Purpose of Counseling and Psychotherapy 

Client awareness, personal growth, coping skills, and how to manage challenges. Throughout the counseling process, client's well-being should improve overtime. Counseling promotes a sense of autonomy for the client.  

Importance of Theories 

By using theories, we as counselors get a base understanding of how to work with a client through a direct framework. By using these theories, we gain understanding in treatment plans, promoting trust in the counselor-relationship (or therapeutic alliance), and more.  

Evolution of Counseling 

Counseling as a profession stems from medicine, philosophy, and eventually psychology. As counseling theories were developed, individuals felt more inclined to work with these theories and make them even better. This is how we have eventually developed umbrella terms for certain theories that today have more specific focuses.  

Ethics 

In this chapter we learn about confidentiality and the code of ethics, as well as different roles we must uphold as counselors, such as empathetic professionalism.  

Culture 

Cultural competence is crucial to the therapeutic relationship. Counselors must always strive to meet the needs of diverse clients, and advocate for their needs as necessary. 

Traditional theories of counseling fall short of addressing needs of diverse clients, and have been criticized for their limitations. 

New models/theories created to address the needs of diverse clients. Don’t replace traditional theories but help counseling become more modernized.  

Constructs

Multicultural: encompasses individual and group cultural differences. This term has become more inclusive over time, which can be seen as positive or negative.  

Groups holding more power: majority, dominant culture, and agent. Groups with less power: minority, nondominant culture, marginalized, and target. Term “diverse clients” almost always identify in the “less powerful” group. Percent of minority in the US will grow for years to come   

Timeline

1950s: ignored cultural differences between counselor/client. 1960s: formation of the Association of Non-White Concerns (ANWC), but not given division status in the ACA until 1972. 1980s/1990s multicultural issues became priority in the counseling field. 

ANWC = Association for Multicultural Counseling and Development (AMCD) 

AMCD approval of the Multicultural Counseling Competencies (MCC) brought legitimacy to multicultural counseling. 2015, MCC included SJ advocacy framework for counselors to advocate for their clients. Important to have cultural empathy, trust, and egalitarian relationships w/ clients 

Counseling from social justice (SJ) perspective 

Facilitate client well-being by seeking equal distribution of power/resource in society w/ advocacy.  

1970s = when psychological problems started being linked with factors from outside the client. Today, multicultural and SJ perspectives are needed to best serve clients 

Models

The Oppression Model: Specific groups = higher value, so more power (dominant) than others. The devaluation process is understood through understanding the roles of stereotypes, prejudice, discrimination, and privilege.  

Atkinson, Morten, & Sue’s Racial/Cultural Identity Development model: Conformity, Dissonance, resistance and Immersion, Introspection, Integrative awareness 

Helm White Racial Identity model: Contact, Disintegration, Reintegration, Pseudoindependence, immersion/emersion, Autonomy 

Worldview: views/opinions in process of how life was, is, will be, should be. Scale to Access Worldviews (Ibrahim): View of human nature & relationships, and nature, time/activity orientation 

Psychoanalytic Theory: Based on concept that individuals are unaware of factors that cause their maladaptive behaviors & discomforting emotions. Treatment=individualized 

Three major influences in Psychoanalysis  

1. Jean-Martin Charcot: Hysteria. Trauma = not the problem, what came of it was the problem. 

2. Josef Breur: unconscious process. Felt hysteria disappeared when underlying causes became conscious

3. Sigmund Freud: Believed talking about life = relives hysteric symptoms, but conditions improve after talking about repressed trauma. Did not believe in hypnosis. Experiences helped him popularize talk therapy. 1896, he renamed “hysteria” as Psychoanalysis.  

Id: instinctual, biological drives of psyche, unconscious; Superego: Critical, moralizing; Ego: organized, realistic. Mediates and seeks balance between first two. works hard to satisfy the id desires in realistic and socially appropriate ways. Superego=2 parts. Ego-ideal: rules/standard of good behavior taught by parents and society. Conscience: info on things viewed as “bad”. Lead to punishment, feelings of guilt/remorse  

5 psychosexual stages: Oral (first year of life)- kids learn w/ their mouths- sucking, talking, etc. Anal (ages 1-3)- controlling blatter/bowel movements, Phallic (ages 3-6)- discover difference in male/female genitalia, Latency (ages 6-12)- id,ego, superego, and Genital (after age 12)- strong sexual desires, interests.  

