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1 Lec1:WhatisCounselling?..................................................................................................................................................51.1 Whydopeoplegotocounselling?.......................................................................................................................51.2 Definitionofcounselling.....................................................................................................................................51.3 PACFA–fromdefinitiontodescription...............................................................................................................51.4 Thethreecomponents........................................................................................................................................51.5 WhatisCounselling?...........................................................................................................................................6
1.5.1 Counsellingis….......................................................................................................................................................61.5.2 HistoryofCounselling..............................................................................................................................................61.5.3 Counsellingworks....................................................................................................................................................61.5.4 Whatweusedtothink….........................................................................................................................................61.5.5 Whatwenowknow….............................................................................................................................................61.5.6 WhatWorksinTherapy...........................................................................................................................................71.5.7 Whatisanoutcome?...............................................................................................................................................7
1.5.7.1 Factorsthatcontributetoapositiveoutcome.................................................................................................................71.5.7.2 ReasonspeoplegiveforNOTattendingcounselling….....................................................................................................8
1.6 GoalsoftheUnit.................................................................................................................................................81.7 Readings.............................................................................................................................................................8
2 Lec2:CounsellingMicroskills–basic...................................................................................................................................92.1 HOWdoyoucounsel?.........................................................................................................................................92.2 Atypicalcommunication.....................................................................................................................................92.3 ReflectiveCommunicationis...............................................................................................................................9
2.3.1 ActiveListening........................................................................................................................................................92.3.2 MicroSkills:thebuildingblocksofActiveListening.Basicskills(forthepurposeofthisunit)..............................9
2.4 ListeningVariables..............................................................................................................................................92.4.1 PhysiologicalInfluencers.........................................................................................................................................92.4.2 PsychologicalInfluencers.......................................................................................................................................102.4.3 ContextualInfluencers...........................................................................................................................................10
2.5 Attending..........................................................................................................................................................102.6 Observing.........................................................................................................................................................102.7 MinimalResponses...........................................................................................................................................112.8 Paraphrasing:reflectingcontent......................................................................................................................112.9 ReflectingFeeling..............................................................................................................................................112.10 ReflectingFeelingandContent..........................................................................................................................112.11 Questions.........................................................................................................................................................12
2.11.1 TypesofQuestions............................................................................................................................................122.11.2 Summarising......................................................................................................................................................12
2.12 Responsestoavoid...........................................................................................................................................132.13 ReadingsGerald_chapter5-8............................................................................................................................13
3 Lec3:AdvancedMicroSkills................................................................................................................................................143.1 AdvancedSkills.................................................................................................................................................143.2 AdvancedMicroSkills.......................................................................................................................................14
3.2.1 Normalising............................................................................................................................................................143.2.1.1 Examples.........................................................................................................................................................................14
3.2.2 Reframing..............................................................................................................................................................143.2.2.1 example...........................................................................................................................................................................15
3.2.3 Challenging............................................................................................................................................................153.2.3.1 WhentoChallenge?........................................................................................................................................................163.2.3.2 Howtochallenge….........................................................................................................................................................16
3.2.4 ExploringOptions..................................................................................................................................................163.2.4.1 GeneratingOptions.........................................................................................................................................................16
3.2.5 Thesignificanceof‘Choice’...................................................................................................................................173.2.6 TherapistSelf-Disclosure.......................................................................................................................................17
3.2.6.1 HistoricalcontextandTherapeuticOrientation.............................................................................................................173.2.6.2 IntentionalSelf-Disclosure..............................................................................................................................................173.2.6.3 Usefulforcertaincohorts...............................................................................................................................................183.2.6.4 Questionstoaskyourself-…............................................................................................................................................18
