Psychotherapy and Counseling Essentials: An Introduction

Psychotherapy and Counseling Essentials: An Introduction
Chapter One

This class is about the mysteries of human distress, human growth, why people change, and how we can help them. We’ll be doing an overview of 9 counseling and psychotherapy theories and applications—with a special emphasis on historical context and practical contemporary applications.

Background and Overview
Psychotherapy theories can explain and predict ways we treat each other, including how we define mental health and mental illness, our ideas about helping , rehabilitation, and personal responsibility.

They help us answer the questions like: What motivates people to do what they do? What disturbs thinking processes, triggers unmanageable anger, lowers individual productivity, and destroys relationships? What makes or breaks an individual? What makes some people resilience after facing traumatic event, while others are weakened or deeply damaged? makes or breaks : batmak ya da çıkmak

There’s no single answer to these questions. It’s common for mental health professionals to strongly disagree with each other on just about every topic.

Human Suffering and Hope
Psychotherapy is an imperfect science, because every human is unique with his/her idiosyncratic ways of being. There is much we don’t know about human behavior, the brain, emotions and interpersonal relationships. Determining why people suffer, how they change, and how to help them live more satisfying and gratifying lives is a huge and important task. İdiosyncratic: nevi şahsına münhasır

Historical Context Every human behavior or set of beliefs has its own particular historical context. This is related to psychotherapy and its close relatives: counseling, therapy, mental health consultation and clinical social work.

Historical Context Contemporary psychology originated in Europe and the United States in the late 1800s. During that time, women and other minorities were excluded from higher education. Much of psychotherapy’s history is written from the perspective of white man advocating a particular theory.

Historical Context Who is the father of psychotherapy?
Who is the mother of psychotherapy? What is meant by the following statement? “In psychology, even the rats are white and male.” even the rats are white and male: Charlie

Who is the father of psychotherapy?
Sigmund Freud. This claim is truth. But it’s impossible to give a single individual the credit or blame for an enterprise as huge as psychotherapy. enterprise : girişim teşebbüs...

Alternative Historical-Cultural Realities
Early treatments for human distress and disturbance consisted of a combination of these four perspectives: The biomedical perspective (then: trephining; now: serotonin hypothesis) The religious/spiritual perspective (then: evil spirits; now: ??) The social-psychological-biomedical perspective (then: ??; now: ??) Feminist and multicultural perspectives emphasize relationship and community over individuality. (How do people with these perspectives define pathology and approach the counseling process?) [**We like to talk with students about how clinical depression might be conceptualized differently from these varied perspectives.]

The Biomedical Perspective
Trephining and lobotomies: Early archaeological findings provide evidence of a treatment procedure, now called trephining. This hole opening was a treatment by a shaman or healer to release and evil spirit from the brain. This is biomedical perspective. About a half million years later, a similar physical intervention , prefrontal lobotomy emerged as a popular treatment for mental patients in the USA. ECT

The Religious/Spiritual Perspective
Human looked for clergy, shamans, mystics, monks and other religious leaders for advice and counsel over the ages. For many Native American tribes, spiritual authorities are still important for healing. Many Asian and African cultures also believe spiritual practices.

Modern pyschosocial interventions include elements of spirituality
Modern pyschosocial interventions include elements of spirituality. Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) use Buddhist approaches to facilitate emotional regulation. Most clinicians know the emotional healing potential of spiritual practices and beliefs. Spiritual leaders have great wisdom and insight into the human condition. DBT: Borderline personality, ACT: 3. Kuşak terapiler.

The social-psychological-biomedical perspective
During the trephining period, about 500,000 years ago, human have probably understood that verbal interactions and relationship alterations can change thinking patterns, mood and behavior. Wise healers from different cultures and traditions use psychological and relational techniques. Siddhartha Gautama (Buddha) and Epictetus are forebears to modern cognitive theory and therapy. Avicenna seems to have been an early strategic or constructive theorist. Forebears: atalar, ancestors

Feminist And Multicultural Perspectives
Traditional historical voices have generally been white and male, but mental health professionals must be aware of minority voices. Feminist mind set differs from traditional male mind. Last 40 years, feminist approaches have been integrated into psychotherapy approaches. Cultural sensitivity is important to positive therapy outcomes with diverse client populations.

Feminist and multi-cultural perspectives emphasize relationship and community over individuality. These are human values. The mental health professionals are beginning to recognise these values as different ways of being and not as pathological.

Definitions of Counseling and Psychotherapy
Should I get a PhD in psychology, a master’s degree in counseling or a master’s in social work? This disscusion leads to the confusing topic of the differences between counseling and psychotherapy.

Definitions of Counseling and Psychotherapy
What is psychotherapy? What is counseling? What are the differences between counseling and psychotherapy?

Counseling versus Psychotherapy I
The Histories Psychotherapy: Freud + Recovery from serious personal problems Counseling: Out of guidance movement, which was/is about helping people with choosing or decision making

What Is Psychotherapy? Anna O., Breuer’s patient, called to the treatment she received as the ‘’talking cure’’. Talking, expressing, verbalizing or sharing one’s pain is potentially healing. How should psychotherapy be practiced? This question is relevent to how psychotherapy is defined.

‘’A conversation with a therapeutic purpose’’ (Korchin, 1976)
‘’The purchase of friendship’’ (Schofield, 1964) ‘’When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder’’ (J.Watkins, personal communication, October 13, 1983) Purchase: satın alma

What Is Counseling? Adler might claim that counseling has an inferiority complex with respect to its older sibling, psychotherapy. Or psychotherapy has a superiority complex with respect to its younger rival, counseling. ‘’Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior. (Burke, 1989) Rival: rakip

What are the differences between counseling and psychotherapy?
Patterson (1973): ‘’There are no essential differences between counseling and psychotherapy’’ “Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do (Corsini & Wedding, 2000, p. 2).”

For Corsini and Wedding’s definiton, both of them engage in the same behaviors but may differ.
Same behaviors: listening, questioning, interpreting, explaining, advising

Counseling versus Psychotherapy III
What are the differences between psychotherapy and counseling? Goals? Shorter versus longer? Problem versus person? Guidance versus advice? A little more on the surface versus a little deeper? Cheaper versus more expensive?

Psychotherapist: Less directive, go a little deeper, work a little longer, charge a higher fee.
Counselor: Slightly more directive, work more on developmentally normal issues, work more briefly, charge a bit less fee.

The Goals of Counseling and Psychotherapy
People come to therapy to alleviate their painful symptoms (e.g., anxiety, depression, guilt) and undesirable behaviors (e.g., compulsions, impulsivity, etc.). People come for assistance in decision making. People also come to therapy to grow or improve themselves.

Counseling and Psychotherapy Defined
A process that involves a trained professional who abides by accepted ethical guidelines and has skills and competencies for working with diverse individuals who are in distress or have life problems that have led them to seek help (possibly at the insistence of others) or the individuals may be

C&P–Defined II choosing to seek personal growth, but either way, these parties establish an explicit agreement (informed consent) to work together (more or less collaboratively) toward mutually agreed upon or acceptable goals

C&P–Defined III using theoretically based or evidence-based procedures that, in the broadest sense, have been shown to facilitate human learning or human development or effectively reduce disturbing symptoms.

What Is a Theory? “A coherent group of general propositions used as principles of explanation for a class of phenomena” (Random House Dictionary, 1993, p. 1967). In psychology, theories are used to generate hypotheses about human thinking, emotion and behavior. For counseling and psychotherapy, a theory needs to accurately describe, explain, and predict a wide range of therapist and client behaviors.

What is a Theory? II “A theory is not built on observation. In fact, the opposite is true. What we observe follows from our theory.” “Without a guiding theory , clinicians would be vulnerable, directionless creatures.” (Prochaska, 2003) But with a guiding theory, what sorts of things are likely to happen?

The Scientific Context of Counseling and Psychotherapy
Major Historical Developments: Eysenck’s (1952) Findings (24 studies) Analytic—44% Eclectic (Mishmash, hugger-mugger) —64% Custodial—72% Hangi yöntemle tedavi edilen hastaların ne kadar iyileştikleri.. hugger-mugger: allak bullak, düzensiz Mishmash: karmakarışık Custodial: Koruyucu

The Scientific Context of Counseling and Psychotherapy II
A Psychotherapy Research Boom Smith and Glass developed method of meta-analysis. Effect size is a statistic used to estimate how much change is produced by a particular intervention. Effect size represents the difference in efficacy between interventions and no treatment control groups. Smith, Glass&Miller, 1977 : Average person who gets counseling is better off than 75% of those untreated. What is the dodo bird effect? Dodo bird effect: Everybody has won and all must have prizes. This phrase refers to the relative equivalency of various therapy approaches and implies that no single therapy approach is more effective than any other approach.

The Scientific Context of Counseling and Psychotherapy III
The Great Psychotherapy Debate Point: Research has demonstrated the superiority of a few select psychotherapy techniques over other specific techniques. Counterpoint: Research doesn’t show that some specific techniques are better than others; instead, research shows there are common therapeutic factors operating across different therapy techniques.

Weinberger’s common therapeutic factors ???
Weinberger: therapeutic relationship, expectations of success, confronting a problem, providing the experience of mastery or control over the problem, an attribution of success or failure

The Scientific Context of Counseling and Psychotherapy IV
Common Therapeutic Factors—Lambert (1992) Extratherapeutic change (40%) : Client Factors (motivation, severity of disturbance, ego strengths, psychological mindedness.) Therapeutic relationship (30%): (Rogers: unconditional positive regard, empathy and congruence) (Freud: therapeutic alliances) Expectancy (15%) : (hope) Techniques (15%) Congruence: uyum Bordin therapeutic alliances: tasks, goals, and bond

Salvador Minuchin: «Don’t be too sure»
No theory holds the key to all problems. No theory entirely explains what it means to be human. When we get too sure about a theory, we close ourselves off to different perspectives.

The Zeitgeist, the Ortgeist, and the Poltergeist
Zeitgeist: The spirit of the time Ortgeist: The spirit of the place Poltergeist: A mischievous spirit or ghost—a mystery Ortgeist: mekanın ruhu Poltergeist: umacı, Mischievous: yaramaz

Poltergeist As a therapist, we should be ready for surprises. Sometimes your clients will say and do shocking things. Or we’ll suddenly feel the urge to say or do something inappropriate. In the therapy room, sitting cheek by jowl with another person for long time can make unusual experiences. cheek by jowl: dip dibe

Five-Minute Discussion
Groups of three or four. Up to now, according to your knowledge as a major, come up with three or four reasons why therapy can sometimes be harmful.

Concluding Comments and Review
Homework: Start dating Freud this week.

PSY 245 CLINICAL PSYCHOLOGY II
Assoc. Prof. Dr. Bahar BAŞTUĞ Clinical Psychologist

Psychoanalytic Approaches
NÖROPSİKANALİZ YAZISINI SINIFTA OKU.

Today we’ll be focusing on psychoanalytic and psychodynamic theory and practice, beginning with the work of Sigmund Freud. As an interesting starting place, say the first word that comes to mind when you hear: “Sigmund Freud.”

Sigmund Freud ( )

Sigmund Freud Freud was born in Freiberg, Moravia, in 1856, he died for larynx Ca in 1939 in London. His intellectual potential was obvious early on and Freud felt like a favored child. He obtained his medical degree from the University of Vienna with the goal of being a research scientist. He went into private practice of neurology because of financial needs. As a neurologist, Freud was exposed to the disorder “hysteria” .

Martha Bernays

Sigmund Freud He became familiar with the work of Jean Charcot, who was using hypnosis to produce hysterical symptoms. Professor Charcot of Paris' Salpêtrière demonstrates hypnosis on a "hysterical" patient. For Freud, the same procedure might be used to treat hysteria.

Sigmund Freud Freud began working with Viennese physician Josef Breuer. Breuer was treating hysteria symptoms by having patients talk about emotionally loaded childhood experiences. Breuer worked with Anna O., discussing her hysteria symptoms and treatment in great detail with Freud. They published Studies in Hysteria in 1895.

Anna O., or Bertha Pappenheim, 1880

Hysteria was the main psychological disorder of Freud’s time.
Psychological theories are a product of the dominant Zeitgeist and Ortgeist. He initially used hypnosis, but later became more enamored with the “talking cure.”

Freud’s Early Fascinations:
Psychosexual Development Unconscious Sexual Meaning of Many Behaviors Fascinations: cazibeleri

Sigmund Freud Freud presented a paper titled “The Aetiology of Hysteria” in Vienna in He made a connection between childhood sexual abuse and later psychopathology. The Seduction Hypothesis suggested that childhood sexual abuse produces later psychopathology (Hy). « at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience” (Freud, 1896, cited in Masson, 1984, p. 263).

Freud’s presentation of the Aetiology of Hysteria met with an “icy reception.”
He abandoned the Seduction Hypothesis in favor of his theory concerning the Oedipal conflict. icy reception: buz gibi kabul gördü. Everyone disliked Freud’s presentation.

Theoretical Principles
Freudian Theory Is one of the “Giant theories” of developmental Psychology (Miller, 2010). Is a one-person intrapsychic model. Includes several different approaches to thinking about human behavior.

Psychoanalytic Theoretical Principles
Classical Freudian theory is a one-person intrapsychic model that treats the client as a separate, individual artifact to be systematically and objectively examined. X X X X X X X X Modern analytic theory treats the therapy encounter more as a two-person field, wherein the therapist’s and client’s intrapsychic and relationship interactions help shed light on patterns that may be troubling the client.

The Dynamic Approach is known as drive theory or instinc theory. He believed humans are filled with mental or psychic energy. This energy comes from two essential sources: INSTINCT: UNLEARNED BEHAVIOR PATTERN WHICH OCCURRED IN THE CASE OF RELATED STIMULUS, UYGUN UYARICILAR KARŞIISINDA MEYDANA GELEN ÖĞRENİLMEMİŞ DAVRANIŞ ÖRÜNTÜSÜ. DRIVE: A POWER THAT APPEARS IN ORGANISM TO OVERCOME A LACK, YEMEK YEME İSTEĞİ, AÇLIK DÜRTÜSÜ İHTİYAÇ> DÜRTÜ> GÜDÜ> DAVRANIŞ NEED>DRIVE>INSTINCT>BEHAVIOR

Eros energy associated with life and sex Libido

Thanatos energy associated with death and aggression.
Eros and thanatos are the two basic drives that energize behavior.

According to drive (dynamic) theory,
Psychic determinism underlies the dynamic approach (“. . . nothing happens by chance” [Brenner, 1973]). every impulse has an origin, aim, object, and intensity. An impulse always originates from some place in the body. Child – oral Their aim is to obtain oral pleasure. IF YOU FORGET YOUR PROFESSOR’S NAME, PERHAPS YOU HAVE AN UNCONSCIOUS AGGRESSIVE IMPULSE TOWARD HER. «ARE YOU ANALYZING ME?»

The pressure or intensity of pleasure need is building.
The baby finds an object that will allow him or her to discharge tension and obtain pleasure.

According to drive (dynamic) theory,
if the internalized cycle does not flow smoothly due to parental withholding, there can be a fixation and later unconscious acting out of the pathological cycle during adulthood. Repeated patterns may result in an internal working model or repetition compulsion.

The Topographic Approach
Divides the mind into three interrelated regions: the unconscious, the preconscious, the conscious.

The Topographic Approach
There is much more going on at the unconscious level than at the conscious. Awareness of our basic, primitive sexual and aggressive impulses might disrupt our daily lives, our brain protects us from them. The main purpose of psychoanalytic therapy is to help us slowly become aware of unconscious impulses. By bringing unconscious impulses to awareness, we’re able to manage them, because even when they are outside awareness, primitive impulses can still act on us in an indirect and destructive manner. MUM ÖRNEĞİNİ VER.

Oedipal conflict X Electra Complex
Resolution of this conflict leads to development of the superego.

The Developmental Stage Approach
Explains how early childhood experiences influence later adult behaviors. Oral: birth to 1 year old Anal: 1 to 3 years old Phallic: 3 to 5 years old: Oedipus complex Latency: 5 to 12 years old Genital: adolescence to adulthood

Each stage is defined in terms of the part of the body around. Each stage presents new needs.The way in which these needs are met (or not met) determines not only how sexual satisfaction is achieved, but also how the child relates to other people and how he feels about himself. Unresolved conflicts in any stage may bother the person throughout his lifetime.

All children progress through all developmental stages. Progress through the stages is driven by biological maturation. At each stage, if parents are overly tolerant or withholding, the child can end up with fixations or complexes associated with the stage. A fixation or complex is an unresolved unconscious conflict.

