Theory and Practice of Counseling Notes PDF

Preview

Summary

Book and Class notes...

Description

Theories of Counseling –Notes Chapter 1: Introduction  The theory you utilize as a counselor influences the way you treat a client but under all theories you are operationalizing the problem, but you might approach it differently  Many people who endorse being eclectic are still usually grounded in one main theory but just aren’t as rigid  The kind of person a therapist is = the most critical factor in a client’s treatment o Counseling is healing through forming relationships, not problem solving or giving advice o It’s impossible to separate the techniques you use from your personality and the relationship you have with your clients. o Most powerful way to teach your clients is by the behaviors you model and the ways you interact with them (i.e., modeling your behavior)  The contextual factors—the alliance, the relationship, the personal and interpersonal skills of the therapist, client agency, and extra-therapeutic factors—are the primary determinants of therapeutic outcome.  Counselors must explore their ow n attitudes and beliefs to be successful  Techniques do not substitute for a good relationship  It is essential to understand various theories of personality and how they are related to theories of counseling  Following a hypothetical client named Stan: o DUI, drinking, referred by judge, believes he has a problem but isn’t addicted to alcohol o Works in construction, loner, social anxiety, in school for psychology o 35 years old, wants to work with people, feels like a failure, previous drug abuse, feels like he is dying inside, suicide contemplation, depression, o He wants to change, divorced, rough upbringing, tough parents, sexual intimacy issues o He wants to stop drinking, lose his fear of women, not be anxious or depressed  Following Gwen: 56 year old, black married woman o Fibromyalgia, difficulty sleeping, anxiety, depression o Mother of 5, CPA, only person of color at job, previously sexually molested, tired of existing o Finds refuge in her religious beliefs, racism and sexism at work, o Not suicidial but feels numb o Lack of motivation Chapter 2: The Counselor: Person and Professional  Counselors must remain open to self evaluation  Clients place more value on a counselor’s personality than their techniques  Our own genuineness and authenticity has a huge impact on our relationship with clients  Techniques themselves are of little importance (studies show that techniques have the least effect on therapeutic outcome) whereas relationships with client are most important

 

  



  

It is the human dimension of therapy and the meeting between therapist and client that allow for treatment. It is essential that the methods used support the relationship being formed with client. Effective therapists have an identity, are open to change, make choices that are life oriented, are authentic, sincere, and have a sense of humor, make mistakes and willing to admit them, live in the present, appreciate the influence of culture, have a sincere interest in the welfare of others, effective interpersonal skills, passionate, and maintain healthy boundaries. o Dual relationship – crossing the healthy boundaries in counseling and changing the relationship The things you pick up when you yourself are in therapy help your abilities as a counselor Effective therapists have also experienced therapy o Healing the healer The Role of Values in Counseling: o Must strive to not let our values influence how we interact with our patients o Help individuals find answers that are congruent with their own values Guard against the tendency to use our power to influence clients to accept our values; persuading clients to accept or adopt our value system is not a legitimate outcome of counseling o Do not succumb to your own worldviews. It is best to recognize things that clients point out about yourself. Separate your values from your practice. o You cannot make decisions for your client, but you can give advice o You may not agree with certain of your clients’ values, but you need to respect their right to hold divergent values from yours and they must be willing to accept the consequences of their behaviors. o Managing your personal values so that they do not contaminate the counseling process is referred to as bracketing. You may have to do this more or less with certain clients. o Counselors must have the ability to work with a range of clients with diverse worldviews. Counselors may impose their values either directly or indirectly. o Value imposition refers to counselors directly attempting to define a client’s values, attitudes, beliefs, and behaviors. o It is largely the client’s decision to make goals for themselves. Allow them to help define what they need so you can collaborate. The Role of Values in Developing therapeutic goals: o Client decides goals in collaboration with therapist Beliefs and Attitudes: counselors are aware of their reactions to other groups of people that may influence their ability to work with a client. Practitioners modify and adapt their interventions to accommodate differences between client and counselor. When working with a client you must recognize that your counseling techniques may be culture-bound. o Ethical obligation for counselors to eb culturally sensitive o Must possess certain knowledge about their own racial and cultural background as well as others



o Multiculutral counselors adapt therapy such that it is consistent with the experiences and beliefs of the client Often times clients teach counselors about aspects of their culture. Regardless of your background, allow your client to teach you as well. The best source for learning about someone else’s culture is from learning from our client’s different cultures.

