Clinical Psychology Study Guide PDF

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Final Study Guide for Clinical Counseling Psychology Kennesaw State University Rachel Kieran...

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1. Insight - Definition & Types Intellectual Insight: Refers to having cognitive understanding or explanation; provides objective explanation for a problem.  Deeply understood; linked to “should” expressions, not actions Emotional Insight: Refers to having connected affect to intellect, such that there is a sense of involvement and responsibility for understanding.  Deeply felt and motivates us to change  Emotional insight entails growth/change  Emotional insight is easier for clients to attain when they actively participate in the helping process. Intellectual insight helps clients further understand their thoughts and behaviors. Emotional insight helps clients develop new perspectives about their emotions. 2. Why do stages happen in order? Typically, the gains made in each stage build on one another to guide the client through the process. The movement through stages is not always direct, but each stage builds on the others and helps facilitate growth 3. Why use challenges? Why not? Use challenges to help clients recognize maladaptive feelings, motives, and desires of which they are unaware/unwilling to change; to help clients recognize dissonance between feelings, motives, and behaviors. Challenging can bring old ideas into consciousness that client was once unaware had power/influence on their everyday life. Challenging can help clients reexamine things in a new life. Challenges are used to nudge clients out of denial, help clients view problems in new light, and to encourage clients to take appropriate responsibility. Do not use challenges to minimize/invalidate feelings (especially negative ones); this can leave client feeling misunderstood.

4. When to use decision making? Often times, helpers are asked a specific question and expected to reply with a clear cut, directive answer. Do not give the client a straightforward answer, but rather work with them to articulate their own opinions, explore their values, and evaluate their options accordingly. Steps of Decision Making 1. Articulate the options  Open questions and probes  “Tell me the various options that you have thought about” 2. Values clarification  Open questions and probes  “What values do you hold that could relate to this decision?” 3. Weigh the relative importance of the values  Process advisement  “Now I would like you to give a number that describes the importance of each value and no two values can be rated the same.” 4. Rate the options  Process advisement  “Now I would like you to weight each option based on your values. 5. Evaluate the results and revise the weightings  Open questions and probes  “How do these results fit for you?” “What was surprising?” “How would you like to modify this?” 6. Follow-up  Open questions and probes  “What thoughts are you having about the decision we came up with last week? Do you want to change anything about it?” 5. Evaluating the effects of a challenge Following a client’s reaction to a challenge, consider it.  Denial? Rethink presentation of challenge.  No reaction? Evaluate effectiveness of challenge.  Partial acceptance/examination? Continue to gently challenge clients to help them progress.  New awareness and acceptance? Summarize and build to help client further acceptance. 6. When to disclose? Disclosure can be used with appropriate boundaries, which can strengthen relationship and facilitate change. Only disclose for the benefit of the client. 7. How to know an interpretation was well received? Possible client reactions include but are not limited to: better self-understanding, new perspective, clear, relief, negative thoughts or feelings, responsibility, unstick, scared, worse, more stuck, lack of direction, confused, misunderstood.  Obviously, some of these are positive and some of these are negative. Positive reactions typically mean the interpretation was well received. Desire client behaviors include: Insight, cognitive-behavioral exploration, and affective exploration.