3.3 Readings...........................................................................................................................................................18
4 Lec4:GOALING/GOAL-SETTINGINCOUNSELLING...............................................................................................................19
4.1 THEPURPOSEOFGOALSETTING…....................................................................................................................194.2 TWOASPECTSTOGOALSETTING…....................................................................................................................194.3 FUNCTIONSOFCOUNSELLINGGOALS….............................................................................................................194.4 WHATSHOULDANEFFECTIVEGOALINVOLVE?.................................................................................................19
4.4.1 EXAMPLESOFOUTCOMEGOAL(EGAN,2010)......................................................................................................194.4.2 MOVINGFROMAGOODINTENTIONTOASPECIFICGOAL(EGAN,2010).............................................................204.4.3 REALISTICANDCONGRUENTGOALS.....................................................................................................................204.4.4 SUBSTANTIVEANDCHALLENGINGGOALS.............................................................................................................204.4.5 NEGOTIATINGATIMEFRAME...............................................................................................................................204.4.6 FLEXIBILITYANDEVALUATION...............................................................................................................................204.4.7 THEFIRSTSTEP......................................................................................................................................................20
4.5 THESHADOWSIDEOFGOALSETTING(EGAN)...................................................................................................204.6 SKILLSASSOCIATEDWITHGOALSETTING..........................................................................................................214.7 Acommonconcept...........................................................................................................................................224.8 ADDITIONALTIPS(ARINANIKITINA)..................................................................................................................224.9 GOALSETTINGINDIFFERENTCONTEXTS...........................................................................................................234.10 THERAPEUTICMODELSANDGOAL-SETTING......................................................................................................23
5 Lec5:RationalEmotiveBehaviourTherapyandCognitiveTherapy.....................................................................................245.1 AlbertEllis(1913-2007).....................................................................................................................................245.2 Self-experimentation........................................................................................................................................245.3 REBTPhilosophy...............................................................................................................................................24
5.3.1 TheA-B-CTheory(Irrationalbeliefs).....................................................................................................................245.3.2 TheA-B-Csofdisputingirrationalbeliefs..............................................................................................................255.3.3 IrrationalBeliefs[Ellis,1975].................................................................................................................................255.3.4 TheoryofrestructuringIrrationalBeliefs..............................................................................................................265.3.5 TheTherapeuticProcess........................................................................................................................................265.3.6 TherapeuticTechniques........................................................................................................................................265.3.7 CognitiveTechniques.............................................................................................................................................265.3.8 EmotiveTechniques..............................................................................................................................................265.3.9 BehaviouralTechniques.........................................................................................................................................275.3.10 TheTherapeuticRelationship............................................................................................................................27
5.4 CognitiveTherapyAaronBeck(1921-stillalive).................................................................................................275.4.1 BasicPhilosophy....................................................................................................................................................275.4.2 CognitiveDistortions(AaronBeck)........................................................................................................................285.4.3 TherapeuticRelationship.......................................................................................................................................295.4.4 TherapeuticProcess..............................................................................................................................................295.4.5 SocraticDialogue...................................................................................................................................................295.4.6 TherapeuticTechniques........................................................................................................................................30
5.5 REBTVSCBT......................................................................................................................................................305.6 FeelingGood.....................................................................................................................................................30
6 Lec6:PsychodynamicTheory..............................................................................................................................................326.1 PsychoanalyticPsychodynamicTheory..............................................................................................................326.2 SigmundFreud(1856-1939)..............................................................................................................................326.3 ModelofPersonality.........................................................................................................................................326.4 ThePsychicEntities...........................................................................................................................................336.5 Centralconstructs.............................................................................................................................................336.6 ConsciousandUnconscious...............................................................................................................................336.7 Anxiety.............................................................................................................................................................33
6.7.1 Egodefensemechanisms......................................................................................................................................346.7.2 EgoDefenseMechanisms......................................................................................................................................34
6.8 PsychosexualDevelopment...............................................................................................................................356.8.1 PsychosexualStages..............................................................................................................................................36
6.9 Therapeutictechniques.....................................................................................................................................366.9.1 GoalsofTherapy....................................................................................................................................................36
6.10 ProcessofPsychodynamicTherapy...................................................................................................................376.11 Videoclip..........................................................................................................................................................37
6.11.1 Questionstovideo............................................................................................................................................376.12 TutorialWeek7................................................................................................................................................38
