Week 13: Humanistic theories , Behavioural & Cognitive Theories of Counselling

Humanistic theories (under week 9) 

  • People are essentially good 

  • People naturally strive for growth and development

  • Helping people is best achieved by facilitating self-understanding by exploration of emotions

3 major humanistic theories

  • Person-centred

  • Existential

  • Gestalt

Carl Rogers 

Person-centered counselling 

  • human nature → People will thrive and strive to grow, human beings innately have this 

  • intrinsic motivating drive for our existence to be a total and whole person 

  • Qualitative experience of a person → their lived experience guides the work with them 

The Self Concept

  • Self-Actualization

  • Congruence between ideal and real selves

  • Need for unconditional positive regard

    • Driven by helper 

    • Model it to help the client do it for themselves (being loving, accepting, non-judgemental) so they can learn to have unconditional positive regard for themselves 

Role of counsellor (person centred approach) 

  • A facilitator (nondirective); create a safe and supportive environment for clients to explore feelings (no need to apply defence mechanisms); therapeutic relationship is central (attitudes and personal characteristics of therapist)

    • Techniques 

      • Empathic understanding

      • Unconditional positive regard 

      • Congruence/Genuineness

Person centred counselling Goals 

  • Client as a person - focus on the inherent potential for growth, the process of becoming self actualized

  • Assists client with coping

  • Acceptance of self/others 

  • Increase decision making

  • Identify and use personal resources and potential

Rollo May & Viktor Frankl - Existential counselling 

  • View of Human Nature – Phenomenological, Existential, people are responsible for their choices

    • We define ourselves by our choices (how a person behaves) 

    • Outside factors can restrict our choices, we are ultimately the authors of our lives

    • The world is meaningless, yet we can create a meaningful existence (unique to each person → What do their core values root in?)

    • Our capacity for awareness gives us freedom and with it the responsibility for the choices we make

Free will of choice & action (anti-deterministic → painful experiences happen, how do we create meaning despite that), emphasis on meaning (of life) through action, experience and suffering

6 major themes 

  • Searching for the meaning of life

    • By doing a deed 

    • By experiencing a value e.g. nature, culture, love

    • By suffering

  • The capacity of self-awareness

    • Freedom and responsibility

    • Striving for identity and relationship to others 

    • Anxiety as a condition of living 

    • Awareness of death and nonbeing

Role of counsellor 

  • Being authentic and entering into deep and personal relationships with clients, model of how to achieve individual potential and make decisions

Goals

Help clients realize the importance of meaning, responsibility, awareness, freedom, and potential

  • Challenge clients to recognize and accept freedom, find meaning and purpose in suffering, work, love

Techniques

Very few (Focus is on understand clients current experience rather than using techniques) 

  • Relationship is viewed as most important technique (authenticity, honesty & spontaneity), confrontation - emphasis on taking responsibility, address 4 “ultimate concerns” (death, freedom, isolation, meaninglessness) 

Gestalt therapy (Fritz Perls) 

Major concepts

  • “Whole is more than the sum of its parts”

  • Overdependency on intellectual experience

  • Unfinished business 

  • Experiential – focus on the here and now

  • Disconnection: Loosing touch with environment; with self; unfinished business; fragmentation; conflict between top and underdog; conflict with dichotomies of life

    • Healing as opposed to internal conflicts 

      • top dog → what one thinks “I should do” (external expectations) 

      • underdog → what i actually want to do (knowing of the self) 

Role of counsellor 

  • create an atmosphere that promotes self-exploration of what is needed to grow; active and directive – use of exercises and experiments

    • Honesty is important

Goals 

  • Integrating disowned parts of self, full experience of the present (here and now), help client recognize patterns in their life, become more aware

    • Eg. someone career focused, successful → Are there other values or other aspects of yourself that you have been quieting? 

      • Making space for “neglected parts of yourself” 

Gestalt therapy techniques 

  • “Enactment” and “Confrontation”

    • Reversal technique

    • Staying with the feeling 

    • Making the rounds

      • E.g., “I can’t trust anyone”

      • “I take responsibility” - focus on language 

      • E.g., I am a smoker and I take responsibility for it 

  • “May I feed you a sentence” – implicit attitudes

    • E.g., “I feel angry at my father because he was never home when I was growing up”

    • Exaggeration of actions

      •  E.g., Tapping foot in an exaggerated manner

Exercises vs experiments 

  •  Empty chair

    • client talks to various parts of their personality (e.g. part that is confident and part that is insecure – helps bring forth rational and irrational parts of the client) 

  • 2 chair technique

    • used to discuss either differential parts of a problem or deal with conflicting issues of self – client moves between chairs representing different voices

Behavioural & Cognitive Theories of Counselling

Behavioural counselling 

  • John Watson, BF Skinner 

    • Psychology as a natural science (i.e., empirical)

    • Focus on the prediction and control of behaviour

  • Rationale 

    • All behaviours are learned (operant conditioning)

    • Change behaviour; thoughts and feelings will follow

Goals 

  • Replace maladaptive behaviours with adaptive behaviours (behaviour modification)

Role of counsellor 

  • Teacher, advisor, reinforcer, consultant, and facilitator

Techniques 

  • Reinforcement and Punishment: positive and negative

  • Systematic desensitization (graduated exposure)

  • Flooding (not gradual, throwing someone full in) 

  • “Time-out”/Magic 1-2-3

  • Shaping

Reinforcement and punishment 

  • Positive reinforcement 

    • Presenting a motivating/reinforcing stimulus to the person after the desired behavior is exhibited, making the behavior more likely to happen in the future.

