Counselling Psychology Final

3rd generation of behaviour therapy

Targets the process of thoughts rather than the content

goal to find peace and shift persepctive

5 interrelated core themes follow

Psychological health

Acceptable outcomes in therapy

Acceptance

Mindfulness

Creating a life worth living

mindfulness

is “the awareness that emerges through having attention on purpose, in the present moment”

acceptance

is a process involving receiving one’s present experience without judgment or preference

mindfulness and acceptance based approaches

Dialectical Behaviour Therapy

Mindfulness-Based Stress Reduction

Mindfulness-Based Cognitive Therapy

Acceptance and Commitment Therapy

dialectical behavior therapy

created to to treat people with borderline personality disorder

borderline personality disorder

a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity.

dialectics

The art of investigating the relative truth of principles, opinions, and guidelines; arriving at the truth by examining the argument and resolving the two into a rational synthesis: two things that appear opposing can actually work together

emotional regulation

The ability to respond to emotions in healthy ways – which can lead to healthier and more fulfilling lives

goal of DBT

to develop dialectical thinking and practice skills that result in emotion regulation, reduced suffering, and improved relationships

distress tolerance

Assists with letting go of or coping with distress

Includes self soothing skills and distraction skills

The Wise Mind A C C E P T S acronym and I M P R O V E acronym – coping strategies to use during times of stress

interpersonal effectiveness

Skills necessary to make requests or convey wants to others, manage and resolve conflicts, establish and maintain positive relationships, and maintain self-respect

D E A R M A N G I V E F A S T acronym

skills of DBT

Validation is most important!

Acceptance before change

Assessment of situation and which skill group is needed

Mindfulness

Distress Tolerance

Emotion Regulation

Interpersonal Effectiveness

Identify and practice a skill in the moment

Assess effectiveness: identify and practice another skill, if needed

current use of DBT

Helpful for people with suicidal ideation, hospitalization, anxiety, and anger

Reduces the symptoms of borderline personality disorder (B P D): especially self-injurious and suicidal symptoms

Helpful for substance use and disordered eating

Effective with trauma, depression, bipolar, and personality disorders

traditional indigenous healing

for culturally sensitive ways of healing that have been passed down for thousands of years. Passed down orally. Learning is done in the wilderness. It is done by a Healer and trains to align with Mother Nature.

traditional Indigenous healing methods

Due to the lack of written documentation and lack of research within academia, is not viewed as a credible treatment for mental illness or mental duress in Western society

goal of the Walker paper

is to highlight overlaps between Western and TIH methods and allow for more informed cultural awareness for Indigenous cultures, making counsellors more prepared to support Indigenous clients without the client having to obtain mental health treatment through culturally incongruent interventions.

primary focus of ACT

acceptance of thoughts

ACT assumes

that avoidance of emotions and thoughts makes problems worse

ACT focuses on

fully accepting present experience and mindfully letting go of obstacles.

There is little emphasis on changing the content of a client’s thoughts. Instead, the emphasis is on acceptance (nonjudgmental awareness) of cognitions.

experiential avoidance

Avoidance of distressing thoughts, emotions, interactions, and events which may lead to increased distress that serves as barriers to development

relational frame theory

Behavioural theory of human language and cognitions that helps people recognize how they become entangled in thoughts and words and use those entangles in internal struggles against themselves

overall goal of ACT

is to help clients accept cognitions and emotions that are outside of their control; encourage clients to make a commitment to creating a life they value

increase psychological flexibility

hexaflex model

Six processes of healthy, flexible living:

Strengthen influence of contextual factors

awareness and acceptance

Clients are encouraged to be aware and accepting of thoughts and feelings rather than push them away

committed action

Clients are encouraged to engage in activities they used to enjoy but have withdrawn from

orienting to values

Persons cannot be psychologically present to their values and simultaneously not moving toward them

cognitive difusion

exercises that disrupt verbal relations manipulate context in which words mean things

the ACT question

Given a distinction between you and the things you are struggling with and trying to change, are you willing to experience those things, fully and without defense, as it is and not as it says it is, and do what takes you in the direction of your chosen values in this time and situation?

current use of ACT

Particularly helpful for anxiety, especially those with social anxiety

mindfulness based stress reduction

not a form of psychotherapy per se, but it can be an adjunct to therapy

assists people in learning to live more fully in the present.

The skills taught include sitting meditation and mindful yoga, aimed at cultivating mindfulness.

