Monday, February 6, 2017 Theory and Practice of Counseling and Psychotherapy Chapter 1: As a Counseling Student.. Where the Author Stands… • you will begin developing a counseling style fitted to your personality based arround theories of therapeutic practice - which is a process that takes years and years of practice in order to develope fully •each theraputic approach is going to have different dimensions and implications that will be mixed and combined to fit a counseling techinique that fits you best • strongly influenced by the existenational approach • generally uses role playing techniques (people reenact scenes from their lives) • our past plays a crucial role in shaping our current personality and behavior, continues to influence present-day emotional or behavioral difficulties •our freedom is what determines our future, accept personal responsibility for actions and behavior even though we are influenced by our social enviornment which much of our behavior is a product of learning and conditioning • as a therapist you should not change the client, give them quick advice or solve their problems for them instead help faciliate a “healing” process • apply what you are reading from this book to your everyday life, it will help you understand the theories and perspectives of diffferent approaches • pay attention to your own personal development and any problems you may face1 Monday, February 6, 2017 Contemporary Counseling Models Psychodynamic Approaches Experimental and Relationship-oriented Therapies: •Psychoanalytic Therapy: a theory of personality development, a philosophy of human nature and a method of psychotherapy that focuses on unconscious factors that motivate behavior (founder: Signmund Freud) -pay attention to the first 6 years of life as determinants of the later development of personality •Adlerian Therapy: a growth model that stresses assuming responsibility, creating one’s own destiny and finding meaning and goals to create a purposeful life. (Founder: Alfred Adler) -focuses on childhood experiences but not the unconscious dynamics • Existential Therapy:this model stresses building therapy on the basic conditions of human existence, such as choice, freedom, responsbility, anxiety, guilt, awareness in order to shape ones life and self determination (founder: Viktor Frankl, Rollo May and Irvin Yalom) - stresses what its meant to be fully human - create meanfulness in the world • Person-Centered Therapy: this approach is based on human experiencing faith, giving responsibility to the client in dealing with problems and concerns (founder: Carl Rogers) - the client has capacity for self-direction without active intervention and direction of therapist • Gesalt Therapy: an experimental therapy that stresses awareness and intergration, it grew as a reaction againsty analytic therapy (Fritz and Laura Pearls) - it intergrates the functioning of body and mind and placing emphasis on therapeutic relationship - gain awareness of experiences here and now 2 Monday, February 6, 2017 Cognitive Behavioral Approaches Systems and Postmodern Approaches • Behavioral Therapy: this approach applies the principles of learning to the resolution of specific behavioral problems (Founder: B.F Skinner) - challlenge beliefs of why one is acting in a certain way • Cognitive Behavioral Therapy: a rational emotive therapy that focuses on cognitive and action of ones behavior (Founder: Albert Ellis) - what we are thinking and how we are thinking is what influences our behavior • Choice Theory and Reality Therapy: this approach foces in client assuming resonsibility in the present (Founder: William Glasser) - stresses on developing new plans for better behavior - Feminist Therapy: focuses on the concerns of pyschological oppression of women caused by sociopolitical status (founder: Jean Baker Miller) • it explores identity development, self-concept, goals and aspirations - Postmodern Approaches: this approach focuses on social constructionism, solution-focused therapy and so forth to maintain that the clienty is the expert in his or own life (Founders: Steve de Shazer and Insoo Kim Berg) - Family Systems Therapy: approach that is based on the assumption that the key to changing an individual is understanding and working with the family3 Monday, February 6, 2017 Intro to Stan Case Things to think about…. 䡧 What themes in their lives merit special attention? 䡧 What are the general goals? 䡧 What techniques and methods would best meet the goals of therapy for Stan and for Gwen? 䡧 How would you describe the therapeutic relationships that are established in these two cases? 