The Structural Approach
involves the interrelationships of: Id: Pleasure principle – primary process Ego: Rational thought – secondary process Superego: Conscience + ego ideal The id is the centre of biological desires. It functions on the pleasure principle and primary-process thought. Id impulses are unconscious. We can view id impulses within ourselves via dreams, fantasies toward pleasure-seeking behavior. The id is the mother of the ego. Conscience : Vicdan

Ego functions include memory, problem- solving ability, and rational or logical thought processes. These functions are defined as secondary thought processes. The superego develops around the time when children resolve their Oedipal issues and begin strongly identifying with parents and parental demands or expectations.

There are two parts of the superego: 1.the conscience develops as a function of parental prohibitions. When mom, dad, or another authority figure says, “No!” or “Stop that!”, these warnings are internalized within the child’s psyche and later used by the child to self-punish or prohibit unacceptable impulses. It becomes the inner source of punishment. 2. In contrast to the negative, punishing quality of the conscience, the ego-ideal is a positive desire. The conscience is a punishment as a motivator, while the ego-ideal is a reinforcement as a primary motivator.

The ego acts as a mediator between the id and the superego. This is no easy task, and therefore the ego often must use defense mechanisms.

Defense mechanisms are designed to defend against unacceptable id impulses. They have four primary characteristics: • They are automatic: Individuals reflexively use defense mechanisms. • They are unconscious. • They defend against unacceptable impulses. • They distort reality.

Defense mechanisms Repression involves forgetting an emotionally painful memory. Denial is usually expressed with more force. “Not me!” Projection occurs when clients push their unacceptable thoughts, feelings, or impulses outward, onto another person . Reaction Formation If it is too dangerous to directly express aggression toward someone, the individual may behave in an excessively loving way. Expressing the opposite Patolojiyle bağlantılarını söyle...Aile Bağları filminde repression, denial

Defense mechanisms (cont.)
Displacement occurs when the individual shifts the aim of sexual or aggressive impulses from a more dangerous person or activity to a less dangerous person or activity. Rationalization occurs when clients use excessive explanations to account for their behavior. Regression involves going back to an old, less sophisticated method of doing things. Sublimation is one of the most productive defense mechanisms.

Psychopathology and Human Change
Psychopathology arises from early childhood experiences. Freud believed that psychopathology existed on a continuum. Normal-abnormal continuum.

There are several key issues: The therapy focuses on early childhood experiences as the origin of psychopathology. Pathological childhood experiences aren’t completely umderstood, recalled consciously. Human change involves an insightful or consciousness-raising experience. Human change isn’t an immediate process; it requires a working through process where consistent practicing of new ways of understanding inner impulses.

Evolution and Development in Psychoanalytic Theory and Practice
Ego Psychology (Psychoanalytic Ego Psychology)-Anna Freud, Eric Erickson Object Relations-Melanie Klein, Otto Kernberg Self Psychology- Hans Kohut

Anna Freud

Anna Freud studied children directly, through psychoanalysis. She studied their dreams and fantasies. She observed children’s unconscious mental processes through play. She changed the psychoanalytic focus from the instinctual drives to the ego development. She is best known for her work with children and her writing on ego defense mechanisms.

Psychoanalytic Ego Psychology
began in about the 1930s. Following Anna Freud, they emphasized that certain ego functions were inborn and autonomous of biological drives. These ego functions are memory, thinking, intelligence, and motor control. In Erik Erikson’s eightstage theory of development, Erikson deviated from Freudian developmental theory in two ways: psychosocial development instead of psychosexual development. the continuous nature of development into old age, rather than ending his stages, like Freud, in early adulthood. Autonomous: özerk Erikson emphasized 1.TRUST X MISTRUST; 2.AUTONOMY X SHAME & DOUBT 3.INITIATITIVE X GUILT 4. INDUSTRY X INFERIORITY 5. IDENTITY X IDENTITY CONFLICT (ROLE CONFUSION) 6. INTIMACY X ISOLATION 7. GENERATIVITY X STAGNATION 8. EGO INTEGRITY X DESPAIR

Object Relations In the 1950s, object relations theorists began reformulating traditional psychoanalytic theory. Traditional Freudian theory focuses primarily on parent-child dynamics during the Oedipal crisis. Object relations theory focused on pre-Oedipal dynamics. Dynamics and motivation: earlier parent-child relationships

Object Relations Objects are not things. Objects are internalized versions of people. Fairbairn states that “libido is object seeking, not pleasure seeking”. Fairbairn’s psychic world is consisted of internalized objects and internalized object relations. Object relations theorists believe humans mentally internalize both a representation of self and a representation of early caregiver figures.

Object Relations (cont.)
These internalized self and other representations are then carried within the individual into adulthood. If during early childhood an object relationship was characterized by trauma or destructive interpersonal patterns, remains of these early self-other relationship patterns can adversely affect a client’s relationships. Object relations therapy attempts to “replace the ‘bad object’ with a ‘good object’. «WE NEED TO TALK ABOUT KEVIN»

Self Psychology Formulated by Heinz Kohut.
Focused on the development of healthy narcissism within individuals. Mirroring is an important therapy concept. Retraumatization is the central client fear that leads to resistance and the therapist’s interpretation of resistance.

Heinz Kohut Therapists are imperfect, and clients retreat from intimacy. Making “optimal failures” and then working toward empathy is seen as the basic therapeutic unit leading to new self structure.

Continuing Theoretical Developments
There are many different psychoanalytic or psychodynamic approaches. Karen Horney’s work focused on how social and cultural factors can affect personality development. Horney criticized Freud’s ideas in a feminist way. Horney’s work has been labeled “neo-Freudian.” Margaret Mahler includes components of drive, ego, object relations, and self psychology. She emphasized mother-child interactions.

The Relational Psychoanalytic Movement
Jacques Lacan Relational psychoanalysis is also referred to as: Intersubjectivity or Two-person psychology It emphasizes that the psychoanalyst is always subjective. The analyst is viewed as participant-observer. Emotional involvement and countertransference reactions are used to facilitate therapy.

The Relational Psychoanalytic Movement
The therapist and client are referred to as the psychoanalytic couple. This means the analyst no longer has the unquestionable authority to make “interpretations” of his client’s unconscious derivatives, but instead is a partner in exploring the client’s personal and interpersonal unconscious and conscious dynamics.

Attachment-Informed Psychotherapy
Attachment theory is a psychoanalytically oriented approach. John Bowlby focused on: Internal working models based on Real child-caretaker interactions (not fantasies!). Actual child-caretaker interactions are foundational to personality formation. PSYCHOANALYTIC MODELS DECREASES, ATTACHMENT THEORY INCREASES IN THE USA.

Attachment-Informed Psychotherapy II
Mary Ainsworth (1970) elaborated on attachment dynamics or styles in her strange situation experiments in the lab. She studied children as they were separated from mothers, reacting to strangers, and were then reunified with mother. She identified three attachment styles: Secure attachment Anxious-resistant insecure attachment Anxious-avoidant insecure attachment Disorganized/disoriented attachment style was added by Mary Main.

Practical Modifications: Short-Term and Time-Limited Psychoanalytic Psychotherapy
There have been efforts to shorten the treatment duration. Sandor Ferenczi (1920, 1950) Therapy is more or less suggestive. Be more active to shorten treatment duration. Alexander and French (1946) wrote about the corrective emotional experience where therapists adopted a compensatory role. If the client suffered from critical parent and due to the transference, expected criticism from the analyst, then the analyst would adopt a very positive and supportive role.

THE PRACTICE OF PSYCHOANALYTIC THERAPY
Goals include: To make the unconscious conscious or increase client awareness To help clients develop greater ego-control or self-control over maladaptive impulses To help clients rid themselves of maladaptive or unhealthy internalized objects and replace them with more adaptive internalized objects To repair self-defects through mirroring, presenting a potentially idealized object, and expressing empathy.

Assessment Issues and Procedures
Psychoanalysts use: Clinical interviewing Projective testing Rorschach Inkblot Test Thematic Apperception Test Free association to specific words Human figure drawings These approaches have been criticized by some. Unless you’ve received adequate training and supervision, you should avoid using projective assessment strategies.

The Basic Rule: Psychoanalysts begin each session the same way. They tell the client, “Say whatever comes to mind.” This is the basic rule in psychoanalysis. Through free association, unconscious impulses can rise more closely toward consciousness.

The Basic Rule All external stimuli are minimized. To let unconscious impulses and conflicts rise to consciousness, distractions must be minimized. This is one reason why Freud used a sofa. If the client lies on a sofa and then the analyst sits behind it, the client cannot see him; the distracting stimulus of the analyst’s facial expressions is eliminated.

The Basic Rule The client’s internal stimuli are minimized. When free associating, it’s best not to be too hungry or thirsty or physically uncomfortable. If clients come to analysis hungry, thoughts about food will flood into their free associations. If the client is physically uncomfortable, it will distract from the free association process.

The Basic Rule Cognitive selection or conscious planning is reduced. Free association is designed to deal with intentional or planned thought processes. If a client comes to therapy with a list of things to talk about, psychoanalytic practitioners might interpret this behavior as resistance.

Psychoanalytic approaches include the following concepts and procedures:
Interpretation Developing a therapeutic alliance Role induction Timing Transference Countertransference Triangles of insight Dream interpretation

Interpretation The Freudian analyst’s job is to listen for and interpret unconscious derivatives. Fenichel is saying that analysts must prepare clients before using interpretation. Proper client preparation involves these steps: Developing a Therapeutic Alliance Role Induction Timing What to Interpret

Role Induction Role induction is a procedure through which therapists tell clients about how therapy works. To use interpretation more collaboratively, you might say something like this: “As I do therapy with you, I may notice some patterns. These patterns may be linked to your early childhood relationships, your relationship with me, or your descriptions of your relationships outside therapy. Is it okay with you if I occasionally mention these patterns so we can explore them together and a better understanding about how they might affect your life?”

Transference is a distortion that involves re-experiencing Oedipal issues in the therapeutic relationship. The client’s experience of the therapist that is shaped by the client’s own psychological structures and past and involves displacement, onto the therapist, of feelings, attitudes and behaviors belonging in earlier significant relationships. Your client treates you like someone you aren’t.

Countertransference: defined as the therapist’s tendency to see the client in terms of his or her own previous relationships. It’s the same as transference, but it occurs only when the transference is directed from the therapist toward the client. For Freud, countertransference is a negative factor in therapy. When working with clients, it’s helpful to pay attention to your own emotions, thoughts, impulses, and behaviors. During a session, you may notice that you feel irritated or annoyed with a client.

Transference X Countertransference
Because clients bring developmental baggage into therapy with them, they will project their parent relationship dynamics onto the therapist. It is called transference. Because therapists bring developmental baggage into therapy with them, the same projection process can occur in the opposite direction. When therapists project their childhood relationship patterns onto the client, it is called countertransference.

Triangles of Insight Beyond resistance, psychoanalytic therapists often focus their interpretations on triangles of insight. These insight triangles are conflict-based or transference- based. The conflict-based triangle of insight includes: (1) the client’s wish, aim, or drive; (2) the threat or imagined threat that makes the direct pleasure of the wish impossible; (3) the defensive compromise. Compromise: anlaşma ödün.

THE PRACTICE OF PSYCHOANALYTIC THERAPY (cont.)
The transference-based triangle of insight includes: (1) observations based on the transference relationship, (2) the client’s reports of his early childhood relationship dynamics, (3) the client’s reports of his current, outside-of-therapy relationships.

THE PRACTICE OF PSYCHOANALYTIC THERAPY (cont.)
Dream Interpretation Freud considered dreams to be the royal road to the unconscious. Dreams consist of unconscious derivatives and require interpretation to produce insight. Psychoanalytic dream analysis is an interactive. It emphasizes client’s reactions to and impressions of the dream’s meaning. Although the analyst’s perspective and interpretations are important, the method involves asking clients to free associate to their dreams, and then a collaborative exploration of responses follows.

Freud’s Theory in Action: Implications for Psychotherapy
Traditional psychoanalysis interprets psychological defenses before conflict. If you interpret underlying conflict first, client will use preexisting mechanisms to deny, repress or defend themselves from your insightful interpretation. If you tell the client that the reason for her silence is fear of rejection, she’s likely to withdraw from you by more silence. But if you interpret defense first, discussing how she uses silence to protect herself, she may use less distorting defenses.

Interpretation works best when nested in an empathic therapy alliance.
Timing is critical for interpretation. Wait until the interpretetive material comes to surface.

Problem formulation Psychoanalytic case formulations have interpersonal foundations. These foundations are built from repeated child-caretaker interactions and later manifest themselves clients’ daily lives.

Outcome measures Contemporaray psychodynamic outcome researchers use a combination of symptom-oriented measures (BDI) and interpersonal process measures.

Cultural and Gender Considerations
Psychoanalytic approaches have historically not been friendly to women and feminist perspectives. There is often blaming of mothers. There is often insensitivity or lack of focus on social explanations for behavior. Psychoanalytic treatment can also be very sensitive to individual differences.

Evidence-Based Status
Research on psychoanalytic approaches is very challenging. Evidence is accumulating to support psychoanalytic approaches. Some studies have weak or defective methodologies. CBTs are sometimes found to be more effective. Controlled research and meta-analyses have indicated that psychoanalytic therapies are at least slightly more effective than no treatment.

Preparing Yourself to Do Psychoanalytically Informed Therapy
Getting psychoanalysis for yourself. When in doubt, don’t forget the basic rule “What’s passing through your mind right now?” Use noncritical, mutual exploration as a general technique. Pay attention to your client’s childhood baggage and possible transference. Pay attention to your own childhood, interpersonal baggage, and possible countertransference.

Allegiance effect: A term used to describe the research finding that a researcher’s therapy choice or allegiance is a strong predictor of outcome study results. ALLEGIANCE: LOYALTY

PSY 245 CLINICAL PSYCHOLOGY
Assoc. Prof. Dr. BAHAR BAŞTUĞ Clinical Psychologist

Individual Psychology & Adlerian Therapy

Alfred Adler (1870 – 1937), founder of individual psychology

Welcome Today we’ll be focusing on individual psychology which is a theory and therapy approach developed by Alfred Adler. This approach is typically referred to as Adlerian therapy. Although some people still refer to Adler as one of Freud’s students, he was Freud’s contemporary and developed his own, very different, approach to counseling and psychotherapy.

He’s like a man from the future.
Some labels Adler as a neo-Freudian.??? Adler’s Individual Psychology is a psychoeducational, present/future oriented, and brief approach. Adler’s psychology was far ahead of its time. He’s known as the father of CBT.

Alfred Adler was born to a Jewish family, second of six children, in Vienna. had a sickly childhood. He suffered from rickets. His physician told his father: «your boy is lost.» His father encouraged Adler. HIS OLDER BROTHER WAS CLEVER, HANDSOME AND HIS NAME WAS SIGMUND. WHEN HE WAS 3 YEARS OLD, HIS YOUNGER BROTHER DIED IN BED NEXT TO HIM. FREUD İLE AYNI ORTAOKULA GİTMİŞ, FREUD’DAN 14 YIL SONRA. MATEMATİK ÖĞRETMENİ BABASINA OKULDAN ALMASINI VE KENDİSİNE AYAKKABI YAPIMCISI OLARAK ÇIRAK YAPMASINI İSTEMİŞ, AMA BABASI OĞLUNU YETENEĞİNE GÜVENEREK ONU ÇALIŞTIRMIŞ. HE BECAME THE BEST STUDENT IN MATHS.

Alfred Adler obtained medical degree from University of Vienna.
married Raissa Timofeyewna Epstein, an early socialist and feminist.

Alfred Adler met Freud in 1902. Adler attended “Wednesday evenings”.
He defended Freud’s “Interpretation of Dreams” and then was invited to what became the Vienna Psychoanalytic Society was man with his own ideas before meeting Freud. In 1911, as president of Vienna’s Psychoanalytic Society, Adler read a highly controversial paper (the masculine protest) at odds with Freudian theory. Adler emphasized the power of culture and socialization.

He noted that some women who reacted to this cultural situation by choosing to dress and act like men were suffering not from penis envy, but from a social-psychological condition he referred to as the masculine protest. In extreme cases, males who suffered from the masculine protest began dressing and acting like girls or women.

Alfred Adler After this presentation, Adler left the Vienna Psychoanalytic Society. He and his colleagues established The Society for Individual Psychology. According to Individual psychology, human functioning was not only biologically based, but also powerfully influenced by social, familial, and cultural factors. The key to psychological health and well-being was encouragement.

THEORETICAL PRINCIPLES
The Whole Person: Adler didn’t believe in dichotomies the individual into different functional parts. He emphasized unity of thinking, feeling, acting, attitudes, values, the conscious mind, and the unconscious mind.