6.12.1 Secondtriangle..................................................................................................................................................38
6.12.2 PsychosexualStages..........................................................................................................................................386.12.3 Anxiety/defencemechanism.............................................................................................................................38
7 Lec7:PersonCenteredTherapy..........................................................................................................................................397.1 CarlRogers[1902-1987]Backgroundandstudies..............................................................................................397.2 AcademicandProfessionalpath.......................................................................................................................397.3 Humanisticpsychology.....................................................................................................................................397.4 MajorEmphasesinRogeriantherapy................................................................................................................39
7.4.1 CentralConstructs.................................................................................................................................................397.4.2 TheTherapeuticProcess.......................................................................................................................................40
7.4.2.1 Empathy..........................................................................................................................................................................407.4.2.2 Unconditionalpositiveregard.......................................................................................................................................407.4.2.3 Genuineness/Congruence............................................................................................................................................41
7.5 TherapeuticGoals.............................................................................................................................................417.6 Maslow’shierarchyofneeds.............................................................................................................................41
7.6.1 Self-Actualisation...................................................................................................................................................417.6.2 Self-Actualisation-towardsgreatercongruency..................................................................................................41
7.7 MotivationalInterviewing.................................................................................................................................417.7.1 BasicPrinciplesofMI............................................................................................................................................427.7.2 TheProcessofChangeinCounselling...........................................................................................................427.7.3 WiderimpactofPCconcepts................................................................................................................................42
7.8 Questionstovideoclip......................................................................................................................................427.9 Tutorial.............................................................................................................................................................42
8 Lec8:ExistentialTherapy....................................................................................................................................................448.1 BasicPhilosophy...............................................................................................................................................448.2 FundamentalConcepts(ExistentialDimensions)...............................................................................................448.3 ExistentialDimensions......................................................................................................................................45
8.3.1 SearchforMeaninginexistence...........................................................................................................................458.3.2 Anxiety...................................................................................................................................................................458.3.3 Self-Awareness......................................................................................................................................................458.3.4 SearchofIdentity..................................................................................................................................................468.3.5 Finiteness...............................................................................................................................................................46
8.4 TheTherapeuticProcess...................................................................................................................................468.5 TherapeuticTechniques....................................................................................................................................468.6 TherapeuticElements.......................................................................................................................................478.7 GoalsofExistentialTherapy..............................................................................................................................478.8 VideoClipQuestions.........................................................................................................................................478.9 Tutorial.............................................................................................................................................................48
9 Lec9:SolutionFocusedTherapy.........................................................................................................................................499.1 ConstructionistTherapies.................................................................................................................................49
9.1.1 ViewofHumanNature..........................................................................................................................................499.1.2 KeyAssumptionsofCT..........................................................................................................................................49
9.2 AlternativeTitles...............................................................................................................................................499.2.1 DevelopmentofSFT..............................................................................................................................................499.2.2 FundamentalPrinciples.........................................................................................................................................499.2.3 BasicAssumptions.................................................................................................................................................50
9.2.3.1 Tutorialvideos................................................................................................................................................................509.2.4 TherapeuticRelationship.......................................................................................................................................51
9.2.4.1 Threekindsofrelationships............................................................................................................................................519.2.5 Goaling...................................................................................................................................................................519.2.6 BuildingBlocksofSFT............................................................................................................................................529.2.7 SFTProcess............................................................................................................................................................529.2.8 thedifferences.......................................................................................................................................................539.2.9 Contradictions.......................................................................................................................................................549.2.10 Evidence............................................................................................................................................................54
