Introduction to counselling and psychotherapy PDF

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Introduction to the module...

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Introduction to counselling and psychotherapy

Module learning outcomes:     

By the end of the module you should be able to: describe a range of counselling-related skills. reflect on how you have developed your counselling-related skills. describe the use of counselling-related skills in different work-based settings. reflect on your own suitability to work as a therapist/counsellor.

Ethical considerations:    

Counsellors & psychotherapists -British Association for Counselling & Psychotherapy (BACP) or Counselling Psychologists - British Psychological Society (BPS) & Health Professions Council (HPC ) Ethics related to practice - to safeguard the client whilst working in their best interest Also need to safeguard therapist For module - using role-play (made-up) scenarios which you can adapt. But don't personalize or disclose personal information - not a therapy session.

Personal/Professional development 

To help others you need to have an understanding of your self

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Personal/Professional reflection Reflecting in action "What am I seeing, hearing, thinking & feeling" (role play)

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Personal/Professional reflexivity Reflecting on action "Why did I respond in this way" (role play)

Assessment

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Part A 1,500 word essay in which you apply counselling skills to non-counselling situations 50% of total mark

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Part B 1,500 word reflective essay focusing on skill development in the role-play sessions How could you have improved (e.g. body posture, attitude, concentration, etc) 50% of total mark

Key therapeutic approaches:     

Many different schools e.g., Psychodynamic, Humanistic, Cognitive, Behavioural, CBT, Integrative, Gestalt, Systemic… Each school is considered to have its own broad approach thus making it different to the other schools Within each school there are subsections which vary in theoretical approach and methods Nowadays, most practitioners use methods & techniques from more than one approach On this module you are not going to learn specific methods & techniques but to develop the communication skills that underpin the practice of 'talking therapies'

Some types of psychotherapy:

Psychoanalytical approach:        

Previous approach - biological Freud (1856-1939) -born in Vienna of Jewish parents 1885 - Paris - studied hypnosis under Charcot Returned to Vienna - Josef Breuer - hypnosis to treat "hysterical illnesses“ Case of Anna O - "talking cure“ Identified "cathartic (purgation) method", later refined to become psychoanalytical method Established psychoanalytical school in Vienna Persecuted by Nazis, exiled to Britain (late 1930s), work continued by Anna Freud & others

Underpinning theory

Freud’s topographical theory]

Things can move from conscious (or preconscious) to unconscious by the process of repression Unconscious can reveal itself:     

In dreams Under hypnosis Through therapy Through parapraxis (Freudian slips) And even then it requires interpretation by a trained analyst

Human personality - id (unconscious), ego, & superego (some conscious awareness)  Psychosexual stages of development (oral, anal, phallic, latent, genital)  Oedipus/Electra complex  Defence mechanisms e.g., repression, displacement, sublimation, rationalization

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Some defence mechanisms:          

Denial: arguing against an anxiety provoking stimuli by stating it doesn’t exist, denying that your physician’s diagnosis of cancer is correct and seeking a second opinion Displacement: taking out impulses on a less threatening target, slamming a door instead of hitting as person, yelling at your spouse after an argument with your boss Intellectualization: avoiding unacceptable emotions by focusing on the intellectual aspects, focusing on the details of a funeral as opposed to the sadness and grief Projection: placing unacceptable impulses in yourself onto someone else, when losing an argument, you state “you’re just stupid"; homophobia Rationalization: supplying a logical or rational reason as opposed to the real reason, stating that you were fired because you didn’t kiss up to the boss, when the real reason was your poor performance Reaction formation: taking the opposite belief because the true belief causes anxiety having a bias against a particular race or culture and then embracing that race or culture to the extreme Regression: returning to a previous stage of development, sitting in a corner and crying after hearing bad news; throwing a temper tantrum when you don’t get your way Repression: pulling into the unconscious, forgetting sexual abuse from your childhood due to the trauma and anxiety Sublimation: acting out unacceptable impulses in a socially acceptable way, sublimating your aggressive impulses toward a career as a boxer; becoming a surgeon because of your desire to cut; lifting weights to release ‘pent up’ energy

Methods:               