Issues faced by beginning therapists:  dealing with anxiety  being yourself and self-disclosure  avoiding perfectionism  being honest about your limitations  understanding silence  dealing with demands from clients  dealing with clients who lack commitment  tolerating ambiguity  developing a sense of humor  sharing responsibility with the client  don’t give advice  defining your role as a counselor  learning to use techniques appropriately  developing your own counseling style  maintain your vitality as a person and as a professional  Consider what to reveal, when to reveal it, and how much to reveal about yourself  Countertransference: any of our projections that influence the way we perceive and react to a client. When we are triggered into emotional reactivity, when we respond defensively, or when we lose our ability to be present in a relationship because of our own issues.

Chapter 3: Ethical Issues in Counseling Practice:  Putting Clients Needs Before your own: o Unethical to meet our needs at the expense of our client’s o Less obvious harmful things: need for power, need to be nurturing, or direct our own values  Ethical Decision Making: o Professional code of ethics provides a basis for reflecting on and improving our practice o Follow legal guidelines but don’t get so bogged down in worrying about being sued o Tips:  Identify problem, potential issues, look at ethics codes, consider the laws, seek consultation, brainstorm courses of action, consequences of decisions, what is best  The Right of Informed Consent: o Clients have the right to be informed about their therapy and to make autonomous decision pertaining to it

 



   



Confidentiality: an ethical concept that states therapists cannot disclose information about a client Privileged Communication: a legal concept that protects clients from having their confidential communication revealed in court without their permission o Does not tend to apply anytime there are more than two people in the room (e.g., group counseling). o Exceptions:  Information must be legally reported by counselors when  Client under the age of 16 is thought to be a victim of rape, abuse, or other crime  The client needs hospitalization  The information is made an issue in a 7court action  When clients request their records be released to them or someone else Multicultural Issues: o Western therapeutic models might not always be best for some groups o Therapists must listen to clients values and beliefs to determine what therapy is best for them o Interventions are tailored toward social action and not just success of the client o Increase a client’s awareness of their options available to fight barriers Assessment: evaluating the relevant factors in a client’s life and identifying themes for exploration Diagnosis: Identifying specific mental health problems based on assessment Ethical issues: failure to consider ethnic and cultural factors in certain patterns of behavior; when diagnosis is done strictly for insurance purposes Evidence-based Practice: the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences o Best available research o Relying on clinical expertise o Taking client’s characteristics, culture, and preferences in consideration Managing multiple relationships in counseling: o Dual or multiple relationships: sexual or nonsexual, occur when counselors assume two or more roles with a client (ACA refers to these relationships as nonprofessional) o ACA does not necessarily say that all multiple relationships are unhealthy or unethical o Pervasive, unavoidable, potentially harmful, o They are unethical when they exploit or bring harm to clients o They cannot be completely prohibited  Minimizing risk:  Set healthy boundaries  Ongoing discussions with clients  Consult with fellow professionals,  Self monitoring