9.3 KeyConceptsinNarrativeTherapy...................................................................................................................549.3.1 TheTherapeuticProcessinNarrativeTherapy......................................................................................................549.3.2 TherapeuticGoals..................................................................................................................................................549.3.3 NarrativeTherapist’sFunctionandRole...............................................................................................................559.3.4 TherapeuticRelationship.......................................................................................................................................55
9.3.5 TherapeuticTechniques........................................................................................................................................559.4 Tutorial.............................................................................................................................................................55
9.4.1 Video......................................................................................................................................................................56
10 Lec10:Systemictherapy.....................................................................................................................................................5710.1 FAMILYSYSTEMS..............................................................................................................................................5710.2 BASICASSUMPTIONS........................................................................................................................................5710.3 CIRCULARCAUSALITY........................................................................................................................................5710.4 HISTORY............................................................................................................................................................57
10.4.1 MULTIGENERATIONALFTMURRAYBOWEN1913-1990...................................................................................5810.5 CENTRALCONSTRUCTS.....................................................................................................................................58
10.5.1 HOWDIFFERENTIATEDAREYOUFROMYOURFAMILYOFORIGIN?.................................................................5910.6 THERAPEUTICPROCESS.....................................................................................................................................5910.7 HUMANVALIDATIONPROCESSMODELVIRGINIASATIR1916-1988..................................................................60
10.7.1 CENTRALCONSTRUCTS.....................................................................................................................................6010.7.2 CommunicationStyles.......................................................................................................................................6110.7.3 FAMILYROLES...................................................................................................................................................6110.7.4 FAMILYRULES...................................................................................................................................................6110.7.5 THERAPEUTICPROCESS.....................................................................................................................................6110.7.6 THERAPEUTICTECHNIQUES..............................................................................................................................62
10.8 STRUCTURALFAMILYTHERAPYSALVADORMINUCHIN1960-............................................................................6310.8.1 STRUCTURALCONCEPTOFTHEFAMILY............................................................................................................6310.8.2 STRUCTURALCOMPONENTS.............................................................................................................................6310.8.3 THERAPEUTICPROCESS.....................................................................................................................................63
10.9 Howdoyourateyoufamilyoforigin/procreationonthesetwoscales?...........................................................6310.10 Tutorial.........................................................................................................................................................65
11 Lec11:BehaviourTherapy..................................................................................................................................................6711.1 Behaviourtherapy(BT).....................................................................................................................................6711.2 TheStimulus-ResponseLaw..............................................................................................................................6711.3 ContemporaryBehaviouralTherapy(basedonLearningTheory)......................................................................68
11.3.1 KeyConcepts.....................................................................................................................................................6811.3.2 UseofClassicalConditioning.............................................................................................................................69
11.4 Operantconditioning........................................................................................................................................7011.4.1 UseofOperantConditioningreinforcement.....................................................................................................7011.4.2 SocialLearning...................................................................................................................................................70
11.5 Self-ManagementPrograms..............................................................................................................................7111.6 Behavioural(FunctionalAnalysis).....................................................................................................................7111.7 GoalinginBehaviouralTherapy........................................................................................................................7111.8 TherapeuticTechniques....................................................................................................................................7211.9 ContemporaryBehaviouralTherapies...............................................................................................................7211.10 Tutorial.........................................................................................................................................................73
11.10.1 Justabouteverythingweareislearnt,exceptthree........................................................................................7311.10.2 Video.................................................................................................................................................................7311.10.3 Druguser...........................................................................................................................................................73
12 Exam...................................................................................................................................................................................74
1 Lec1:WhatisCounselling?1.1 Whydopeoplegoto
counselling?Tovent
1.2 Definitionofcounselling
Counsellingistheskilledandprincipleduseofarelationshiptofacilitateself-knowledge,emotionalacceptanceandgrowth,andtheoptimaldevelopmentofpersonalresources.Theoverallaimistoprovideanopportunitytoworktowardslivingmoresatisfyinglyandresourcefully.Counsellingrelationshipswillvaryaccordingtoneed,butmaybeconcernedwithdevelopmentalissues,addressingandresolvingspecificproblems,makingdecisions,copingwithcrisis,developingpersonalinsightsandknowledge,workingthroughfeelingsofinnerconflictorimprovingrelationshipswithothers.Thecounsellor’sroleistofacilitatetheclient’sworkinwaysthatrespecttheclient’svalues,personalresourcesandcapacityforself-determination(BAC1989)Aprincipledrelationshipcharacterizedbytheapplicationofoneormorepsychologicaltheoriesandarecognizedsetofcommunicationskills,modifiedbyexperience,intuitionandotherinterpersonalfactors,toclient’sintimateconcerns,problemsandaspirations.Itspredominantethosisoneoffacilitationratherthanofadvice-givingorcoercion.Itmaybeofverybrieforlongduration,takeplaceinanorganizationalorprivatepracticesettingandmayormaynotoverlapwithpractical,medicalandothermattersofpersonalwelfare.Itisbothadistinctiveactivityundertakenbypeopleagreeingtooccupytheroleofcounsellorandclient…anditisanemergingprofession…Itisaservicesoughtbypeopleindistressorinsomedegreeofconfusionwhowishtodiscussandresolvetheseinarelationshipwhichismoredisciplinedandconfidentialthanfriendship,andperhapslessstigmatizingthanhelpingrelationshipsofferedintraditionalmedicalorpsychiatricsettings(FelthamandDryden1993)Counsellorsarenottheretotellclientswhattodo,itisforthemtofigureoutwhattodointheirowntime/pace.