䡧How might the therapist proceed in each Intake Interview and Autobiography - setting: community health agency - attends counseling because he is a heavy drinker, convicted of a DUI (past-drugs) - Stan accepts he has a problem but does not believe he is addicted to alcohol - Stan is 35 years old and works in construction, spends most of his time alone because he has difficulty socializing with people which is why he drinks (to take off the edge of socializing) - He wants to turn his life around but doesnt know where to start, he started to go back to school and earn a degree in social work or counseling - he has very few friends, he gets scared around people, he gets overwhelmed especially around women - he was once married but got divorced; his parents fought all the time but stayed together for him high anxiety feels alone suicidal depressed -greatly affected by his parents relationship -wasnt considered good enough Themes in the Case and his 3 siblings - he wants to turn his life around, hes determined - he wants to make a difference in someones life - he continueously puts himself down - he wants to learn how to deal with his self-destructive tendencies - he drinks to feel better when he feels alone, scared or overwhelmed - he feels guilty and anxious 4 Monday, February 6, 2017 intro to Gwen Case Background Information on the Case - Gwen is 56 year old married African American Women who was recently diganosed with fibromyalga - She has a masters degree in accounting and works at a large firm as a CPA - she has difficulty sleeping - she has a history of anxiety and depression - she is 1 of 5 and is responsible for taking care if her younger siblings - She has been married for 31 years, has 3 children - she is attending counseling about a couple life concerns, work issues and too emotional and angry often feels stress and isolated at her job because she is the only african american working there and works very long hours she is taking care of her mom, often is tired and feels like she cant enjoy the things she loves to do 5 Chapter 2 The Counselor as a Therapeutic Person - Counseling is an intimate form of learning and it demands a practitioner who is willing to be an authentic person person in the therapeutic relationship • the one-on-one connection between the counselor and therapeutic relationships contribute to the outcome of the the client is the main factor in having the client experience growth - an effect relationship between the counselor or therapist and the client greatly affects the The person and the professional are intertwined facets that cannot be separated in reality outcome of the therapy sessions and effects the growth of a client and the counselor • contextual factors- relationship, alliance, personal and interpersonal skills It is not the theories and techniques that heal the suffering client but the human dimension of therapy and the “meetings” that occur between a therapist and the client as the work together a client and the therapist are suppose to work together to help reach the common goals - Personal Characteristics of an Effective Counselor • therapists who have an identity- know who you are in as a counselor, as a person; what they want out of life • therapists respect and appreciate themselves- they can receieve help as much as they give it • therapists are open to change- have willingness to change something if need be, open minded, they work toward what it is they want to change • therapists make choices that are life oriented- committed to living fully rather than living a life of what ifs or should haves • therapists are authentic, sincere, and honest • therapists have a sense of humor- remember how to laugh • therapists make mistakes and admit to them • therapists live in the present- they live in today, not in the pasts • therapists have sincere welfare of others Not an all or nothing many counselors portray either some or all traits • therapists become deeply involved in their work and dervive a meaning from it • therapists are passionate - Personal Therapy for the Counselor • A counselor should involve themselves in some type of a therapy, not only will it benefit them from just talking to someone, but it also contributes to their work - a model for therapeutic practice - enhances interpersonal skills - helps deal with ongoing stresses whether its work or outside of work - learn how to centralize warmth, empathy, and an interpersonal relationship in their therapy session - Instrumental in healing the healer - developes patience with their clients Counselors Values and Therapeutic Process - Roles of Values in Counseling and Therapeutic Goals • values and core beliefs influence how we act both in professional and personal lives • Role is to create a climate in which clients can examin in their feelings, thoughts and actions to enpower them to arrive at their own solutions problems Personal values influence how we view counseling and the manner in which we interact with our clients • task is to assist individual in finding answers that is in equalization to the clients values - help them develope new ways of thinking and behaving to help them move closer to their goals • figure out the clients goals in the early sessions - What do you expect from counseling? - What do you want? - What do you hope to leave with? • Bracketing— managing personal values so they do not interfer with the counseling process - set aside personal beliefs and values • Value Imposition: term refering to counselors directly trying to define a clients values, attitudes, beliefs and behaviors • pay attention and examine your beliefs and values Becoming an Effect Multicultural Counselor Unethical!!