Adler avoided reductionism. Freud was reductionist.
Reductionism X Holism Adlerian holism: Humans are a single complete unit; a whole that cannot and should not be divided into separate parts (id, ego, superego).

Striving with Purpose According to individual psychology, humans actively shape themselves and their environments. There is a third element—beyond biology and the environment—that influences and directs behavior; Adler referred to this third force as “attitude toward life” Attitude toward life is composed of a combination of individual human choice and purpose.

Striving with Purpose Human behavior is purposeful. We move toward specific goals in life. Humans are driven by hopes for the future, rather than instinctual forces from the past. Adler referred to the endpoint of our future purposeful striving as fictional finalism because the endpoint is each individual’s subjective fiction.

Striving with Purpose Everyday behavior can be analyzed with respect to its purpose. When an Adlerian therapist notices a maladaptive quality to the client’s behavior patterns, threapist wonders why that behavior occurs. For Adler, the question was neither ‘How does mind affect body?’ nor ‘How does body affect mind?’ but rather ‘How does the individual use body and mind in the pursuit of goals?”

Striving with Purpose Striving with purpose is helpful in child psy and parenting. Dreikurs identified «the four goals of misbehavior» to understand of children misbehavior. To get attention To get power or control To get revenge To display inadequacy

Social Interest and Community Feeling
Humans are born into an interpersonal context. As a consequence, the development of individual personality is shaped by interpersonal factors. When an individual experiences a deep sense of connection to others, he or she is experiencing community feeling.

Social Interest and Community Feeling
Social interest is community feeling in action.Social interest or a sense of social responsibility is a goal of therapy. As an individual’s social interest develops, so does the capacity for empathy. Psychologically healthy individuals feel a sense of communion with others. Social interest is positively related to spirituality,positive psychology & attachment.

Striving for Superiority
The most basic human motive is striving for superiority. Individuals strive for a perceived plus in themselves and their lives. Within the individual there is opportunity for both interpersonal gain and individual developmental gain. Adler is neutral. He doesn’t believe in the innate goodness or innate destructiveness of humans. He believes we are what we make ourselves; we have within us the potential for goodness and evil.

Striving for Superiority (cont.)
Adler viewed individualistic superiority striving as a sign of psychopathology. The basic striving is the striving for completeness. Even a flower that grows strives to reach its completeness. The fundamental law of life is to overcome one’s deficiencies. Humans strive; we are active, creative, and persistent in our drive to move toward completion and excellence. We can become discouraged and resigned due to unfortunate life circumstances, but our natural state is forward moving.

Phenomenology Adler was an early existentialist; the concept of phenomenology is a central assumption of individual psy. Individual experience is a subjective fiction based on each individual’s perception. The individual actively creates and adapts personal reality. Adler had an influence on Victor Frankl and Rollo May.

An Idiographic Approach
For Adler, general statements about humans and human psychology are helpful, but of limited use. A human being cannot be typified or classified. Every individual is unique. To really understand an individual, a couple,or a family, you must work with that individual, couple or family. Meeting and spending time with clients are more important than providing a diagnostic label. Individual psy is about the psy of the single, unique, whole individual.

Soft Determinism Individual psychology is not deterministic approach. Adler didn’t emphasize the causal determinants of human behavior. Soft determinism is the midpoint between deterministic, cause-and-effect thinking and nondeterminism which assumes no causal connections.

Soft Determinism From the individual psychology perspective, human behavior is a function of a combination of influences. There is no single, direct causal factor that produces a single behavior. There are many influences or contributing factors. Adler believed every individual is responsible for his/her behavior. Adlerian theory is hopeful and optimistic.

Lifestyle: The Early Cognitive Map
Adler was deeply influenced by Hans Vaihinger. According to Vaihinger, we each create our own world and then live by the rules we’ve created. Vaihinger’s philosophy is based on a cognitive psychological model. Vaihinger’s book was “The Philosophy of «As If»” Adler referred to a client’s fictional goals or fictional finalism as a future-oriented concept that influences an individual’s present behavior. An individual’s lifestyle is both conscious and unconscious. It is a subjective cognitive map of how the world works. Hayvanat bahçesinde üç çocuğun farklı tepkileri lifestylelarını gösterir.

Lifestyle: The Early Cognitive Map
The future is now. This is because the future strongly influence your everyday behavior. In addition, the future is then. This means that your future was established by your early childhood experiences. Humans are characterized by continuity; the past, present, and future are all closely intertwined. An individual’s personal continuity or lifestyle may be more or less adaptive. Some people hold onto beliefs about the self, world, and others that cause them emotional pain and distress. Adler has referred to these beliefs as basic mistakes, and these cognitive mistakes are an obvious target of therapy.

Adler is hopeful and optimistic about the possibility for helping individuals change their cognitive maps through therapy.

Tasks of Life Adler believed all humans face 3 life tasks:
Work, or occupation Love and marriage Social Relationships Later, other Adlerians added 3 more tasks: Self Spirituality Parenting and Family These six tasks constitute the challenges of life.

The clients come to therapy because they have had difficulty with one or more basic life tasks. The difficulties arise from mistakes and maladaptive perceptions associated with their lifestyle. The goal of therapy is to help clients adjust or modify their lifestyles in ways that help them more effectively complete their life tasks.

Work or Occupation This is a life demand that we all must face and work through. Adler believed the best way to solve the life task of work or occupation was by solving the second life task, social relationships, through “friendship, social feeling, and cooperation”.

Social Relationships Adler proposed positive social relationships. Establishing healthy social relationships was the key to solving the work or occupational problem. Humans are interdependent. Everyone needs to belong to some social group. Humans need to belong and are interdependent and must also face the life task of dealing with relationships. Some clients come to therapy because they have social relationship problems. From the Adlerian perspective, clients’ social problems arise from inappropriate expectations, beliefs, and interpersonal habits.

Love and Marriage Adler viewed marriage as a partnership.
Many clients come to therapy with intimacy problems, both sexual and nonsexual. Road to recovery: modify the lifestyle and develop empathy (community feeling).

Self This task emphasizes that everyone has a relationship with himself or herself. The nature of your relationship with yourself is established during childhood. Mosak and Maniacci describe four dimensions of the self life task: Survival of self: Am I taking good care of my physical self? Am I taking good care of my psychological self ? Am I taking good care of my social self ? Body image: Is my perception of my body reasonable and congruent with my actual body?

Self Opinion: What is my opinion of me? To evaluate this in an interview, Adlerians often ask clients to complete the incomplete sentence, “I ....me”. Evaluation: Some clients have various extreme perspectives of the self. From the object relations perspective, the question would be “Am I good or am I bad?”

Spirituality Mosak and Maniacci describe five specific issues related to the spirituality task. As individuals grow up and face life, they must approach and deal with each of these issues: Relationship to God: Religion: Relationship to the universe: Metaphysical issues: Meaning of life: İnsanlar Tanrı’ya inanır mı? İnanırsa nasıl bir Tanrı? İnanmazsa neye inanır? İnsanların evrenle ilişkisinin doğası nasıldır? Cennet, cehennem, reencarnasyon, karma konusunda inançları nasıldır? İnsanların bu konulara nasıl baktıkları yaşam tarzlarının bir işlevidir.

Parenting and Family Giving birth to, raising a child & functioning as a family are extensions of love and marriage task. Some individuals function as single parents and raise children outside marriage. Individual parents also develop strong feelings and beliefs about how children should be raised. How individuals face the parenting and family task is both a function of and a challenge to the lifestyle.

Parenting and Family Adlerian parenting approach has some core characteristics: Democratic-authoritative Autocratic/authoritarian or permissive Responsive Problem-solving Encouragement Punishment Contemporary parenting authorities

Theory of Psychopathology
Psychopathology is often defined as “discouragement”. The discouraged individual is unable or unwilling to approach and deal with essential life tasks. In the case of mental disorder, one or more of the life tasks have become overwhelming. The person struggling to adequately face a life task becomes discouraged. He or she feels inferior or unable to successfully manage the life task demands, and therefore symptoms arise.

Patients are suffering from the effects of their inaccurate or mistaken lifestyles. Symptoms become an answer to the question “What shall I do if I cannot successfully manage this life task?” From an Adlerian perspective, symptoms have a purpose and help individuals avoid facing life tasks. For example “If I become anxious, I will not have to approach one or more of the basic life tasks. Perhaps I can avoid marriage or work.”

Although feelings of inferiority are natural, they can also become pathological.

The Practice of Adlerian Therapy
In the practice of Adlerian therapy, there are four phases: 1. Forming the therapeutic relationship 2. Lifestyle assessment and analysis 3. Interpretation and insight 4. Reorientation

The Practice of Adlerian Therapy II
Forming the therapeutic relationship The relationship is equalitarian and characterized by listening and caring. The therapist is like a friendly teacher or business consultant. Therapist and client sit on chairs of equal status and look more or less directly at one another. Therapy is conducted collaboratively. “What do you want me to know about you? Clients are encouraged to be active participants in therapy. Equalitarian:eşitlikçi Adler doesn’t use sofa.

The Practice of Adlerian Therapy III
Therapist-client goal alignment is important; sample goals include: Fostering client social interest or community feeling Helping clients overcome feelings of inferiority and discouragement. Helping clients change the basic mistakes embedded in their lifestyle. Shifting client motivation from self-focused superiority to a community focus. Helping clients believe and feel as equals in their relationships. Helping clients become contributing members to society.

The Practice of Adlerian Therapy IV
The therapist focuses mostly on positives and not pathology. Focus on client strengths. There is also sometimes a focus on client problems. Adlerians focus on the person and strengths as well as problems. The goal is to establish an environment characterized by encouragement.

Initial Lifestyle Interpretations
“Tell your client something you’ve learned about him toward the end of the first session” The purpose of this early interpretation is to further the connection between therapist and client and begin the process of a deeper analysis.

Lifestyle Assessment and Analysis
Several approaches to lifestyle assessment are available. The main assessment strategies are: The family constellation interview The question Earliest recollections (memories)

The Family Constellation Interview
is a particular approach to obtaining information about the client’s childhood experiences. Topics covered include descriptions of each family member, descriptions of how family members interacted with one another, how each family member was viewed by the client, who fought, who didn’t fight, and more. Adler considered birth order to be a strong contributor of lifestyle. He emphasized that every individual is born into a different family; this is because with the addition of a new family member, the family dynamics change and a new family is born.

Birth order We shouldn’t use birth order like astrology to describe personality and to predict human behavior. Birth order is psychological, not chronological. If a first-born child has illnesses, a second-born may adopt personality characteristics associated with first-borns.

Oldest: may be spoiled, later dethroned, may be bossy, authoritarian; Oldest child may feel responsible for others, identify with father. Middle: may have trouble finding her place in life. Youngest: may feel she/he should be treated like royalty. She/he dreams of being bigger and more powerful, learns to manipulate others.

Only: takes attention from both parents, feels special, may have problems with peer relationships due to lack of sharing experience. Only boy among girls: may need to prove he’s a man, is to be sensitive to feminine issues. Only girl among boys: may become feminine, tries to compete with her brothers.

The Question In order to obtain information about the purpose of the client’s symptoms, the therapist asks the client “the Question.” How would your life be different if you were well? What would you be doing in your life if you no longer had your symptoms? This question is a method to look for underlying motivations or secondary gain (remember: all behavior is purposeful).

Earliest Recollections
This is a method for understanding the client’s lifestyle. It helps clarify the self ideal. The early recollection is a message from the past, still active in the client’s present life, a forecast of the future. The accuracy of the memory is much less important than the existence of the memory. The memory is an active expression of the client’s living lifestyle. If the memory was not important in the present, there would be no purpose for the client to remember it.

Basic Mistakes An Adlerian becomes able to identify a client’s basic mistakes: 1.Overgeneralization 2.False or impossible goals 3.Misperception of life and life’s demands 4.Denial of one’s basic worth 5.Faulty values 1.DUNYADA HİÇ ADALET YOK 2.HERKES TARAFINDAN KABUL EDİLEN BİR PATRON OLMALIYIM. 3.DÜNYA BANA KARŞI. 4.HİÇ KİMSE BENİ ASLA SEVMEDİ 5.BEN KAZANMALIYIM, BAŞKALARININ NE KADAR ZARAR GÖRDÜĞÜ ÖNEMLİ DEĞİL.

Interpretation and Insight
Insight is central to Adlerian therapy. There’s a strong link between insight, motivation, and action. Insight stimulates motivation, motivation stimulates action. Insight is generally achieved through interpretation. Collaboratively «Could this be true?» The purpose of interpretation is to demonstrate continuity of an inaccurate, maladaptive lifestyle; it’s not important to show a causal connection between past and present.

The Practice of Adlerian Therapy X
Reorientation is the final phase of Adlerian therapy. This is where many specific teaching and learning strategies are employed, including: The future autobiography Creating new images Acting “as if.”

Reorientation: Specific Therapy Techniques
The Future Autobiography: The future guides and shapes everyday behavior. This technique is for helping clients reshape their view of the future. This technique is especially useful for clients who like to write, draw or tell stories. First, this technique can be used as an assessment tool. The future autobiography can help identify the client’s fictional life goals (self-ideal). A discussion of the client’s future autobiography can help the client take greater conscious responsibility for directing and shaping life.

The future autobiography can be used in a therapeutic manner
The future autobiography can be used in a therapeutic manner. You can use it after gathering information about client’s past and lifestyle. You can help the client to write a realistic and adaptive future autobiography.

Creating New Images Clients have images of themselves in the past, present, and future. This procedure can be used in many different ways. In some cases, the therapist may try to use a short phrase to visually and metaphorically capture a client’s behavior, attitude, or value. This technique can also be used to encourage clients to actively develop new and more adaptive self-images. ANNESİNİN ZENGİNLİĞİNDEN RAHATSIZ OLAN AMA İSTEDİĞİ GİBİ DE PARA HARCAMAK İSTEYEN ÇOCUK İÇİN «GİZLİ ŞIMARIK ZENGİN ÇOCUĞU» GİBİSİN ŞEKLİNDE BİR İMGE YARATMAK İÇREL ÇATIŞMALARINI TARTIŞMASINA İMKAN VERMİŞ.

Acting “as If” Clients often wish for traits they don’t have. The “acting as if ” technique is used when clients express a desire to be different. «What if you were self-confident?» This technique is primarily experimental. Clients gain new perspectives and motivation for behaving in different, more adaptive ways. BU HAFTA BOYUNCA SANKİ SELF-CONFİDENTMİŞSİN GİBİ DAVRAN.

Reflecting As If There are 3 stages:
Reflecting: therapists ask clients to reflect on how they wish they might act differently. Planning: building a hierarchy of specific behaviors linked to the ideal-self. Implementing: the client identifies one or two as if behaviors that would be easiest to implement. RAI can be used with adults, children & couples. NASIL FARKLI DAVRANIYOR OLURDUN? YAŞAMININ BİR FİLMİNİ İZLİYOR OLSAM, NE FARKLI OLURDU?

The Push-Button Technique
Adler believed that under every feeling there is a cognition. The technique is designed to help clients have greater emotional control. The push-button technique is an ABA reversal experimental design that teaches clients the power of thoughts and images over feelings. “Depressed people feel depressed. It’s because they’re consistently thinking depressing thoughts.” This technique can be used with depressed people. GÖZÜNÜ KAPAT, HATIRLAYABİLDİĞİN KADAR DETAYLI GÜZEL BİR ANINI HATIRLA, BİTİRDİĞİNDE PARMAĞINI KALDIR SONRAKİ AŞAMAYA GEÇELİM. ŞİMDİ KÖTÜ BİR ANINI HATIRLA, NE KADAR KORKUNÇ OLDUĞUNU HATIRLA, BİTİRDİĞİNDE PARMAĞINI KALDIR SON KISMA GEÇELİM. YİNE HOŞ BİR ANINI HATIRLAMANI İSTİYORUM, EĞER HATIRLAYAMAZSAN İLK KISIMDAKİ AYNI ANIN OLABİLİR. SANKİ TVDE SEYREDİYOR GİBİ CANLI GÖZÜNÜN ÖNÜNE GETİR, HAZIR OLDUĞUNDA GÖZÜNÜ AÇ.

Spitting in the Client’s Soup
Clients avoid demands & responsibilities of basic life tasks. Spitting in the client’s soup is a metaphor and technique for destroying the client’s avoidance strategy. Its purpose is to increase client awareness and destroy the use of the maladaptive behavior pattern in the future. Develop a friendly and supportive relationship with the client characterized by good listening and encouragement. Identify a repeating and unhelpful behavior or thinking pattern (basic mistake) that the client uses repeatedly and plans to use in the future. Ask and get the client’s permission to share an insight. Share the repeating and unhelpful pattern that the client is planning to continue using. Be open to discussing the client’s reaction to having his/her soup spat in. KİM İÇİNE TÜKÜRÜLEN ÇORBASINI İÇMEK İSTER?