1.3 PACFA–fromdefinitiontodescription
PsychotherapyandCounsellingareprofessionalactivitiesthatutiliseaninterpersonalrelationshiptoenablepeopletodevelopunderstandingaboutthemselvesandtomakechangesintheirlives.ProfessionalPsychotherapistsandCounsellorsworkwithinaclearlycontracted,principledrelationshipthatenablesindividualstoobtainassistanceinexploringandresolvingissuesofaninterpersonal,intrapsychic,orpersonalnature.PACFA:PsychotherapyandCounsellingFederationAustralia
1.4 Thethreecomponents
´ ReflectiveCommunication:theacquisitionofarangeofmicroskills,bothbasicandadvanced,thatpromotesclientself-reflectionandautonomousthinking
´ TheoriesofHumanBehaviour:thatseektoexplainhowhumansthink,feelandactandtheconsequencesofsuchbehavioursforthemselves,othersandsociety
´ TherapeuticRelationship:thebuildingofauniquenon-judgmentalrelationshipbetweenclientandcounsellorbasedontrust,respectandempathy
CounsellingReflective
Communication
TheoriesofHumanBehaviour
TherapeuticRelationship
1.5 WhatisCounselling? ´ Helping:oftendonebyrelatives,friends,supportworkers,humanservicepersonnel;oftenspontaneously.Involvesadvising,caring,problemsolving,teaching
´ Counselling:aprofessionalactivitythatusesareflectivestyleofcommunication,withinaninterpersonalrelationshiptohelpindividualsdevelopself-awarenessandmakechangesintheirlives
´ Psychotherapy:anindepthandintensiveprocesswhichinvolvestherestructuringofthepersonality
1.5.1 Counsellingis….. ´ aprocess
´ aself-helpprocess´ empoweringandliberating´ arelationship´ presentfocused´ forchange´ actionoriented(notrealactionassuch,butjustbeinginacertainway)´ realitybased´ interactional´ aboutproblembehaviournotproblempeople
1.5.2 HistoryofCounselling ´ Counsellingemergedinthelate1800sandearly1900s
´ EventsincludingWWI,WWIIandtheGreatDepressioninfluencedtheevolutionofcounsellingthroughouttheearly20thcentury.
´ The1950ssawaprofoundchangeincounsellingwiththeestablishmentofassociationsincludingtheAmericanPersonnelandGuidanceAssociationandtheSocietyofCounsellingPsychology,alongwiththenewguidanceandcounsellingtheories(suchasbehaviouraltheoriesandcognitivetheories).
´ Counsellingasadistinctprofessionincreasedsteadilyfromthe1960s.´ Throughoutthe1980s,counsellingdiversifiedandcounsellorsbegantobeemployedin
significantnumbersinschools.´ Currenttrends
´ 400-500different‘theories’´ practicedinavarietyofsettings´ variousmodesofdelivery´ stepstowardsregulationinthelast20years(moreonthislaterinthesemester)
https://prezi.com/lpdsqf1h6n75/trinity540-counseling-history-timeline/
• Hippocrateso Developed1stcounsellingtechniquesandinterventionso Introducedtheconceptofprognosis
§ Thinkingaboutwhattheoutcomemightbe• DorotheaDix
o StartedSocialreformof1880sinUSsystemo Bekindtopeoplewhoaresuffering
• Moderndaycounselling:earlybeginningsinvocationsandtestingo Gettingtoknowtheperson
1.5.3 Counsellingworks ´ counsellingalwaysworksmuchbetterthannocounselling
´ someclientsrecoverfasterthanothers´ allapproachesachieveequivalentresultsforgenerallifeissues´ counsellingcanmakeaminorityofclientsworse
1.5.4 Whatweusedto
think…• Thattheefficiencyofaparticularapproachtotherapyisduetotheuniqueaspectsofthat
therapy• Psychoanalytic–interpretation• CBT–Modificationofcognitions• EMDR–Eyemovement• Narrativetherapy–externalisation• Gestalt–Emptychair
1.5.5 Whatwenow • Thecurativepropertiesofagivenpsychotherapylienotinitsuniquecomponentsbutin
