Couseling Notes 2010

Counseling Notes

Counseling Introduction
Session 1

Definitions
Counseling is an interactive process conjoining the counselee who needs assistance and the counselor who is trained and educated to give the assistance
Perez,1965

Counseling is that interaction which

Occurs between two individuals called counselor and client Takes place in a professional setting Is initiated and maintained to facilitate changes in the behavior of client
Pepinsky & Pepinsky (1954)

Process involving interpersonal relationships between a therapist and one or more clients by which the former employs psychological methods based on systematic knowledge of the human personality in attempting to improve mental health of the latter
Patterson (1959)

Counseling is a process by which the structure of the self is relaxed in the safety of the clients relationship with the therapist, therapist and previously denied experiences are perceived and then integrated into an altered self
Rogers (1952)

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Couseling Notes 2010

Psychotherapy: Definition
Counseling is a learning oriented process, carried on in a simple, one to one social environment, in which the counselor, professionally competent in relevant psychological skills and knowledge, seeks to assist the client by methods appropriate to latter's needs and within the context of the total personal programme to learn programme, how to put such understanding into effect in relation to more clearly perceived, realistically defined goals to the end that the client may become happier and more productive member of society
Gustad (1953

Psychotherapy is a set of techniques intended to cure or improve psychological and behavioral problems in humans. The commonest form of psychotherapy is direct personal contact between therapist and patient, mainly in the form of talking. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect patient privacy and client confidentiality.

Psychotherapy is term used to describe a variety of different talking therapies used to treat psychological disorders. Psychotherapy involves talking to a licensed professional during a scheduled series of appointments. It has proven to be effective in treating different psychological disorders, and can be combined with drug therapy to treat all degrees of disorders.

A treatment by psychological means, of problems of an emotional nature in which a trained person establishes a professional relationship with the patient with the object of (1) removing, modifying, modifying or retarding existing symptoms (2) symptoms, mediating disturbed patterns of behavior, and (3) promoting positive personality growth and development. (Wolber, The Technique of Psychotherapy, 1977).

Psychotherapy is a set of techniques used to treat mental health and emotional problems and some psychiatric disorders. It helps the person to understand and accept their strengths and weaknesses, as well as what makes them feel positive or anxious. Identifying feelings and ways of thinking helps the person to cope with situations they find difficult, and new ways of approaching them.

Psychotherapy is often used to deal with psychological problems that have built up over a number of years. This requires a trusting relationship between the person and the psychotherapist, and treatment usually lasts for months or sometimes years. Psychotherapy may be carried out on an individual basis as part of a group or basis, with your spouse or partner. Sessions are normally hourly, each week or fortnight. Psychotherapy is sometimes referred to as a 'talking treatment', as it is often based on talking to a therapist or a group of people who have similar problems.

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Couseling Notes 2010

Counseling and Psychotherapy

Counseling Psychotherapy Counselors, Practiced by psychiatrist, Clinical pastoral couns, Psychologist and Psy. Social Worker couns psycholo etc. Aims at better personal adj. Shorter duration Practiced in different settings g personality y Aims at creating p change/restructuring personality Often for treatment Longer in duration and number of sessions Mostly in medical/clinical setting

Counseling and Psychotherapy

Similarities:
uses Similar approaches and techniques Objective for assisting clients Further reading:
Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc Graw Hill Publishing Company Ltd. pp. 24-32

SIMILARITIES & DIFFERENCES IN COUNSELING & PSYCHOTHERAPY

Characterized by words like EDUCATIONAL PREVENTIVE SHORTSHORT-TERM PROBLEMPROBLEM-SOLVING Characterized by words like RECONSTRUCTIVE SEVERE EMOTIONAL PROBLEMS REMEDIATION LONGLONG-TERM

EVERYDAY NORMAL PROBLEMS LIKE ADJUSTMENTS SCHOOL AND ACADEMIC PROBLEMS Terms: COUNSELOR CLIENT Characterized by words like DISORDER DYSFUNCTIONS CLINICAL PROBLEMS PATIENT THERAPIST

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GUIDANCE & COUNSELING

PSYCHOTHERAPY

DIFFERENCES AND SIMILARITIES

GUIDANCE & COUNSELING PSYCHOTHERAPY

1. Concentrates on helping normal individual

1. People with emotional, Psychological disturbance

3. Concerns with vocational areas, academic problems, interpersonal, educational, marital, personal, and social adjustments 4. Helps the person to adjust to a situation