Brief psychodynamic theory: what happened in the past that’s created the current issue 

Chapter 4: Jungian Analytical Theory 

Jungian Analytical Theory: Look at whole person, mind, body, & soul. Links conscious w/ unconscious aspects of people in search of life’s meaning. Individualization- process of becoming true self (Self-actualization). Personality continues to develop in life. Saw libido as a life energy 

Jung’s 4 basic stages of development: Childhood (ruled by urges and desires), adolescence (confusing; big changes), Middle age (he deemed most important), & old age (reflective) 

Collective unconscious: we inherit unconscious memories from ancestors’ experiences 

Archetypes: images/symbols representing ones ancestral past. 4 types manifest in self- Shadow (part of self leaning toward chaos), anima (female), animus(male) (rep ones true self), self (important. Is the “ego”) 

4 nonsequential stages Jungian psych: 1) catharsis (client shares feelings) 2) analytical stage (therapist analyzes assessments, dreams, etc) 3) Insight stage (client/therapist get info on  clients life, create goals) 4) transformational/individualization stage (client use insight to understand self) 

Jung’s focus on introversion-extroversion/its scale inspired personality theories/tests 

Chapter 5: Adlerian Therapy 

Adler founded individual psych: understanding a person within their environment. Guide to improve the individuals psychological state & connectedness to social environment. He did not agree w/ Freud’s theory 

• 3 central principles of individual psych: goal orientation, social interest, and holism 

• 3 concepts interpreting behavior patterns children use to give action to their lifestyle: Birth order, family constellation, and early recollections.  

• Adler placed emphasis on family atmosphere and how unique it is to every family. 

• Adler’s Human Personality Theory: 3 phases- explanation of inferiority feeling, understanding inferiority, and social interest 

Existentialists: Focus on individuals unique experiences. The journey is as important as the destination. Less focus on science. Each choice represents the loss of an alternative; ppl have freedom to choose but must balance this w/ the responsibility of their choices. 

Existential Psychotherapy (EP): Focuses on what it means to be human. Victor Frankl- key developer. Believed psychological disorders were a manifestation of a loss of meaning in one’s life. The spiritual part of existence is essential. Goal of EP = “tragically optimistic” 

Existential Counseling Therapies 

Humanistic Existential focus: on one’s being a part of the world, deep respect for relationships, and freedom as well as responsibility for one’s choices.  

Psycho analytic/dynamic Existentialism: Focus on resolution of inner conflict & anxiety 

Transpersonal Existentialism: Spirituality cannot be separated from individual. Spirituality = part of existential struggle. Existential quest = spiritual awakening unfolds. Hope emerges from despair.  

Human Nature: A developmental Perspective 

People grow when more mindful/reflective of present condition, regardless of developmental time frame. Death is understood at each stage of devel. Devel starts at infancy, non-verbal stages. Adolescents also encounter death. Changes through school can cause anxiety/depression, which can lead to thoughts of suicide. Midlife- time for developing an integrated self. Process of devel in life is characterized by anxiety, of which death is the primary cause. 

A worldview: Existential therapy is becoming more popular. Interest is growing as it uniquely acknowledges the usefulness of all psychotherapies.  

Major Constructs: Death, Freedom, Isolation, and Meaning 

Death/Life: if fully present, something within us must die. Confrontation w/ death = rebirth of a more aware, authentic way of life. Freedom/Responsibility: We experience loss, but our reactions give us freedom Isolation/Connection: isolation from one's true self keeps us from connecting w/ others Meaning/Meaninglessness: without meaning, people's lives are meaningless. Authenticity/vulnerability: counselors are authentic while honoring the client’s power 

Buber’s existential relationships: Superficial relationships (I to it, I to I, it to it) lacking individuality (we to we) compassion (us to them), & others objectified/distanced (I to you) 

Existential approach uses I to Thou (being present in a respectful, honoring manner) 

Existential Intervention Strategies 

Telling the Story: Finding the Meaning of Myth- sharing stories is helpful as a client. Lets healing process begin. Presence: when seen, clients feel respected/valued. Dream work: window to the unconscious; insight. Closure: process of termination w/ a client. Short-term existential therapy: focus on the here and now with the client. 