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Hypnosis - later dropped The couch Free association Client says whatever comes into their mind - thoughts, feelings, images Free association is NOT free, it is guided by unconscious desires, wishes and fears Resistance - block in free association e.g., client stops or changes conversation Could be meaningful! Transference and countertransference Transference (of feelings) - client projects the same feelings experienced in childhood relationships onto therapist e.g., anger towards parent - anger towards therapist Can give insight into how client is with others Countertransference - therapist projects feeling onto the client Can give insight into how other might treat the client Dream analysis Very symbolic: manifest content: the literal dream, latent content the hidden meaning I dreamt I was at the seaside, on the beach. I suddenly discovered I was all alone - no more clothes or luggage. My wife had gone away or left me. I was rather confused and thinking how to overcome that embarrassing position. (35 year old male who has been thinking of leaving his wife for some time)

Humanistic Counselling & Therapy Humanistic therapy:     

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Existential (Irvin Yalom) Person-Centred (Carl Rogers, 1902-1987) People are born capable of making good decisions for themselves (organismic valuing) They should learn to follow their instincts and value their choices and they way they are (unconditional positive self-regard) “Every human being is born a prince or princess; early experiences convince some that they are frogs, and the rest of the pathological development follows from this” (Berne, 1966, pp. 289-290) "Conditions of worth" (Rogers): living up to other people's rules to feel valued Leads to conditional positive self-regard "I'm only worthwhile if I'm X" Transactional Analysis (Eric Berne, 1910-1970) Gestalt (Fredrick Perls, 1893-1970)

Humanistic therapy        

Everyone capable of self-actualization. “People are trustworthy, resourceful, capable of self-understanding, self-direction, able to make constructive changes and able to live effective and productive lives” (Cain, 1987). Therapist works with client to remove barriers to self-actualization. An empathetic understanding of the client’s internal frame of reference Provide a supportive environment for the client to express feelings openly ("unconditional positive regard") Be a facilitator to help client explore their life Effective listening & reflecting Client is able to translate what he or she learnt in therapy to outside relationships with others

Humanistic listening skills:     

Attentive, limit your own talking, be patient, not interrupting, aware of non-verbal behaviors, aware of what is not said, & own emotional reaction Reflection of content Reflection of feelings Paraphrasing Analogy & Metaphor

Cognitive behavioural therapy (CBT): Behavioural therapy (BT):       

Uses behaviourist principles to modify behaviour Reward desirable behaviour Punish undesirable behaviour We often fear things because we avoid them Flooding Systematic desensitisation Modify the relationship between stimulus and response

From BT to CBT:     

Aaron Beck developed Ellis's approach focusing on Behaviour and Cognition To produce Cognitive Behavioral Therapy (CBT) Two focii Changing the way the client thinks about the world Changing their behaviour

CBT approach:      

The aim of the therapist is to help the client change their behaviour and/or thinking so that s/he can move on. Focus is on the here and now. Brings together Behavioural and Cognitive approaches. Behavioural component - more scientific than psychodynamic, focus is on observable behaviour as opposed to unconscious thoughts/process. Cognitive component - focus is on cognitive processes e.g., thoughts, attitudes, beliefs that underlie behaviour. Also takes into account emotions/feelings & physiological reactions.

Levels of cognition: 1. Core Beliefs (also called schemas) I am useless/ I am a failure

2. Dysfunctional Assumptions (Rules for Living) If I always try to be perfect, nobody will find out how useless I am. I must not fail.

3. Negative Automatic Thoughts (NATs) I am thick/ They hate me/ My life is ended

Methods:

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Collaborative e.g., agenda setting & homework

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Client authority & in control/ dialogue

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Short term, e.g., 2, 6 or 8 sessions plus follow-ups

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Highly structured - initial interview/ formulation / agree goals/ structured activities/ assess goals, terminate

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Structured activities, e.g., behaviour experiments, exposure therapy, daily thought records, responsibility chart, relaxation breathing, visualization & imagery

Thought records: 3 column technique (Beck & Emery with Greenberg, 1985/2005. pp. 201& 202)

Current popularity of CBT:     

When making referrals for treatment GPs are guided by the recommendations of NICE (The National Institute for Health and Clinical Excellence). NICE recommend CBT as an effective treatment for depression and anxiety related conditions. Therefore CBT (or derivative) often offered by NHS. Main considerations - funding plus evidence of treatment success. Considered to be more structured & goal focussed than Humanistic or Psychodynamic approaches....