Counselling
Psycho-therapyHelping
know… commoncomponentssharedbyalltherapies.• FrankandFrank(1991–PersuasionandHealing)identifiedfoureffectivecharacteristics
(sharedbyalltherapies)• Anemotionallycharged,confidingrelationshipwithahelpingperson• Ahealingsetting
• E.g.bedroomisnotone• Arationale,conceptualschemeormyththatprovidesaplausibleexplanationfor
thepatient’ssymptomsandprescribesaritualorprocedureforresolvingthem• Aritualorprocedurethatrequirestheactiveparticipationofbothpatientand
therapistthatisbelievedbybothtobethemeansofrestoringthepatient’shealth.(pp42,43)
• Lambertassignedpercentagestocommonfactors…
1.5.6 WhatWorksinTherapy
client,extra-therapeutic:• Client’sintelligent,opennesstochangeplacebo,hopeandexpectancy• justbygoingtocounsellingwillhelpyoufeelbetter
1.5.7 Whatisanoutcome? ´ ResolutionoftheoriginalproblemØ newunderstandingorperspectiveontheproblemØ acceptanceoftheproblemØ takingactiontochangeproblemsituation
´ LearningØ newunderstanding,skillsandstrategiestobetterhandlesimilarproblemsinthe
future´ Interpersonalimpact
Ø betterequippedtocontributetohealthyrelationshipsandwell-beingofothers
1.5.7.1 Factorsthatcontributetoa
1. Support–providingreassurance,empathy,trustandcarthasis(releaseofemotions,notjustaboutventing,butcryingetc).
positiveoutcome 2. Facilitationoflearningwhichincludescognitivelearning,payingattentiontofeelingsandfeedback(fromothers)
• Knowledgetypeoflearning3. Action,includingbehaviourregulation,cognitivemastery,realitytesting,andpractising
newbehaviours(LambertandBergin,1994).4. Reflectivepractice,supportedbysupervision,afocusonchangeprocesses,and
awarenessofthesocialandculturalcontextsofindividualproblemsarealsoimportant(Boswelletal.,2010).
• Engageinself-reflectionØ WhatdidIsay/dothatstrengthen/weakentherelationship
• Continuesprofessionalsupervisionthroughoutcareer5. Beingempathic…https://www.youtube.com/watch?v=5O11_Ma20Rk
• Notproblemsolve,evenifyouthinkyouknowtheanswer
1.5.7.2 ReasonspeoplegiveforNOTattendingcounselling…
1. Havingcounsellingisasignofweakness2. Counsellingisforcrazypeople–I’mnotcrazy3. PeoplewillendupfindingoutI’mhavingcounselling4. Iwouldn’tknowwhattosay/talkabout5. Icanjusttalktomyfriends6. Idon’tknowhow“justtalking”toacompletestrangercouldhelp7. I’dfeellikeIwasbetrayingmyfamily/friend/partner8. Talkingaboutmyproblemswilljustmakeitworse–it’llopenacanofworms9. Whatifmyprofessionalindemnityinsurerfindsout?
Stigmasingettinghelpinemotionalproblems
1.6 GoalsoftheUnit • enhancedself-awareness• insightintoyourdevelopmentalhistory• developingself-monitoringskills• matureunderstandingofhumanbehaviour• moreskilledasahelper• helpdiscoveryofyourpotential• beingagoodadvocateforthecounsellingprofession• assistinthechoiceofacareerpathincounselling
1.7 ReadingsChapter1:WhatisCounselling;Chapter2:TheCounsellingRelationship-Geldard,David,Geldard,Kathryn
• Geldard,D&K.BasicPersonalCounselling,Part1• McLeod,J.AnIntroductiontoCounselling,Chapter1
2 Lec2:CounsellingMicroskills–basic2.1 HOWdoyoucounsel? u It’saboutjoiningwithaclientandcommunicatingeffectivelywithintheparametersof
facilitatingashiftorchange.u Specificcommunicationtoolsareusedtoassistthecounsellorinunderstandingwhatthe
clientisREALLYsaying.u TheunderlyingprincipleshouldalwaysbeoneofBeneficence–“First,donoharm”.Isthe
tool/strategy/microskilltherightoneforthisclient,atthistime,inthesecircumstances.