Catching Oneself Self-awareness and self-control
is designed to help clients become aware of their maladaptive behavior patterns and goals. The therapist coaches the client on how to catch himself when he or she slips into old, unhelpful behaviors. The technique of catching oneself is a historical precursor of CBT’s self-monitoring and thought stopping.

Paradoxical Strategies
Paradox in therapy involves prescribing the symptom. If the client is self-critical, therapist might suggest that she negatively analyze and criticize herself at a higher rate.

Advice, Suggestion, and Direction
Adlerian therapists offer advice within the context of a friendly, collaborative, positive relationship. I’ll Betcha Danışandan bir şey yapmasını isterim, danışan işe yaramayacak der, ben bahse girerim işe yarayacak derim. Küçük bir para karşılığında bahsi kabul ederse, söylediğim şeyi yapar işe yaramazsa o kazanır, işe yararsa ben kazanırım.

Case Analysis and Treatment Planning
The Problem List Inferiority feelings or low self-esteem A range of different maladaptive behaviors and cognition. Problem Formulation Interventions Outcomes Measurements

Outcomes Measurements
Assessment is integrated into the treatment process and assessment via lifestyle analysis. A primary goal is to develop client social interest. It focuses on the ability of clients to face and complete the tasks of life. These goals are measurable and relevant to treatment outcomes. Research shows that higher self-interest scores are associated with fewer symptoms and lower diagnostic rates. Sulliman Social Interest Scale Social Interest Index Social Interest Scale

Adlerian theory and therapy is not value-free. One value is social equality. His feminist perspective is, of course, welcomed by feminists. He stated that women’s psychopathology is shaped by a prejudiced society. His emphasis on family and family dynamics as influencing the individual also plays well in multicultural counseling. value-free: değer yargılarıyla hareket etmeyen.

Professionals and teachers have applied the principles of individual psy within educational settings, for parent education, and for group, family, couple, and individual therapy. Numerous contemporary approaches such as CBT, existential and reality therapy borrow from individual psy. Despite the prominent use of Adler’s concepts, empirical research confirming to the efficacy of Adlerian therapy is little. Perhaps the greatest reason for this is the fact that Adler found nomothetic research that compares group outcomes to be relatively useless. Consequently, the Adlerian focus continues to be idiographic case studies.

Early research reviews, based on only four empirical studies of Adlerian psychotherapy, indicate that the procedures are slightly more effective than placebo treatment and have efficacy similar to psychoanalytic and person-centered therapy. Birth order and social interest have studied. The relationship of birth order to specific personality traits have been mixed. Positive correlation between positive psy & social interest Positive correlation between spirituality & social interest Higher social interest is associated with fewer symptoms and increased well-being. İdiographic: bireysel farklılıkları açıklayan

PSY 245 CLINICAL PSYCHOLOGY-II

Jung and the Practice of Analytical Psychotherapy

Carl Gustav Jung ( )

Carl Gustav Jung was born in Switzerland in 1875 and died in Zurich in 1961. Carl was an only child until the birth of his sister, 9 years later. His mother, a housewife, became ill. Jung’s father, a clergyman, was invested in his son’s intellectual development. Young Carl Jung was resistant to certain traditional subjects, and he learned to have fainting spells in order to stay home from school.

At one point he overheard his father stating that his son was quite disabled and would probably never lead a normal life. This inspired Jung to overcome his malingering tendencies, and he returned to school, determined to succeed.

Carl Gustav Jung Jung considered careers in archaeology and theology before medical training, which he completed in However, he continued to develop his interest in spiritual and psychic phenomena, working with Eugene Bleuler at a mental hospital in Zurich, and later with Pierre Janet in Paris.

Married, 1903. Had four daughters
Married, Had four daughters. Interested in the “paranormal” and spiritual. Traveled extensively, including Uganda, Kenya, New Mexico, Tunis, and Algiers.

Jung and Freud Jung began corresponding with Freud in 1906.
Freud, Jung, and Adler were contemporaries, known each other. Similar to Adler, Jung had a professional life before his contact with Freud. CORRESPOND WITH: MEKTUPLAŞMAK

Also similar to Adler, a few years of close contact with Freud and psychoanalysis, Jung is heir-apparent, the “eldest son.” At almost the same moment, Jung began to question Freud, the “father.” Following these years, Jung severed all ties with Freud. However, unlike Adler, Jung was not expelled from the Psychoanalytic Society.

Post-Enlightenment The Enlightenment period in history is also referred to as the Age of Reason. Jung’s intellectual development was strongly influenced by post-Enlightenment thinking. He began exploring concepts and experiences beyond the reasonable and rational. In contrast to Freud’s positivistic, mechanistic, scientific, and materialistic approach, Jung accepted mystical and religious symbols and experiences.

Jung is the most multiculturally oriented of the early theorists
Jung is the most multiculturally oriented of the early theorists. Jung, like Plato, imagined that individuals who, given the proper opportunities, could be both the political and moral leaders of humankind. He hypothesized racially specific collective unconscious patterns.

Whereas Freud was pessimistic, and preoccupied with unconscious, conflict-ridden, instinctual drive states, Jung was optimistic, and preoccupied with unconscious forces, mystery, myth, magic and symbol. Both Jung and Freud believed the key to psychological healing and growth involved making the unconscious conscious.

Jung called his theory and therapy “analytical psychotherapy” to distinguish it from Freud’s psychoanalysis. It is important to understand that the word analytical does not imply a close relationship to the concept of analysis. Psychoanalysis has come to mean an analysis of the unconscious. Jung was very clear that one should not simply attempt to analyze the unconscious.

Theory of Personality Unconscious:
This is the vast pool of forces, motives, predispositions, and energy in our psyches that is unavailable to our conscious mind but can offer balance and health. Jung divided the unconscious into two entities: personal unconscious collective unconscious

The personal unconscious is particular to each individual and is material that was once conscious. It contains information that has been forgotten or repressed but that might be made conscious again, under the right circumstances. Dreams and fantasies represented the personal unconscious.

Theory of Personality The collective unconscious is a shared pool of motives, urges, fears, and potentialities that we inherit by being human. This part of the unconscious was far larger than the personal unconscious. It was universally shared by all members of the human race. When dreams and fantasies contain unrelated material to personal experiences, they originated from the collective unconscious. The collective unconscious consisted of universally shared myths and symbols, common to all humans. THERE ARE ARCHETYPES IN THE COLLECTIVE UNCONSCIOUS.

Complexes For Jung, a complex was a swirling pool of energy generated in the unconscious. The energy whirls and circles because there is something discordant and unresolved in the person’s life. Complexes weren’t necessarily negative, but their effects might be. If you had a difficult or an absent father, and you might not be as neutral and balanced about the concept of “father” as your peers. You might not react in what are considered normal ways to father figures. You might fight wildly, although you might not be aware that you do so. You also might not be able to explain your emotions or actions to yourself. In short, you might have a father complex. The possible complexes are as diverse as human experience. SWIRLING:

Archetypes The collective unconscious contains patterns and principles that are essential components of the common human experience. Jung called these patterns archetypes. The concept of archetypes is not easy to understand. Archetype as an image of instinct is a spiritual goal toward which the whole nature of man strives.

Archetypes Persona Shadow Anima/ Animus Self

Persona The persona is the archetype that takes and/or changes form where situation meets person. Healthy people adapt to the social demands around them. Our persona is the mask we wear. Our professional persona is and should be different from our persona at a party or our persona when spending time with loved ones.

Persona

Shadow is that aspect of our psyche we have either never known or have repressed. It contains aspects of ourselves that we’ve been unable to accept. It is reciprocal relationship with the persona. ID’E BENZETENLER VARDIR.

Anima-Animus

Anima-Animus have a great deal in common with the Chinese concepts of yin and yang. The feminine and the masculine principles present in all humans. In men, there existed a feminine image, anima. Similarly, a male impression exists in women, animus.

When properly functioning, a male’s anima enables him to be caring, connected, and emotionally spontaneous and available, and a female’s animus enables her to be strong, directive, active, disciplined, and aggressive.

Self is one of the most interesting and spiritually loaded archetypes. It is the central, organizing archetype, the archetype of awareness of being.

There are many other archetypes that analytical therapists use in their work. These include the warrior, the hero, the great mother, and the innocent. Various archetypes emerge occasionally during a person’s life. When they emerge, they are thought to be important messages and guiding influences from the unconscious. WARRIOR:SAVAŞÇI

Personality Types Jung believed that our personalities are organized by certain mental functions and attitudes. The two basic attitudes were: Extraversion, an orientation to the outer world of people, things, and activities, Introversion, an orientation to the inner world of concepts, ideas, and internal experience. ÖRNEK VER::: KIRDA GEZERKEN ŞATO GÖREN VE İÇERİ GİREN İKİ KİŞİ... BIG FIVE SCALE DE ....

Personality Types Extraverts tend to enjoy interacting with people frequently, have many friends, and are at ease in social interactions. Introverts have a smaller circle of friends, enjoy spending time alone, and may feel some unease in social interactions. Although individuals could behave in both Extraverted and Introverted ways, there is a tendency for one way or the other to feel more real, comfortable, and energizing.

IRRATIONAL FUNCTIONS:
SENSATION INTUITION RATIONAL FUNCTIONS: -THINKING - BELIEVING

Irrational functions Along with the defining attitudes of Introversion and Extraversion, Jung identified four functions, two of which he believed were “irrational,” in that they do not involve evaluation or judgment. He called these nonrational functions Sensation and Intuition. These are the perceiving functions.

Sensation is the function that notices the real world around us and establishes the fact that something exists. Intuition is the function that guesses the origins and direction of things and ideas. People tend to trust one or the other of these functions more fully as their source of information.

Irrational functions Sensation-trusting people take in information through their senses. They notice and are informed by the world around them. Intuition-trusting people are more likely to make inferential bounds related to cause and effect. They take in the details around them, but their reality is informed more by their sense of possibility than their sensation of reality. They believe there is more to a situation than meets the eye.

Rational functions Jung’s rational functions were called Thinking and Feeling. Thinking and Feeling are the judging functions, influenced not by perception, but by reflection.

People who have a Thinking preference apply specific, logical, linear principles in their analyses of the information they’ve taken in via their perception functions—either sensing or intuiting. Thinking is an objective function, not influenced by values or concerns about wellbeing.

Rational functions Feeling judgments are informed by an assessment of values and the potential impact of choices on individuals and groups. People who prefer the Feeling function will take into account the values, concerns, and welfare of themselves and of those around them. They have the ability to operate empathically with others, and although they are able to conceptualize issues objectively and logically, they will tend toward decisions and outcomes that establish harmony and uphold group or individual values.

Jungians believe that people come to counseling because they are called for there by their unconscious. Something needs attending to; something isn’t right in the person’s life, or development and the unconscious will send troubling messages until the person pays attention what is wrong. People seek help due to a vague, unspecified unhappiness.

Client is seeking help to
Individuate Transform

The Practice of Jungian Therapy
Jung believed that humans follow a journey toward individuation. This is an inner journey toward completeness. Adults become aware of the limits when we seek to meet the social demands around us through our persona. We begin to admit to ourselves our imperfections, childish longings, and dissatisfactions.

Aspects of the journey There are four stages of the journey:
Persona and authenticity Making peace with the Dark Side Integrating Anima/Animus Transcendence

Persona and Authenticity
In the individuation journey, the questions posed in this effort might be “Who am I, really? Deep down, at my core, who am I? When all the superficial masks are taken away, who am I?” Many of us suffer from the sense that people don’t know us. —they don’t know our deepest selves, and they’ve assumed we’re something we’re not. For others, there is the belief that we’ve been undervalued and misunderstood and denied a chance to develop.

Making Peace with the Dark Side
In the journey toward individuation, we must realize we have a shadow—our very own dark side—. We must begin the work of understanding and incorporating this regressed and repressed part of ourselves into consciousness. In working with our shadow, the job is to resolve the opposites. It’s important to learn to use the creative energy present in our shadow.

Integrating the Anima/Animus
The work of integrating the anima/animus aspect carries us deeper into union and wholeness: It involves getting in touch with the opposite-sex archetype each of us.

Transcendence, Wholeness, Fully Conscious Living
Psychotherapy moves us toward a sort of spiritually whole place where one encounters, welcomes, and brings to full consciousness the God Within, the Wise Old Man, or the Great Mother. The Self is consciously known and honored, leading to a transcendent sense of self-actualization, or psychic wholeness.

Preparing Yourself to do Therapy from a Jungian Perspective
Analysis is long-term commitment. Therapy was a relationship between a therapist who had acquired a certain level of self-awareness and a client who was seeking to increase his or her self-awareness. Theory has much to offer eclectically. Jungian analysis has individuation (transcendence or self-actualization) as its ultimate goal.

Preparing your Client for Using Jungian Concepts
Clients who seek out a professional who uses Jungian techniques are often people who’ve read about Jung or know about some of the treatment approaches that use a Jungian framework.

Preparing your Client for Using Jungian Concepts
Jungian techniques can be helpful with clients who remember and are troubled by their dreams. Clients are expected to be as open, spontaneous, and self-observant as they can be while in therapy.

Jungians generally do not use formal assessment procedures and are not likely to diagnose problems or psychopathology as disease. Jung’s theories provide a rich language and set of images to work with in understanding human ways of being and distresses.

Jungian core tenets: No matter how advanced one’s age, there is a drive toward growth and transcendence. The relationship with the analyst is deep, trusting, spontaneous, and informative.

Jungian core tenets: Dreams will often provide enormous amounts of important information, far transcending what is available to the conscious mind. Analysis will move through the archetypal forces, beginning with struggles around persona and moving toward the deep Self- (or spiritually) related archetypes.

Specific Therapy Techniques

Specific Therapy Technique: Trusting the Dream
Jung’s approach to dream work focuses on two main perspectives, the practical and the spiritual. To help in the process of dream understanding, here are a number of guidelines or suggestions compatible with a Jungian approach to dream work:

The Practical Perspective
Anyone who wants to work with dreams must find a strategy for remembering them. Most therapists recommend keeping a dream journal, in which clients write down the dream as soon as possible after dreaming it. The persona archetypes will show themselves in dreams as shelter, coverings, costumes, masks, and other externally defining features of a character.

The shadow archetype usually appears as a character of the same sex as the dreamer but of very different values and orientation. The shadow figure might be disgusting, frightening, or just mostly hidden. Opposite-sex figures might represent the anima or animus of the dreamer.

The Self or God-like archetypes will be wise, older characters who have something to show or offer the dreamer. The overall theme and emotional values in the dream will be somehow related to the dreamer’s current life. If the dreamer dreams of persons who are close to the dreamer in real life, it may be a signal to pay attention to that relationship in the waking world.

When faced with a difficult dream, the dreamer might ask, “How does this theme compensate for something in my waking life?” The dreamer can gain much meaning by having conversations with characters in the dream. Jung believed the dreamer could give voice to each character in the dream and produce a very helpful inner dialogue.

Dreams can be related to one another. The dreamer can sometimes note a series of dreams that make sense together and are interrelated over weeks, months, or even years.

Therapy Outcomes Research
Research is limited. Comparatively few practitioners identify themselves as practicing solely Jungian therapy. Therefore, outcome studies would be impossible to conduct. It is difficult to obtain outcome data on treatments as extensive as Jungian analyses. However, it is clear that many of Jung’s concepts and techniques are helpful in furthering understanding and insight into the nature of humans and their interactions.

Existential Theory and Therapy

Welcome Today we’ll be focusing on existential theory and practice.
This approach is very much about philosophy and meaning. The nature of existential therapy is creative, non-linear and meaning-focused.

Frankl (1969) noted: “. . . man also only returns to himself, to being concerned with his self, after he has missed his mission, has failed to find meaning in life (p. 9).

Psychoanalysis evolved primarily from medical practice with disturbed patients. Behavior therapy arose from experimental psychological research. Person-centered therapy and individual psychology have roots in clinical practice. Existential approaches are more directly and deeply linked to philosophy.

Humans face inevitable conditions, such as death, responsibility, freedom and purpose. This therapy approach focuses on these conditions. Existentialists avoid scientific research, they believe that the scientific research is unauthentic. UNAUTHENTIC: YAPAY, SAHTE.

They practice therapy with individuals, couples, families, & groups
They practice therapy with individuals, couples, families, & groups. Their philosophical perspective guides them.

