1. Theory Applied to Practice
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Theory as a Roadmap
Theory: A framework for making sense of the many interactions that occur within the therapeutic relationship
Helpers may emphasize feeling, thinking, and/or behaving based on their theoretical perspective.
Helpers may focus on the past, present, or future as the most productive avenue of exploration.
Becoming A Helper - Chapter 7(1)
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3. Five Contemporary Theoretical Orientations
1) The psychodynamic approaches
2) The experiential and relationship-oriented approaches
3) The cognitive behavioral approaches
4) The postmodern approaches
4) The family systems approaches
Becoming A Helper - Chapter 7(2)
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4. Psychoanalytic Approach
Longer-term exploration of personality
Main goal: The restructuring of personality
Emphasis on interpretation of the therapy relationship as the healing intervention
Assumption: Human behavior led by primitive hedonistic drive
Becoming A Helper - Chapter 7(3)
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5. Psychoanalytic Approach
Psycho-Sexual Development
Oral Stage: birth-1 year
Anal Stage: 1-2years
Phallic Stage: 2-6 years
- Oedipal Complex
- Penis Envy; Castration Anxiety
Latency Stage: 7-12 years Sexual drive sublimated; focus on academics and same sex socialization
Becoming A Helper - Chapter 7(4)
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Psychoanalysis
Structure of the Personality: Arises from Development
Id: hedonistic, immediate gratification
Ego: Reality centered; socially conventional
Superego: moralism; absolute right & wrong
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Psychoanalysis
Unconscious: domain of all psychological conflict; out of awareness
Conscious: Awareness; Overt crises; mindfulness
Purpose of Interpretation: to bring suppressed conflict into the light of conscious thought. Resolution of neurosis arises through resolution of defenses and awareness.
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Psychoanalysis
Defenses: Attempts to avoid realization of unacceptable desires
Denial: immature; some possibility of awareness
Intellectualism
Repression: Material completely outside of consciousness
Projection: Attributing own issues/wants to others
Sublimation: to transfer unacceptable desires to socially acceptable pursuits
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Dream Interpretation
Dreams a window into unconscous
Dreams symbolically represent desires and conflicts
Dream Interpretation: Client shares remembered dream; therapist role to interpret symbolism in dreams in hopes of bringing to light unconscious conflict
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10. Psychoanalysis in Session
Video: Note the psychoanalytic framework
Therapist: blank slate, out of eye contact
Frequency: 4-5x weekly
Class Question:
What type of patient would be best suited for psychoanalytic therapy?
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Adlerian Approach
Humans are shaped by environment and biological drive
The therapeutic relationship is a collaborative partnership.
Social interest: A sense of identification with humanity, a feeling of belonging, and a concern with bettering society
Becoming A Helper - Chapter 7(5)
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Adlerian Approach
Drive for Mastery: (not sexual fulfillment) Inferiority feelings often motivate people to strive for mastery, superiority, and perfection.
Inferiority can become a complex governing peoples’ lives
Focus is on challenging clients’ mistaken notions, and faulty assumptions.
Emphasis is on examining lifestyle and clients’ functioning in the life tasks.
Becoming A Helper - Chapter 7(6)
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Adlerian Approach
Compensation: we overfunction or underfunction to manage feelings of inferiority
Therapy purpose: Provide encouragement so that clients can develop socially useful goals.
Cognitive, behavioral, and experiential techniques
are used.
Becoming A Helper - Chapter 7(7)
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Existential Approach
The existential approach is based on the following assumptions:
We define ourselves by our choices.
Freedom and responsibility go together.
Anxiety is part of the human condition.
Death gives significance to life.
Becoming A Helper - Chapter 7(8)
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Existential Approach
Emphasis in therapy is on understanding the current world of the client.
People seeking therapy often have led a restricted existence, functioning with a limited degree of self-awareness.
Therapists are not bound by any prescribed procedures.