Didactic instruction is minimized and experiential learning and self-discovery are emphasized.

programs are offered in hospitals, clinics, schools, workplaces, offices, law schools, prisons, and health centers.

mindfulness based cognitive therapy

8-week group treatment program of two-hour weekly sessions adapted from MBSR that includes components of cognitive behaviour therapy (CBT)

The primary aim is to change clients’awareness of and relation to their negative thoughts, rather than on merely challenging the content of thoughts

the being mode

The opposite of the doing mode; being mode is in direct experience, moment by moment, recognizing bodily sensations as they arise, without agendas or judgments, and letting go of thoughts

key concepts of MBCT

the being mode

acceptance

tenants of mindfulness

What makes mindfulness work

Observing inner experiences

Acting with awareness

Nonjudgment of inner experience

Describing or labeling inner experience

Nonreactivity

MBCT goal

is assist clients in moving away from obsessing and perseverating on thoughts and feelings of their concern and instead teach them to be more present in the here and now

conscious thought processing

Clients are encouraged to acknowledge thoughts and feelings that exist, and allow them to pass and not control them

decentering

Maintaining a degree of separation from inner experiences and viewing experiences as mental processes rather than facts

also known as diffusion in ACT

compassion-focused therapy

Developed by Paul Raymond Gilbert

Aims to help clients feel safer and more capable

Teaches clients how to be more compassionate and kind to themselves (as the focus)

early maladaptive schemas

Self-defeating emotional patterns from childhood

5 schema domains

Disconnection and rejection

Impaired autonomy and performance

Impaired limits

Other-directedness

Over vigilance and inhibition

goals of schema therapy

to help people achieve and maintain a healthy adult mode of functioning and to help clients develop and sustain a healthy adult schema and stop engaging in maladaptive coping styles

Generally longer in duration – typically 2 weekly individual sessions over the course of 3 years

Assessment is important and can be done through experiential exercises and schema inventories

limited reparenting

Using the power of the therapeutic alliance to provide connection, warmth, and nurturance – clients depend on therapists by regulating emotions

empathetic confrontation

Challenge clients’ maladaptive schemas in a warm and respectful manner

cognitive interventions

Using homework assignments, challenging beliefs, and modifying maladaptive behaviours – challenging of schemas

strengths of 3rd wave CBTs

Fits needs of culturally diverse clients because of the emphasis on values and context

Mindfulness is effective for a wide variety of people

ACT’s experiential focus may fit well with people who have a difficult time letting go

Schema therapy proposed that early maladaptive schemas play a role in mental health

DBT’s effects are long-lasting

Collaborative nature

limitations of 3rd wave CBTs

Concern over spiritual aspects of mindfulness-based approaches

DBT may be too narrow and focused on BPD, however, it can be adapted to fit needs of other populations

Demanding of therapists and extensive training is required

Misunderstanding of theories can lead to misuse of approach(es)

modernists believe

There is an objective reality that can be systematically observed and systematically known through the scientific method

postmodernists believe

There is no single or objective “reality” or “truth,” but there exist rather “truth claims,” based on contingent, transient, partial, and situated realities.

development of postmodern theories

New assumption that people create their own realities and there is no objective truth

constructivism

The belief that individuals create their own views, constructs of events, and relationships in their own lives based on their own perceptions and experiences

social constructivism

People’s individual sense of reality and the meaning they find in their experiences are constructed and created in social situations and interactions with others

social constructionists believe

Knowledge is constructed through relationships rooted in a cultural, socioeconomic, and socio-political context rather than being solely a product of the individual

assumptions

Challenges the notion that knowledge is based on objective observations (critical stance toward taken-for-granted knowledge)

Understanding of the world is culturally and historically rooted

founders of narrative therapy

michael white and david epston

narrative therapy

People make meanings of their experiences through the language of stories that become part of themselves

Stories can be adaptive or maladaptive – goal is to change maladaptive stories to become adaptive

Narrative refers to the emphasis places on stories of people’s lives and the differences that can be made through particular tellings and retellings of these stories

key concepts of narrative therapy

Establishing therapeutic alliance and viewing clients as experts is essential

Therapists do not pathologize or diagnose clients

Clients are encouraged to share their stories and therapists listen to various resources they possess

Stories: People’s narratives help them make meaning of their experiences and give them identity

narrative therapy therapeutic goals

Overall goal is to develop new stories and find new language that better serve interests, positive meanings, and contribute to well-being

goals of narrative therapy

Help people deconstruct their problem-saturated stories

Help identify preferred directions

Create alternative stories that support these preferred directions

therapeutic process 3 stages of narrative therapy

eliciting stories, deconstruction of stories, and revisioning and reauthoring

mapping

Presenting problems are linked to stories to identify how problems emerged and are shown in narratives

externalizing

Separating clients from their problems – the problem is outside oneself rather than within clients

Gives clients more power over their problem

Naming the problem, letter writing, and drawing the problem are strategies to externalize the problem

therapeutic documents

Materials that provide evidence of clients’ accomplishments and progress

Used to reinforce and solidify gains

narrative techniques

Externalization

Identifying Unique Outcomes

Re-authoring/Developing Alternative Stories

Community of Support

Therapeutic Letters

externalizing conversations

Map the influence of the problem in person’s life

Track the problem from it’s origins to the present

narrative therapy relationship between client and therapist

Collaborative and egalitarian therapeutic relationship

Therapists are empathetic, encouraging, respectful, and optimistic

Therapists use the following techniques to develop a therapeutic alliance:

Empathy

Careful listening

Summarizing

Encouraging hope, courage, and resourcefulness

current use of narrative therapy

Particularly helpful for people who have been victimized or disenfranchised

Women, older adults, diverse groups, people who are transgender

family interventions and involvement

strengths of narrative therapy

Effective for a wide range of populations

Using questions as a technique is essential for gaining understanding of thoughts, feelings, behaviors, attitudes, and perceptions

Optimistic approach viewing clients as experts

Pays attention to the therapeutic relationship

limitations of narrative therapy

May not be suitable for clients who:

Cannot engage in a coherent conversation

Seek a quick solution to a specific problem

Those in crisis

Those who do not believe counseling will work

Therapists need to be highly skilled and trained

Some therapists may view ideas as mechanistic

May be harmful to only focus on a few techniques

solution focused therapy founders

Steve de Shazer and Insoo Kim Berg

strengths based approach

A focus on clients’ strengths, resources, wellness, and capacities

Ensures a more holistic, balanced, and optimistic approach to counselling

Believes that clients have the ability to provide their own solutions to their problems

4 areas of resiliency

Social competence

Problem solving

Autonomy

Sense of purpose

field of psychotherapy

Characterized by a diverse range of specialized models

Practitioners have been battling over the “best” way to bring about personality change (dating back to the work of Freud)

Early history of counselling is full of theoretical wars

Only recently have practitioners seriously considered integrating the best ideas from the various schools rather than searching for the best theory

Society of the Exploration of Psychotherapy Integration (SEPI)

Interdisciplinary, international organization

Primary aim is to promote the development and evaluation of approaches to psychotherapy that are not limited by a single orientation

In the spirit of encouraging multiple viewpoints, SEPI aims to promote, examine, and, where possible, integrate diverse approaches to bringing together the strengths of the various orientations in our field.

psychotherapy integration

“characterized by attempts to look beyond and across the confines of a single-school approaches to see what can be learned from other perspectives”

Not claiming allegiance to a particular therapeutic school

integrative therapies

Most therapists, using an integrative approach

When therapists have knowledge of many techniques, they can use the ones that best fit the needs of each client

reasons integrative therapies are growing

No single theory has been found to address needs of all clients

Due to variation in people’s experiences and cultural backgrounds, adhering to only one approach can cause harm

No single theory has been shown to be the most effective

+ lots of overlap in theories!!

components of sound eclectic approaches

building on strengths of existing theories

coherent combination that creates a unified whole

understanding of human behaviour and development

philosophy of change

guidelines for adapting the approach

strategies related to underlying theory

inclusion of commonalities of effective counselling

challenges of integrated and eclectic approaches

Demands more of therapists than choosing one theory

Therapists must set limits on their scope of practice – no therapist will have sufficient expertise of all approaches for all problems

Therapists must carefully consider their approach while working with various clients

benefits of eclectic and integrated approaches

Brings flexibility to the counselling process

Tailoring of approach to fit diverse needs of different clients

Can work with a broader range of clients due to various approaches

Allows therapists to adopt approaches that fit with their view of human development and their own personality

Focus on empirical research and a scientist-practitioner role

4 pathways to integrated therapy

Technical eclecticism

Theoretical integration

Common factors approach

Assimilative integration

technical eclectism

Aims at selecting the best treatment techniques for the individual and the problem

Does not necessarily subscribe to the theoretical positions of the techniques

No necessary connection between conceptual foundations and the techniques

theoretical integration

Refers to a conceptual or theoretical creation beyond a mere blending of techniques

Aims to create a conceptual framework that synthesizes the best aspects of two or more theoretical approaches under the assumption that the outcome will be richer than either theory alone

Emphasizes integrating the underlying theories of each therapy along with techniques from each

common factors approach

Searches for common elements across different theoretical systems

A recognizable core of counselling practice is composed of nonspecific variables common to all therapies

E.g., a focus on the therapeutic relationship

assimilative integration

Grounded in a particular school of psychotherapy

Openness to selectively incorporate practices from other therapeutic approaches (flexible variety of interventions from various systems)

multimodal therapy

Therapists select procedures from different modalities based on what works best for the client’s needs, but without necessarily subscribing to the overall theories (Technical Eclectic Approach)

Ability to address client concerns from multiple vantage points simultaneously

3 points of multimodal therapy

Can be grounded in a theory of the therapist’s choice

Enhanced by interventions associated with compatible approaches to counselling

Focused on interventions that have had their value substantiated by research

basic ID (Multimodal therapy)

behaviour: observable actions, responses, and habits

affective responses: moods and emotions

sensations: physical concerns, sensory experience images: fantasies, dreams, memories, mental pictures, people’s views of themselves, their lives, and their futures

cognitions: thoughts, beliefs, philosophies, values, plans, opinions, insights, self-talk

interpersonal relationships: friendships and intimate relationships, interactions with others

drugs, biological functions, nutrition, and exercise: overall health, self-care

4 factors that account for change in therapy

client factors (40%)

alliance factors (30%)

expectancy factors (15%)

theoretical models and techniques (15%).