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Comprehensive Exam Review Click the LEFT mouse key ONCE to continue.

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2 Comprehensive Exam Review Click the LEFT mouse key ONCE to continue

3 Helping Relationships Part 2 Click the LEFT mouse key ONCE to continue

4 Gestalt Therapy - Fritz Perls A Gestalt means a whole, and Gestalt therapy is based on the person feeling whole or complete in his/her life. Gestalt therapy is considered to be a “here- and-now” therapy focusing on awareness, with the belief that when clients focus on what they are and not what they wish to become, they become self-actualized. Thus, the client achieves self-actualization through self-acceptance.

5 Gestaltists believe that the individual naturally seeks to become an integrated whole, and thus to live productively. Gestaltists are antideterministic because they believe that people have the ability to change and become responsible. Gestalt borrows heavily from existentialist, experientialist, and phenomenologicalist viewpoints, with the emphasis on the present and awareness and the client's own inner world of interpretation and assessment of the present life situation.

6 Gestaltists believe that individuals emphasize intellectual experience and diminish the importance of emotions and senses, which results in an inability to respond effectively to situations or events in their lives. Gestaltists believe that current thoughts, feelings, and reactions to past events or situations impede personal functioning and prevent here-and-now awareness, a phenomenon referred to as “unfinished business.”

7 Awareness is considered to be on a continuum, with the healthiest person being most aware of his/her needs and dealing with them through manipulation of the need and the environment. In the Gestalt perspective, people experience difficulties through loss of contact with or overinvolvement in their environment, fragmentation, difficulties with life’s dichotomies (e.g., love/hate or pleasure/pain), conflicts between shoulds and wants, and failure to resolve unfinished business.

8 The Gestalt counselor’s role is to help the client explore his/her needs in order to grow, focus on using energy to adapt positively, and discern life patterns. The counselor also helps the client to use present tense verbs, address persons directly rather than talk about them, use “I” instead of referring to personal experiences in the second (you) or third (it) person, focus on how and what rather than why, and turn covert questions into statements.

9 The goals of Gestalt Therapy include helping the client to become aware in the here-and- now of the client's experience, make current awareness choices, resolve past issues, become congruent, reach intellectual maturity, and shed neuroses. Primary techniques in Gestalt therapy usually manifest in one of two forms: either an exercise or an experiment. Typical exercises include activities such as frustration actions, fantasy role playing, fantasy, and psychodrama.

10 Experiments are unplanned, creative interventions that grow out of the here-and- now interaction between the client and the counselor. Dream work in Gestalt therapy consists of the client telling the dream and then focusing his or her awareness on the dream from the perspective of each character or element in the dream.

11 The “Empty Chair” technique is a process wherein the client addresses parts of his/her personality, or that of another, as if it were an entity sitting in an empty chair. In confrontation, the counselor calls attention to incongruities between the client's verbalizations and observed emotions or behaviors. “Making the Rounds” is a group exercise in which the client is instructed to say the same sentence to each member of the group and then to add something personal to each person.

12 Exaggeration is overdramatizing the client's gestures and movements to help the client gain insight into their meaning. “May I Feed You?” is the question the counselor asks before giving the client a more specific expression of what the counselor believes is the underlying message of the client. “I Take Responsibility” is a statement the counselor has the client say after expression of perceptions to help the client to integrate internal perceptions and behaviors.

13 Rational Emotive BehaviorTherapy - Albert Ellis Rationale Emotive Behavior Therapy (REBT) assumes the individual has the capacity to be rational or irrational and sensible or crazy, which Ellis believes is a biologically inherent capacity. REBT is most concerned with irrational thinking, especially that which creates upsetting thoughts and related behaviors. REBT views the individual as being easily dis- turbed because of gullibility and suggestibility.

14 Ellis is a proponent of the individual thinking of behavior as separate from personhood (i.e., "I did a bad thing" rather than "I am a bad person”). Ellis believes that each individual has the ability to control his/her thoughts, feelings and actions, but in order to gain this control, a person must first understand what s/he is telling him/herself (self-talk) about the event or situation.

15 Ellis believes that cognitions about events or situations can be of four types: positive, negative, neutral, or mixed, and that these cognitions result in “like thoughts,” with positive leading to positive, negative leading to negative, etc.