Key Figures and Historical Context
The roots of existential philosophical thought are diverse. Majors players in the early formulation of existentialism are 19th century philosophers,: Soren Kierkegaard (1813–1855) Friedrich Nietzsche (1844–1900)

Soren Kierkegaard ( )

Soren Kierkegaard The Danish philosopher Kierkegaard lived in Copenhagen. He was hard religious. For him, traits, such as responsibility, honesty,and commitment are subjective choices. Kierkegaard did not describe himself as an existentialist, but his work is seen as pioneer to the existential philosophical movement, which formally began some 70 years following his death.

Freidrich Nietzsche (1844–1900)

Freidrich Nietzsche The German philosopher Freidrich Nietzsche had negative feelings toward Christianity. He coined the phrase “God is dead.” in his book Thus Spake Zarathustra. He believed that individuals should channel their passions into creative, joyful acitivities, instead of following a religion.

Yalom combines existential principles into a fictional encounter between Freud, Nietzsche and Breuer.

Learning from Dialectics
There is a paradox or dialectic within existential thinking. Theist X Atheist Fritz Perls: «every psychological phenomenon... is experienced as a polarity.» Hegel: human reasoning and ideas develop by a dialectical process. thesis, antithesis, synthesis

Linehan’s Dialectical Behavior Therapy involves a direct application of Hegel’s dialectic. «I accept you as you are and I’m helping you to change.» THE GOAL OF EXISTENTIAL THERAPY IS TO HELP THE CLIENT DISCOVER AND EXPLORE THE AUTHENTIC SELF.

Humans naturally create polarities.
These polarities generate conflict. There is a potential for synthesis and intellectual development. Some traditional theorists emphasize the centrality of the self, postmodern perspectives don’t emphasize the self. We learn from both perspectives, develop a more balanced view of self.

Beyond Kierkegaard and Nietzsche, the works of Pascal, Husserl, Vaihinger, Sartre, Heidegger, Jaspers, and Marcel were useful in popularizing existential perspectives. Zeitgeist: after World War I & II, holocaust of Jewish, key terms of existentialism

Jean-Paul Sartre (1905 –1980) Sartre claimed “Freedom is existence, and in its existence precedes essence” and “Man’s essence is his existence”. ????? ARE YOUR MINDS CONFUSED??? WHAT DO YOU FIGURE OUT???

“Freedom is existence, and in its existence precedes essence”
There are no absolute or essential truths (essences), but we as individual human beings create our own truth and reality. Adler and Vaihinger’s concepts of life style, fictional finalism and «acting as if» are consistent with this statement. Each individual constructs his or her reality. CLOCKWORK ORANGE

“Man’s essence is his existence”.
Humans contain no permanent elements. To reinvent yourself Existentialism emphasize personal choice, personal responsibility and personal consciousness. If humans construct their own reality and are continuously capable of self-reinvention, all behavior is owned by the individual.

Sartre: «I’m my choices.»
Existentialism is antideterministic. Existentialism XXX Freud and behaviorists If you suggest to existentialists that human behavior is determined by particular factors, events, or mental processes, they are likely to react. Existentialists reject the proposition that humans are enslaved by Freudian unconscious, instinctual drives, and they reject environmental stimulus-response determinants.

They state individual choice and human freedom, in place of instinctual or environmental causes of behavior. The past doesn’t determine the future. Our choices in this moment determine the now. Our choices in the next moment determine that moment.

VIKTOR FRANKL ( ) He was born to a Jewish family in Vienna. In 1944,he and his family were sent to a concentration camp. He worked there as a psychiatrist. His father, mother and wife died in the camp. He was released from the camp in 1945.

«Man’s Search for Meaning, 1963»
young Viktor Frankl joined Adler. Logotherapy focused on helping clients find meaning. “The striving to find a meaning in one’s life is the primary motivational force. He who has a why to live can bear with almost any how.”

Rollo May ( ) May introduced and integrated existential thought into American psychotherapy. He was a missionary teacher in Greece for 3 years. During that time, he took some seminars from Adler in Vienna.

He gave up the life of a priest and studied clinical psychology
He gave up the life of a priest and studied clinical psychology. He suffered from tuberculosis. May was granted a doctoral degree with his dissertation, The Meaning of Anxiety, argued that anxiety was an essential component of the human condition.

The Courage to Create

More contemporary key figure:
Irvin Yalom (1931– )

There is no single theorist. The existential theory of psychotherapy is based on existential philosophy and phenomenology. Principles of existential therapy: The I-Am Experience Four Existential Ways of Being The Daimonic The Nature of Anxiety Normal and Neurotic Guilt

The I-Am Experience (May)
is the experience of being, of existing. This is also referred to as the ontological experience.A major focus consists of exploring the immediate individual human experience. Boss and Binswanger used Dasein (being in the world) to describe the sense-of-existence. ‘‘Dasein choosing,’’ is also used to describe the-person-who-is-responsible-for-his-existence choosing. ONTO: TO BE, LOGICAL: THE SCIENCE OF

Existential therapy is in the service of self-awareness or self-discovery XXXXFreud’s interpreting client unconscious processes.

Four Existential Ways of Being-in-the-world. Boss, Binswanger and May described: 1. Umwelt: Being with nature or the physical world. 2. Mitwelt: Being with others or the social world. 3. Eigenwelt: Being with oneself or the world of the self. van Deurzen described: 4. Uberwelt: Being with the spiritual or over world.

Some people focus more on one dimension than others, shift from one to another related to the situations.

The Daimonic For May, “The daimonic is any natural function which has the power to take over the whole person”. The daimonic includes both positive and negative potential. It is a form of psychic energy or an urge that is the source of both constructive and destructive impulses, similar to Jung’s general conception of libido. TAKE OVER: ÜSTÜN OLMAK...

Jung emphasized the integration of the shadow archetype, May considers the integration of the daimonic to be a main task in psychotherapy. Integrating the biological and natural daimonic urge maximizes creative behavior.

The Nature of Anxiety Anxiety leads authenticity and freedom. May conceptualized anxiety as a good thing. May emphasized that anxiety was a normal byproduct of human existence. We should explore it, experience it, engage it, and redirect it into constructive activities—we should not avoid it.

two types of anxiety: - normal anxiety - neurotic anxiety. Normal anxiety is proportional to the situation. It is within our awareness and can be used creatively. Neurotic anxiety is disproportionate to the situation; it is usually repressed, denied, or avoided, and is not used for creative or constructive purposes. It is destructive.

THE GOAL OF EXISTENTIAL TREATMENT IS NOT TO DO AWAY WITH ANXIETY, BUT TO REDUCE NEUROTIC ANXIETY.
This is achived by helping clients live with and cope effectively and creatively with the normal anxiety that accompanies existence.

Normal and Neurotic Guilt
Guilt has positive and negative qualities. Guilt inspires people to act in thoughtful and conscientious ways. Normal guilt is like a sensor: When functioning well, it alerts us to what’s correct and guides us toward morally acceptable behavior.

PSYCHOPATHOLOGY ARISES FROM NEUROTIC GUILT
PSYCHOPATHOLOGY ARISES FROM NEUROTIC GUILT. Neurotic guilt usually consists of an exaggerated, or minimized version of normal guilt. Neurotic guilt doesn’t serve a productive purpose. DOMESTIC VIOLENCE YAŞAYAN BİR KADIN ABUSERINI KENDİSİNİN PROVOKE ETTİĞİNİ DÜŞÜNEREK KENDİNİ SUÇLAR, BU NEVROTİK SUÇLULUKTUR. YAPICI BİR AMACA HİZMET ETMEZ. ABUSER EŞİNİ DÖVDÜKTEN SONRA GEÇİCİ YA DA ÇOK AZ SUÇLULUK DUYAR, KİŞİSEL SORUMLULUĞUNU İNKAR EDER, MİNİMİZE EDER. KÜÇÜK BİR ÖZÜR YA DA ONLARCA GÜL İLE SUÇLULUKTAN RAHATLAMAYA ÇALIŞIR.

Existential Psychodynamics
Like psychoanalists, existentialists believe that humans are in intrapsychic conflict with powerful forces. The existential therapist helps clients face «existential psychodynamics» or “ultimate concerns” of existence. These ultimate concerns cause anxiety.

Yalom describes four ultimate concerns relevant to psychotherapy.
Death Freedom Isolation Meaninglessness ultimate concerns : nihai endişe

Death Yalom outlines two therapy-relevant propositions about death:
1) He emphasizes that death and life exist simultaneously. We can not ignore the possibility of death. Death is knowable and unknowable. We will die; it is only a question of when, where, and how. Death is part of the reality of life.

2) Yalom claims that death is a “primal source of anxiety” and is the main source of psychopathology. For anyone who has directly faced death, the potential influence of death anxiety is obvious. The purpose of facing death is to experience life more deeply and fully.

Freedom Humans are condemned to freedom, and existential therapists have followed suit by articulating the many ways in which freedom is an anxiety-loaded burden (Sartre, 1971). Personal responsibility is the first and primary burden of freedom. If you are free, you are responsible. Every action becomes a choice. CONDEMN: MAHKUM

The more freedom you experience, the more choices you have; and the more choices you have, the more responsibility you have. Personal responsibility is a heavy burden to carry. It’s so heavy that many individuals can’t bear the weight. When the weight of personal responsibility is too heavy, individuals defend themselves with denial, displacement, and blaming.

Isolation Every individual is fundamentally alone.
We enter life as an independent being and we leave from life alone. Many individuals who come for therapy come because of social problems that include feelings of loneliness.

Isolation The goal of existential therapy with respect to isolation is to help clients connect as deeply as possible with others. Yalom refers to this as a “need-free” relationship. Need-free relationships are unselfish relationships in which one person knows another person intimately, gives love without a personal agenda. When a need-free relationship exists, both parties usually feel more alive and engaged in life.

Isolation Martin Buber has written on the “I-Thou” relationship. An I-Thou relationship has the deepest of all possible connections between two individuals. It is a completely mutual relationship. I-Thou moments are rare and relatively brief. This is the relation toward which we should strive, but it is impossible to live consistently in an I-Thou connection.

Isolation Yalom claims that denial is the most common way that humans deal with the conflict between being an individual and experiencing the frightening quality of existential isolation. One of the most common forms of denying isolation is through love with another individual.

Isolation You’ve been around friends, relatives, or clients who desperately seek social or intimate contact. These individuals hate being alone, and if they’re in an intimate relationship that ends, they move quickly to replace their former partner. They have not developed the inner strength, identity, and sense of completeness to face the painful anxiety associated with existential isolation.

Isolation The heightening a client’s awareness of existential isolation should improve the ability to form healthy interpersonal relationships. Getting in touch with existential isolation has a positive effect. To face aloneness gives us the strength to face the world.

Meaninglessness The existential crisis or existential neurosis occurs when an individual faces the question “What is the meaning of my life?” Seeking life’s meaning can be an painful process. It’s common for many of us to just stay busy with daily activities, instead of grappling with life’s biggest question.

Meaninglessness Most existentialists would likely respond to “It is up to you to invent, create, or discover meaning in your life. Your challenge is to find meaning in meaningless world.”

Meaninglessness Frankl has written the most about the importance of living a meaningful life. He believes the “will to meaning” is a primary motive. Many clients come to therapy because they are suffering from the absence of meaning in their lives.

Is Life Meaningful? Frankl is claiming two things:
Humans have a will to meaning. Meaning does exist in the world, it’s up to us to find it. Frankl emphasizes that the individual does not find meaning through preoccupation with the self. We must look outside ourselves to find meaning.

Is Life Meaningful? Frankl’s approach to helping clients find meaning in life is logotherapy (logos = meaning; therapeia = healing). The key to logotherapy is to confront clients directly with the need for meaning. Clients are responsible for their lives and choices regarding the seeking of meaning.

Is Life Meaningful? The question “Is life meaningful?” can be answered in many different ways: Altruism: Clients can serve others by unselfishness. Dedication to a cause: Clients can dedicate themselves to political, religious, medical, familial, scientific, or other causes.

Is Life Meaningful? Creativity: Clients can choose to create something beautiful, powerful, and meaningful. Self-transcendence: Guilt, depression, personal salvation, and other self-oriented goals can be put aside to follow selflessness.

Is Life Meaningful? Suffering: Clients can face suffering with optimism, dignity, and integrity. God/religion: Clients can focus on serving God or their religion instead of serving self or seeking material goals.

Is Life Meaningful? Hedonism: Clients can choose to live life to the fullest each moment, to drink up the excitement, joys, and sorrows of daily life. Self-actualization: Clients can dedicate themselves to self-improvement, to meeting their potential.

Existentialism and Pessimism
Death, Freedom>>>>Burdens of responsibility, Love>>>>>>>isolation Meaninglessness Existentialism is often linked with depressing thoughts about life’s ultimate concerns. But the goal is not pessimism or depr, but to embrace life and foster hope.

Self-Awareness Self-awareness is central to existential therapy. The goal of existential therapy is to facilitate self-awareness—including the awareness of death, freedom, isolation, and life’s meaning. Humans are always looking at themselves and engaging in self-discovery.

Psychopathology results from failure to adequately face and integrate basic inner daimonic impulses, and from failure to acknowledge life’s ultimate concerns. It results from decreased self-awareness.

Signs of decreased self-awareness: Emotional numbness or automation living Avoidance of one’s anxiety, guilt, or other meaningful emotions Avoidance of inner daimonic impulses. Failure to acknowledge and reconcile life’s ultimate concerns RECONCILE: UZLAŞTIRMAK

Successful therapy is about living as fully in the moment as possible.
Neurotic behavior is linked to avoidance. As clients reject natural urges and avoid ultimate concerns, they progressively or suddenly develop psychological, emotional, or behavioral symptoms.

The treatment involves facing oneself, facing life, and acceptance the reality of death, freedom, isolation, and meaninglessness. This does not mean that life becomes easy. However, clients who face ultimate concerns with an integrated sense of self will experience normal anxiety and guilt, rather than neurotic anxiety and guilt.

The practice of existential therapy
Providing informed consent is essential in existential therapy. Here-and-now interactions should continue gently and educationally in first session.

A Word (or Two) on Specific Therapy Techniques
Existential practitioners are generally reluctant to discuss therapy techniques because technical interventions are viewed as artificial or fake. The I-Thou interpersonal existential encounter is viewed as the change agent and not technique.

Firstly, the interpersonal therapy encounter develops
Firstly, the interpersonal therapy encounter develops. Then, therapists may use specific techniques for awareness, creativity and self-development.

The Therapy Process I and Thou, Here and Now, What and How

The therapeutic factor employed by existentialists is the therapeutic encounter. This encounter is best articulated by Buber’s I-Thou relationship. The therapy encounter facilitates creativity, the expansion of awareness or consciousness, and self-development.

Forming an I-Thou Relationship and Using It for Positive Change
I-Thou relationship is characterized by: Depth Mutuality Connection Immediacy IMMEDIACY: YAKINLIK

Personal Responsibility: As the therapist, you’re responsible your behavior within the session. You aren’t responsible for your client’s wellbeing, but you are responsible for therapy process. Therapist’s job is to create conditions to facilitate an interpersonal therapeutic encounter and avoid behavior inhibiting therapy.

Presence: As the therapist, you’re alert, interested and as fully in the room as possible during every minute of every session. If you feel bored or distracted, your responsibility is to get reconnection. Here and now. PRESENCE: VAROLUŞ, MEVCUDİYET

Empathic Mirroring and Focusing: Some specific verbal techniques:
Topical focus: «take a moment to see what’s present for you». «what really matters right now?» «Can you give me an example?» Topical expansion: «tell me more» «stay with that feeling a few moments». Content-process discrepancies «you say you are fine, but your face is downcast». «when you talk about that job, your eyes seem to get wet».

Feedback and Confrontation:
When therapist are ready and mirroring back to clients what they see, hear and experience, feedback and confrontation are used. Feedback and confrontation are together with presence, empathic mirroring and focusing. Without a strong therapeutic connection or alliance, feedback and confrontation can be too painful to integrate. BAZILARI DAHA DOĞRUDAN KESKIN BİR ŞEKİLDE FEEDBACK VERİRKEN BAZILARI DAHA SABIRLI VE YUMUŞAK OLMAYI TERCİH EDER.

Mindfulness is a Buddhist approach, emphasizes acceptance of one’s thoughts and of challenging life situations. Mindfulness meditation was a factor in the development of Linehan’s dialectical behavior therapy, Acceptance and Commitment Therapy & Mindfulness Based Cognitive Therapy. Mindfulness emphasizes acceptance of internal cognitive thought processes. MINDFULNESS: FARKINDALIK.