3. With total personality structure

2. To assist young people with adjustment problem

2. With behavioral/ mental disorder (psychogenic origin)

5. A Relationship to improve restore adjustments or functioning

4. Psychological Procedures, Psychoanalysis, Play Therapy, Behavior Modification

Counselors: * Give, interpret psy tests, interview, observe * Offer practical approaches in resolving a problem * Mostly in schools * Not necessarily trained in doctoral level

Psychotherapists: *Treat specific mental or emotional disorder *Usually a psychiatrist, clinical psychologist *Trained under doctoral level or Post-Doctoral

Counseling & Psychotherapy * Respect Clients as unique / worthy individual, right to freedom of choice and to self-determination * No coercion / pressure * Help person to take responsibility, restore self-esteem and functioning

Psychiatry
1. Psychiatry: The medical specialty concerned with the prevention, diagnosis, and treatment of mental illness. illness 2. The branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders.

Guidance
Assistance given to individuals in making intelligent choices and adjustments Makes people self dependent and self directed through
P Promoting utilization of ones own potential ti tili ti f t ti l

Performs a complimentary educational function, assisting normal development and personal autonomy Applied in educational systems
Ref: Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc Graw Hill Publishing
Company Ltd. pp. 34-39

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Couseling Notes 2010

Process -ARPIE
Preparatory Stage: Attending

Fuster, J. M. (2002). Personal Counselling. Mumbai: Better

Counseling Process
Session 2&3

YourselfStage: Responding First Books.

Second Stage: Personalizing Third stage: Initiating

Subsequent Stage: Evaluating

Preparatory Stage: Attending

Skills
Social skills Attending Physically Observing Listening

First Stage: Responding

Attitudes Respect Genuineness Empathy Concreteness Self Disclosure Skills Responding to content Responding to feeling Responding to questions Making summary responses End the stage with a neat summary of the dominant feeling and their reasons and get it checked by the counselee

Attitudes

Respect Genuineness Empathy

Second Stage: Personalizing

Attitudes All of first stage Confrontation Immediacy Skills Personalizing the problem and goal together g

Third stage: Initiating

Attitudes
All the above

Skills
State the goal clearly Identify appropriate steps to reach the goal Formulate the first step

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Couseling Notes 2010

Subsequent Stage: Evaluating

Attitudes All the above Skills Evaluate after implementation and modify p y plan of action based on feedback Sustain motivation

Phases of Counseling
Relationship building Phase Exploration and understanding phase Problem Solving Phase Termination and Evaluation Phase

Yeo,Anthony.(1993). Counselling a Problem Solving Approach. Boa Vista: APECA publications in India.

Problem Solving Steps

Problem definition Attempted Solutions Desired changes Intervention plan 1. 2. 3. 4. 5.

Five Stage Model

Preparation Assessment Contracting Engaging Terminating

Yeo,Anthony.(1993) pp.107-148

Adapted from
Carroll, Michael.,(1996). Workplace Counseling: As systematic Approach to Employee Care.London: Sage Publications. pp 102-137

A Problem Solving Approach to Counseling (Five-Stage Model)

Five Stage Model

Steps in Counseling Process

Stage 1: Awareness of need for help Stage 2: Relationship building Stage 3: Expression of feelings & Clarification f Cl ifi ti of problem bl Stage 4: Exploration of deeper feelings Stage5: Synthesis &Integration client potentialities and direction of needs to goals

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Couseling Notes 2010

STAGE ONE
Stage 6:Focusing on the present and understanding the past Stage 7: Awareness/insight of the problem & seeking solutions Stage 8:Generalising gains to the day to day life
Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc Graw Hill Publishing Company Ltd pp.122-124

Forming rapport and gaining the students trust Assuring confidentiality and discussing limits of confidentiality Allowing ventilation Allowing expression of feelings

1
Exploring the problems), asking the client to tell her story Clarifying client expectations of counseling

1
Describing what the counsellors can offer and their method of working Statement from the counsellor about their commitment to work with the client

STAGE TWO
Definition and understanding of roles, boundaries and needs Explaining roles and boundaries of the counselling relationship Establishing and clarifying client goals and needs

2
Prioritizing client goals and needs Detailed history taking telling the story in specific detail E l i client b li f k Exploring li t beliefs, knowledge and l d d concerns

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Couseling Notes 2010

STAGE THREE
Process of ongoing supportive counseling Continued expression of thoughts and feelings Id tif i options Identifying ti Identifying existing coping skills

3
Development of further coping skills Evaluating options and their implications Enabling behaviour change Supporting and sustaining work on client problems

3
Monitoring progress towards identified goals Altering plans as required R f Referral as appropriate l i t

STAGE FOUR 4
Closure or ending the counselling relationship Client acting upon plans Cli t managing and coping with d il Client i d i ith daily functioning Existence of a support system and supports being accessed

4
Identification of strategies for maintenance of change Closure discussed and planned A Appointment intervals l i t ti t l lengthened th d

4
Available resources and referrals identified and accessed Assurance provided to the client of the option to return to counselling if necessary

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Couseling Notes 2010

THE GATHER STEPS

G Greet clients in an open, respectful manner. Give them full attention. Talk in a private place if possible. Assure the client of confidentiality. Ask the client how you can help, and explain what the clinic can offer in response. A Ask clients about themselves. Pay attention to what clients express with their words and their gestures and expressions. Try to put yourself in the clients place. Express your understanding. Find out the clients knowledge, needs, and concerns so you can respond helpfully.

