Theories of Counseling and Psychotherapy: Systems Strategies and Skills Chapter + 10,C11 + Part + 1 + Easyprint PDF

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Chapter 10,11 Par t 1

Gestalt Therapy

Be who you are and say what you feel because those who mind don’t matter and those who matter don’t mind. Dr. Seuss

View of Human Nature

• • • •

Self-reliance and reintegration Dialogue b/w client and therapist (therapist has no agenda Spontaneous; here and now experience Human nature is rooted in existential philosophy, phenomenology, and field theory

•

Individuals have the capacity to self-regulate in

their

environment

•

The process of “reowning” parts of oneself that have been disowned

Wholeness, Integration, and Balance Integrating Polarities

Integrating Figure and Ground

Ego Boundary

Awareness The Outer Zone

The Inner Zone

The Middle Zone

Making Contact The phony layer

The phobic layer

The impasse layer

The implosive layer

“peeling the onion”

The explosive layer

The Now

• Existential & Phenomenological

– it is

grounded in the client’s “here and now”

• Initial goal is for clients to gain awareness of what they are experiencing and doing now – Promotes direct experiencing rather than the abstractness of talking about situations – Rather than talk about a childhood trauma the client is encouraged to become the hurt child

•

The Now Ask “what” and “how” instead of “why”

•

Our “power is in the present” – Nothing exists except the “now” – The past is gone and the future has not yet arrived

•

For many people, the power of the present is lost – They may focus on their past mistakes or engage in endless resolutions and plans for the future

Video

Unfinished Business

•

Feelings about the past are unexpressed – These feelings are associated with distinct memories and fantasies – Feelings not fully experienced linger in the background and interfere with effective contact – Pay attention on the bodily experience because if feelings are unexpressed they tend to result in physical symptom

•

Result: – Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior – Solution: get in touch with the stuck point.

Contact and Resistances to Contact

•

CONTACT – interacting with nature and with other people without losing one’s individuality – Contact (connect) and Withdrawal (separate)

•

RESISTANCE TO CONTACT – the defenses we develop to prevent us from experiencing the present fully – Five major channels of resistance:

• Introjection • Projection • Retroflection

• Deflection • Confluence

Contact and Resistances to Contact

•

Introjection: uncritically accept others’ belief and standards without thinking whether they are congruent with who we are

•

Projection: the reverse of introjection; we disown certain aspect of ourselves by assigning them to the environment

•

Retroflection: turning back to ourselves what we would like to do to someone else – Directing aggression inward that we are fearful to directing toward others.

Contact and Resistances to Contact

•

Deflection: A way of avoiding contact and awareness by being vague or indirect. – e.g., overuse of humor

•

Confluence: less differentiation between the self and the environment. – e.g., a need to be accepted---to stay safe by going along with others and not expressing one’s true feeling and opinions.

•

Clients are encouraged to become increasingly aware of their dominant style of blocking contact

Energy and blocks to energy

•

Pay attention to where energy is located, how it is used, and how it can be blocked

•

Blocked energy (resistance): – Tension some part of the body; numbing feelings, looking away from people when speaking, speaking with a restricted voice

•

Recognize how their resistance is being expressed in their body

•

Exaggerate their tension and tightness in order to discover themselves

Therapeutic Goals

• •

Increasing Awareness and greater choice Awareness includes knowing the environment, knowing oneself, accepting oneself, and being able to make contact.

• Stay with their awareness, unfinished business will emerge.

Therapist’s function and Role

• Increase clients’ awareness • Pay attention to the present moment • Pay attention to clients’ body language, nonverbal language, and inconsistence between verbal and nonverbal message (e.g., anger and smile)

• “I” message

Client’s Experience in Therapy

• Therapist  no interpretation • Client  making their own interpretation • Three-stage (Polster, 1987) – Discovery (increasing awareness) – Accommodation (recognizing that they have a choice) – Assimilation (influencing their environment)

Relationship Between Therapist and Client

• • •

The quality of therapist-client relationship Therapists knowing themselves Therapists share their experience to clients in the here-and-now

•

Therapist

 Use of self in therapy

Therapeutic techniques and procedures

•

The experiential work – Use experiential work in therapy to work through the stuck points and get new insights

•

Preparing client for experiential work – Get permission from clients – Be sensitive to the cultural difference (e.g., Asian cultural value: emotional control) – Respect resistance (e.g., express emotions

 fear of

losing control, could not stop, or weakness)

Therapeutic techniques and procedures

•

Increase awareness about the incongruence between mind and body (verbal and nonverbal expression)

• • • • • • •

The Hot Seat The internal dialogue exercise Making the rounds Rehearsal exercise Exaggeration exercise Staying with the feeling The Gestalt approach to dream work

Therapeutic techniques and procedures

•

The Hot Seat

Therapeutic techniques and procedures

•

The internal dialogue exercise – Top dog (critical parent) and underdog (victim)

– Empty-chair (two sides of themselves)

Therapeutic techniques and procedures

•

Making the rounds – Go around to each person and say “What makes it hard for me trust you is……”

•

Rehearsal exercise – Reverse the typical style (e.g., behave as negative as possible)

Therapeutic techniques and procedures

• Rehearsal exercise − May get stuck when rehearsing silently or internally − Share the rehearsals out loud with a therapist

•

Exaggeration exercise – Exaggerate gesture or movement, which usually intensified the feelings attached to the behavior and makes the inner meaning clearer.