16 1. It is absolutely essential to be loved or approved of by every significant person in one's life. 2. To be worthwhile, a person must be competent, adequate, and achieving in everything attempted. 3. Some people are wicked, bad, and villainous, and therefore should be blamed or punished. Ellis listed the most common irrational beliefs that clients find disturbing:

17 4. It is terrible and atastrophic when- ever events do not occur as one hopes. 5. Unhappiness is the result of outside events, and a person has no control over such despair. 6. Something potentially dangerous or harmful should be cause for great concern and should always be kept in mind. 7. Running away from difficulties and responsibilities is easier than facing them.

18 8. A person must depend on others and must have someone stronger on whom to rely. 9. The past determines one's present behavior and thus cannot be changed. 10. A person should be upset by the problems and difficulties of others. 11. There is always a right answer to every problem, and a failure to find this answer is a catastrophe.

19 The counselor’s role in REBT is direct and active in teaching and correcting the client's cognitions. Ellis believes that a good REBT counselor must be bright, knowledgeable, empathic, persistent, scientific, interested in helping others, and use REBT in his/her personal life.

20 The primary goals of REBT are to help people live rational and productive lives; see that it is their thoughts and beliefs about events that creates difficulties, not the events or situations themselves; understand that wishes and wants are not entitlements to be demanded; stop catastrophizing; and change self-defeating behaviors. REBT stresses using the appropriate emotional response to a situation or event, and the acceptance and tolerance of self and of others in order to achieve life goals.

21 Initial REBT-based counseling is devoted to learning the “ABC Principle,” in which: A = A ctivating event B = B elief or thought process C = emotional C onsequence. Cognitive disputation is a technique aimed at asking the client questions that challenge the logic of the client's response. Imaginal disputation has the client use imagery to examine a situation where the client is likely to become upset.

22 The Emotional Control Card is an actual card intended for the client to carry in his/her wallet on which there is a list of inappropriate or self-destructive feelings countered with appropriate, non-self-defeating feelings. Behavioral disputation involves having the client behave in a way that is opposite to the way the client would like to respond to the event or situation.

23 Confrontation occurs when the counselor challenges an illogical or irrational belief that the client is expressing. Encouragement involves explicitly urging the client to use RET principles rather than to continue self-defeating responses.

24 Transactional Analysis - Eric Berne In the Transactional Analysis (TA) viewpoint, people can change, and can change at any point in life. Four major methods are used in TA to analyze and/or predict human behavior: Structural Analysis Transactional Analysis Game Analysis Script Analysis

25 Structural analysis looks at what is happening within the individual and describes each person in terms of three ego states: 1. The Parent ego state contains the parental admonishments and values with dos, shoulds, and oughts. 2. The Adult ego state contains the objective, thinking, rational, and logical ability to deal with reality. 3. The Child ego state is the source of childlike behaviors and feelings.

26 Transactional analysis looks at what is happening between two or more people and describes interactions as three transactions: 1. Complementary transactions are characterized by both people communicating from the same ego state. 2. Crossed transactions are characterized by both people coming from different ego states, which results in a hurtful response. 3. Ulterior transactions are characterized by people coming from different ego states, but the responses appear to be from the same ego state.

27 Game analysis looks at transactions between individuals that lead to negative feelings and involve three levels of games or ulterior transactions that appear to be complementary: First degree games are played in social situations and lead to mild upsets. Third degree games are violent and usually end in the jail, hospital, or morgue. Second degree games are played in more intimate circles and lead to really bad feelings.

28 Script analysis looks at the life plan the individual has chosen to follow and includes life plans such as: Never scripts result in a person who believes he/she is a ne’er-do-well. Until scripts result in the person who continues to wait until he or she can deserve the reward. Always scripts result in a person continuing without change.

29 After scripts results in anticipation of difficulty after a certain event. Open-ended scripts result in lack of direction after a given time or event. Ideal scripts are characterized by “I am ok and you are ok.” (Less desirable scripts are characterized by “I'm ok, you are not ok”; “I'm not ok, You're ok”; and “I'm not ok, You are not ok”)

30 The counselor’s role in TA is as a teacher of TA and its unique language. The counselor contracts with the client for the changes that they desire. The goal in TA is not only to learn to adjust to life but also to attain health and autonomy. Through gaining autonomy, the client becomes more aware, intimate and spontaneous, living a life free of games and self-defeating life scripts.