T Tell clients about choices. H Help clients make an informed choice. Help the client think about what course of action best suits his or her situation and plans. Encourage the client to express opinions and ask questions. Respond fully and openly.

Factors influencing Counseling process

E Explain fully how to use the chosen method. R Return visits should be welcomed. Discuss and agree when the client will return for follow-up & always invite the client to come back any time for any reason.
Counselor variables National Vocational Guidance Assoc. Interest in people Patience Sensitiveness E ti Emotional stability l t bilit Objectivity Hamrin & Paulson Understanding Sympathetic attitude Friendliness Sense of humor Stability Patience Objectivity Sincerity Tact Fairness Tolerance Neatness calmness

Mowrer(1951) Personal maturity

Counselling Skills

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Couseling Notes 2010

Counseling Introduction
Role Play 1
Team of three Counselor, counselee, observer Focus on the beginning of the counseling interview (first session)

Ask
the counselor put the client at ease? the counselor introduced herself? the counselor assured confidentiality and discussing limits of confidentiality The Counselor Allowed free expression of the problem/ask the client to tell her story The counselor allowed expression of feelings Clarifying client expectations of counseling

Rate : Excellent (5)- Poor (0)

Role Play 2 nonverbal skills

Team of three Counselor, counselee, observer Focus on the nonverbal communication of the counseling interview

SOFTEN
Smiling Open Posture Forward Lean Touching Eye to eye contact Nodding

Verbal following skills

Furthering Paraphrasing Closed ended and open ended questions Seeking concreteness Providing and maintaining focus summarizing

Furthering
Minimal prompts I see, yes, then what etc Accent responses repeating certain phrases used by clients in a questioning tone

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Couseling Notes 2010

Paraphrasing
Use fresh words to restate the clients message concisely

Seeking concreteness
Clients tends to generalize issues Making the clients responses specific Used for
Checking out perceptions Clarifying the meaning of vague or unfamiliar terms Explore basis of conclusions drawn by clients Help to personalize statements Elicit specific feelings Explore details

Nonverbal communication facial expression

Importance of verbal and nonverbal communication Nonverbal communication
Ph i l attending Physical tt di
Desirable Direct eye to eye contact Warmth and concern reflected in facial expression Eyes at same level as clients Appropriate facial expressions Occasional smiles Undesirable Avoidance of eye contact Eye level above or lower than the clients Lifting eyebrow critically b iti ll Lifti Nodding head excessively Frozen or rigid facial expressions Inappropriate slight smile Pursing or biting lips

Nonverbal communication posture

Desirable Arms and hands moderately expressive, appropriate gestures Body leaning slightly y g g y forward, attentive but relaxed Undesirable Rigid body posture, arms tightly folded Body turned at an angle to client Fidgeting with hands Squirming or rocking in the chair Slouching or placing feet on desk Hand or fingers over mouth Pointing finger for emphasis

Nonverbal communication voice

Desirable Clearly audible but not loud Warmth in tone of voice V i Voices modulated to d l t dt reflect nuances of feeling and emotional tone of clients messages Moderate speech tempo Undesirable Mumbling or speaking inaudibly Monotonic voice Halting h H lti speech Prolonged silences Excessively animated speech Slow or rapid speech Consistent clearing of throat Speaking loudly

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Couseling Notes 2010

Nonverbal communication physical proximity

Desirable 3-5 feet between chairs Undesirable Excessive closeness or distance

Role Play 3 Listening skills

Team of three Counselor, counselee, observer Focus on the listening and summarizing

SOLER
Sit Squarely Open posture Leaning forward Etec Relaxed

Empathy
Very good empathic response Good Moderate Slight No empathy

Situation 1
Woman to marital conselor I cant make up my mind whether to get divorc or not. There are so many things to consider. Also I am scared of being my own Counselor Response a) Well, h ) W ll how l long you b been married and are th i d d there any children hild involved b) Youre undecided about divorce since there are so many angles, including yours fears of being alone c) Youre too frightened to get divorced at the moment