Existential Therapy Techniques

Specific Existential Therapy Techniques
Most existential therapists reject the use of techniques. Some existentialists, particularly Frankl and Fritz Perls, wrote about interventions: Paradoxical Intention Cognitive Reframing

Paradoxical Intention
Paradoxical intention was a technique originally used by Alfred Adler. Frankl attributes the success of this approach to humor. He claims that humor is therapeutic in that it allows individuals to place distance between themselves and their situation. YAZAR KRAMPI OLDUĞU İÇİN YAZI YAZAMAYAN BİR MUHASEBECİ İŞTEN ATILMAK DURUMUNDA OLABİLİR. HER ZAMAN YAPTIĞININ TAM TERSİNİ YAP, GÜZEL YAZMAYA ÇALIŞIYORSAN KARALA. DENDİ, AMA ERTESİ GÜN TERAPİYE GELDİĞİNDE KARALAMAYA ÇALIŞTIM FAKAT YAPAMADIM. BÖYLECE YAZAR KRAMPINDAN KURTULDU.

Frankl emphasizes that through this technique, clients are taught to intentionally exaggerate, rather than avoid, their personal existential realities. Frankl claims that paradoxical intention is effective for anxiety, compulsions, and physical symptoms. PARADOXICAL INTERNEVTIONS COME FROM ADLER.

Cognitive Reframing has its origins in the individual psychology of Adler. However, Frankl employed this technique, and later Ellis and Beck emphasized its power as a therapeutic technique. KARISININ ÖLÜMÜNDEN SONRA CİDDİ DEPRESYONDAN KURTULAMAYAN BİR HASTAYA İLK SİZ ÖLSEYDİNİZ VE KARINIZ SİZİ YAŞATMAK ZORUNDA KALSAYDI NE OLURDU? O BUNUN İÇİN KORKUNÇ OLURDU. NASIL KATLANIRDI BU ACIYA. DOKTOR: İLK SİZ ÖLEREK BÖYLE BİR DERTTEN ONU KURTARMIŞ OLURDUNUZ.ŞİMDİ ONUN YASINI TUTARAK ONA ÖDEMİŞ OLUYORSUNUZ. KARISININ ACISI İÇİN KURBAN OLMA ANLAMLI BİR HALE GELMEKTE. ANLAMI OLMADAN DERT ÇEKME DEPRESYONA NEDEN OLUR. SIKINTISINA ANLAM VERİLDİĞİNDE DEPRESYON ORTADAN KALKAR.

Awareness and Existential Integration
Constriction, expansion and centering: Constriction and expansion are natural human rhythms. We experience intermittent periods of expansion and constriction. Expansive periods are characterized by growth, risk, and moving forth, Constrictive periods are characterized by inhibition, isolation, and drawing back. CONSTRICTION: SIKMA, DARALMA

Shifting from expansion to constriction to expansion is healthy
Shifting from expansion to constriction to expansion is healthy. Different situations produce a natural rhythm between expansion and constriction.

Therapists are intermittently nondirective and directive
Therapists are intermittently nondirective and directive. They develop an I-Thou relationship, then push the clients to difficult issues. Doing existential therapy requires significant training and personal psychotherapy.

Existential therapy focuses on moment to moment experiences inside and outside the therapy office. Therapists don’t depend on treatment planning. Therapist is not comfortable offering direct advice. Offering direct advice is inconsistent with existential philosophical values to impose her frame for living onto her client.

When it comes to big life decisions, an existential therapist doesn’t assume to know what’s best for another person. Generally, the client’s problems are related to weakened awareness, avoidance of death anxiety, and avoidance of acknowledging the limits of personal control.

Interventions Therapy techniques include:
establishing a therapeutic presence (I-Thou relationship) empathic mirroring feedback and confrontation cognitive reframing monitoring client’s constrictions and expansions with the goal of becoming a more centered, self-aware and intentional being.

Outcomes measurement Traditional existential therapists don’t believe in using assessment instruments. Psychometric assessment procedures are useless, antitherapeutic and/or unethical because they decrease the human encounter.

But, to narrow the focus and to seek the measure specific behaviors are possible. In some existentialists’ model, the focus is on meaninglessness. Life Regard Index (Battista & Almond, 1973) Purpose in Life Test (Crumbaugh, 1968; Crumbaugh & Henrion, 1988) Seeking of Neotic Goals Test (Crumbaugh, 1977) Spiritual Meaning Scale (Mascaro, Rosen, & Morey, 2004) Toronto Mindfulness Scale (Lau et al., 2006)

Existential therapy continues its paradoxical preoccupation with polarities. Some view it as culturally and gender insensitive. Because it emphasizes on the individual experience and discovery of the unique self, it can be viewed as ethnoculturally sensitive. Feminists complain that existentialism is a theory of wealthy, white, Western men.

“Only in existentialism and the movies, people have unlimited freedom, construct their own meanings and execute boundless choices. Save it for the wealthy, worried well.” (Prochaska & Norcross, 2003, p. 133) Others view it and enact it in a way that is respectful of the individual.

To say «I know how you feel» is a violation of existential therapy. The best we can do is to communicate to clients, regardless of their cultural background.

There is a small amount of empirical research supporting existential group therapy. There is some research on the effectiveness of paradoxical intention.

Concluding Comments Existential therapy is about finding meaning. It’s about facing the fact that we die and often we feel very much alone.

CARL ROGERS: PERSON-CENTERED THEORY AND THERAPY

Welcome This week we’re focusing on person-centered theory and therapy (PCT). This approach was developed by Carl Rogers. The approach is deeply optimistic and guided by principles of trusting clients and an actualizing tendency.

Carl Rogers (1902 –1987)

Freud >>>>pessimist
Adler & Jung >>>>optimist Rogers>>>>superoptimist. Rogers developed a distinctive approach: Listening.

In his life, he strove to be a genuine and open person, he strove to be himself.
Other theorists criticized Rogers being superoptimist.

LIFE OF ROGERS…. Born in 1902, in Oak Park, Illinois

Biographical Information:
4th of 6 children to a farm family in Illinois. His family was rigid fundamentalist Christians. Traveled to China, had a significant change of view. “Rogers appears to have become Rogers”

FORBIDDEN CITY IN BEIJING

Biographical Information: Carl Rogers
Carl Rogers’s development as a person was characterized by the following (and more) events: He rejected his parents’ conservative religious ideology. He decided to marry his childhood sweetheart. He decided to pursue graduate studies at the liberal Union Theological Seminary in New York City. He studied clinical psychology at Columbia University.

Married in 1924 Rogers’s relationship with his wife had a powerful affect on him. Because of his poor social skills, she was the first person with whom he ever had a caring and sharing relationship.

in 1928

At the time, Columbia University was interested in John Watson’s behaviorism. Rogers was oriented more toward the contemporary scientist-practitioner model. He was the first person to tape-record actual therapy sessions.

Rogers’s first clinical position was at the Adlerian-oriented Rochester Child Guidance Center. During this time, academic psychologists were behavioral, while clinicians were trained in either psychoanalytic or neo-analytic theory. Since Rogers wanted to help people (rather than work in a laboratory), he was trained in an analytic approach.

Rogers attended a seminar with Otto Rank and learned from a social worker, Elizabeth Davis. Ms. Davis’ way of articulating clients’ feelings fascinated Rogers.

Rogers adopted the following principles from Otto Rank:
Clients have creative powers. Therapy should help clients accept their personal uniqueness and self-reliance. The client is the central figure in the therapy process; the therapist only helps clients access their powers of self-creation.

Therapists shouldn’t educate clients.
Therapist shouldn’t foster dependency with clients by becoming love objects. Therapy works when clients experience the present within the therapy setting.

Rogers was influenced by the person of Roosevelt
Rogers was influenced by the person of Roosevelt. Roosevelt was optimistic. Rogers was influenced by the philosophy of John Dewey.

Historical Context Rogers was influenced by: Elizabeth Davis
President Franklin D. Roosevelt John Dewey His relationship with his wife His clients

Historical Context Honoring the Client
Rogers credited his clients as the greatest source of his development. Natalie Rogers stated: “And so like Carl, I stayed open to learning from my clients. They are always our best teachers.”

His daughter, Natalie Rogers, has become a significant force in integrating dance, movement, and the arts with person-centered theory and therapy.

Struggles with Psychiatry and Psychology
Rogers developed his client-centered approach to psychotherapy in a climate openly hostile to his ideas. He had to fight the behaviorism of academic psychology as well as the psychoanalysis of the clinical world. Rogers had a battle with psychiatry to obtain for psychologists the right to practice psychotherapy.

Rogers socialized with social workers, counselors, and teachers
Rogers socialized with social workers, counselors, and teachers. He rebelled against the traditional class lecture, he participated in encounter groups. DISDAIN: KÜÇÜMSEME

However, he was elected president of the American Psychological Association in 1946.

Evolution of Person-Centered Therapy
Rogers’s practice of person-centered theory and principles is divided into 4 periods: 1. Nondirective counseling. This period began in the 1940s and was characterized by Rogers’s growing aversion to directive, traditional therapy methods.

2.Client-centered therapy. In the 1950s Rogers changed the name of his approach from nondirective counseling to client-centered therapy.

3. Becoming a person. During the 1960s, Rogers focused on self-development. His work was strongly associated with the human potential movement. He published On Becoming a Person and moved from academia at the University of Wisconsin to California in 1964. Person-centered therapy HE CHANGED THE NAME OF HIS APPROACH TO

4.Worldwide issues. In the 1970s and 1980s, Rogers became more interested in worldwide issues. He began dedicating his work to improving interracial relations and producing world peace. He met with Irish Catholics and Protestants, visited South Africa and the Soviet Union, and conducted cross-cultural workshops in Brazil, Dublin, and Hungary.

Theory of Personality

The person-centered approach includes a theory of personality and theory of psychotherapy. The theory of personality is complex and difficult to formulate. For this reason, it gets little attention.

Theory of Personality Self theory
Phenomenology and the valuing of experience Learning and growth potential Conditions of worth

Self-Theory Every person exists within an ever-changing world in which he or she is the center. The self is not a fixed structure, but a structure in process, capable of both stability and change.

Self-Theory The term organism refers to the locus of all psychological experience. The organism is the entire realm of an individual’s experience, while the self is the “me” portion of the organism. Rogers’s self has both conscious and unconscious components.

Self-Theory The distinction between organism and self makes it possible that an individual’s self can be inconsistent with its overall psychological experience. This discrepancy is referred to as incongruence.

Self-Theory In contrast, when the self’s experiences and perceptions are consistent with the organism’s total experience, there is congruence. Congruence between self and organism is highly desirable; it leads to adjustment, maturity, and a fully functioning individual.

Phenomenology and the Valuing of Experience
This theory is basically phenomenological. Personal experience. Although both intellectual thinking and feelings are valued informational sources, experiencing is a direct way of accurately knowing oneself and the world.

Phenomenology and the Valuing of Experience
Person-centered therapy is designed to help clients be more open to personal experiences. True learning is best achieved through lived experience.

Learning and Growth Potential
Rogers believed in the inherent actualizing or formative tendency in humans. Rogers believed people have the capacity to learn on a moment-to-moment basis. Rogers’ actualizing tendency is similar to Adler’s striving for superiority.

Conditions of Worth The main two learned needs are the need for positive regard and the need for self-regard. The baby begins developing a greater and greater consciousness of self. Most parents see this behavior in their children at about age two, when the child’s favorite words become “mine!” and “no.”

Conditions of Worth 2. The growing child develops a strong need for positive regard or approval. This need for positive regard—to be prized and loved—becomes so powerful that the child is almost always looking to caregivers and significant others for acceptance and approval.

Conditions of Worth Children begin distinguishing between approved and disapproved feelings and actions. They sense and understand the conditions of worth present in their lives. Children internalize caregivers’ appraisals.

A young girl loves to play aggresively with other boys and experiences disapproval from parents, she concludes: When I play aggresively I’m bad. (negative self regard) My parents don’t like me (negative regard from others) I don’t like to play aggresively (denial of a desirable organismic experience)

Conditions of Worth Over time, if children continually experience conditions of worth incongruous with their organismic values, a conflict may develop between their conscious, introjected values and their unconscious genuine values.

Conditions of Worth When individuals are unaware of true selves and desires, psychopathology develops. A discrepancy occurs between real self and ideal self. It’s known as incongruence.

Conditions of Worth Individuals are capable of perception without awareness. This process is subception. In the case of subception, a person unconsciously perceives a threatening object or situation. SUBCEPTION: ALTALGI

In sum, it emphasizes several concepts
In sum, it emphasizes several concepts. It is the theory of self, experience, striving for maintenance and enhancement of the self, and learned needs of positive regard.

Psychopathology can be a discrepancy between the real self and the ideal self. As humans confront challenges in life they will misperceive, operate on mistaken beliefs, and behave inadequately. Dysfunctionality occurs if we fail to learn from feedback. Dysfunctionality is a failure to learn and change.

The failure to learn from experience. Person-centered therapists work so hard to help clients become open to learning from new experiences. Rigidity is considered the antithesis of psychological health. Rigidity impairs learning.

Since every moment is an opportunity for new learning, avoiding or ignoring these moments is pathological.

Theory of Psychotherapy
Psychopathology stems from the individual’s experience of judgment of the self by significant others. A nonjudgmental atmosphere will facilitate psychological health.

The success of person-centered therapy depends on two fundamental factors: • The therapist must trust the client. • The therapist must establish a certain type of relationship with the client.  So, clients will be able to begin trusting themselves, experiencing greater personal development and psychological health.

It is related to Rogers’s theory of personality. For constructive personality change, it is necessary for the following core conditions to exist: 1. Two persons are in psychological contact. 2. The client is in a state of incongruence. 3. The therapist is congruent in the relationship.

4. The therapist experiences unconditional positive regard. 5. The therapist experiences an empathic understanding. 6. Communication of unconditional positive regard and empathic understanding is at least minimally achieved.

The therapist communicate
congruence, unconditional positive regard, and empathic understanding to the client.

Congruence is defined as authenticity or transparency. The congruent therapist is real, open, and honest. «The more that the therapist can be genuine in the relationship, the more helpful it will be.» Therapists should acknowledge and express both positive and negative feelings within the context of the therapy relationship. How would you describe congruence?

Unconditional Positive Regard
Acceptance, respect, or prizing Valuing the client as a separate person or organism whose thoughts, feelings, beliefs, and entire being are openly accepted, without any conditions. If the therapist can accept clients completely, the clients can begin exploring who they really are and what they really want. By accepting clients, therapists lead clients to begin accepting themselves.

This acceptance should extend to the moment-to-moment changes and inconsistencies manifested by clients during sessions.

At one moment the clients may identify only feelings of love and kindness toward someone, and at the next they may rage about the same person. To the person-centered therapist, both love and rage are important, valid, and equally worthy of attention. By simply listening and reflecting back both feelings, the therapist allows clients to accept what’s been expressed.

How would you describe unconditional positive regard?

Accurate Empathy or Empathic Understanding

Accurate Empathy or Empathic Understanding
Noticing your clients’ feelings. Entering into the client’s world, seeing and experiencing what client sees and experiences.

Rogers shifts from using a second-person pronoun (“When he left, you felt betrayed and alone”) to using a first-person pronoun (“he just up and left, and I felt betrayed and alone”). This pronoun shift is referred to as walking within.

Kızılderili Atasözü “komşun hakkında hüküm vermeden önce iki ay onun makosenleriyle yürü.”

Empathy has been most widely discussed and researched. Empathy is a prerequisite for therapy and a necessary condition. Empathy is a multidimensional concept. Three components are commonly discussed in the literature:

Subjective empathy involves to identify with a client and imagine and experience what it is like to be a patient. Interpersonal empathy occurs when you attempt the phenomenological experiencing of a client from an extended perspective. Objective empathy involves using the observational data to understand the client.

THE PRACTICE OF PERSON-CENTERED THERAPY
two different types of person-centered therapists: The Classical person-centered therapist is highly nondirective, does not use assessment procedures, and does not establish any specific goals for clients. The contemporary person-centered therapist is a more active and directive therapist.

The Practice of PCT: A Way of Being With Clients
Assessment Issues and Procedures Classical person-centered therapists don’t employ standardized assessment or diagnostic procedures. Contemporary person-centered approaches sometimes employ assessment procedures.

The Practice of PCT: A Way of Being With Clients
The Therapist’s Opening Statement Clients can take the lead in determining what to talk about. Example: “Anything you’d like to tell me about yourself that will help me to know you better, I’d be very glad to hear.” (Rogers, 1963)

Experiencing and Expressing Congruence
This can be tricky. How do you think therapists should experience and express congruence?

Experiencing and Expressing Congruence
The basic question is: If I am to be congruent, do I need to tell the client about my every thought and feeling? The answer is “No.” That’s not to say that therapists should be too cautious about self-disclosing to clients. The main aim of this openness is communicating helpful information to clients. THERAPIST CONGRUENCE HAS IMPLICATIONS FOR THERAPY AND FOR THE THERAPIST.