31 In addition to structural, transactional, game and script analysis, TA counselors use other techniques such as: Treatment contract, in which an agreement is reached between the counselor and client about what is to be accomplished and agreed upon responsibilities. Interrogation, in which the client is forced to answer from the adult ego state through a succession of confronttional questions.

32 Confrontation, in which the counselor points out the client’s inconsistencies. Explanation, in which the counselor teaches the adult ego state of the client as a tenet of TA. Illustration, in which a story or example is used to portray a point. Confirmation, in which the counselor directs the client's attention to a previously modified behavior that is reoccurring.

33 Interpretation, in which the counselor explains to the (client’s) child ego state the reasons behind the client's behavior. Crystallization, in which the client realizes that game playing can be given up and the client can enjoy the freedom of choice in behavior. Specification, which is identifying the ego state that is the source of the transition.

34 Behavioral Theories - B.F. Skinner Behaviorists, with the exception of cognitive behaviorists, concentrate on behavior that can be observed, particularly with a here- and-now focus. A basic tenet of Behavioral Counseling is that all behavior is learned, whether the behavior is maladaptive or adaptive, and that adaptive behavior can be learned so as to replace maladaptive behavior.

35 Behaviorists set well-defined, measurable, and observable goals in therapy, reject the idea that human personality is composed of traits, and strive to obtain empirical evidence to support the use of specific techniques. Respondent learning is often referred to as stimulus-response learning in which the learner does not (necessarily) need to be an active participant. The outcome of Behavioral Therapy is the counter-conditioning (i.e., unlearning) of involuntary responses.

36 Operant conditioning requires that the participant be actively involved and involves rewarding desired behavior and/or punishing undesired behavior until the person learns the desired behavior that elicits the reward. Operant conditioning differs from respondent conditioning in that operant conditioning is the conditioning of voluntary responses through rewards or reinforcers.

37 Social modeling is the process in which new behavior is learned from watching other people and events without experiencing the consequences from the behavior or engaging in the behavior. Roles of the behavioral counselor are varied and include being a consultant, teacher, advisor, reinforcer, and/or facilitator. The counselor is active and may supervise other people in the client's environment to achieve the goals of therapy.

38 Counselors using social learning may model the desired behavior, while respondent and operant conditioning counselors are more directive and prescriptive in their approach to the therapy goals. The goal of Behavioral counselors is to improve the life of the client through better adjustment and for the client to achieve personal goals professionally and personally.

39 Four steps in developing therapeutic goals are: Define the problem concretely, specifying when, where, how, and with whom the problem exists. Take a developmental history of the problem, eliciting conditions surrounding the beginning of the problem, and what solutions the client has tried in the past.

40 Establish specific subgoals in small, incremental steps toward the final goal. Determine the best behavioral method to be used to help the client change. Establishment and use of reinforcers are the primary techniques used to increase desired behaviors. Positive reinforcers are things desired by the client, while negative reinforcers are things to be avoided.

41 Primary reinforcers are intrinsic while secondary reinforcers are tokens that acquire value by being associated with a primary reinforcer. Schedules of reinforcement include: Fixed-ratio, wherein the reinforcer is delivered after a set number of responses. Fixed-interval, wherein the reinforcer is delivered after a set time lapse.

42 Variable-ratio, wherein the reinforcer is delivered after varying numbers of responses. Variable-interval, wherein the rein- forcer is delivered at varying time intervals. Shaping is learning behavior in small steps that are successive approximations toward the final, desired behavior.

43 Chaining is the order of the desired sequence of skills leading to the desired behavior. Generalization is the transfer of learning from behavioral therapy to the client’s world. Extinction is the elimination of a behavior through withholding a reinforcer. Punishment is the delivery of aversive stimuli resulting in suppression or elimination of a behavior.

44 Systematic desensitization is a process accomplished through successive approximation to reduce anxiety toward an anxiety provoking event or situation. The steps needed to accomplish the behavior are listed and prioritized. Because a client cannot feel anxious and relaxed at the same time, the phenomenon is termed reciprocal inhibition. The counselor helps the client to learn relaxation techniques to reduce/overcome anxiety.

45 Behavioral rehearsal is repeating and improving a behavior until the client accomplishes the behavior that is desired. Environmental planning is a process in which the client arranges the circumstances to promote or inhibit particular behaviors. Maintenance is the consistent continuation of learned behaviors without support from sources external to the client's self-control and self-management.