Existential approach fits within the “recovery-oriented attitude”; to gain meaning/hope 

Phenomenological Perspective: individuals see the world from own unique perspectives 

Background 

Rogers = first to intentionally and creatively subject therapeutic processes to rigorous scientific study. Put emphasis on the counselor-client relationship. To test his theory, he worked with children, then mentally ill clients, then group therapy.  

A Developmental Perspective 

Person-Centered Perspective is based on 5 key beliefs 

1) People are trustworthy 2) people move toward self-actualization and health 3) people have the inner resources to move in positive directions 4) people respond to their uniquely perceived world (phenomenological world) 5) there is interaction of key beliefs with external factors. When we activate these factors in external environment, it brings about most desirable aspects of devel 

Major Constructs 

Person-Centered Theory is based on a set of beliefs about people and relationships, not a series of programmable verbal and behavioral techniques.  

Constructs to understand – a) No two people see the world exactly alike b) empathic understanding is critical c) people make mistakes in judgement d) place confidence in the client e) perceived world of client may not approximate the world sought f) congruent individuals trust own worldview.  

Applications 

Goals: Movement from incongruence to congruence. Reaching a point of increased self-empowerment. Successful clients become more flexible in their thoughts and actions, and free themselves from stereotypes of worth.  

Process of change: Guided by 3 basic conditions on the end of the counselor- genuineness, acceptance/caring, and empathic understanding.  

Traditional Intervention Strategies 

Active Listening (show you are paying attention), Immediacy (here-and-now approach), genuineness and self-disclosure (look inwards. Have self-confidence before guiding others), personalized counselor actions (bring your personality into session), non-client-centered interventions (counselor and client work together) 

Brief Intervention Strategies  

Implementation of Core Conditions, Intro of Constraints, Group Work, Emergence of Neuroscience 

Background

Fredrick (Fritz) & Laura Perls: founders of Gestalt theory. Fritz’ work carried on by Laura after his death in 1970. Paul Goodman worked w/ Laura after Fritz’ death. 

Gestalt Pillars

Phenomenology- study of human experience through observing individuals. Can be internal (self) or external (environment). Existentialism: human existence as experienced; find meaning. Field Theory: focus on whole. Elements = relationship/influence one another. Dialogue: goal is rapport/relationship building with client. 

Gestalt therapists engage whole person (holism). Humans have capacity to grow/develop & become who they want to be. Developmental mind: client in process of being in here and now. Healthy individual- Can differentiate themselves & also make contact w/ others.  

Confluence: lose sight of self by incorporating too much environment or others into “self” 

Boundaries: firm enough to differentiate self from others, yet open enough to make contact with others. Retroflection: doing to “self” what should be to environment (if dislike someone, punish self because do not have opportunity to punish the other person) introjection: taking in too much environment. projection: take parts of self & blame others 

Dichotomies: parts of field fight against instead of working together. Polarities: opposite parts in field that work together. 

Awareness: key in gestalt therapy. Practitioners use cycle of awareness (sidebar 8.3) as a method of problem solving. Concept one manages, rather than a problem one solves 

Gestalt is reflected in phrase: I- Thou, What and How, Here and Now  

Goals of Gestalt

Develop/expand physical and emotional awareness, client/counselor relationship is existential, counselors support clients in enactment and experimentation, change occurs as result of awareness of client/counselor interaction/experimentation. 

