction to the client, the interaction/relationship.

Immediacy example?

"I notice we've both gotten quiet when we talk about your dad. What's happening between us right now?"

Early vs. modern MI?

Early: express empathy, develop discrepancy, roll with resistance, support self-efficacy. Modern: engage/accept, evoke/plant seeds, listen for change talk vs. sustain talk and discord, empowerment, hope, confidence.

MI spirit?

Partnership, Acceptance, Compassion, Empowerment (PACE).

4 tasks of MI?

Engaging (can we work together?), Focusing (where are we going?), Evoking (why go there?), Planning (how will you get there?).

OARS?

Open questions, Affirmations, Reflections, Summaries.

Activities to increase well-being?

Gratitude journaling, mindfulness, pleasant activity scheduling, exercise, using strengths, acts of kindness, social connection.

Existential counseling assumptions?

Seek authenticity and meaning. Problems come from lying to ourselves (denying parts of self) or others (playing roles). Uses existential confrontation of avoidance.

Four existential "givens"/sources of anxiety?

Death, freedom/responsibility, isolation, meaninglessness.

Existential theorists?

Viktor Frankl, Rollo May, Irvin Yalom, Rollo May. (On the exam, May = existential.)

Logotherapy (Frankl)?

"Will to meaning": find purpose through work (creating), relationships (loving), and attitude toward unavoidable suffering.

Gestalt assumptions?

Experiential, focus on here-and-now emotions and awareness. We lose ourselves by overvaluing social roles and playing games.

Top Dog / Under Dog?

Top Dog is the demanding, scolding "should" voice. Under Dog is the passive, excuse-making, defiant voice. They are a polarity in conflict.

Empty chair technique?

Client speaks to an imagined person (or part of self) in an empty chair. This is the answer when a client imagines a critical partner in the session.

PCT strengths?

Self-esteem/identity issues, mild-moderate distress, clients open to self-exploration, clients who feel misunderstood. Skills: rapport, UPR, empathy, consciousness raising. More generalizable than behavioral skills.

PCT weaknesses?

Severe mental illness alone, behavioral issues/skill building, clients wanting directive style, acute crisis, lack of structure. Weakest in the Action stage.

Most important mechanism of change in PCT?

Quality of the therapeutic relationship.

Why is PCT "phenomenological"?

It's important to understand the client's perceived reality, not impose your own.

Assertion?

Expressing needs and opinions directly and respectfully; a skills-training target for controllable stress and interpersonal issues.

Empiricism?

Knowing by observing; a foundation of behavior therapy.

Overt vs. covert behavior?

Overt = observable. Covert = emotions and thoughts.

Voluntary vs. involuntary?

Voluntary = operant (shaped by consequences). Involuntary = reflexive, classical (conditioned by pairing).

Social learning theory (Bandura)?

Learning by observation/modeling; vicarious reinforcement and punishment; cognitive factors → self-efficacy; reciprocal determinism (behavior, cognition, environment influence each other).

Reciprocal determinism examples?

Environment → behavior (study better in library); behavior → environment (you study, roommate turns TV down); cognition/affect → behavior (nervous, so scroll TikTok); environment → cognition (not worried until night before).

Operant conditioning involves what behavior? What controls it?

Voluntary behavior; controlled by its consequences (reinforcement increases it, punishment decreases it).

Positive vs. negative reinforcement?

Positive = add a pleasant stimulus. Negative = remove an unpleasant stimulus. Both increase behavior.

Ways to reinforce?

Tangible rewards, pleasant activity, self-reinforcement, dispensing rewards (positive); removing aversive stimulus (negative).

Shaping?

Reinforcing successive approximations toward the target behavior.

Extinction and extinction burst?

Extinction = removing the reinforcement maintaining a behavior. Extinction burst = temporary increase in the behavior when reinforcement is first removed.

Punishment vs. negative reinforcement?

Punishment decreases behavior (add aversive or remove something pleasant). Negative reinforcement increases behavior by removing something aversive.

Forms of punishment and issues?

Natural consequences, corporal punishment, withholding privileges, time-out, self-criticism. Issues: effective short-term only, fear/resentment/avoidance, works better paired with positive reinforcement.

