Counseling Theories
Terms
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- IPT Therapeutic Process Theory
- Short-term, present-oriented therapy, therapist should not address additional problems, but remain focused on primary problem, No ideological hesitation to use medication
- PCT Importance of Treatment adherence
- Large effects in treatment engagement, retention, and adherence
- (Establishing) Interpersonal Problems Areas
- 1-Interpersonal loses ( grief; loss of a loved one) 2-Role Disputes 3- Role Transitions 4-Deficits
- IPT
- Time-limited, Focused, About current relationships, Interpersonal, Improving relationships, Identifying assets, Learning how to cope
- PCT Cultural Considerations
- some clients may prefer a more directive, structured treatment, Individuals accustomed to indirect communication may not be comfortable with direct expression of empathy or creativity, Individuals from collectivistic cultures may disagree with the emphasis on internal locus of control,
- Communication theory
- communication of distress is highly dependent upon the client's
- REBT Behaviors
- secondary focus, measure of progress
- Unsupported ipt applications
- psychosis< severe
- REBT Common Irrational Beliefs About SA
- IB: I NEED to use drugs to relax, IB Alternative:I want to use drugs, but don't have to use them
- REBT Applications
- Family/Couples, Individual, Groups (Mild to mod/severe mental disorders, Anger-aggression, anxiety, depression, contraindicated in psychotic disorders, impulse control, suicidal/homicidal ideation, more research needed on diverse groups
- Rational Emotive Behavioral Therapy
- 1 stresses thinking, judging, deciding, analyzing, and doing 2 Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship 3 highly didactic, very directive, and concerned as much with thinking as with feeling 4 Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations
- REBT Mustabatory Thinking
- rigid and dogmatic beliefs
- REBT Catastrophizing
- unrealistic and over-generalized attributions generated by beliefs
- PCT Theory of Psychopathology
- positive correlation between psychopathology and the level of conditional parents' love, Incongruence between experience and self-concept, reflects a divided personality due to lack of wholeness, defensive reactions prevent awareness, defenses cause inaccurate perceptions due to distortions and selective omission of information
- IPT Treatment example (Role dispute)
- Role dispute - help client examine dispute & seek resolution
- REBT Emotions
- changed by changing irrational beliefs, not changed directly
- Opening Phase of IPT
- Diagnose, interpersonal inventory,Establishing the interpersonal problem area, Making the interpersonal formulation,Obtaining the patient's agreement to the formulation, Establishing the therapeutic relationship, psychoeducation, hope
- MI Communication Style
- elicit internal motivation, gentle and active listening, respect for patient values and autonomy
- IPT Treatment example (Bereavement related depression)
- - help client mourn, then explore new replacement relationships and activities
- MI Strategies
- Examine pros/cons of change and staying the same, Assess importance and confidence, Use hypothetical, Agenda setting, Provide information/feedback (with client permission)
- Interpersonal Inventory
- catalogue of important relationships, informal, Inquire about important people, Explore omissions as well as those easily discussed
- Practicalities of PCT
- Psych testing rarely conducted, Efforts to enhance trainee's empathy confused with mindless parroting or sterile technique, Modest effects of such training on empathy
- REBT Therapeutic Alliance
- collaborative; clinician teaches client about rationale & irrational; clinician helps identify, dispute & modify Irrational Beliefs; clinician facilitate development of more rational philosophy; clinician uses influence, persuasion, praise, instruction & humor
- REBT Disputing Irrational Beliefs
- logic, empirical evidence, pragmatic/functionalism, constructing alternate rational beliefs
- MI Key Qualities
- Flexibility, Tolerance of uncertainty, Encouraging thoughtfulness, Handing over responsibility, Respect for patient choice, Avoidance of righting reflex, Collaborating (not arguing)
- REBT Psych health
- Appreciation of others, social interest, self-direction & creative pursuits, Acceptance of ambiguity, flexibility, high frustration tolerance, thinking logically/scientifically/rationally, taking sensible risks, accept responsibility for own emotional difficulties, realizing we can't always be happy
- social theory
- client's ability to generate social support
- REBT Evaluation
- needs more study with problems and different groups, may pay too little attention to history, efficient, teaches/empowers, straightforward, can be integrated
- REBT's Theory of Therapeutic Processes
- consciousness raising (aware of irrational thinking patterns), counterconditioning (replace irrational thinking with rational thinking), contingency management (rearrange reinforcements to support behavior changes)
- Limitations of the PCT
- Cultural considerations, Lack of focus on the use of specific techniques makes standardization difficult, Beginning therapists may find it difficult to provide both support and challenges to clients, Limits of the therapist as a person may interfere with developing a genuine therapeutic relationship
- Person-Centered Therapy Emphasis