Becoming A Helper - Chapter 7(9)
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16. Carl Rogers: Person-Centered Approach
Clients are at the center of the helping process.
Clients are able to change without a high degree of structure and direction from the therapist.
Effective helping is based on the quality of the helping relationship:
Techniques are secondary to the counselor’s attitudes.
Becoming A Helper - Chapter 7(10)
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Rogerian Approach
Healing come from:
Unconditional Positive Regard: therapeutic relationship
Acceptance
Congruency
Techniques:
Reflection
Paraphrase
Empathic Unconditional Acceptance
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Gestalt Approach
Gestalt therapy: focuses on the emotional experience
focuses on here-and-now
Change arises with emotional awareness
Counselors suggest experiments and emphasize doing rather than “talking about.”
Example: “Empty Chair Technique”
Becoming A Helper - Chapter 7 (11)
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Class Exercise
Mock Therapy:
Rogerian Therapy: Assign roles of therapist, client, observor(s)
Therapist: reflect, paraphrase, summarize, promote Unc Pos Regard
Client: Share a minor dilemma or a recent experience
Observor: note effect of approach on client
Gestalt Therapy:
Therapist: direct client to act out experience with person in chair
Client: Carry out a conversation with person avoiding; imagine that person sitting in chair listening and responding to you
Observor: How effective was this technique; why/why not?
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20. Cognitive Behavioral Approaches
Cognitive behavioral approaches share these attributes:
A collaborative therapeutic relationship
A focus on changing faulty cognitions to produce desired changes in affect and behavior
A time-limited and educational treatment
Mental Illness caused by incorrect thinking and dysfunctional environment
Becoming A Helper - Chapter 7(12)
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21. Examples of Irrational Thinking
Castastrophic Thinking (common in Panic d/o)
Over-generalization
Negative Predicting
Magical Thinking (common in OCD)
Grandiousity (common in Mania)
Minimizing
Personalization
“All or Nothing” thinking
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Behavior Therapy
The focus of the behavioral approach is on:
observable behavior.
Environment shapes the behavior: operant conditioning (reward and punish) or associative conditioning (pairing stimuli with behavior)
Changing environmental contingencies can change the behavior
rigorous assessment of stimuli in environment that is reinforcing behavior
Becoming A Helper - Chapter 7(13)
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23. Examples of Conditioning
Operant Conditioning: Child lives in a household with parents who are emotionally overwhelmed by two high need children. Child client learns that the only way to gain attention is to help parents feel less anxious and so is shaped to become the parents “little mother”.
Associative Conditioning: College student experiences a panic attack for the first time in a classroom. She then experiences panic whenever she enters a classroom and slowly evolves into a phobia
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CBT Theories
Theory of Learned Helplessness: (Martin Seligman) Depression evolves from an environment that is critical an shapes a person to lose their self-mastery and develop hopelessness
Treatment of Depression: Improve self-mastery through successful experiences, increase experiences of pleasure
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CBT Treatment
Panic Disorder Treatment: Empirically Supported
Cognitive Intervention: Reduce Negative Predicting; Reduce Castatrophic thinking, challenge erroneous thinking (I will be stranded and no one will help me)
Behavior Intervention: Reduce body anxiety; Relaxation techniques, Mindfulness techniques
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26. Ellis’s Rational Emotive Behavior Therapy
Emotional problems are the result of Illogical Thinking; “I ought” and “I should”
Correcting the thinking will eliminate the emotional disturband
Cognitive techniques include teaching clients coping statements, disputing beliefs, and psychoeducation methods.
Becoming A Helper - Chapter 7(14)
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27. Rational Emotive Behavior Therapy
Emotive techniques include imagery, humor, shame-attacking exercises, role playing, and unconditional acceptance.
Behavioral techniques include self-monitoring strategies and carrying out homework in daily life.
Example: Helping a client overcome a break-up; What perceptions would you explore; what illogical thoughts would you confront?