Boundary crossing: departure from commonly accepted boundaries that would benefit the client  Boundary violation: a crossing that harms the client Chapter 4: Psychoanalytic Therapy  Founder was Sigmund Freud o He has a doctor-patient relationship with people o Freud’s greatest contribution was the concept of conscious and unconscious and all of the different defense mechanisms  Key Concepts: o View of Human Nature – determined by irrational forces, unconscious motivations, and biological and instinctual drives  Deep unconscious drives must be healed to treat behavioral problems  Libido - sexual drives (this term was later broadened to energy of all the life instincts)  Life instincts-serve the purpose of survival  Death instincts-aggressive drive  Eros (drive for life) and Thanatos (drive for death)  Unconsciously people just want to be able to die and return to the elements o Structure of Personality  Id – primitive impulses that are not always socially acceptable; untamed drives;  The id is driven by the pleasure principle: aimed at reducing tension, avoiding pain, and gaining pleasure  At birth a person is all id  Ego – a person’s personality; the mediator between the id and the superego  Ruled by the reality principle – realistic and logical thinking and formulates a plan of actions  Governs, controls, regulates personality  Mediates between instincts and reality  Superego – conscience, be a good person, internalized social component  Inhibits the id impulses; substitute moralistic goals for realistic ones  The superego makes us strive for perfection.  Another name for the superego is conscience.  Introjection – the process by which the values of your parents are given to you o Consciousness and Unconscious:  Conscious, preconscious, and unconscious (inferred from behavior) minds. Preconscious is when you can get a feeling of why you are doing but you don’t really know why. (e.g., Did I do that because I am jealous? Could be)  The unconscious cannot be studied directly but can be inferred from behaviors  Postulating the unconscious includes dreams (symbolic of unconscious needs, slips of the tongue and forgetting, material derived from free

association, material from projective tests, and symbolic content of psychotic symptoms  The unconscious stores all experiences, memories, and repressed material. The aim of psychoanalysis is to make the unconscious motives conscious.  E.g., Rorschach projective techniques (project your unconscious conflicts onto the ink blot so it takes a form  Thematic apperception test (they have to tell a story of what is going on in the picture and how they feel)  Then they give them a blank card and make them describe his own story and describe it o Anxiety:  Within the limbic system, the hippocampus gives you the detail of a memory (sights, smells) but the amygdala gives a general memory (lends itself to behavioral modification)  Hippocampus isn’t fully developed until 11-12 years old so children don’t have that detailed of memories, it isn’t down in their subconscious  People become anxious because of dread resulting from repressed feelings, memories, desires and experiences  Reality anxiety – real life-threatening situations  Neurotic Anxiety – fear that the instincts will get out of hand and cause something bad  Moral anxiety – the fear of one’s own conscience o Ego-defense mechanisms – help the individual cope with anxiety and prevent the ego from being overwhelmed  They are normal behaviors that can have adaptive value provided they do not become a style of life that enables the person from facing reality  Denial – person who won’t admit their problems (person who cannot admit their anxiety)  Repression – something was conscious but moved to unconscious (the act of pushing something back into the unconscious)  Reaction formation – actively expressing the impulse you shouldn’t be (superego won) (person who exhibits overly nice behavior even though they’re angry)  Projection – seeing the faults that you have in other people (man judges other people for being alcoholic)  Displacement – shifting from a threatening object to a safer object (directing an emotion onto something other than what caused it) (the nice kid starts being bullied so he starts threatening other kids) o Man fights with wife  Rationalization – manufacturing “good” reasons to explain a bruised ego; explain your behavior  Sublimation – diverting sexual or aggressive energy into other channels (the healthiest ego defense mechanism) (taking all the