- Therapy as a journey shared by two fallible people, The person's innate striving for self-actualization, The personal characteristics of the therapist and the quality of the therapeutic relationship, The counselor's creation of a permissive "growth-promoting" climate, People are capable of self-directed growth if involved in a therapeutic relationship
- Person-Centered Therapy is a reaction
- against the directive and psychoanalytic approaches,
- IPT Diagnosing
- medical model, Defining psych problem as independent of the client's personality or character, Offers a hopeful, optimistic, empowering & forward looking approach, Assigned the sick role - excuses the person from self-blaming
- REBT Therapeutic Process
- Therapy is seen as an educational process; Clients learn to identify the interplay of their thoughts, feelings and behaviors; Clients learn to identify and dispute irrational beliefs that are maintained by self-indoctrination; Clients learn to replace ineffective ways of thinking with effective and rational cognitions; Clients learn to stop absolutistic thinking, blaming, and repeating false beliefs
- Possible IPT Applications
- substance abuse, Axis I
- PCT Growth-Promoting Climate
- Congruence (Genuineness), Unconditional positive regard ( Acceptance of clients as a valuable person and as they presently are but not approval of all client behavior), Accurate empathic understanding (ability to deeply grasp the client's subjective world, helper attitudes are more important than knowledge
- PCT Therapeutic Processes
- combination of consciousness raising and corrective emotional experience, Therapists control the process of therapy but not the content, use facilitative conditions (genuineness, positive regard, empathy)
- REBT ABC Theory of Personality
- activating event (A)+belief (B)=consequences (C);Change Beliefs and create a new consequence (new feeling) by disputing intervention (D)+ effective philosophy (E)= new feeling (F)
- IPT Treatment example (Role Transition)
- Role transition - redefine & label the chaos felt as a role transition involving the loss of a familiar old role & potential assumption of a new one
- REBT View of Human Nature
- inborn potential for rational and irrational thinking, biological/cultural tendency to think crookedly and needlessly disturb ourselves, we learn/invent disturbing beliefs and keep ourselves disturbed through self-talk, we have capacity to change our cognitive, emotive, and behavioral processes
- Rogers' Core Conditions for the Therapeutic Environment (Client)
- self-concept (low at beginning), Locus-of-Evaluation (what others think), Experiencing (initially rigid) are all addressed in an environment of trust
- Empirically Supported IPT Applications
- Deppression, bulimia
- PCT 6 Conditions for Personality Change
- 1 two persons are in psychological contact, 2 The client, is experiencing incongruence, 3 The therapist is congruent or integrated in the relationship 4 The therapist experiences unconditional positive regard or real caring for the client 5 The therapist experiences empathy for the client's internal frame of reference and endeavors to communicate this to the client 6 The communication to the client is, to a minimal degree, achieved
- M Spirit
- focus on client's concerns, arguments for change elicited from client, counselor helps client examine ambivalence, direct persuasion, confrontation & argumentation are avoided, collaborative
- Interpersonal Distress
- Acute Interpersonal Crisis (stressor) + Social Support + Biopsychosocial (Vulnerability)
- Interpersonal Distress
- Acute Interpersonal Crisis
- REBT Mustabutory belief systems examples
- I must be perfect and loveable ALL the time, Other people must always treat me kindly & fairly or I can't stand it & they are evil people who should be punished for mistreating me, Life must go the way I want it to go & must never be too difficult or frustrating
- REBT's Theory of Psychopathology
- Psychopathology occurs when irrational beliefs cause emotional consequences, Psychopathology explained by ABC's
- REBT Relationship Cognitive (thoughts, beliefs, attitudes)+emotions+behaviors(actions)
- all interconnected
- REBT Main Qualities of Self-Disturbing Philosophies
- rigid/dogmatic beliefs (musturbatory thinking), beliefs generate unrealistic & over-generalized attributions (catastrophizing)
- PCT Therapeutic Relationship
- Genuineness/congruence, positive regard, accurate empathy
- Effectiveness of PCT
- Research on empathy, genuineness, and positive regard are valuable contributors to outcome but are neither necessary nor sufficient; Meta-analyses found PCT was clearly superior to no treatment but barely better than placebo, PCT is slightly less effective than CBT
- MI Applications
- Anxiety (integration with CBT), OCD (motivation Tx refusing clients), Depression (prelude to & integration with CBT), Eating disorders (engagement, feedback), Substance use & addictions (Mandated clients)
- REBT 3 levels of insight
- 1 Choose to upset ourselves, 2 Learn and maintain irrational beliefs, 3 See we need to work to change
- Albert Ellis
- sick as a child, decided not to be miserable, trained as a psychoanalyst, dissatisfied with inefficiency, read a lot of Greek and Asian philosophy, apprehensive about asking women on dates so forced himself to ask out 100 women
- Motivational Interviewing
- a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence
- IPT Example of case formulation
- "Your move from CA to NY has been very difficult for you. Your role transition has meant coming to a new city while loosing touch with friends & giving up a house you loved. We'll focus on how this role transition is related to your depression and explore how you can make this transition more manageable for you.