A certain amount of censoring is necessary.
To use techniques in therapy is appropriate, but only when the techniques come up spontaneously, not when they’re preplanned.

Experiencing and Expressing Unconditional Positive Regard
This is also tricky. It involves accepting clients as they are and avoiding judgments. Is this possible? How do you think you could experience and express unconditional positive regard?

Everyone is human and judges others. The problem is how to best express positive regard. Would it be appropriate to say, “I accept you completely and totally as the person you are” or “I prize and value your total being”?

Most therapists get themselves in trouble if they directly express unconditional positive regard to clients, for two reasons: 1.Expressing too much positive regard can be overwhelming to clients. Clients may react by wanting to break down therapy boundaries. Upon hearing such positive, loving statements they naturally seek more closeness, a friendship or romantic relationship. Some clients may react to direct expressions of affection with fear. These clients may try to expand the boundary between themselves and the therapist.

2. Saying “I care about you” or “I won’t judge you” can be viewed as unrealistic, especially if the therapist hasn’t spent much time with the client and doesn’t really know the client well.

If it’s inappropriate to directly express unconditional positive regard to clients, how can therapists communicate this important message? 1.by keeping appointments, and by listening sensitively. 2.by allowing clients freedom to discuss themselves in their natural manner.

3.by demonstrating that you hear and remember specific parts of a client’s story. 4.by responding with empathy to clients’ emotional pain and intellectual conflicts. 5.clinical experience and research both indicate that clients are sensitive to an interviewer’s intentions. By making an effort to accept and respect your clients.

Experiencing and Expressing Empathic Understanding
Person-centered therapists do not believe it’s possible for one individual to directly know and experience another individual’s feelings. As with unconditional positive regard, what appears important regarding empathy is not that therapists perfectly experience and express empathy, but that they try their best to do so.

Experiencing and Expressing Empathic Understanding
Entering and becoming at home in the client’s personal perceptual world. Being sensitive from moment to moment with the client’s changing meanings and emotions. Temporarily living, and moving in the client’s life. Sensing deep meanings, but not uncovering feelings that are too far out of awareness.

Entering and Becoming at Home in the Client’s Private Perceptual World
Entering the client’s private world requires preparation. You need to be open to feeling what the client feels and willing to ask the empathy question: “How would I feel if I were _____ and saying these things?” The procedures employed to enter the client’s world include reflection of feelings, empathic exploration, and clarification.

Being Sensitive from Moment to Moment with the Client’s Changing Meanings and Emotions
Moment-to-moment sensitivity requires focused attention to your client’s changing way of being. In his emotion-focused therapy, Greenberg recommends focusing on meaning associated with the client’s verbalizations.

Temporarily Living, and Moving in the Client’s Life
To reside in another person’s life is serious business. Rogers says to do this temporarily. Your goal is to have one foot inside the world of the client and one foot planted in your own world.

Temporarily Living, and Moving in the Client’s Life
Martin Buber, existantialist, referred to this sort of relationship experience as an I-Thou relationship, and he emphasized that it’s impossible to constantly maintain such a relationship.

Sensing Deep Meanings, but not Uncovering Feelings That Are Too Far out of Awareness
Rogers talked about working on the edge of his clients’ consciousness. As a person-centered therapist moving about within your client’s world, if you have an impulse to tell a client about something outside of his or her awareness, it’s best to hold your tongue. Your main job is to follow the client’s lead, not to walk your own path.

Motivational interviewing Emotion-focused therapy
PCT has been integrated with other therapies. These include: Motivational interviewing Emotion-focused therapy Nondirective play therapy

Motivational Interviewing
was developed by William R. Miller. In his work with problem drinkers, Miller discovered that structured behavioral treatments were no more effective than an encouragement-based control group. He concluded that reflective listening and empathy were crucial in producing positive treatment effects with problem drinkers, and began his development of motivational interviewing. MI builds on person-centered principles by adding more focused therapeutic targets and specific client goals.

Focusing on Client Ambivalence (primary target of MI)
Their four central principles of MI flow from their conceptualization of Rogers’s approach. According to these principles, it is the therapist’s job to Use reflective listening skills to express empathy for the client’s message.

Motivational Interviewing
Notice and develop the theme of discrepancy between the client’s deep values and current behavior. Meet client resistance with reflection rather than confrontation. Enhance client self-efficacy by focusing on optimism, confidence that change is possible, and small interventions that are likely to be successful.

Empowering of all persons, including women. Designed to address the needs and interests of unique clients. Too indirect for some cultures, but actually could be too direct (focusing on self and emotions) in other cases.

Rogers was the first to record his sessions. Rogers studied client-centered relationship variables in the treatment of 16 hospitalized schizophrenics. The patients made little progress in PCT. But, patients who rated their therapists as higher empathy, warmth and genuineness had shorter hospital stays than patients who rated their therapists as less degree of empathy, warmth and genuineness.

Evidence-Based Status II
Recent research on the effectiveness of PCT has yielded small, but positive results. PCT is consistently more effective than no treatment. It is more effective than placebo treatment. It is less effective than structured cognitive and behavioral treatments.

Concluding Comments It may be that at least in some cases, the person of the therapist and the attitudes of the therapist holds are more important than specific problems or techniques.

from Lao-tse : If I keep from meddling with people, they take care of themselves, If I keep from commanding people, they behave themselves, If I keep from preaching at people, they improve themselves, If I keep from imposing on people, they become themselves. MEDDLING:KARIŞMA COMMANDING:HÜKMETME PREACHING: VAAZ VERME IMPOSING. DAYATMA

PSY 245 CLINICAL PSYCHOLOGY II

Behavioral Theory and Therapy

This week’s focus is on behavioral theory and therapy.
We should all put our science caps on. 

Behaviorism and its application, behavior therapy are linked to the science within academic psychology. Behaviorism and behavior therapy sprang from scientific efforts to describe, explain, predict and control observable animal and human behavior.

Behaviorism and psychoanalysis are opposite each other in some ways, and similar in some ways.
The biggest difference between behaviorism and psychoanalysis is: Psychoanalysis subjectively focuses on inner dynamic or mental concepts. Behaviorism objectively focuses on observable phenomena or materialistic concepts.

Psychoanalysis use techniques derived from clinical practice.
Behaviorism use techniques derived from scientific research.

Both approaches are highly deterministic, positivistic and mechanistic perspectives to understanding human. Michael Mahoney referred to psychoanalysis and behaviorism as the yin and yang of determinism (1984).

They are often considered reactions to unscientific psychoanalytic approaches.

For the behaviorist, all behavior is LEARNED
For the behaviorist, all behavior is LEARNED. The most complex human behaviors are explained, controlled, and modified through LEARNING PROCEDURES.

HISTORICAL CONTEXT Three major historical stages in the contemporary behavioral approaches: • Behaviorism as a scientific attempt • Behavior therapy • Cognitive behavior therapy (CBT)

HISTORICAL CONTEXT Existential-humanistic psychology is called the third force. As a third force, existential-humanistic psy is an alternative to psychoanalysis and behaviorism. Why does this behavior therapy chapter come after the existential- humanistic chapters?

Although behaviorism began gaining popularity in the early 1900s, behavior therapy was not identified until the 1950s. Applied behavior therapy came later.

Behaviorism In the early 1900s, a new and different mechanistic view of humans, behaviorism, was in contrast to other perspectives. Most early 20th century psychologists were interested in human consciousness and free will, and used a procedure called introspection to identify the inner workings of the human mind. Behaviorists excluded consciousness and introspection. They believed in determinism rather than free will.

John Watson ( )

Prior to Watson, William James, identified himself as a philosopher, claimed that psy is no science, only the hope of a science.

Father of behaviorism Watson believed in psychological science. He was interested in experimental psy, the classical conditioning learning model as demonstrated by Pavlov’s dogs. For Watson, behaviorism was far beyond “the hope of a science.” He published behaviorist manifesto in 1913, and redefined psychology as a pure science. «Psy as a behaviorist views it is a purely objective branch of natural science.»

He was elected to the presidency of the APA in 1915, at the age of 35.

In opposition to James’s free will, the purpose of Watson’s behaviorism was the deterministic prediction and control of human behavior. Watson viewed humans and animals as indistinguishable.

“Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I’ll guarantee to take any one at random and train him to become any type of specialist I might select—doctor, lawyer, artist, merchant-chief and yes, even beggar-man and thief, regardless of his talents, tendencies, abilities, vocations, and race.”

Watson had a strong interest in the application of behavioral scientific principles to human suffering. This may have been because he experienced a nervous breakdown as a young man and had not found psychoanalysis helpful.

Little Hans and Little Albert
In 1909, Freud reported an analysis of Little Hans (5-year-old) who was afraid of being bitten by a horse because of unresolved Oedipal issues and castration anxiety. Freud explained that Little Hans’s phobia was from castration anxiety. Watson showed that Little Albert could develop a phobia from classical conditioning.

Watson sought to demonstrate that severe fears and phobias were caused not by psychoanalytic constructs but by classical conditioning of a fear response. In his famous experiments with 11-month-old Little Albert, after only five trials in which Watson and his assistant Rosalie Raynor paired the presentation of a white rat to Albert with the striking of a metal bar. Albert developed a strong fear and aversion to white rats.

His conditioned fear response generalized to a variety furry white objects, such as a dog, cotton wool and Santa Claus mask.

Little Peter MARY COVER JONES
Jones showed that fear could be extinguished through counterconditioning and/or social imitation.

Little Peter In 1924, Mary Cover Jones, who was student of Watson, conducted an investigation of the effectiveness of counter-conditioning or deconditioning with a 3-year-old boy named Little Peter. It was study that illustrated the potential of classical conditioning techniques in the treatment of psychological fears and phobias.

Prior to his involvement in the behavioral experiments, Little Peter exhibited fear in response to several furry objects, including rabbits, fur coats, and cotton balls. Jones proceeded to systematically decondition Little Peter’s fear reaction by pairing the gradual approach of a caged rabbit with Peter’s involvement in an enjoyable activity—eating his favorite foods. In the end, Peter’s fear response was extinguished.

Early behaviorists made many important contributions to psychology:
• The discovery by Pavlov, Watson, and their colleagues that emotional responses could be involuntarily conditioned in animals and humans via classical conditioning procedures. • The discovery by Mary Cover Jones that fear responses could be deconditioned by either (1) replacing the fear response with a positive response or (2) social imitation. • The discovery by Thorndike and its later elaboration by Skinner that animal and human behaviors are powerfully shaped by their consequences.

Behavior Therapy In the 1950s, three different groups in three different countries independently introduced the term behavior therapy to modern psy: 1. B. F. Skinner in the United States 2. Joseph Wolpe, Arnold Lazarus, and Stanley Rachman in South Africa 3. Hans Eysenck and the Maudsley Group in the United Kingdom

B. F. Skinner in the United States
Skinner box

Skinner ( ) His early work was an experimental project on operant conditioning with rats and pigeons in the 1930s. He demonstrated the power of positive reinforcement, negative reinforcement, punishment, and stimulus control in the modification of animal behavior. Within the confines of Skinner box, he was able to teach pigeons to play ping-pong via operant conditioning procedures.

Skinner In the 1940s, he began extending operant conditioning concepts to human social and clinical problems. His book Walden Two was a story of how operant conditioning procedures could be used to create an utopian society. His next book, Science and Human Behavior, was a critique of psychoanalytic concepts and a reformulation of psychotherapy in behavioral terms. In 1953, Skinner and his colleagues first used behavior therapy referring to the application of operant conditioning procedures to modify the behavior of psychotic patients.

Joseph Wolpe, Arnold Lazarus, and Stanley Rachman in South Africa
Joseph Wolpe was interested in conditioning procedures as a means for resolving neurotic fear. He established the first nonpsychoanalytic, empirically validated behavior therapy technique. His book Psychotherapy by Reciprocal Inhibition outlined the therapeutic procedure now called systematic desensitization. Wolpe’s approach is very similar to Jones’s counterconditioning principle wherein a conditioned negative emotional response is replaced with a conditioned positive emotional response.

Wolpe’s work attracted the attention of two South African psychologists, Arnold Lazarus and Stanley Rachman. Conditioning procedures were used as a means for resolving neurotic fear. A conditioned negative emotional response is replaced with a conditioned positive emotional response.

Lazarus advocated the integration of laboratory-based scientific procedures into existing clinical and counseling practices. He used the term behavior therapy in a journal. Rachman has influenced developing behavior therapy procedures. His contribution involved the application of aversive stimuli to treating neurotic behavior, including addictions.

Hans Eysenck and the Maudsley Group in the United Kingdom
British psychiatrist Hans Eysenck used the term “behaviour therapy” to describe the application of modern learning theory to the understanding and treatment of behavioral and psychiatric problems.

Conclusion, All these researchers lead to born behavioır therapy.

Cognitive Behavior Modification
Contemporary behavior therapy now includes cognitive variables. Most behavior therapists now work with cognition. Many articles focus on thoughts, expectations, and emotions. Behavior therapy is no longer a process that focuses on external behavior. Behavior therapy continues to develop.

THEORETICAL PRINCIPLES
Two primary principles characterize behaviorists and behavioral theory: • Behavior therapists employ techniques based on modern learning theory. • Behavior therapists employ techniques derived from scientific research.

Theoretical Models The four main models of learning form the theoretical foundation of behavior therapy. Operant Conditioning: Applied Behavior Analysis Classical Conditioning: Neobehavioristic, Mediational Stimulus-Response Model

Operant Conditioning: Applied Behavior Analysis
B. F. Skinner Applied behavior analysis is a clinical term referring to a behavioral approach based on operant conditioning principles. The operant conditioning position is straightforward: Behavior is a function of its consequences. Operant conditioning is a stimulus-response theory.

Applied Behavior Analysis
Applied behavior analysis is a clinical term, based on Skinner’s operant conditioning principles. Behavior is a function of its consequences. «Operant» refers to how behaviors operate on the environment, thereby producing specific consequences.

Operant conditioning is a stimulus-response (SR) theory. Applied behavior analysis focuses on observable behaviors. Therapy proceeds through the manipulation of environmental variables to produce behavior change.

The main procedures are reinforcement, punishment, extinction, and stimulus control. These procedures are used to manipulate the environmental contingencies (rewards and punishments). The goal is to increase adaptive behavior through reinforcement and stimulus control and to reduce maladaptive behavior through punishment and extinction. Several behavior therapy techniques, such as assertiveness training, the token economy, and problem-solving training are derived from applied behavior analysis.

Classical Conditioning: Neobehavioristic, Mediational Stimulus-Response Model
The neobehavioristic mediational SR model is based on classical conditioning principles. Its principles were developed and articulated by Pavlov, Watson, and Wolpe. Classical conditioning is sometimes referred to as associational learning because it involves an association of one environmental stimulus with another.

In Pavlovian terms, an unconditioned stimulus is one that naturally produces a specific physical-emotional response. The physical response elicited by an unconditioned stimulus is mediated through smooth muscle reflex arcs, so higher-order cognitive processes are not required in order for conditioning to occur.

The experience of being struck from behind while waiting for a red light is the unconditioned stimulus. This stimulus automatically (or autonomically) produces a reflexive fear response (or unconditioned response). After only a single, powerful experience, the 34-year-old man suffers from a debilitating fear of impending death (a conditioned response) whenever he is exposed to the interior of an automobile (a conditioned stimulus).

As Wolpe emphasizes, this scenario represents classical autonomic conditioning or learning because the man has no cognitive expectations or cognitive triggers that lead to his experience of fear when he is sitting inside an automobile. Because of the lack of cognitive processing involved in classical conditioning, when an individual experiences a purely classically conditioned fear response, often he or she will say something like, “I don’t know why it is, but I’m just afraid of elevators.”

Classical conditioning principles include: stimulus generalization, stimulus discrimination, extinction, counter-conditioning, and spontaneous recovery.

Classical conditioning principles
Stimulus generalization: the generalization of a conditioned fear response to new settings, situations, or objects. In the case of Little Albert, stimulus generalization occurred when Albert experienced fear in response to stimuli similar in appearance to white rats (e.g., Santa Claus masks, cotton balls, etc.). .

Stimulus discrimination occurs when a conditioned fear response is not elicited by a new or different stimulus. In the case of Little Albert, stimulus discrimination occurred when Little Albert did not have a fear response when exposed to a fluffy white washrag.

Extinction: the gradual elimination of a conditioned response. It occurs when a conditioned stimulus is repeatedly presented without a previously associated unconditioned stimulus. If Watson had kept working with Little Albert and repeatedly exposed him to a white rat without a frightening sound of metal clanging, Little Albert would lose his conditioned response to rats. Extinction is not the same as forgetting.