Situation 2
My firm is making me redundant. Im 45 and should be at the height of my career. It really hurts Response p A) youre angry at the way you are treated B) youre wallowing at self pity at this moment C) youre in a lot of pain because you have been made redundant when you should be at your peak

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Couseling Notes 2010

Situation 3
When things get on top of me I get this craving. Its like I simply must have a fix to get some happiness and relief Response A) Having a fi i your way of coping with psy pain H i fix is f i ith i B) you feel compelled to have a fix when life gets too much for you C) when you feel vulnerable and overwhelmed drugs seem the only way out

Restating content
My husband was a fine man.His unexpected death was a great shock. I still miss him terribly

Restating content 2
My mother says do this. father says do that. I really dont know where I stand

The professional ethics to be held in counseling

1.Confidentiality 2.Respecting the right of Privacy 3.Respecting the gender identity of the Client

4. Respecting the Profession p g 5. Accepting the Client 6. Unnecessary probing

7. An appropriate time and place 8. Prolonging the counseling sessions 9. Respecting the freedom 10.Unnecessary dependency

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Couseling Notes 2010

Guidelines for ethical and legal practice

Dual relationships
Aware of own needs how needs influence clients Should have training and experience Responsibility for appropriate stands in ethical dilemma Theoretical framework of behavior change Client is primary Continuous learning and updated knowledge

Discuss limits of confidentiality Know boundaries of competence Should become models

Rational Emotive therapy

RET/REBT
Proposed by Albert Ellis Emphasized the role of thinking in human behavior

Basic Concepts
Propositions
People are born with a potential to be rational (self constructive) as well as irrational (self destructive) ) Peoples tendency to irrational thinking ,self damaging habituations wishful thinking are formed from their culture and families Humans perceive, think, emote and behave simultaneously

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Couseling Notes 2010

ABC Concept Ellis (1989)

RET do not believe in warm relationships as necessary condition for making change rather believe in active directive therapeutic process Uses variety of techniques such as role p y g y q playing, assertion training, desensitization, humor, suggestion etc. RET asserts that insights often do not lead to major personality change RET think beyond the S- R ideology
Activating Event Belief Consequence

Disputing

Effect

New Feeling

Therapy process
Goal: decrease clients self defeating outlook and to acquire more realistic, tolerant philosophy of life p p y Therapist uses a rationalization approach in assisting the client

Techniques
Continuum used for assessing the emotions and feelings of the client ( help in establishing a baseline) Teaching the ABC model Personal discovery challenges the client to do selected self help exercises that help achieve deep seated cognitive change

Self Exploration REBT self help form Positive Self talk Triple column technique
Automatic thought Cognitive distortion Rational response

Confronting Unconditional positive self- regard Forceful coping statements Analogies and images

Humor

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Couseling Notes 2010

Rational Self Analysis

Client Centered Therapy

Client Centered Therapy

Proposed by Carl R Rogers (1902-1987) Based on humanistic view Also called human centered therapy

Central Concepts
The growth potential of any individual will tend to be released in which the helping person is experiencing and communicating realness, caring, realness caring and deeply sensitive nonjudgmental understanding

Central Concepts
IT - THEN hypothesis
IF certain conditions are present in the attitudes of the person designated therapist in a relationship namely, congruence, positive p y, g ,p regard, and empathetic understanding, THEN growthful change will take place in the person designated client

Basic Concepts
Inner resources of client could be brought out through basic optimism ( belief that individuals know their need and how best to obtain it)
True understanding of clients subjective experiences

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Couseling Notes 2010

Trust in the constructive directional flow toward the realization of each individuals potential
Self Actualization motive

Necessary core conditions for facilitating client growth and change

Empathy Congruence Warm regard

Accepting the clients world as the client perceives and values it reduces the resistance of the client and encourages personal growth provides positive sense of self worth and, personal direction and a capacity to take personal risks

Self Concept persons perceptions and feelings about self ( Rogerian Therapy Focuses on
altering the self concept)

Ideal self Incongruence between self and experience ( (private world of the individual ) The nature of relationship is viewed as the key element in creating positive change

Therapy Process
Conditions for the therapy to occur
The client and therapist should be in psychological contact The client must be experiencing some anxiety, vulnerability or i l bilit incongruence The client must receive the or experience the conditions offered by the therapist The therapist must create a nonthreatening atmosphere of acceptance and genuine caring

Techniques
Empathy Congruence consistency in thought and behavior transparent, authentic, genuine and h i d honest t Warm regard/Positive regard

The therapists role is NONDIRECTIVE

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Couseling Notes 2010

Techniques Contd.
Setting the therapeutic environment Confirmation of confidentiality Consent Active listening Reflection Restate content