Today

Gestalt therapy = more measurable. Still existential and phenomenological. Focus less on behavior changes, more on developing insight and interpersonal awareness. (Table 8.1 intervention strategies) It does not often align with the DSM-5. Gestalists do not believe in disease, but rather dis-ease. Effective for disorders as brief therapy not long-term clients 

Note gestalt experiments - not suited for everyone, especially emotionally fragile clients 

Discovered rate of responding as a dependent variable was sensitive to a variety of experimental manipulations. Then discovered how this law of effect (now law of reinforcement) worked & under what circumstances. From this, learned other laws of operant learning (aka behavior analysis), including extinction, punishment, & discrimination/generalization. Using within- or single-subject research design, carried out ‘experimental analysis of behavior of individual subjects’ 

Conducted research on animals to essentially learn about humans, not the animal 

Behavior Shaping: Reinforcing Successive approximation to a target or terminal behavior 

Skinner has provided significant portion of methods used in infant research 1950s-now 

Operant shaping and learning processes are central to understanding skills/socialization in human infancy & childhood (how does the environment affect the infant, and vice versa) 

Claims developmentalism is structuralism with time or age added as an independent variable. 1- evidence that species ‘develop’ before darwin 2- cognitive psychologists argue concepts develop in children in fixed orders, and Freud said same for psychosexual functions 3- anthropologists contend that cultures must evolve through prescribed serious of stages. All three stages explained by the “development” of contingencies of selection 

• The aging of a person depends upon changes in the physical/social environment. Behavior develops only as the individual’s environment develops. 

• Development: “Progressive changes in interactions between the behavior of individuals and the events in their environment” 

• Environment: “all stimuli that affect behavior at a given moment” 

3 areas that Skinner extended the science he pioneered to infant/child development 

1. Research: operant learning starts at birth. Behavior in infants are shown as conditionable, such as head-turning, smiling, imitation, attachment, etc. Babbling is a response to the environment, aka parents talking.  

2. Theory: Operant Theory has held its own since 1930s and has only improved. Behavior-analytic theory is based on Pavlovian and Operant Learning. Many standard topic areas in infant and child devel have been explained by this theory. Operant Methods/Principles teach what otherwise are considered to be behaviors only possible after certain cognitive structures and processes are present.  

3. Application: After discovered, operant learning quickly applied to education (Skinner cared most about), treatment, and care of children. Education problem: students not told at once if their work is right/wrong, and they all move at same pace regardless of preparation or ability. Treatment and care: be aware- rate of response. Gentle forms of punishment can be effective. Operant conditioning can be used to tackle societal problems involving children (Food Dudes & Good Behavior Game) 

Background 

John B Watson: Influenced behaviorism. Believed behaviorism should be sole subject matter. Argued against Freudian emphasis on the unconscious.  

BF Skinner’s reinforcement and operant conditioning further developed behaviorism. Behavioral analysis includes reinforcement, punishment, extinction, stimulus control. Systemic desensitization- pair response that’s incompatible w/ anxiety w/ an anxiety provoking stimulus  

Developmental Perspective 

Born with blank slate, learn to associate stimuli and responses. Behavior is maintained by external events/cues and reinforcers, or internal processes (cognition). Focus on present events & how they affect behavior, rather than on childhood events. 

Major Constructs 

Key constructs = 3 parts of treatment, Treatment target, approach, and evaluation. Lists both cognitive interventions, behavioral interventions, as well as overlap of cognitive-behavioral interventions. See table 9.1 on page 231 for details.  

Abnormal behavior is learned/developed the same way that normal behavior is, and CBT can be applied to change this behavior. Focus on learning as the way behavior is acquired. To understand behavior, must know events that precede & follow (consequences) it. While using techniques, must also incorporate warm/supportive therapeutic environment  

Applications 

Cognitive-Behavioral interventions: directive, structured, goal-directed, and time limited. Use hw assignments & skills practice, focus on problem solving ability. Aware of diversity when apply CBT.  

5 components of CBT case formulation: problem list, diagnosis, working hypothesis (most critical), strengths and assets, and treatment plan.  

Self-Efficacy: used as a pathway to explain how people change. 4 mechanisms: inactive attainments (specific to an individual's own experience), vicarious experiences, verbal persuasion, and recognition of physiological states (emotional arousal)  

Behavioral Interventions: focus on changing specific behaviors. Ex: reinforcement, extinction, shaping, stimulus control, and aversive control (e.g. punishment) 

Cognitive Interventions: focus on role of cognitions in lives of clients. Ex. of cog distortions: all-or-nothing thinking, disqualifying the positive, and catastrophizing. Use positive self-statements and thought stopping to change mindset.  