Counter-conditioning.New associative learning. Mary Cover Jones’s work with Little Peter is an example of successful counter-conditioning or deconditioning. Counter-conditioning involves new associative learning. The subject learns that the conditioned stimulus brings with it a positive emotional experience. When Jones repeatedly presented the white rat to Little Peter while he was eating some of his favorite foods, eventually the conditioned response (fear) was counter-conditioned.

Spontaneous recovery occurs when an old response suddenly returns after having been successfully extinguished or counterconditioned. If, after successful counter-conditioning through systematic desensitization, Wolpe’s client suddenly begins having fear symptoms associated with the interior of automobiles, he has experienced spontaneous recovery.

MALADAPTIVE BEHAVIOR IS LEARNED AND CAN ALWAYS BE EITHER UNLEARNED OR REPLACED BY NEW LEARNING. PSYCHOPATHOLOGY MAY BE A FUNCTION OF INADEQUATE LEARNING OR SKILL DEFICITS.

An underlying principle of assertiveness training is that individuals who exhibit too much passive or too much aggressive behavior simply have skill deficits; they haven’t learned how to appropriately use assertive behavior in social situations. The purpose of assertiveness training is to teach clients assertiveness skills through modeling, coaching, behavior rehearsal, and reinforcement.

Behaviorists systematically apply following scientific methods: •Observe and assess client maladaptive behaviors. •Develop hypotheses about the cause, •Test behavioral hypotheses through the application of empirically justifiable interventions. •Observe and evaluate the results of their intervention. •Revise and continue testing new hypotheses as needed.

THE PRACTICE OF BEHAVIOR THERAPY
To practice behavior therapy requires that you take notes and think like a scientist. You are a teacher. Your job is to help clients unlearn old maladaptive behaviors and learn new, adaptive behaviors.

What Is Contemporary Behavior Therapy?
Nearly all cognitive therapies are used in conjunction with behavior therapies. There are now several new-generation cognitive-behavioral therapies. These therapies include: Dialectical Behavior Therapy (DBT) Acceptance and Commitment Therapy (ACT) Eye Movement Desensitization Reprocessing (EMDR)

Behavior therapists would be able to directly OBSERVE clients in their natural environment to obtain specific information about what happens before, during, and after adaptive and maladaptive behaviors occur. The main goal of behavioral assessment is to determine the external (environmental or situational) stimuli and internal (physiological and cognitive) stimuli that directly precede and follow adaptive and maladaptive client behavioral responses. Both internal and external stimuli may be of interest.

Functional Behavior Analysis (FBA): This assessment procedure is sometimes referred to as obtaining information about the client’s behavioral ABCs: • A = The behavior’s antecedents (everything that happens just BEFORE the maladaptive behavior is observed) • B = The behavior: operant definition by concrete terms • C = The behavior’s consequences (everything that happens just AFTER the maladaptive behavior occurs)

Through direct observation, the behavior therapist gathers information. But, direct behavioral observation is inefficient, for several reasons: 1. Most therapists can’t afford the time required to observe clients in their natural settings. 2. Many clients object to having their therapist come into their home or workplace to conduct a formal observation.

3. Even if the client agreed to have the therapist come perform an observation, the therapist’s presence influences the client’s behavior. Because behavior therapists usually cannot use direct behavioral observation, they employ a variety of less direct data collection procedures.

The Behavioral Interview
The clinical or behavioral interview is the most common assessment procedure. During interviews, behavior therapists directly observe client behavior, inquire about behavioral antecedents and consequences, and operationalize the targets of therapy. The operational definition or specific, measurable characteristics of client symptoms and goals are crucial behavioral assessment components.

Defining the client’s problem(s) in behavioral terms is the first step in a behavioral assessment interview. Behavior therapists are not satisfied when clients describe themselves as “depressed” or “anxious”. Instead, behaviorists seek concrete, specific behavioral information.

The Clinical or Behavioral Interview
Despite many practical advantages of behavioral interviews, this assessment procedure also has several disadvantages: (1) low interrater reliability, (2) lack of interviewer objectivity, and (3) frequent inconsistency between behavior in a clinical interview and behavior outside therapy. (4) false, subjective clients’ report.

The Clinical or Behavioral Interview
Behavior therapists compensate for the inconsistent and subjective nature of interviews through two strategies: They employ structured or diagnostic interviews such as the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (SCID-DSM-IV). They use additional assessment methods beyond interviewing procedures.

Self-Monitoring Sometimes, to directly observe client behavior outside therapy is impractical. Clients are trained to monitor their own behavior. In CBT, clients frequently keep thought or emotion logs that include at least three components: disturbing emotional states, the exact behavior engaged in at the time of the emotional state, and thoughts that occurred when the emotions emerged.

Advantages of selfmonitoring is cheap, practical, and usually therapeutic.
Disadvantages of selfmonitoring is that the client can collect inadequate or inaccurate information, or resist collecting any information. Clients may not make accurate recordings of their behavior.

Standardized Questionnaires
Objective psychological measures include standardized administration and scoring. Behaviorists prefer instruments that have established reliability and validity. These are often used to determine outcomes.

Operant Conditioning and Variants
In the tradition of Skinner and applied behavior analysis, the application of behaviorism to therapy is direct operant conditioning. Skinner’s emphasis is on environmental manipulation rather than processes of mind or cognition.

Contingency Management and Token Economies
Using operant conditioning requires an analysis of behavioral consequences in the client’s physical and social environment. This process is contingency management. It’s used more common in educational, family, institutional and drug treatment settings.

An appropriate use of operant conditioning involves several systematic steps: 1. The parents need to operationalize the target behaviors and identify behavioral objectives. 2. The therapist helped the parents develop a system for measuring the target behaviors. They were each given a pencil and notebook to follow the frequency of their teen’s behaviors. 3. The parents were instructed on how to monitor and evaluate the effects of their new contingency schedule.

Operant conditioning principles have been applied to educational and institutional settings. Following Skinner’s work aimed at modifying the behavior of psychotic patients, operant conditioning within institutions has come to be known as a TOKEN ECONOMY. Within token economy systems, individuals are givencoins or symbolic rewards for positive or desirable behaviors. These tokens are used like money, to obtain goods or privileges.

Token economies have been criticized as forcible and as not having lasting effects that generalize to the world outside the institution. After the desirable behavior patterns are well established, the behavioral contingencies would be slowly decreased. This procedure is referred to as fading and is designed to maximize the likelihood of generalization of learning from one setting to another. The desired outcome occurs when the subject internalizes the contingency system.

Positive reinforcement faces some criticism. Thorndike, Skinner concluded that punishment led to behavioral supression, but it wasn’t effective for controlling behavior. Then, Solomon claimed that punishment could generate new, learned behavior.

Now, it is accepted that punishment is a powerful behavior modifier, but it has disadvantage. In the attachment and trauma literature, excessive punishment leads to trauma bonding. There is a debate on using punishment as a learning tool.

The direct application of punishment, or aversive conditioning, is used to reduce undesirable and maladaptive behavior. It has been applied with some success to smoking cessation, repetitive self-injurious behavior, alcohol abuse or dependency, and sexual deviation.

Behavioral Activation (BA)
For Skinner, depr was caused by an interruption of healthy behavioral activities. Depressed individuals engage in fewer pleasant activities and obtain less positive reinforcement than others. So, if they change their behavior, they may improve or recover.

Behavioral Activation (BA)
BA was previously referred to as activity scheduling and used as a component of various cognitive and behavioral treatments for depression. Recent research suggests BA may be as good as the whole CBT package for depressive disorders. YAPILAN BİR ÇALIŞMADA BA’NIN DA OLDUĞU TAM BİR CBT PAKETİ, SADECE BA VE SADECE OTOMATİK DÜŞÜNCELER İÇİN CBT’YI KARŞILAŞTIRMIŞLAR. BA’NIN DİĞER TEDAVİLERE EŞDEĞER OLDUĞU BULUNMUŞ.

Relaxation Training Edmund Jacobson was the first scientist to write about relaxation training as a treatment procedure. Progressive muscle relaxation (PMR) was initially based on the assumption that muscular tension is an underlying cause of a variety of mental and emotional problems.

Relaxation Training PMR is an evidence-based treatment.
But PMR can make some clients more anxious.

Systematic Desensitization and Other Exposure-Based Treatments
Joseph Wolpe introduced systematic desensitization as a technique. Systematic desensitization = Jone’s deconditioning approach + Jacobson’s PMR procedure. “To be relaxed is the direct physiological opposite of being excited or disturbed.” (Jacobson, 1978, p. viii)

After clients are trained in PMR techniques, they build a fear hierarchy in collaboration with the therapist. Systematic desensitization usually proceeds in the following way: 1.The client identifies a range of various fear-inducing situations or objects.

2. Using a measuring system referred to as subjective units of distress, the client, with the support of the therapist, rates each fear-inducing situation or object on a scale from 0 to 100 (0 = no distress; 100 = total distress). 3. Early in the session the client engages in PMR. 4. While deeply relaxed, the client is exposed, in vivo or through imagery, to the least feared item in the fear hierarchy.

5. The client is exposed to each feared item, gradually progressing to the most feared item in the hierarchy. 6. If the client experiences anxiety at any point during the imaginal or in vivo exposure process, the client reengages in PMR until relaxation overcomes anxiety. 7.Treatment continues systematically until the client achieves relaxation competence while simultaneously being exposed to the entire range of fear hierarchy.

Imaginal or In Vivo Exposure and Desensitization
Systematic desensitization is an exposure treatment. In the exposure treatments, clients are treated by exposure to the thing they want to avoid: the stimulus that evokes intense fear, anxiety, or painful emotions.

Imaginal or In Vivo Exposure and Desensitization
There are three ways in which clients are exposed to their fears during systematic desensitization: 1. Exposure to fears can be accomplished through mental imagery. Computer simulation (virtual reality) has been used in therapist’s office. 2. In vivo exposure to feared stimuli. In vivo exposure involves direct exposure to real-life situations.

3. computer simulation (virtual reality) has been used as a means of exposing clients to feared stimuli. Psychoeducation and a good therapeutic alliance are essential for exposure.

Massed (Intensive) or Spaced (Graduated) Exposure Sessions
Is desensitization more effective when clients are exposed to feared stimuli during a single prolonged session or when they are slowly exposed to feared stimuli during a series of shorter sessions? Either approach can be used effectively.

Virtual Reality Exposure (VRE)
a procedure wherein clients are immersed in a real-time computer-generated computer environment. It has been empirically evaluated as an alternative to imaginal or in vivo exposure in cases of acrophobia (fear of heights), flight phobia, and spider phobia. VRE has been empirically validated.

Interoceptive Exposure
It is similar to other exposure techniques but focuses on internal anxiety signals or triggers. Research on Panic Disorder has showed that some clients who experience intense fear are responding less to situational stimuli and more to internal physical sensations.

Panic-prone individuals are sensitive to internal physical cues (e.g., increased heart rate, increased respiration). They interpret those sensations as signs of physical illness, death, or loss of consciousness. Although specific cognitive techniques have been developed to treat clients’ tendencies to catastrophically overinterpret bodily sensations, interoceptive exposure has been developed to help clients learn, through exposure and practice, to deal more effectively with the physical aspects of intense anxiety or panic.

Six introceptive exposures that trigger anxiety: Hyperventilation Breath holding Breathing through a straw Spinning in circles Shaking head Chest breathing

Before interoceptive exposure, the client receive education about body sensations, learn relaxation techniques, and learn cognitive restructuring skills. Through repeated successful exposure, the client becomes desensitized to feared physical cues.

Response Prevention and Ritual Prevention
According to Mowrer, when a client avoids a feared or distressing situation or stimulus, the maladaptive avoidance behavior is negatively reinforced. For example, clients with Bulimia Nervosa who purge after eating specific “forbidden” foods are relieving themselves from the anxiety and discomfort they experience upon ingesting the foods. Purging behavior is negatively reinforced. Similarly, when a phobic client escapes from a phobic object or situation, or when a client with OCD engages in a repeated washing or checking behavior, negative reinforcement of maladaptive behavior occurs.

Response Prevention and Ritual Prevention
With the therapist’s assistance, the client with bulimia is prevented from vomiting after ingesting a forbidden cookie, the agoraphobic client is prevented from fleeing a public place when anxiety begins to mount, and the client with OCD is prevented from washing hands following exposure to a “contaminated” object.

Participant Modeling Social learning principles have been evaluated for anxiety treatment. For example, individuals with airplane or flight phobias don’t find it helpful when they watch other passengers getting on a plane without experiencing distress. In fact, such observations can produce increased hopelessness. There is too large a gap in emotional state and skills between the model and the observer, so vicarious learning does not occur.

Participant Modeling Behavior therapists provide models of successful coping. Group therapy provides an excellent opportunity for participant modeling and vicarious learning.

Skills Training Skills training techniques are based on skill deficit models of psychopathology. Many clients have not acquired the necessary skills for functioning. Behavior therapists evaluate their clients’ functional skills during the assessment phase of therapy and then use specific skills training strategies to treatment the clients’ skill deficits.

Traditional skills training targets include assertiveness and other social behavior as well as problem solving.

Assertiveness and Other Social Behavior
Wolpe and Lazarus defined assertiveness as a learned behavior. Individuals are evaluated as having one of three possible social behavior styles: passive, aggressive, or assertive. Passive individuals behave in submissive ways; they say yes when they want to say no. Aggressive individuals dominate others. Assertive individual speaks up, expresses feelings.

The most common social behaviors targeted in assertiveness training are: introducing oneself to strangers, giving and receiving compliments, saying no to requests from others, making requests of others, speaking up or voicing an opinion, and maintaining social conversations.

Assertive behavior is taught through the following strategies:
• Instruction: Clients are instructed in assertive eye contact, body posture, voice tone & verbal delivery. • Feedback: The therapist or group members give clients feedback regarding how their efforts at assertive behavior come across to others. • Behavior rehearsal or role playing: Clients are given opportunities to practice specific assertive behaviors, such as asking for help or expressing disagreement without becoming angry or aggressive.

• Coaching: Therapists whisper feedback and instructions in the client’s ear as a role-play or practice scenario progresses. • Modeling: The therapist or group members demonstrate appropriate assertive behavior for specific situations. • Social reinforcement: The therapist or group members offer positive feedback and support for assertive behavior. • Relaxation training: It is needed to reduce anxiety in social situations.

Assertiveness training for individuals with specific social anxiety and social skills deficits are used. Social Phobia—a condition characterized by an excessive, irrational fear of being scrutinized and evaluated by others—is treated with a combination of relaxation and social skills training that includes almost all the components of traditional assertion training and graduated or massed exposure to challenging social situations and interactions.

Problem Solving Therapy (PST)
It is a behavioral treatment with cognitive dimensions. For rationale of PST, effective problem solving is a mediator that helps clients manage stresful life events. It focuses on: Problem orientation: This involves teaching clients to have a positive attitude toward problems. Problems are opportunity, are solvable. Believing in own ability to solve problems and recognizing that effective problem solving requires time and effort.

Problem Solving Therapy (PST)
Problem-solving style: Clients are taught a rational problem-solving style: 1. Define the problem. 2. Identify the goal. 3. Generate options. 4. Choose the best solution. 5. Evaluate the outcome

Discerning the differences between cognitive and behavioral therapies is difficult. Most behavior therapists use cognitive treatment and most cognitive therapists use behavioral treatments. Cognitive-behavioral therapy.

One characteristic of behavior therapy is the generation of a clear and concrete problem list. Items in the problem list are defined in behavioral terms and measurable.

Each behavior therapy session includes four parts:
1.check-in and homework review 2. psychoeducation about the patient’s disorder and behavior therapy 3. in-session behavioral or cognitive tasks 4. new homework assignments.

Some research indicates behavioral treatments are effective with minority clients; however, Craske (2010) admits that generally cognitive and behavioral therapies are not yet proven multiculturally efficacious. Behavior therapists need to make multicultural adjustments in their practices.

Behavioral and cognitive therapies are far and away the largest producers and consumers of therapy outcomes research. The most recent APA Division 12 list of ESTs includes 60 different treatment protocols, most of which are behavioral or cognitive-behavioral.

Token economies and contingency management>> Behavioral activation>>depr Progressive muscle relaxation>> Exposure+response prevention>>anx dissorders Problem solving therapy>>depr.

Concluding Comments Behavior therapy deserves credit for demonstrating that particular approaches are effective—based on a quantitative scientific-medical model.

If it can’t be empirically validated, then it’s not behavior therapy.

Psychotherapy and Counseling Essentials: An Introduction

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Psychotherapy and Counseling Essentials: An Introduction

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