Processes of Change and Human-Existential Theories

To be good counselors, we should be:

1) A scientist-practitioner: using evidence-based transtheoretical models

2) Culturally competent: incorporating culture into case conceptualization and practice

3) Integrational: utilizing both awareness and action processes

How are we expected to be culturally competent counselors?

By making an effort to understand how culture impacts a person and striving for cultural humility

cultural humility

not just attaining knowledge but trying to learn about others' culture and how it interacts with a client's mindset

How is change a process?

The questions isn't if you are going to have a relapse/challenge but how do you respond to it when you have a relapse/challenge

-focus on the process rather than the progress

T/F: Theoretical orientation is the be-all and end-all

False, it's a way for the counselor to understand/conceptualize clients and their issues, but it is not the bible

Stages of Change (Transtheoretical Model)

The client's readiness for change

Precontemplation Stage

Client is unaware of the problem, cons >pros of change

Where the counselor builds dissonance and rapport

Typical problems: creating problems for others, mandated to attend as a consequence, desire to change someone else

Contemplation Stage

Client admits to having a problem, has limited insight, pros = cons of change

Typical problems: ambivalence, doubt they can change, risk of dropout if pushed too far too fast

Preparation Stage

pros > cons of change, developing an action plan

Typical Problems: plan is vague; anticipate potential challenges from unsupportive others

When making a plan in the preparation stage, goal-writing should be______

something measurable

Action Stage

Client is actively changing and modifying the environment

Typical problems: coping with slips, changing too many things at once, unsupportive others

Maintenance Stage

Client is sustaining change; maintenance sessions

Typical problems: streamlining the plan, coping with lapses, incorporating change into the overall lifestyle

There is at least _______ of action before transitioning into maintenance

6 months

What creates change in counseling?

common factors, specific factors, principles of change

Common Factors

Therapeutic relationship/alliance

Empathy and warmth

Hope and positive expectations

Client factors and resources

Collaborative goals

The more the therapist embodies these factors, the more the client can benefit from whatever approach is used

Specific Factors

Theory-specific conceptualization of the problem

Specific techniques and strategies

interventions

Principles of Change

Foster hope and motivation: meeting the client where they are and letting them know that based on what we know, we have hope for them

Build therapeutic alliance

Increase awareness and insight

Facilitate corrective experiences

Encourage reality testing, consolidate learning

How do the factors work together?

Common factors are the conditions for change, specific factors are the concrete ways to facilitate change, and principles of change are what needs to happen for the client to move toward change

Change process: expectation

Instilling hope; the client needs to know that we understand their view of the problem

Change process: attention

Counselor's attention to the client

Hawthorne effect: people show improvement just when someone is in the room

Change process: relationship

Counselor factors, collaborative goals and tasks of therapy, and a strong therapeutic alliance make way for change in counseling

Counselor factors

Mental health (taking care of oneself)

Genuiness

Non-judgmental (unconditional positive regard)

Empathic

Processes of Change

Overt and covert activities people do to change thinking, behavior, and relationships

Levels of Change

What to change and the theoretical approach

-Symptom/Situational

-Maladaptive Cognitions

-Interpersonal

-Family/Systems

-Intrapsychic/Intrapersonal

Symptom/Situational Level

focus is managing or eliminating a present symptom

-ex. phobias

Maladaptive Cognitions Level

Focus is identifying and challenging irrational or distorted thoughts/beliefs

-ex. social anxiety driven by the belief of judgment

Interpersonal Level

The focus is on maladaptive patterns in relationships, including establishing and maintaining relationships, communication, and conflict resolution

-ex. difficulty with assertiveness

Family/Systems Level

The focus is on examining and restructuring expectations, roles, and patterns within a family system

-ex. child is acting out due to parents' marital issues

Intrapsychic/Intrapersonal Level

The focus is on the deep, underlying causes of chronic or pervasive issues

-ex. pattern of toxic relationships stemming from childhood trauma

What should you know about the levels of change?