- it is an ETHICAL OBLIGATION for counselors to develope a sensitivity to other cultures and ethnic groups aside from their own • make goals and decisions based upon their world view, even if its not something you believe in - Culture: ones values, behaviors and behaviors that shared by a group of individuals - Understand your own cultural conditions, your cultural values and the ones your client is apart of - Competencies and Standards of Different Cultures • beliefs and attitudes - respect clients beliefs, attitudes, religious beliefs and spiritual beliefs or vales - be comfortable with other races and cultures - accept and value cultural diversity • knowledge - know specifically about your clients race, cutlure, or ethnic group and know about your own - understand their world view - understand historical background, traditions, values and client populations • skills - take responsibilty for educating clients on the therapeutic process - set goals relating to their cultural beliefs, values and so forth - use methods to define goals consistent with their life expereinecces and values Issues Faced by Beginning Therapist - Dealing with anxiety • understand self-doubting is normal • openly discuss your worries, your doubts - Be yourself and Self-Disclosure • Be authentic, Be yourself • consider what to reveal and what not to reveal, how much and when to reveal certain things • be careful when thinking automatically, dont want to judge your client - Avoid Perfectionsim • accept you are going to make mistakes • share mistakes with othrs- Be Honest about Limitations • learn and know your limits • accept you cannot help everyone - Understand Silent Moments • has multiple meanings such as waiting for the therapist to say something or for the client to say something, the client may be preoccupied or thinking about what was discusses • acknowledge the silence - Dealing with Demands • clients will demand for things such as advice or answers to a problem, advise them do not solve everything for them - Dealing with Involuntary Clients • prepare them with what the process entitles • explain the goals, create goals - Becoming Aware of Countertransference • Be fully present in the therapy hour, avoid outside distractions - Developing a Sense of Humor • its okay to laugh • distinguish betwen human that distracts and humor that enhances the situtation - Sharing Responsibility with the Client • find a balance between counselor and the client • address in early sessions - Declining to Give Advice • help them discover and recognize solutions • help client make independent choices and accept the consequences of their choices - Define Role as a Counselor• help clients organize their own strengths, help discover what is preventing them from using their client resources, clarify and so forth - Learning to use Techniques Properly • techniques should evolve over time and will be used on different clients dependin gon which technique fits the client best - Develope Your own Style • allow your style to be influenced by teachers, therapists, supervisors and yourself • borrow from others but tweak them to fit your styleThursday, February 9, 2017 Chapter 3 Ethical Issues in Counseling - Mandatory Ethics: involves a level of ethical functioning at the minimum level of professional practice - Aspirational Ethics: focuses on doing what is in the best interest of the client • the counselor does more than meet the standards of the ethics codes - Positive Ethics: an approach taken by practioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble Our professional relationships with our clients exist for their we need to be aware of our needs, areas of unfinished an ethical problem occurs when our needs are met over the clients needs buisness, potential personal problems and especially contertransference As a counselor you will have to apply the codes of your profession to almost all practical problems you face • pay attention to the ethics code • confide in collegues • learn about the resources 1 Thursday, February 9, 2017 Role of Ethics Code as a Catalyst for Improving Practice - Professional code of Ethics purpose is to.. • educate counseling practioners and general public about the profession • provide a basis for accountability • protect clients from unethical practices • basis for reflection and improvement When making an ethical decision… • identify the problem or dilemma • identify potential issues • look at ethic codes for general guidance • consider applicaple laws and regulations • decide on best action plan for your client Right of Informed Consent - Informed Consent: the rights of clients to be infromed about their therapy and make autonomous decisions pertaining to it • it is an ethical and legal requirement that is a intergral part of the therapeutic process • establishes a basic foundation for creating a working alliance and collaborative partnership • Given orally or written use as a guideline to make the best judgement educate clients about their rights and responsibility to build a strong trusting relationship with your clientExplain goals of counseling, responsibilities of the cousnelor towards the client, responsibilities of the client, limitations and expectiations of confidentiality, legal and ethical parameters that could define the relationship, qualifications and background of practioner and so forth 2 Thursday, February 9, 2017 Dimensions of Confidentiality - Confidentiality: an ethical concept and in most states it is the legal duty of therapists not to disclose information about the client • central to develope