problems you had as a child and turning it into being a great parent)  Regression – going back to an earlier period in your life (praying at end of life even when you aren’t religious anymore) (acting like a child). OCD can come from anxious people regressing back to childhood magical thinking (reverting to a childhood stage)  Introjection – incorporating other’s values as your own (helps the development of the superego)  Identification – identifying with successful causes, organizations, or people in the hope that you will be perceived as worthwhile (e.g., Jews identifies with Germans)  Compensation – masking perceived weaknesses or developing certain positive traits to make up for limitations (compensation) (masking bad traits about yourself) Development of Personality: o Early development –  Psychosexual stages  Oral stage – inability to trust oneself or others (trust vs mistrust)  Anal stage-inability to recognize and express anger (autonomy vs shame)  Phallic stage-can’t accept one’s sexuality and sexual feelings (initiative vs guilt)  Latency stage – nothing really going on (industry vs inferiority)  Genital stage – sexual drives (supposedly continues all the way to the rest of your life) (identity vs role confusion)  Intimacy vs isolation  Generativity vs stagnation  Integrity vs despair  Erikson’s psychosocial stages Therapeutic Process: o Transference (patients putting their own feelings/issues onto the counselor) vs. countertransference (counselor doing that to their patient) (e.g., treating you counselor like a father figure)  Countertransference includes any of our projections or unresolved conflicts we had  Transference occurs when a client treats the counselor like one of their important figures in their life. o Therapist’s function and role:  “blank screen approach” – assume an anonymous non-judgmental stance  Freud stayed out of sight so that patients could transfer onto him  Very different from humanistic approach where you should share your experiences and feelings with your patient o Classical psychoanalysis: intense, long-term therapy  After some time, the clients start lying facing away so they can do free association (talking for a while until something from the unconscious comes up and the therapist interprets that story)

Classical analyst offers interpretations Contemporary psychodynamic therapists focus on earlier reenactment by bringing the past up.  Clients must become aware of unconscious material but also must be aware of the effect of childhood events on them. But just because you have insight doesn’t mean you can change your behavior.  Working-through process consists of repetitive and elaborate explorations of unconscious material and defenses  Interpretation consists of the counselor gives explanations for a client’s behavior/thoughts.  Abreaction: try to get a client to have you react differently to something you told the counselor Dream Analysis o Dreams consist of latent (hidden, symbolic and unconscious motives, wishes and fears) and manifest content (how the dream appears to the dreamer)  



Jung’s Perspective on the Development of Personality: o Jung broke away from Freud’s approach o Freud referred to Jung as his spiritual heir o Analytical psychology: an elaborate explanation of human nature that combines ideas from history, mythology, anthropology, and religion o Places importance on the psychological changes that are associated with midlife o Still believed in the unconscious mind o Achieving individuation: harmonious integration of the conscious and unconscious aspects of personality  E.g., terrible two’s occur because children realize they are separate from their parents and they are becoming individuals. Child begins to exert counter will against their parents. o Collective unconscious: deepest and least accessible level of the psyche (everyone’s unconscious is part of the universal unconscious) (e.g., God) Jung was becoming spiritual while Freud was strictly biological o We are influenced by our future as well as our past o Archetypes: the images of universal experiences contained in the collective unconscious  Persona: mask/public face (Jung wrote that we have a persona, which is the mask we use to protect ourselves)  Animus and anima represent both the biological and psychological aspects of masculinity and femininity (Yin and Yang)  Accept your shadow or dark side. Thoughts and actions that we disown or project onto others. Jung believed we need to get in touch with our dark side and he referred to this as our shadow. o Contemporary Trends: o Ego psychology: part of classical psychoanalysis with the emphasis placed on the vocabulary of id, ego, and superego and on Freud’s identification of defense mechanisms

o Object-relations theory: how our relationships with other people are affected by the way we have internalized our experiences of others Chapter 5: Adlerian Therapy o Alfred Adler was a major contributor to psychoanalytic therapy o Also broke away from Freud o Person’s past as perceived in the present. What actually happened is not as important as how you perceive what happened. o Key Concepts: o View of Nature:  Inferiority feelings: driven to strive for higher levels of achievement. We have a life goal. This is opposed to Freud’s biological basis. Believed people could change through social learning.  Places emphasis on values, beliefs, attitudes and goals  Systems theory: important to understand people in terms of the systems that influence them o Subjective Perception of reality  Phenomenological orientation: refers to people’s subjective reality as opposed to what actually happened o Unity and patterns of human personality  Individual psychology: understanding the whole person in the context of his or her  Lifestyle the movement from a felt minus to a desired plus result in the devel...