As you move deeper down the levels, treatment will last longer

You have to look at where the client is, but also where they are ready to start

In general, start at the highest level because it's the most available, immediate, and it's what your client is most ready for

Inner Directed Change Processes

Consciousness raising, catharsis, choosing, and helping

Consciousness raising

the activity of seeking to make people more aware of information and self, giving feedback and psychoeducation

Catharsis

a release of emotional tension; corrective emotional experience; especially useful for people who are disconnected from their emotions

choosing

Self-liberation: taking responsibility for your choices

Behavioral: what are the options for behavior change and the goal

Humanistic: using conciousness raising to make a choice most aligned with your authentic self

T/F: not choosing is also a choice

true

Helping

Creating a sense of safety for your client and forming a therapeutic alliance

What are the action-oriented change processes?

Conditional stimuli, contingency control, choosing, helping relationship

Conditional stimuli

Counterconditioning, where the response to a stimulus is more helpful; exposure instead of avoidance

-stimulus control: controlling the environment to reduce the likelihood that the stimulus will occur

-think about the impact on the quality of life

contingency control

Consequences control behavior; contingency management (reinforcement and punishment) and reevaluation (shifting our understanding of the experience)

Effectiveness of reinforcement/punishment is tied to what?

Immediacy, frequency, and saliency (relevance to the client)

Choosing (action-oriented)

social liberation by making changes in the environment that provide more alternatives

helping relationships

Family, friends, etc., influence us and these relationships might change when the client makes changes

Also, the therapeutic relationship

5 Ps of Case Formulation

Presenting Problems: What is the client's problem?

Predisposing factors: Biopsychosocial; what increases vulnerability?

Precipitants: recent events/triggers exacerbating the problem

Perpetuating factors: What factors are reinforcing or maintaining the problem?

Protective factors: What strengths can the client draw on? Are there social supports and/or community resources or assets?

What questions should you ask while learning about theories?

How does this theory understand people?

How does it explain problems/distress?

How does change occur?

What is the counselor's role?

What skills and techniques does the counselor use?

What are the major humanistic-existential theories?

Person-centered, existential, experiential

Experiential Theory

Client engages in activities that facilitate emotional experience and insight

Existential Theory

Heavy emphasis on personal responsibility and confronting existential realities (ex. mortality)

-How do we help clients move towards more meaningful lives?

Person-Centered Theory

emphasizing the therapeutic relationship and the client's capacity for self-directed growth and change

What are the fundamental assumptions of human-existential theories?

Phenomenological (only concerned with the client's subjective experience)

Authenticity, choice, and meaning

growth oriented

therapeutic relationship

Person-Centered Therapy development

Founded by Carl Rogers

- person-centered counseling, client-centered therapy, Rogerian therapy

-seminal works including Counseling and Psychotherapy and Client-Centered Therapy

What are the fundamental assumptions of person-centered therapy?

Humanistic: emphasizing the inherent worth of individuals

A healthy person: fully functioning and living authentically and congruently

Central Drive: actualization

What is the theory of personality for person-centered therapy?

We have an inherent actualizing tendency and we respond to a perceived reality (phenomenological); we develop a need for positive regard and a conditional positive regard can overshadow our actualizing tendency

According to PCT, what can conditions of worth do to us?

Alienate us from our true selves and lead to an incongruence in the mind

What is the root of our distress according to PCT?

Actualizing tendency --> need for positive regard --> conditional positive regard--> conditions of worth--> conflicts with self-concept (authenticity vs positive regard)--> incongruence--> distress

What is the PCT approach to change?

Unconditional positive regard + empathy + congruence --> related conditions of worth --> greater openness to experience --> increased congruence/self-trust --> growth

Conditions of worth

Social, cultural, and environmental factors that either stunt our self-actualization or allow us to flourish

-can be dominating, marked by conditional messages, or put a value on things

PCT Theory of Change

The goal is to promote growth, empowerment, self-awareness and congruence

The therapeutic relationship provides soil for growth and change and is collaborative, with unconditional positive regard, empathic understanding, genuineness, and immediacy