a trusting and productive client-therapist relationship - Priviledged Communication: is a legal concept that protects clients from having their confidential communication revealed in these laws ensure that disclosures clients to protect from exposure of the therapist court that protects clients from having thie confidential communications revealed in court without their permission - When to break confidentiality… • when a case involves child abuse, abuse of the elderly, abuse of dependent adults, and danger to self or others • when the therapist believes a client needs hospitalization • when the client under the age of 16 is a victim of rape, abuse or another crime Ethical Issues in the Assessment Process - Assessment: the process in which evaluating the relevant factors in a client’s life to identify themes for further exploration in the counseling process - Diagnosis: is the part of the assessment process, consisting of identifying a specific mental disorder based on pattern of systems • explains causes to the clients difficulties • help identify disorders and how to deal with the disorder • IDENTIFY disruptions in clients present behavior and lifestyle both are an intergrally related to the counseling process and its a continuing process- be aware of unintentional bias and keep an open mind to the presence of distinctive ethnic and cultural patterns - ethical dilemma may be created when diagnosis is done for insurance purposes or if there is a misdiagnosis 3 Thursday, February 9, 2017 Ethical Aspects of Evidence-Based Practice - Evidence-Based Practice: the intergration of the best available research with clinical expertise in the context of patients characteristics, culture and preferences • look for best available research • rely on clinical expertise • take into consideration of client characteristics, culture and preference Dual or Multiple Relationships enhance effectiveness of client services and improve public health and warn mental health professionals to take a stance - it is either a sexual or non-sexual relationship that occurs when counselors assume two or more roles simultaneously or sequentially with a client • blend their professional relationship with another kind of relationship ethical concerns arise • it can do serious harm both to the client or counselor • sometimes are unavoidable - boundary crossing: a departure from commonly accepted practice that could potentially benefit a client - boundary violation: a serious brance that harms the client and is therefore unethical • a boundary crossing that takes the counselor out of the professional role - involves explotation and harm to the client it is essential that you develope a process for thinking about and dealing with ethical dilemmas 4 Study Guide for Chapters 1-3 Chapter 1 - What are three important points the author stresses about where she stands as a counselor? - What are the four catergories for therapy approaches? - What approach is the author influenced by? - What two therapies where under the Psychodynamic Approach? - Who was Stan? How old was he? Why was he attending therapy? - Who founded the Behavioral Therapy? - What are the three therapies in the Cognitve Approach - Explain the therapies under the Experimental and Relationship-orientated category of therapy approaches - What therapy is focused on childhood experience? - Does the author believe that our past has no effect on how we behave today or what our personality is? - For the Psychoanayltic therapy, what years of our life are crucial to the developemtn of our personality? - What are three themes of the Stan Case? - Why is Gwen attending counseling? - Explain the three therapies in the Systems and Postmodern Approach? - According to the author what determines our future? Chapter 2 - What is counseling? - What contributes to the outcome of the therapy session? - What do our values and beliefs influence? - What is Bracketing? - What are a few issues faced by being a therapist? - What are the competencies and standards on different cultures? - What do our personal values influence? - What are three personality traits of an effective counselor? - What are the contextual factors of a client-therapist? - Why should a therapist be involved with counseling sessions of their own? - What is Value Imposition?- True or false? It is ethical to impose your own values, beliefs and worldview on your clients? - What is culture? - What questions are asked in order to determine goals of the therapy sessions? - What are the roles of a counselor? Chapter 3 - What is the profession code of ethics suppose to do? - What is informed consent? - True or false? informed consent can only be written - what is a boundary violation? - What is confidentiality? - What are positive ethics? - Is it okay to have a relationship aside from a professional one while they are your client? how about if they are no longer your client? - When does an ethical problem occur? - What is a boundary crossing? - What should we do when making an ethical decison? - What is privledged communication? - What is the goal of Evidence-Based-Practice? - What is the purpose of confidentiality and privledged communication laws? - How to we explain right of informed consent? - True or false? The code of ethics should be used as a guideline?