8. When to move from insight to action? Move to action when the client is ready. The client has gained insight and talks about taking action, or the client is stuck in insight and needs to be gently encouraged to move into action. 9. Cultural considerations in insight and action stages Each person’s cultural values will impact their helping process in different ways.  Immediacy is not used in some cultures and can create discomfort if used inappropriately.  Imposing values on a client will limit what clients can safely explore and put pressure on them to behave in ways that are inconsistent with their values.  Some clients expect a lot of action and direction from their helpers, whom they perceive as authorities, wise people, experts.  Helper may need to incorporate spirituality into the action stage for clients for whom spirituality and religion are important issues.  Barriers to action can vary by culture. 10. Why assess previous attempts to change? This helps us avoid prescribing actions that the client has already tried, as well as respects the client’s previous efforts. This also allows us to assess both internal and external forces that motivate and inhibit change. 11. Commonalities between action goals/processes Action goals consist of: relaxation, behavior change, behavioral rehearsal, and decision making. 12. Creativity/flexibility in the action stage Flexibility and creativity are essential to the action stage. Steps to helpful processes (e.g., decision making, behavioral rehearsal, etc.) are taught in a linear fashion, but must be applied to each client in a unique manner that serves the needs of the clients best. Helpers must be creative with their interventions to appeal best to the client. Lastly, it is important to model flexibility and creativity for the client, because the skills they learn will not be applied in a clear cut manner either. 13. Differences between the three stages? Exploration Relates to client-centered therapy; focuses on building rapport and getting to know client in order to start conceptualizing. There is no need to offer insight during this stage as it is about the client figuring themselves out, with the helper just being a guide.  Goals: Attend, observe, listen, explore thoughts and feelings  Associated Skills: Nonverbal behaviors, minimal verbal behaviors, restatements, and reflections.  Allows client to get to know themselves better.

Insight  Based on psychoanalytic therapy; focuses on deepening the client’s understanding of their feelings, thoughts, and behaviors.  Goals: Foster awareness and insight  Associated Skills: Open questions/probes for insight; interpretations; disclosures of insight; challenges; immediacy Action  Based on behavioral perspective; focuses on implementing desired changes realized in insight stage and applying new skills.  Goals: Facilitate insight into relationships and facilitate actions.  Associated Skills: Open questions/probes for action; giving information; process advisement; direct guidance; disclosures of strategies. 14. Transference and countertransference Transference: Client distortions of the helper based on past experiences. The client places on the therapist characteristics that belong to other people with whom one has unresolved issues. Countertransference: The same thing except the therapist is doing it to the client. 15. Aha! Moments When a skill used by the helper is helpful… When an interpretation is helpful, client feels a sense of “aha” of learning something that “clicks”. This feeling allows the client to see things in a new light. Helper’s disclosures can lead to an aha! Moment. Aha! Moments are ideal and hoped for during the insight stage.

16. Why are both types of insight important? Intellectual insight fuels emotional insight, which motivates someone to change. 17. Three styles of attachment Bowlby’s Attachment Theory: Bowlby developed a theory to explain behavioral and cognitive responses that keep young children close to primary caretaker(s).  We are born with the ability to form attachments  When feeling threatened, the attachment system becomes activated and infants seek proximity and protection from attachment figure.  Bowlby identified types of attachments: secure and insecure. o Secure Attachment: Caregivers provide supportive, comforting presence, which reduces sense of anxiety and promotes feelings of security. A secure attachment allows a child to explore curiously, confidently, and with knowledge that caretaker is consistently present.

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o Insecure Attachment: Attachment figure is unavailable, unresponsive, or ineffective in soothing needs. With an insecure attachment, a child worries if they can depend on others and learns not to rely on others when in need of help. Ainsworth identified three patterns of attachment. o Secure: Child explores freely in caregiver’s presence, shows some anxiety when separated from caregiver, but is easily comforted when reunited with caregiver. o Anxious-Ambivalent: Child feels excessive anxiety/anger, tends to cling to caretaker to an extent that interferes with exploration. Children with an anxious-ambivalent attachment are more difficult to comfort. o Anxious-Avoidant: Child feels distant, shows little interest in caretaker, and displays little affection. o Disorganized (Identified in later research): Child does not fit into any category; disorganized attachment styles show the most problematic outcomes over time.