2.2 Atypicalcommunication
Notpartofeverydaycommunication:hastobelearntthrough:
u readingappropriatetextsu modelingbycompetentcounsellorsu videotapeddemonstrationsu observingreallifecounsellingsessionsu intensivepractice
2.3 Reflective
Communicationisa) Tuningintotheclient’sagenda,gettingontheclient’swavelength,perceivingthe
experiencefromwithinhis/her‘frameofreference’b) Reflectingthatexperiencebacktotheclient;holdingitupinamannerthattheclient
beginstogetaclearer,sharperpictureofhis/herexperience/thought(s)/feelingsItistherefore….
u activelisteningu clientcenteredu exploratoryu Non(overtly)evaluative/non-judgmentalu Non-directiveu empathic
2.3.1 ActiveListening u Notjusthearing
u Notpolitesilenceu Listeningwithyoureyesu Enteringtheclient’s‘frameofreference’u Communicatingtotheclientsthatyouarefullypresentu Requiresarangeofspecificcommunicationskills.Micro-skillsare“individualskillsthat
canbelearntwhichgreatlyenhancethequalityandeffectivenessofthecounsellingrelationship”.
https://www.youtube.com/watch?v=OS0Tg0IjCp4
2.3.2 MicroSkills:thebuildingblocksofActiveListening.Basicskills(forthepurposeofthisunit)
Non-Verbalu attendingu observing
Verbal
u minimalresponses(verbalandnon-verbal)u paraphrasing–reflectingcontentu reflectingfeelingsu reflectingfeelingandcontentu effectivequestioningu summarising
2.4 ListeningVariables 2.4.1 Physiological
Influencersu Sensoryacuity,especiallyauditoryandvisual,isbasictolistening.Age-related
deteriorationofsensorymechanismscanleadtolossofboththeverbalcontentandthenonverbaldimensionsofthecommunication.
u Agealsoisanimportantlisteningvariable.Children,adolescents,youngadults,olderadults,andeldersreportdifferentlisteningneeds,differentlisteninggoals,anddifferentlisteningstrategiesastheyaccountforlisteningexpectationsandforlisteningexperiencesalike.
o Dependsonwhatyourneedsareiswhatyouwillhear(selectivehearing)
u Gender:Brainimagingresearch(Phillips,Lowe,Lurito,Dzemidzic,&Mathews,2001)demonstratethatmenandwomenhavedifferentattentionstylesandcognitiveprocessingstylestothecommunicativeinteraction.
u Menandwomen“learntolistenfordifferentpurposesandhavedifferentlisteninggoals.Theprimarycontrastappearsintaskversusinterpersonalunderstanding:Malestendtohearfacts,whilefemalesaremoreawareofthemoodofthecommunication”(Booth-Butterfield,1984,p.39).
2.4.2 Psychological
Influencers
u Attitudinalstate:Apositivelisteningattitude,alongwithlisteningknowledge,isacriticalingredientofeffectivelistening.Beinterested!
u Beingopentohearingdifferingpointsofviewandtospeakerswhosestylesarenotnecessarilyattractiveorengaging.
o Somepeople’sstylecanbeloudandharsh,andifcounsellorsletthisaffecttheirfeeling,thentheywillnotbeabletohearexactlywhatthesepeoplearesaying
u Positivelisteningattitudesarenotoftencommunicated:“You'renotlistening.”“Youneverlistentome.”“Bequietandlisten.”Wehearthesecommentsmoreoftenthan:“Thanksforlistening”or“You'reagoodlistener.”
u Communicationapprehension:“thefearofmisinterpreting,inadequatelyprocessing,and/ornotbeingabletoadjustpsychologicallytomessagessentbyothers”.Listeninganxietystemmingfromstressfulsituationscanleadtodistortedmessagesandmisunderstandings.