•

Staying with the feeling – Go deeper into the feelings they wish to avoid

Therapeutic techniques and procedures

•

The Gestalt approach to dream work – Not interpret or analyze dreams – Bring dream back to life as though they were happening now

Therapeutic techniques and procedures

•

The Gestalt approach to dream work – The dream is acted out in the present to become different parts of the dream

– Projection: every person or object in the dream represents a projected aspect of the dreamer. – Royal road to integration – Dreams serve as an excellent way to discover personality – Not remembering

 refusal to face what it is at that time

From a multicultural perspective

•

Contributions – Work with clients from their cultural perspectives

•

Limitations – Focus on “affect”

• Asian cultural value: emotional control • Prohibiting to directly express the negative feelings to their parents.

Summary and Evaluation

• Contributions – Present-centered awareness – Pay attention on verbal and nonverbal cures – Bring conflicts or struggles to actually experience their conflict and struggles – Focus on growth and enhancement – See each aspect of a dream as a projection of themselves – Increase awareness of “what is” – Empirical validation for the effectiveness

Summary and Evaluation

• Limitations – Ineffective therapists may manipulate the clients with powerful experiential work – Not appropriate with severe cognitive or impulse disorders

Chapter 10,11 Par t 2

Narrative Therapy

Narrative Therapy

MICHAEL WHITE

DAVID EPSTON

The Narrative

• Focus of the narrative • The role of stories • Listening without judging or blaming

The Narrative

• Dominant Story: A way of understanding a situation that has been so widely accepted that it appears to represent reality.

• Generally, we have many stories occurring at the same time

• The broader social context impacts our stories.

Key Concepts of Narrative Therapy

• Listen to clients with an open mind • Encourage clients to share their stories • Listen to a problem-saturated story of a client without getting stuck

• Therapists demonstrate respectful curiosity and persistence

• The person is not the problem, but the problem is the problem

Goals

• Invite the client to describe their experience in new and fresh language.

• In doing this their client opens up new ideas of what is possible in the future.

Narrative Therapist’s function and role

•

To become active facilitators

•

To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination

•

To adopt a not-knowing position that allows being guided by the client’s story

•

To help clients construct a preferred alternative story

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To separate the problem from the people (instead of person own the problem)

•

To create a collaborative relationship --- with the client being the senior partner

Therapeutic Relationship

•

Emphasize the quality of therapeutic relationship, in particular therapists’ attitudes

•

Client-as-expert, clients are the primary interpreters of their own experiences

•

Therapists seek to understand client's lived experience and avoid effort to predict, interpret, and pathologies.

Techniques and Procedures

• No recipe, no set agenda, and no formula • This approach is grounded in a philosophical framework 1.

Questions and more questions

2.

Externalizing and Deconstructing

3.

Search for Unique Outcomes

4.

Alternative Stories and Reauthoring

5.

Documenting Evidence

Questions and more questions

•

Questions are used as a way to generate experience rather than to gather information

•

Asking questions can lead to separating “person” from “problem”, identifying preferred directions, and creating alternative stories to support these directions.

Externalizing and Deconstructing “It is not the person that is the problem, but the problem that is the problem”

•

Externalizing Conversation: A way of speaking in which the problem may be spoken of as if it were a distinct entity separate from the person.

•

Externalizing conversations can lead clients in recognizing times when they have dealt successfully with the problem.

•

Problem-saturated stories are deconstructed (taken apart) before new stories are co-created

Search for Unique Outcomes

• The therapists talks to the client about moments of choice or success regarding the problem. This is done by selecting any experience that stands apart from the problem story

Alternative Stories and Reauthoring

• The turning point in this therapy is when the client makes the choice to stop living in a problem saturated story and create an alternative story (reauthoring).

• Develop an alternative story. • Reauthoring occurs either in free flowing conversation or through questioning.

Documenting Evidence

•

Narrative therapists believe new stories take hold when there is an audience to appreciate and support them

•

Letter Writing

•

Therapists can also write and send a letter to clients between sessions regarding their strengths and accomplishments, alternative story, and unique outcomes or exceptions to the problems.

Overview of the Therapeutic Process 1.

Come up with a mutually acceptable name for the problem.

2.

Personify the problem and attribute oppressive intentions to it

3.

Investigate how the problem has disrupted, dominated, or discouraging the client

4.

Invite the client to see his story from a different perspective by offering alternative meanings for events.

5.

Discover moments when the client wasn’t dominated or discouraged by the problem by searching for exceptions to the problem.

6.

Find evidence to bolster a new view of the client as competent enough to have stood up, defeated or escaped the dominance or oppression of the problem.

7.

Ask the client to speculate about what type of future could be expected from the strong competent person that is emerging.

8.

Find or create an audience for perceiving and supporting the new story.

From a multicultural perspective

• Contributions – Fit with diverse worldview – Clients provide their own interpretations of life events – View people are competent and able to create solutions and alternative stories

• Limitations – Diverse clients may expect therapist as a expert instead of “client-as-expert”...