Third-Wave Behavior Therapy: seeks to understand and accept intrusive thoughts and their content through mindfulness as the fundamental concept to facilitate change. Includes- Dialectical  Behavior Therapy (DBT), Acceptance and commitment therapy, Mindfulness-based cognitive therapy, and behavioral activation. 

Albert Ellis/Background

Grandfather of CBT and founder of REBT. Known as the second most influential psychotherapist next to Rogers. Had nephritis and was constantly hospitalized when younger. Use to be just Rational therapy, then rational emotive, now REBT to stress importance of thoughts feelings AND behaviors; REBT is a self-help approach. 

Human Nature- Developmental Perspective

Humans have biological tendency to think irrationally/dysfunctionally, and rationally/functionally. We self-sabotage our growth w/ irrational thoughts, but we can enhance our thoughts feelings actions, and are motivated to change things for the better 

3 Demandings- 1) self-demandingness (idea that one must perform well to win others approval, if not, can result in self-hatred/anxiety) 2) other-demandingness (others should treat us kindly. If not, they deserve punishment. Leads to rage and jealousy) 3) world-demandingness (conditions we live in must be enjoyable/safe, if not, it is awful/unbearable. Leads to depression/self-pity). 

Major Constructs 

REBT Goal: Develop a rational philosophy of life (increase happiness/decrease emotional distress) 

The theory drives the therapeutic process. Emphasize that irrational beliefs can be changed, but it is difficult and takes persistent practice. Two categories of psychological disturbance: 1) Ego Disturbance (when we make demands on selves, others, and the world. If not met, put themselves down) 2) Discomfort Disturbance (low frustration tolerance, an “I can’t stand it” attitude) 

7 Principles of REBT

1- Cognition is the most significant of human emotions. 2- irrational thinking causes emotional distress. 3- to change disturbed emotions, we must change the way one thinks.  4- irrational beliefs are the biggest contributor to irrational thinking. 5- two types of emotion. Helpful, functional, healthy, adaptive Vs. Unhelpful, dysfunctional, unhealthy, maladaptive 6- REBT focuses on present (not past) influences on emotion 7- irrational can become rational beliefs 

Applications  

Help clients change core irrational beliefs at a philosophic level than their automatic thoughts.  

1) acknowledge the problem. 2) identify meta-emotional problems (secondary problems about primary problems). 3) identify irrational beliefs/get why they are irrational. 4) understand why rational beliefs are helpful. 5) challenge irrational beliefs/replace them. 6) keep working on tendencies to think this way 

The A-B-C Model

When attempting to fulfill goals, we encounter an Activating event (A) that helps or blocks them, can be pos or neg. When we seek therapy, we believe that this activating event has caused negative emotional/behavioral Consequences (C). According to REBT, it's not C that causes A, but is Beliefs (B) people hold about these activating events. The next step is Disputation (D) 

To maintain change from A-B-C model, therapists provide homework, role play, visual aids, etc. Cognitive, Emotive, AND Behavioral interventions = huge part of REBT.  

Recap: Through Linehan’s time w/ Stacy, she uses several DBT techniques when talking to Stacy about self-harm behavior and suicidal ideation. Marsha worked on how to regulate her emotions and coping skills she can use. Stacy’s life had many moving parts (lack of stability, employment, and relationships), so it was intriguing to hear Marsha guide through the therapeutic process.  

Ch. 12 – Reality Therapy/Choice Theory 

Reality Therapy: helps people control their lives/fulfill their needs. Goals: Process goals and outcome goals, leading to more satisfying relationships, happiness, & inner control. Our needs, & therefore behaviors, differ based on age & culture.  

Choice Theory: the theoretical basis for reality therapy. Emphasize motivation for human choices & changes. Use the WDEP system. W= help client explore wants. D= client describes behavioral direction in their life. E= help clients w/ self-evaluation with questions. P= help clients w/ action plans (SAMI2C3) 

William Glasser: Originator of Reality Therapy. People are responsible for own behavior. Cannot blame the past/outside forces and at same time achieve high degree of mental health. This theory = controversial 

Major Constructs 

Glasser’s choice theory: 1) humans born with 5 needs. Belonging, power, fun, freedom, and survival. 2) difference between what we want and what we perceive we are getting is immediate source of behaviors. 3) all human behavior composed of doing (actions), thinking, feeling. 