18. Conceptualization: Hypotheses about what is going on for client; hypotheses about the client’s functioning and dynamics typically based on theoretical orientation and observations of client.  Used to help make decisions about how to intervene during insight stages.  Need to have some thoughts about underlying processes (dynamics) before offering direction towards insight.  Conceptualization enables helper to focus their intentions for interventions.  Need to have some sort of conceptualization before offering insight. 19. Types of Challenges Challenges used in the insight stage… To challenge client to foster awareness; to help client increase awareness of automatic thoughts and actions.  Challenges of discrepancies: Discrepancies/contradictions can indicate unresolved issues, ambivalence (mixed feelings), or suppressed feelings (most common type of challenge used). o Useful stems: “On one hand ____, but on the other hand ____”, “I’m hearing ____, but I’m also hearing ____.  Challenges of thoughts: Thoughts tend to be overgeneralizing, overly negative, overemphasize insignificant details, overly rigid. Challenges of thoughts can help gently draw attention to flaws in logic and understand how they impact emotion. o Be careful to challenge the belief, not the person  Challenges through Chair Work: Chair work is useful in challenging clients to become aware of conflicting feelings; technique originates from Gestalt therapy. o Empty-Chair Work (focuses interpersonally) or Two-Chair Work (focuses intrapersonally)  Empty-chair work involves “talking” to others and working on issues with others; two-chair work involves talking to ones self and working with parts of oneself.

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o Two-Chair Work: Can be used when client expressed major conflict between two opposing sides. These conflicts come from internal “shoulds”. Clients alternate from one chair to the other and can express what they truly feel. The purpose of two-chair work is to deepen conflicting feelings to better understand them. o Empty-Chair Work: Useful for clients with “unfinished business”. Clients talk to empty chairs as if it were the individual that they need to address their thoughts and feelings to imagine how the other might respond. Challenging through questions: Ask simple, gentle questions to gently challenge clients to think. Silence as a type of challenge: Silence can challenge clients to take responsibility for what they want to say. We do not want to rush into trying to soothe, explain, or take care; we want to use silence to encourage the client to say something. o Silence can convey empathy and warmth. o Silence can increase discomfort enough to unlock new truths and examine thoughts. o Only use when the relationship has been established  if relationship is not strong, silence can be damaging. o Helpers should assess what is going on for client during silence. Using nonverbal behaviors to challenge: Helpers can point out a nonverbal behavior that may reflect discrepancies/underlying feelings about what a client is saying/denying.

20. Interpretations: Interventions that go beyond what client overtly states, recognizes, and presents a new meaning, reason, or explanation for behaviors, thoughts, or feelings so client can see the problem in a new way.  Connections between seemingly disparate information.  Point out themes or patterns in a client’s behaviors, thoughts, or feelings.  Work to understand defenses, resistances, and transference  Offer new ways to understand thoughts, feelings, and behaviors. Intention is to promote insight, identify and intensify feelings, to encourage selfcontrol. Follow up interpretations with open questions asking the client about his or her reaction. 21. Identify good challenges Good challenges tend to resonate with the client and allow them to continue progressing their thought process. Challenges should be presented in a tentative manner to avoid assumptions and should be preceded with something positive  Ideally client responds with some degree of acceptance and new awareness.

22. When are clients ready for challenges? Need for challenges vary on basis of where client is in helping process. Challenges are usually helpful with identifying defense mechanisms that were once functional, but are no longer needed and have become detrimental. Individuals in the precontemplation and contemplation stage are more likely to need challenges to nudge them out of complacency and encourage them to change; however, individuals in this stage are less likely to appreciate challenges. 23. When to use humor? (and when not to) Using humor as a type of challenge is helpful as long as you are laughing with the client, not at them. Humor can help a client see something from a new perspective or raise awareness. Humor must be used carefully in a secure relationship and must have an intention. 24. What does A-B-C stand for in cognitive theory? Antecedents, behaviors, and consequences.  Helps therapist assess behavior in a situation and properly role play the client’s behavior in the example that went badly.  First ask about the antecedent, then inquire about behaviors of event, and finally ask about the resulting consequences of event. o Antecedent: “What was going on before you got angry?” o Behaviors: “Describe what happened when you became angry.” o Consequences: “What happened as a consequence of your anger?” 25. How to increase client efficacy/responsibility taking?  