Characteristics of a fully functioning Person

Openness to all experiences No defenses used to distort experiences Self concept congruent with experiences Own locus of evaluation Unconditional positive regard for themselves Enjoys others because of reciprocal positive regard Socially effective and approved by significant others

Adlerian Therapy Focus

Importance of the feelings of self (ego) that arise form interactions & conflicts Sense of self(ego) central core of personality Ego = core individuality of person Start from Psychoanalysis Emphasis on motivation & social interaction

Adlerian Therapy
Corey,Gerald.(1986).Theory and Practice of Counseling and Psychotherapy. California: Brooks/Cole Publishing House

Alfred Adlers Individual Psychology

A phenomenological approach-subjective perception of reality Personality as a unity, an invisible whole Behavior purposeful and goal directed Social interest is stressed- social connectedness Birth order and sibling relationships Therapy as teaching, informing and encouraging Basic mistakes in the clients private logic The therapeutic relationship a collaborative partnership

Adlers Individual Psychology

Based on the unique motivations of individuals Importance of each persons perceived niche in society Importance of goal directness of human nature teleological aspect Concern with social conditions-need to take preventive measures to avoid disturbances in personality

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Couseling Notes 2010

The Phenomenological Approach

Adlerians attempt to view the world from the clients subjective frame of reference
How life is in reality is less important than how the individual believes life to be It is not the childhood experiences that are crucial ~ It is our present interpretation of these events

Social Interest
Adlers most significant and distinctive concept Refers to an individuals attitude toward and awareness of being a part of the human community y Mental health is measured by the degree to which we successfully share with others and are concerned with their welfare Happiness and success are largely related to social connectedness

Unconscious instincts and our past do not determine our behavior

Role of Birth Order

Motivates later behavior:

Birth Order
Adlers five psychological positions: 1. Oldest child ~ receives more attention, spoiled, center of attention 2. Second of only two ~ b h 2 S d f l t behaves as if i a in race, often opposite to first child 3. Middle ~ often feels squeezed out 4. Youngest ~ the baby 5. Only ~ does not learn to share or cooperate with other children, learns to deal with adults

First-born: favored, only, pseudo-parenthigh achievers

Second-born: rivalry & competition Last-born: more pampered, babycreative, rebellious, revolutionary, avantgarde

Encouragement
Encouragement is the most powerful method available for changing a persons beliefs p Helps build self-confidence and stimulates courage Discouragement is the basic condition that prevents people from functioning Clients are encouraged to recognize that they have the power to choose and to act differently

Complexes
Inferiority Complex: normal feelings of incompetence and exaggerates themimpossible to to achieve goals-hopeless Superiority Complex: very high opinion of self-bragging and quick to argue personal solutions to problems are right one-convince others of being valuable to them and to self

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Couseling Notes 2010

Other Adler Concepts

Organ Inferiority: everyone is born with some physical weaknessmotivate life choices Aggression Drive: reaction to perceived helplessness or inferiority-lashing out against the inability to achieve or master

More Adler Concepts

Masculine protest: Kids work to become independent from and = adults & people in power-autonomous-positive assertive Perfection striving: people who are not neurotically b ti ll bound t an i f i it d to inferiority complex spend their lives trying to meet their fictional goals. Elimination of their perceived flaws as if philosophy Gives motivation and focus

More Adler Concepts

Social Responsibility & Understanding-social issues Occupational tasks-career-self-worth Societal task-creating friendshipsnetworks Love tasks-life partner Positive & Goal Oriented Humanitypeople striving to overcome weaknesses to function productively-contributing to society
Adlers Types

Adlers Personality Typology

Greek Humors Yellow Bile Phlegm Black Bile Blood Greek Types Social Interest Low Low Very Low High Activity Ruling-Dominant Getting-Learning Avoiding Socially Useful Choleric irritable Phlegmatic Lethargic Melancholic brooding Sanguine cheerful High Low Low High

How an Adlerian does Therapy

Comprehensive Assessment using:
Family Constellation-questionnaire-social world assessment Early Reflections-single incidents from childhood Lifestyle Assessment-develop targets for therapy by identifying major successes and mistakes in the clients life

What Clients do in Therapy

Explore private logic-concepts about self, others, & life philosophy lifestyle is based Discover purposes of behavior or symptoms and basic mistakes associated with their coping Learning how to correct faulty assumptions & conclusions

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Couseling Notes 2010

Client Therapist Relationship

Relationship based on mutual trust, respect, confidence, & alignment of goals Collaborative relationship D Develop a th l therapeutic contract-goals f ti t t l for therapy Emphasis of responsibility of client for his or her own behaviors