      • Little boy gets $5 for every A → To influence behaviour to be continued 

  • Negative reinforcement

    • A certain stimulus (usually an aversive stimulus) is removed after a particular behavior is exhibited. The likelihood of the particular behavior occurring again in the future is increased because of removing/avoiding the negative consequence.

      • Child who eats all vegetables at dinner does not have to do dishes 

  • Positive punishment 

    • A certain desired stimulus is removed after a particular undesired behavior is exhibited, resulting in the behavior happening less often in the future.

      • If a child does not follow direction or acts inappropriately, he loses a token for good behaviour that can later be cashed in for a prize 

  • Negative punishment 

    • Presenting a negative consequence after an undesired behavior is exhibited, making the behavior less likely to happen in the future.

      • Child grabs toy from another child and the toy is taken away as a result 

Limitations to Behavioural Therapy

  • Only deals with explicit behaviours (not whole person) – overly focused on symptoms 

  • Sometimes too systematic & simplistic

  • Best used under experimental conditions

  • Ignores past, history & unconscious 

  • Ignores higher level needs – self-worth, self-actualization & sense of fulfillment 

  • Cannot explain observational learning without including cognitions

Cognitive & Cognitive-Behavioural Counselling (CBT) 

Rational Emotive Behavioural Therapy (REBT)

  • Albert Ellis 

    • View of human nature 

    • People have both rational and irrational beliefs, humans are gullible, humans are fallible

      • To realize that individuals are irrational, they must have the ability for “self talk” to gain command of their lives → Conscious mind

Role of the counsellor 

  • Teacher (active, direct), correct cognitions, challenge irrational beliefs

  • Listen for illogical statements and be very analytical

Goal 

  • Restructuring thoughts (core beliefs) to live more productive and rational lives through practice

Major Concept

  • ABCDE model of REBT

    • A (Activating experience)

    • B (Belief)

    • C (Emotional Consequences)

    • D (Disputing irrational thought)

    • E (Effective thoughts, new personal philosophy)

    • F (New feelings)?

Techniques

  • Cognitive disputation

  • Imaginal disputation (imagining a situation, analyzing irrational thoughts)

  • Behavioural disputation (e.g., role playing)

  • Confrontation, encouragement

  • Bibliotherapy & homework 

Strengths

  • Easily learned

  • Can be combined with other techniques

  • Can be short term 

  • Empirical evidence

Limitations

  • Not effective with severe cognitive challenges (schizophrenia)

  • Mechanical

  • Does not emphasize working alliance (directive and argumentative/adversarial)

  • may not be simplest way of changing emotions

  • Can be overly focused on deficit/symptom reduction (medical model)

Cognitive therapy (CT) - Aaron Beck 

  • View of Human Nature

    • Dysfunctional behaviour is caused by dysfunctional thinking

Role of counsellor 

  • Active 

  • Make covert thoughts overt

  • Gain awareness of automatic thoughts 

  • Help client evaluate the evidence for thoughts, test through behavioural experiments

Goals 

  • Change negative thoughts and cognitive distortions (ex: all-or-nothing thinking, overgeneralization)

Techniques 

  • Challenge the way info is processed

  • Counter mistaken beliefs (poor reasoning)

  • Self-monitoring exercises – to stop ATs (catching thoughts → preventing spiral)

  • Improve communication skills

  • Increase positive self-statements (affirmations, positive thinking) 

  • Homework

Strengths

  • Applicable in a number of cultural settings

  • Evidence-based (empirical evidence)

  • Lead to useful assessment tools (i.e., BDI) 

Limitations 

  • Clients need to be active - Homework

  • Highly structured 

  • Not useful for low cognitive functioning individuals

  • Can be overly focused on deficit/symptom reduction (medical model)

Reality therapy 

William Glasser (1925–2013)

View of human nature

  • Human beings operate on a conscious level; they are not driven by unconscious forces or instincts. Everyone has a health/growth force: physical & psychological Major Concepts:

  • Four primary psychological needs are the following:

    • Belonging —the need for friends, family, and love

    • Power—the need for self-esteem, recognition, and competition

    • Freedom —the need to make choices and decisions

    • Fun—the need for play, laughter, learning, and recreation

  • need for Identity —the development of a psychologically healthy sense of self •

  • human learning is a life-long process based on choice

Goal

1) help clients become psychologically strong and rational and realize they have choices in the ways they treat themselves and others

2) to help clients clarify what they want in life

3) to help the client formulate a realistic plan to achieve personal needs and wishes

4) meaningful relationship between client and therapist

5) to focus on behaviour and the present

Role of counsellor 

  • teacher, model, warm and involved environment. Special attention is paid to metaphors and themes clients verbalize

Reality therapy 

Techniques

  • action-oriented techniques; teaching, employing humor, confronting, role-playing, offering feedback, formulating specific plans, and composing contracts

  • WDEP System to make progress and employ techniques

    • W – want 

    • D – direction 

    • E- evaluation 

    • P- plan 

Strengths 

  • Versatile populations

  • Concrete

  • Can be short-term

  • International training centres

  • Promotes responsibility and freedom

  • Challenges medical model- refreshing alternative to pathologizing models

  • Addresses conflict resolution 

  • Focus on the control we have in the present 

Limitations

  • Ignored concepts- unconscious, personal history developmental stages

  • All mental illness result of external events 

  • Requires clear two-way communication

  • Could become overly moralistic