Becoming A Helper - Chapter 7(15)
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Cognitive Therapy
Changing how people think tends to result in changing feeling and behaving (schema restructuring).
Clients are encouraged to weigh the evidence in support of their beliefs.
(not about logic, but about accuracy)
Counselors guide clients to discover the connection between thinking, feeling, and behaving.
Becoming A Helper - Chapter 7(16)
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29. Class Exercise: Cognitive Therapy
Role Play use of a Thought Record (cognitive reconstruction)
Client: You present with severe public speaking phobia and it is compromising your ability to get ahead in your field.
Therapist: assist client in working through each section of the thought record
Observer: How effective was the thought record in reducing anxiety and promoting risk taking?
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Reality Therapy
Developed by Glasser : worked with girls in residential setting
Emphasis is on taking responsibility for circumstances and asserting control
Clients are challenged to ask how their current behavior is hurting or helping them?
Becoming A Helper - Chapter 7(17)
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Reality Therapy
The procedures for reality therapy through the WDEP model:
W= wants, needs, and perceptions
D= direction and doing
E= evaluation of total behavior
P= planning and commitment
Becoming A Helper - Chapter 7(18)
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Reality Therapy
Therapist encourage clients to come up with goals and solutions
Set up detailed plan, iterating doable small steps, with follow through
Emphasis on support and commitment, no excuse
No punishment either
Create Loving relationships where person experiences freedom, power, and fun = Essence good mental health
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33. Solution-Focused Brief Therapy
Techniques focus on the future and how best to solve problems, not the cause of problems.
Originated in Family Therapy
Do not use Dx, avoid pathologizing
The approach tends to be brief and collaborative.
Premise that small changes pave the way for bigger changes.
Becoming A Helper - Chapter 7(19)
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34. Solution-Focused Brief Therapy
Techniques used in SFBT:
Pretherapy change: what changed after you made appt
Exception questions: At what times were things better?
The miracle question: If you had a wand….?
Scaling questions: Rating progress, feelings, etc.
Homework: growth encouraged outside of therapy
Summary feedback: last 10 min, compliment, suggestion
Becoming A Helper - Chapter 7(20)
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Narrative Therapy
Narrative therapy examines people’s stories and the meaning of their stories.
It is based on the assumption that there is no absolute reality.
Clients are invited to view their stories from different perspectives and co-create an alternative life story.
Becoming A Helper - Chapter 7 (21)
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Narrative Therapy
Narrative therapy involves identifying how societal standards are internalized by the client in a limiting manner.
The therapist collaborates with the client and avoids predicting, interpreting, or pathologizing.
The therapist and client engage in externalizing inner dialogue.
Becoming A Helper - Chapter 7 (22)
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37. Family Systems Approaches
Family therapy involves a conceptual shift from individual to the system. Family is the client.
The client with symptoms is the “identified patient” whose symptoms serve a function for the whole system. (e.g., acting out child to distract from marital dysfunction)
Symptoms stem from family dysfunction and dysfunctions are often passed across generations.
Becoming A Helper - Chapter 7 (23)
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38. Family Systems Approaches
This approach tends to be short-term, solution-focused, action-oriented, and present-focused.
Patterns of relationships that are not working well are targeted. Cut-offs, enmeshments, triangulations, estrangements are problematic relationships
If a system changes so will the individuals within the system.
Becoming A Helper - Chapter 7 (24)
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Sample Family Systems
Structural Family therapy Session:
What is the role of the therapist?
Who is the patient?
What is the therapist trying to accomplish?
Can you identify the problematic relationships?
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40. An Integrative Approach to the Helping Process
Each therapist develops their own therapeutic style
Developing an integrative perspective takes much study and clinical practice.
Allowing for an eclectic approach creates more possibilities and a comprehensive treatment plan.
What therapeutic style do you foresee yourself adopting?
Becoming A Helper - Chapter 7(25)
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