Therapeutic Techniques & Procedures

Establishing the Relationship Exploring the psychological dynamics operating in the client-assessment E Encouraging d i development of selfl t f lf understanding-insight into purpose Helping client make new choicesreorientation & reeducation

1. Establishing Relationship
Therapist get to know the client as a person Collaborate on goals for therapy Supportive therapist-caring human therapist caring connection Therapist works to make client feel deeply understood and accepted Client focuses on what needs to changed in therapy

2. Exploring Individuals Dynamics

Subjective interview
Client tells own story as expert on own life Therapist listens for clues to clients coping and approach to life The Question: How would your life be different and How different, what would you do differently, if you did not have this symptom or problem?

Objective interview ~ Life Style Assessment

Family constellation Early Recollections Personality Priorities Integration and Summary

3. Encouraging SelfUnderstanding & Insight

Insight = understanding of motivations that operate in clients life Client-disclosure & Therapist-interpretation Therapist interpretations offered in open-ended manner t to:
Make unconscious process conscious Confront resistance so to help client & therapist to align Explore purposes of symptoms, feelings, behaviors & human difficulties or blocks

4. Helping with Reorientation & Reeducation

Encouragement process to build courage to change to overcome discouragement-personal growth is encouraged and reinforced Change and search for new possibilities Making a difference-through change in behavior, attitude or perception

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Couseling Notes 2010

Where Adlerian Approaches are Applied

Education Parent Education-Children the ChallengeRudolph Dreikurs & Soltz, 1964 M i Marriage C Counseling li Family Counseling Group Work

Reality Therapy

Introduction
William Glasser Individuals are responsible for their behavior Th Therapy aim at creating more responsible i t ti ibl behavior

Basic needs
Power (which includes achievement and feeling worthwhile as well as winning). Love & Belonging (this includes groups as well as families or loved ones). ) Freedom (includes independence, autonomy, your own 'space'). Fun (includes pleasure and enjoyment). Survival (includes nourishment, shelter, sex). Behavior is for fulfilling these needs

Characteristics
Existential-phenomenological orientation
People are moved by inner forces Perceive world in the background of our needs Behavior is the result of choices

Concepts
Rejection of the medical model
Neurosis and psychosis as behaviors attempted to control the external world

Success Identity and p y positive addiction

Persons with success identity have strengths Positive addiction as psychological strength

Control theory
All living organisms constantly act to control the world around them acco. to some purpose within them Behavior is the control of our perceptions

Emphasis on responsibility De-emphasis on exploration of past De-emphasis on transference

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Therapeutic Process
Helping individuals to be emotionally strong Helps individuals to achieve autonomy

GOALS OF REALITY THERAPY

The basic goal of reality therapy is to help individuals meet their psychological needs for belonging, power, freedom, and fun. These goals are met in such a way that they do not infringe on the needs of others. The focus is on responsibility and choices.

Therapist Roles
Focus on clients strengths, attributes, and potentials that can lead to success Pinning down C f t ti Confrontation
1. 2. 3. 4. 5. 6. 7. 8.

Therapeutic Techniques and Procedures

Assist client to develop a success identity
Create a relationship Focus on current behavior Invite clients to evaluate their behavior Help clients to develop an action plan Get commitment Refuse to accept excuses Refuse to use punishment Refuse to give up

Action Plan
Simple and clear Short and able to be broken into small units S Something th client will d thi the li t ill do Dependent on what the client does Specific, what, when, where, how often Repetitive, daily immediate

REALITY THERAPY STRATEGIES

Reality therapists do not emphasize specific techniques. However, they are more likely to use some techniques than others. Because of the focus on exploring and evaluating behavior, reality therapists are likely to ask many questions. They may also listen to client metaphors and make use of them when talking to clients. Because much of reality therapy focuses on making plans and commitment to them, using humor and being positive can be helpful in encouraging clients. Confrontation helps therapists deal with clients when they do not follow up on plans. Paradoxical techniques are ways to help clients when they may be resistant to carrying out plans.

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QUESTIONING
Questions can be used to help clients explore their wants, needs, and perceptions. They are also good approaches to understanding how the client thinks, to gather information, to giving information and making sure its understood, and in helping clients take more effective control.

BEING POSITIVE
Reality therapists take many opportunities to reinforce the constructive planning of their clients and their success in following through on g g the plans. Reality therapists may turn negative occurrences into positive ones by taking advantage of opportunities to communicate hope to clients.

METAPHORS
When clients talk, they sometimes use metaphors such as When I got caught, the whole world fell apart. Therapists listen to those metaphors and respond to the metaphor such as, What happened when the world fell apart?