46 Assertiveness training is a technique in which the client is taught to express appropriate feelings without hostility, anxiety, or passivity. Contingency contracts are written agreements in which the desired behaviors are specifically described, as are the reinforcers to be given and the circumstances in which the reinforcers will be administered.

47 Implosion is desensitizing the client by having the client imagine an anxiety provoking situation that may have a dire consequence in a safe environment. Time out is an aversive technique in which the client is prevented, usually through some form of isolation, from receiving a positive reinforcer. Overcorrection is an aversive technique in which the client is required to restore the environment and to improve it substantially.

48 Covert sensitization is an aversive technique in which a behavior is eliminated through pairing with an unpleasant thought. Cognitive restructuring is helping clients change how they think about an event or situation by examining their thoughts and challenging the irrational or self-defeating thoughts.

49 Thought stopping is a series of procedures in which the client replaces self-defeating thoughts with assertive, positive, or neutral thoughts. The procedure is one in which the counselor asks the client to think obsessively in a self- defeating manner, then suddenly and unexpectedly yells, "stop." If successful, the client cannot continue the self-defeating thoughts after this disruption.

50 Stress inoculation is a three step preventative technique that includes: The nature of stress and coping for the client is defined. Specific stress reduction and coping skills are taught to expand those stress and coping skills already used by the client. The client practices the new skills in real life situations.

51 Reality Therapy - William Glasser Glasser maintains that people act on a conscious level, that they are not driven by instincts or the unconscious, and that there is a force in every person that seeks both physical and psychological health and growth. Glasser separates the forces into the “old brain,” or primitive physical needs, and the “new brain,” or psychological needs.

52 Glasser believes that identity, or a healthy sense of self, is crucial. A success identity comes from being loved and accepted, and a failure identity comes from not having needs met for acceptance, love, and worth. The old brain contents itself with maintaining life, and the new brain seeks belonging, power, freedom, and fun.

53 Children ages 5 to 10 who already have socialization or academic problems often establish a failure identity. Children ages 2 to 5 are socialized to deal with frustrations and disappointments. Children not getting support and love from their parents during this critical time begin to establish a failure identity. Glasser espouses two critical periods in children’s development.

54 Glasser suggests that human learning is a life long process; therefore, identity can be changed at any time by learning what needs to be learned. Glasser believes that humans are self- determined, that each person has within him/herself a self-picture or perception, and that the person behaves in a way that is determined or controlled by this self-image.

55 Glasser’s Control Theory has three parts: B is the behavior. C is the control, in which comparison is made between the desired image and the image the behavior is producing. P is the perception or the development of the image. The role of the counselor in Reality Therapy is as a teacher and a model to the client.

56 The counselor creates an atmosphere of acceptance and warmth, helping the client focus on the control of displayed thoughts and actions. The reality counselor uses "ing” verbs to help the client describe thoughts and actions (e.g., angering, bullying, or excusing). The focus of counseling is on the behavior that the client needs or wants to change and how to change that behavior in a positive manner.

57 The primary goal of Reality Therapy is to help the client become psychologically strong and rational (i.e., a strong and rational person who is autonomous and behaves responsibly toward self and others). Other goals include to help clients to determine what they want in life, develop practical plans to accomplish personal needs and desires, put the past behind and focus on present behaviors, and accept no excuses and eliminate punishment from life.

58 The three primary steps of Reality Therapy are: The counselor helps the client to see the reality and understand how a behavior is unrealistic. The counselor separates the client from the behavior and rejects the behavior without rejecting the client. The counselor teaches the client how to fulfill needs realistically and positively.

59 Humor is used to point out absurdity without being sarcastic. Confrontation is used to help the client accept responsibility for behavior. Reality therapy uses WDEP: establishing what the client wants, clarifying what they have been doing, evaluating how helpful the actions have been, and planning for how they want to behave in the future.

60 The eight steps in Reality Therapy to accomplish its goals are: Establish a relationship. Focus on present behavior. Client evaluates his/her behavior. Develop a contract or plan of action. Get a commitment from the client. Don’t accept excuses. Allow reasonable consequences but refuse to use punishment. Refuse to give up on the client.

61 This concludes Part 2 of the presentation on Helping Relationships

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