Goals of Reality Therapy and Choice Theory 

Goal: help client make positive choices (help them see that better choices exist). Helping client to change their actions is more efficacious than having them change their thoughts.  

Figure 12.1: Cycle of Counseling: environment and procedures used to facilitate change 

Intervention Strategies 

Positive environment, non-judgment, do the unexpected, humor, be yourself, listen for metaphors/themes, summarize & focus, allow consequences & silence, be ethical, create suspense, establish boundaries. 

Ch. 16 – Constructivist Theories: Narrative Therapies(Sidebar 16.3-Construct as umbrella concept) 

Social Constructivism: Social interpretation of reality. Clients choose reality that fits their needs.  

Narrative Counseling: Roots in family therapy and postmodernism. Created by Michael White and David Epson. Purpose = interpret and alter stories people create to make sense of their lives. Also interpreted through 2 concepts- 1) people view world based on own experiences 2) people compare or identify lives from others experiences They are experts on their own lives, not the therapist. 

Narrative Coherence: connections stemming from individuals’ reactions w/ themselves or their environment. Two forms- Thematic (developing themes that underlie events/behaviors) & autobiographical (expectation of how life is experienced by others) Identification Stabilization: how people relate stories is connected to where they see themselves in the story 

Narrative Career Counseling: 2 approaches- systems theory (role of environmental influences one a person) & theory of career construction (role of subjectivity in identity formation) 

Interventions

externalize the problem – Essays, folktales/Cuentos, proverbs/dichos, testifying 

Feminist Theory: stems from feminist movement in 1960s. Theory includes an appeal for social justice and advocacy for social change. Today, it includes psych of woman, research on woman’s devel, CBT techniques, multicultural awareness, and social activism. 

Background 

As feminist movement grew, woman formed groups to raise awareness on their lack of voice. Feminist counseling came from these self-help groups in 1970s. No specific founder 

Radical feminists communicated goals, including a) encourage financial independence b) viewing woman’s problems as influenced by external factors c) suggest client becomes involved in social action. Liberal Feminists view counseling as a process of gaining self-understanding. See necessity for flexibility in helping the client solve problems. The current tone of this theory is more moderate. 

Not all feminists believed in feminist counseling. Felt woman were used to please the therapist. So, group settings became best form of feminist therapy so there was an equal dynamic between client-counselor. 

Mainstreaming era: 1980s. Took traditional theories and only used the parts of the approaches that promoted a dichotomous view of men and woman 

Womanists: term preferred by feminists of color. Consider sexism, classism, and racism 

Developmental Perspective 

Focus on gender roles and how woman have a stronger concern for connectedness. Self-In-Relation theory focuses on the mother-daughter relationship which confirms female values. 

Major Constructs 

Core Principles: Counselors are- aware person is political, have commitment to social change, establish egalitarian relationships, honor women’s voices & ways of knowing, recognize types of oppression  

Applications 

Many who practice this theory practice it in conjunction with one or more others. Goals are to: promote change, inde/inter pendence, equality, self-nurturance, empowerment & diversity. Feminist theory emphasizes external factors as root of problem, so goal is to change these factors, not just adjust to them.  

Chapter 16: Constructivist Theories (Solution-Focused) 

Solution Focused Counseling: Focus on 2 conditions- counselor is fully engaged, and client is motivated toward key variances. Encourages client to look past present problem and focus on how reality will look once problem is solved. Work through client perspectives, not thoughts/behaviors. Avoid dwelling on past 

Major Constructs 

Client systems (family, social, etc.) will influence how they deal with issues, and prevent them from identifying clear solutions. Don’t dwell on past, focus on solutions to present so the future can look different/more beneficial. Short-term therapy striving for autonomy. Goal is to change something.  

Change Process - Clients are seen as agents of their own change, role of counselors is facilitator. Creating shared and collaborative meanings is a huge part of change. 

Interventions

The most common are the Miracle Question, exception seeking, scaling, & problem free talk