HUMOR
Because humor is spontaneous and idiosyncratic, it can only occur at the moment so that it can fit in naturally. Humor is a part of friendly involvement as therapists can sometimes laugh at themselves which encourages clients to do the same.

CONFRONTATION
When clients dont follow through on plans, confrontation is unavoidable. N t accepting excuses, being positive, and Not ti b i iti d using humor can be ways of confronting clients.

PARADOXICAL TECHNIQUES
When clients are reluctant to carry out plans or resist making plans, sometimes paradoxical techniques can be used. They are among the most difficult techniques for therapists to use because they are counter-intuitive counter intuitive. Reframing the way clients think about a topic can help them believe a previously undesirable behavior is desirable. (like spitting in the clients soup)

Another paradoxical technique is to prescribe a symptom such as telling an anxious person to schedule times when they are anxious.

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Couseling Notes 2010

Procedure WDEP- Robert Wubbolding

W = Want D = Direction and Doing E = Evaluation P = Planning

W = Want
Clarify clients wants: their quality world Questions: What do you want? What do you want that you are getting? What do you want that you are not getting? How will you know whether you are getting it or not?

D = Direction and Doing

Overall direction and specific actions that occurred recently Questions: Where are you heading? What are your recent successes? Recent challenges? What have you tried so far?

E = Evaluation
Getting clients to evaluate their behavior Questions Is what you are doing helping you? Is it working?

P = Planning
Characteristics of good plans: SAMIC S = Simple A = Attainable M = Measurable I = Immediate C = Controllable

Existential Therapy

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Existential Therapy
Defined as an attitude that transcends orientation (May, Angel, & Ellenberger, 1958), a dynamic therapy that addresses life s lifes ultimate concerns (Yalom 1980) (Yalom, 1980), practically any antideterministic psychotherapy (Edwards, 1982)

Existential Therapy
Is a diffuse school of theorists and practitioners more aligned in their philosophical emphasis than in technique or practical consequences More of a philosophy of therapy than a system of therapy. Many American clinicians have assembled the many strands of the philosophy into a coherent clinical approach (Rollo May, James Bugental and Irving Yalom)

Existential Therapy
Philosophical/Intellectual Approach to Therapy
BASIC DIMENSIONS ~ OF THE HUMAN CONDITION The capacity for self-awareness The tension between freedom & responsibility The creation of an identity & establishing meaningful relationships The search for meaning Accepting anxiety as a condition of living The awareness of death and nonbeing

The Capacity for SelfAwareness

The greater our awareness, the greater our possibilities for freedom Awareness is realizing that: We are finite - time is limited We have the potential, the choice, to act or not to act Meaning is not automatic - we must seek it We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation

Freedom and Responsibility

People are free to choose among alternatives and have a large role in shaping personal destinies Manner in which we live and what we become are result of our choices People must accept responsibility for directing their own lives

Identity and Relationship

Identity is the courage to be ~ We must trust ourselves to search within and find our own answers Our great fear is that we will discover that there is no core, no self Aloneness ~ we must tolerate being alone with self-must g have a relationship with self Struggling with identity-trapped in doing mode to avoid experience of being Relatedness ~ At their best our relationships are based on our desire for fulfillment, not our deprivation Relationships that spring from our sense of deprivation are clinging, parasitic, and symbiotic

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The Search for Meaning

Meaning ~ like pleasure, meaning must be pursued obliquely Finding meaning in life is a by-product of a commitment to creating, loving, and working Th will t meaning i our primary striving The ill to i is i ti i Life is not meaningful in itself; the individual must create and discover meaning Goals deal with Discarding old values Coping with Meaninglessness Creating new meaning

Anxiety A Condition of Living

Anxiety-arises from strivings to survive & maintain own being Existential anxiety is normal - life cannot be lived, nor can death be faced, without anxiety A i t can b a stimulus f growth as we Anxiety be ti l for th become aware of and accept our freedom We can blunt our anxiety by creating the illusion that there is security in life If we have the courage to face ourselves and life we may be frightened, but we will be able to change

Awareness of Death & Nonbeing

Awareness of death is a basic human condition which gives significance to living We must think about death if we are to g y think significantly about life If we defend against death our lives can become insipid & meaningless We learn to live in the now, one day at a time-results in zest for life & creativity

Ultimate Concerns
1. Freedom 2. Death 3. Isolation 4. Meaninglessness

Goals of Existential Therapy

1. Help clients be more aware of themselves 2. Face defense mechanisms 3. Engage in action that is based on the authentic purpose of creating a worthy existence.