Response cost?

Punishment that removes something desirable (privilege, tokens) after an undesirable behavior.

Why understand antecedents?

They show the conditions under which behavior occurs (when, where, with whom). Internal = thoughts, feelings, sensations. External = events (bell ringing).

Antecedent control?

Changing events/triggers before a behavior to evoke desired behaviors.

ABC?

Antecedent (trigger), Behavior (observable response), Consequence (outcome after).

ABC practice: student avoids speaking in class.

A: question + anxiety about judgment. B: avoids speaking. C: immediate relief (negative reinforcement), later worry.

ABC practice: counseling student's transcription.

A: reviewing session + intense self-criticism. B: hand-transcribes and critiques every mistake. C: temporary reassurance, then more anxiety before next session (negative reinforcement maintains the cycle).

Classical conditioning components?

UCS → UCR; neutral stimulus paired with UCS becomes CS → CR.

Operant vs. classical?

Operant = voluntary behavior, driven by consequences. Classical = involuntary behavior, driven by associations/events before (antecedents).

Jordan: how was anxiety acquired?

Classical conditioning: speaking (NS) paired with classmates laughing (UCS → embarrassment) → speaking now triggers anxiety (CS → CR).

Jordan: what maintains it?

Operant (negative reinforcement): avoiding speaking/faking sick removes anxiety, increasing avoidance. Strategies: exposure, systematic desensitization, skills training.

Observational learning in group therapy?

Modeling and imitation of peers and leaders; vicarious reinforcement.

Precontemplation behavioral techniques?

Increase awareness (functional assessment/self-monitoring), change environment, reinforce steps toward adaptive behavior, monitor readiness. Change consequences (response cost, with caution about resentment; reward adaptive behavior; token economy). Use models.

Functional analysis A-R-C?

Antecedents (what precedes? distal = sets the stage, proximal = trigger now), Response (thinking, feeling, doing; skill deficits?), Consequences (what follows?).

Jon's ARC?

Distal: work demands, stress, single parenting. Proximal: late/tired, messy kitchen, TV blaring. Response: anger, shouting, grabbing/pushing. Consequences: immediate = daughter complies; later = guilt, crying, damaged relationship.

Three assessment methods?

Self-report (thinking/feeling: interviews, questionnaires, self-monitoring); Observation (behavior: naturalistic, role-play); Instrumentation (physiological: devices, biofeedback).

Aspects to self-monitor?

Frequency, duration, intensity/qualitative aspect, amount.

Why self-monitor?

Consciousness raising: helps clients see how behavior affects their lives and provides a baseline.

Preparation tasks?

Pros > cons; set baseline; define observable, measurable behavior; set goals; select intervention; build skills/self-efficacy; prepare environment (public commitment, ask for support).

Turning a problem into a goal?

(1) State what to increase/decrease/do differently. (2) State criteria. (3) State time frame. Example: "Within four weeks, I'll increase time with others from 1 to 4 hours per week."

Action: changing antecedents?

Minimize exposure (avoidance, narrowing, modifying chain of events, distraction/thought stopping, desensitization). Add antecedents for new behavior (cues, positive self-talk, positive peers).

Changing responses?

Arrange incompatible response, match coping to stress type, teach skills.

Controllable vs. uncontrollable stress coping?

Controllable: express needs, say no, delegate, plan/prioritize, mentally rehearse. Uncontrollable: avoid reminders, distract, compare to others, find silver lining, increase social support and pleasant activities.

Steps in skills training?

(1) Educate, (2) model (verbal and nonverbal), (3) rehearse, (4) feedback, (5) try again, (6) generalize to real life.

Changing consequences?

Increase behavior: pleasant activity, tangible reward, self-praise, reward menu. Decrease: incompatible response, time-out. Behavioral contracts specify the behavior, length, rewards, and consequences.

Exposure therapy: how it works and learning principles?

Repeated, gradual exposure to a trigger to reduce fear. Draws on two-factor theory: classical (fear association) + operant (avoidance is negatively reinforced, so exposure undoes it).

In vivo vs. imaginal?

In vivo = real life. Imaginal = imagined. In vivo is generally more effective.