Interpretations: Provide labels for experiences that seem confusing, upsetting, etc. Homework that encourages behavioral rehearsal

26. Difference between challenge and interpretation A challenge encourages the client to think about and respond to something themselves, whereas an interpretation is offered by the therapist in an attempt to offer insight about why an individual COULD be acting in a certain way. 27. Best practice for interpretations With interpretations, you should not just guess and hope you’re right. Instead, work with the client to get them to open up and understand at their pace. Psychological relevance is more important than accuracy. Develop the interpretation with client and pay attention to their reactions.

28. Psychoanalytic reasons for interpretation - what do they do? Psychoanalytic perspective has served as the basis of interpretations. Interpretations are referred to as “pure gold” of therapy and are the central technique for producing selfknowledge and change in clients.  Interpretations thought to work by replacing unconscious processes with conscious processes, which enables the client to work on unresolved conflicts.  The psychoanalytic perspective often focuses on childhood experience when referring to interpretations.  It is almost important to interpret any transference and both you and the client’s reaction. 29. Disclosure of insight: Reveals an understanding that the helper has learned about his or herself and is used to facilitate client’s understanding of their own thoughts and feelings.  Different from insight in other stages in that helpers use this as a hint about a potentially helpful insight. Emphasis on the word potentially— you do not know is this is accurate so make sure to phrase this tentatively.  Can be useful when client feels stuck; can help clients achieve realization.  Less threatening than challenges and interpretations. 30. When do disclosures occur? Types of Disclosure: Disclosure of… feelings, insight, and strategies  Disclosures of Feelings (aka Self-disclosure)  typically used in exploration stage to normalize clients feelings and make them feel less alone.  Disclosures of Insight  Used in insight stage to slightly suggest something to client. A disclosure of insight kind of gives the client a small starting point in a direction the therapist thinks the client needs. The client does not have to go along with this.  Disclosures of Strategies  Encourages and uplifts clients, makes clients feel capable of going through with action. Disclosure of Fact: Reveals outside information about helper (e.g., where they are licensed) Disclosure of Feelings: Reveals personal nonimmediate information about the helper’s feelings to provide a model and help client continue to explore feelings. Disclosure of Insight: Reveals an understanding the helper has learned about himself or herself and is used to facilitate the client’s understanding of his or her thoughts, feelings, behaviors, and issues. Disclosure of Similarities: Reveals personal nonimmediate information about ways in which clients and helpers are similar; used to encourage clients to think about their personality. Disclosure of Strategies: Helpers reveal strategies they personally have used in the past to provide ideas for clients and help clients feel less alone or different.

31. Therapy as a model for interpersonal learning By talking openly about what is going on between the helper and the client, it is possible to work through issues in the relationship, clarify distortions of transference and countertransference, model healthy interpersonal functioning, and encourage clients to interact differently with others outside of therapy. Therapy can provide a “corrective relational experience”, meaning it can show clients how they would like to go about obtaining, maintaining, and dealing with their relationships in a healthy manner. 32. What is immediacy? Immediacy refers to the helper directly asking or talking about immediate feelings about the client, herself/himself in relation to the client, or the therapeutic relationship. Immediacy can focus on the overall relationship, a specific event in a session, or present personal reactions to the client. The intention of immediacy is to promote insight, strengthen the therapeutic relationship. Immediacy helps clients gain better insight into how they come across to others and see patterns in their reactions.  Immediacy should communicate caring and authenticity, honest and empathic feedback, willingness to be criticized, and willingness to hear strong emotion.  Immediacy allows clients to become aware of how their relationships affect others and can make changes in a safe setting. 33. Best practices for immediacy Open Questions/Probes about Relationship  Helper invites client to share feelings about the therapeutic relationship (also called process statements). These often involve the helper checking in with the client about how the client is feeling. Statements of Reactions to the Client  Involves disclosure of helper’s own feelings in the moment, followed by a question about how the client feels. Making the Covert, Overt  Verbalize nonverbal and paraverbal behavior that may be trying to communicate something.  When clients are speaking indirectly, work to restate their ...