Existential Therapeutic Techniques

1) Write their eulogy 2) Imagine their own death 3) Focus on the loss of another, milestones or major life events 4) Self-imposed isolation 5) Engagement 6) Who Am I

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Couseling Notes 2010

Who Am I Exercise
Write down ten phrases that best describe who you are O d them in t Order th i terms of priority and f i it d centrality to yourself Cross out each description, beginning with the least central one Reflect

Write Your Own Obituary

Write Your Own Obituary during the next 48 hours

Existential Theory of Personality

Uncomfortable with the term personality
Seems to be a fixed set of traits Existence is an emerging and becoming process Existence occurs not only for the individual but between the individual and their world

Existential Theory of Personality

Being and world are inseparable because they are created by the individual Phenomenologically, the world we relate to is our own construction

W exist in relation t th We i t i l ti to three l levels i th world l in the ld

Umwelt- equates to the physical and bio aspects Mitwelt- social world or being-with-others Eigenwelt-own world, the way we reflect upon, evaluate, and experience ourselves (being-foroneself)

Existence = being-in-the-world
Person and environment are an active unity Reject dualism of mind-body, and experience and environment

In the process of creating a healthy existence, we are faced with dilemma of choosing the best way to be in-nature, with-others, and forourselves
Best alternative is to be authentic which is its own reward An authentic existence brings with it an openness(awareness) to nature, to others, and to ourselves. Also brings spontaneity with others with no fear that we might contradict what we pretend to be

Authentic existence brings integration with others, not conflict

Tillich talked about existential anxiety

Awareness that we, at some unknown time, must die, being implies nonbeing

Conscious beings
We make choices and are alone responsible

Meaninglessness is another contingency of human existence that produces anxiety. Sources of meaning can disappear and be replaced

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Couseling Notes 2010

The conclusion that ones existence is totally absurd can be immobilizing Our isolation or fundamental aloneness also causes anxiety
We share experiences with others but can never be them nor they us

Gestalt Therapy

Death reflects our finiteness, accidents reflect our limits of power, anxiety over decisions, inadequacy of our knowledge, the threat of meaninglessness, the finiteness of our values, isolation, the finiteness of our empathy, and rejection the finiteness of control over others

Introduction
Developed by Frederick Fritz Perls & Laura Perls Focused on the awareness of environment p process in the therapeutic p Organisms primary inborn motives are toward self preservation and actualization of the self People have inner wisdom to change for their own well being

Concepts
Awareness is considered as the primary goal and tool
The therapy focuses on building awareness The goal of awareness to help the client to take responsibility and control of self

Believe that once client becomes aware of the NOW , they are in a position to own their individual choices Done through allowing the client the opportunity to come in contact with the authentic self

The NOW
Emphasis on the here and now the present Anxiety is described as gap between now and the later Why questions lead to rationalizations and self deceptions and encourage resistance to presnt

Resistance to awareness things that impairs awareness

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Personality
Unfinished business refers to unexpressed feelings Persists till the individual faces and deals unexpressed feelings Results into compulsive, self destructive behaviors The core of personality is seen as peeling of individual layers of onion Five layers of onion
Ph Phony L Layer reacting t others in ti to th i stereotypical and inauthentic ways Phobic Layer avoiding the emotional pain associated with seeing ourselves the way we really are

Therapeutic Process
Impasse Layer the point where we are stuck in our own maturation Implosive layer exposing our defenses and beginning to make contact with our authentic g g selves Explosive layer- releasing an enormous amount of energy as we let go of phony roles and pretences

Therapeutic Goals: Move from environmental support to self support Attaining Att i i awareness of reality f lit

Forms of experiments
Uses a series of EXPERIMENTS to create awareness in the client Experiments facilitate clients ability to deal with impasses Experience the feelings associated with conflicts, ( not just talking about them) Imagining a threatening future encounter Setting up a dialogue between the client and some significant person Dramatizing the memory of a painful event Reliving in the present a particularly profound early experience Assuming the identity of ones father or mother in role playing

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Couseling Notes 2010

Focusing on gestures, posture, and other nonverbal signs of inner expression Carrying out a dialogue between conflicting aspects within oneself COUNSELOR SHOULD HAVE PERSONALLY EXPERIENCED THESE EXPERIENCES BEFORE DOING WITH CLIENTS

HELPS THE CLIENT IN THE HERE AND NOW Uses the Gestalt process make client responsible, responsible self supporting

Techniques
The dialogue exercise empty chair or chair
exercise helps in building awareness of various sides of conflicts

Sharing Hunches Substitute Phrase Exaggeration helps to exaggerate then emotions expressed by the client

Making the rounds Guided fantasy Playing the projection

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