- Attachment Theory of Psychopathology
- Relationships affect mood, & mood affects; Relationships, Interpersonal disruption causes and results from depression; Disorders surface when situational stressors expose inability to cope
- PCT Therapist
- focuses on quality of the therapeutic relationship, provides a supportive therapeutic environment in which the client is the agent of change and healing, serves as a model of a human being struggling toward greater realness, Is genuine (integrated, and authentic), can openly express feelings and attitudes that are present in the relationship with the client, is invested in developing his or her own life experiences to deepen self-knowledge and move toward self-actualization
- Attachment theory
- way in which individuals form, maintain & end relationships - humans
- IPT Theoretical underpinnings
- Attachment theory, Communication & social theory
- PCT Applications
- Addictive behaviors (Largest evidence base), Health Behaviors (HIV risk reduction, adopting exercise & healthy eating habits,
- REBT Change through Thoughts
- accept responsibility for creating your emotional problems, stem from irrational beliefs, focus on present thoughts, doesn't focus extensively on roots, forceful and creative strategies used, positive results occur when clients gain awareness of irrational beliefs & take effective action to change them, teach client the skills to become own therapist
- IPT Therapuetic Relationship
- Patient advocate, not neutral commentator, Not a manifestation of transference, IPT rarely nalyzes the interpersonal relationship in psychotherapy, Therapist expresses empathy and warmth but not unconditional acceptance
- Rogers' Core Conditions for the Therapeutic Environment (Therapist)
- Empathy, Unconditional Positive Regard, Congruence create an environment of trust
- Principles of MI
- Express Empathy, accept resistance, Support self-efficacy, Develop Discrepancy
- REBT Goals
- Goal oriented, focus on changes in beliefs & symptom reduction, de-emphasizes process, enabling people to learn the cognitive skills that promote rationale thinking
- IPT after formulation
- Tx focuses on the interpersonal problem area
- MI is not
- transtheoretical model, A way of tricking people into doing something they don't want to do, a technique, a form of PCT, Consciously goal directed & strategic
- Future Directions of PCT
- Methods assimilated by mainstream therapies, Slowly declining in popularity in USA, Empathy making a comeback, Needs to maintain openness to integration with other psychotherapy systems and active and eclectic methods in era of short-term treatments, Motivational Interviewing is on the rise
- PCT Therapeutic Process Goal
- increase congruence between self and experience
- PCT Challenges
- the assumption that "the counselor knows best," the validity (of advice, suggestion, persuasion, teaching, diagnosis and interpretation), belief that clients cannot understand and resolve their own problems without direct help, the focus on problems over persons
- Obtaining client agreement
- 1. Client MUST agree on the salience of the problem proposed and to work on it. 2. Need to limit the choice to one area to avoid diffuse Tx 3. Client buy in suggest you have chosen a "good enough" focus
- REBT Mustubatory evaluations
- involve overgeneralizations, judgments of self & others, and inflexibility
- PCT Theory of Personality
- Basic motivating force is actualization, inborn with actualizing forces that motivate us, valuing processes that regulate us, We create our subjective world, Acquire conditions of worth, Need for unconditional positive regard
- Development of REBT
- Adler's emphasis on social system & importance of goals & purpose, changed names -RT -RET -REBT, emphasizes thoughts but views emotions, behaviors & thoughts intertwined
- Motivational Interviewing History
- William R. Miller, Combines elements of person-centered style and strategy, Found therapist empathy (not tx method) predicted success of therapy for problem drinkers, Research supports MI's effectiveness, developed by psychologists, confront and persuade equals resistance