o E.g.notrememberingwhatyousaidandhearafterajobinterviewu RobertsandVinson(1998)determinedthattheimportanceofthetopicisthecrucial
factorinestablishingalistener'swillingnesstolisten.u Listeningpreferences.Listenerschoosedifferentwaystolisten:
o (1)apeople-orientedstyle,whichfocusesontheemotionalandrelationalaspectsofacommunication;broadlyspeaking,womentendtohavethisstyle
o (2)acontent-orientedstyle,centredonprocessingcomplexinformation;o (3)anaction-orientedstyle,wherethelistenerprefersclear,efficient
information;o (4)atime-orientedstyle,wherethelistenerhasapreferenceforshort,limited
messages.o agoodtherapistshouldhavealltheseskills
2.4.3 Contextual
Influencersu Roles,culture,andtime.u Welistendifferentlyindifferentcontexts:familymembers,friends,students,workers,or
managers.u Culture.AnthropologistEdwardHall(Hall&Hall,1989)describedhowdifferentcultures
manageinformationindifferentways.o Low-contextcultures,suchastheUnitedStatesandAustralia,require
communicatorstogiveandreceiveaconsiderableamountofverbalinformation,o High-contextcultures,suchasJapanandSaudiArabia,requireslessextensive
verbalmessagesu Time.Peopledealwithinformationdifferentlyatdifferenttimesoftheday.Information
presentedintheafternoonmayberetainedlongerthanthatofferedinthemorning.(Wolvin,2009)
u Listenerscanlisten(andthink)aboutfourtimesfasterthanthenormalconversationrate.Thereisa“timegap”inthesystemforattentiontowanderandtolosefocus.
2.5 Attending u checkingcomfortlevel
o physicalcomfort,e.g.chair,water,temperature,tissuesu physicalattending–SOLER
o "Sitsquarely";"Openposture";"Leantowardstheother";"Eyecontact;"Relax"u conveyingavailabilityandpresence
o makingclientsfeellikeyouarelisteningtotheirmessagesu expressivenessu mirroringposture
o wehavemirrorneurons,soifweareconnectedwithsomeone,wewillnaturallymirrorwhatothersaredoing
u avoidstereotypicalcounsellormannerisms
2.6 Observing u bodylanguage
u verbal-nonverbalcongruenceo mismatchonwhatisbeingsaidandclient’saffect
u facialexpressionsu para-language
o clients’gesturemaychangewhenaparticulartopicistouchedu movementsu physicalattireu emotionalstateu energylevelu dyadicinteraction(couplecounselling)
2.7 MinimalResponses Byshowingsubtleactioncanencourageclientstokeeptalkingasyouareshowingthatyouare
payingattention.• Verbal–oneortwowords,aphrase,anutterance.eg,uhhuh,mmmm,yes,and,ok,…• Non-verbal–amovement,eg,anodoftheheadormovementofthearmsorhands
u confirmsactivelisteningu encouragesclienttokeeptalkingu emphasisessignificanceu establishesclarity
not:useminimalresponsestomake(wrong)assumption
u endorsingu agreeingu sympathising,consolingu pattingontheback
2.8 Paraphrasing:
reflectingcontentu isolatingthesalientcontentoftheclient’sresponseu reflectingthatbacktotheclientinaclear,moresuccinctmanneru mustbebrief,notanexpansionorarandomconvolutedsummaryofcontentu inaccurateparaphrases?
Notu parrotingu interpretingu labeling
o e.g.youareinthesunbecauseyouarefitu puttingnewideas/thoughtsintotheclient’shead
2.9 ReflectingFeeling u isolatingwhattheclientisexperiencingemotionally
u sensitivereflectingbacktotheclientthesefeeling/su identifyingbothexplicitandimplicitexpressionoffeelingu identifyingthelevelofintensityu facilitatingtheexpressionoffeelingsandprovidinga‘space’forcatharsisu watcharbitrarylabeling;givingclientsfeelingsu counsellorneedstodealwithhis/herfeelings
o whataretheappropriateandinappropriatefeelingsu contributesmosttobuildinganempathicrelationshipu it’simportanttopractice,e.g.
o whenIfeelangryIfeel…..e.g.itconsumesme/impulsive/outofcontrolo whenIfeelacceptedIfeel….E.g.valued
TIPforcounselling:• startlookingforandlearningaboutfeelingwords,e.g.
http://www.psychpage.com/learning/library/assess/feelings.html• Emotionallexicon:wordsassociatewithbasicemotions(anger,fear,anticipation,trust,
surprise,sadness,joy,anddisgust)andtwosentiments(negativeandpositive)
2.10 ReflectingFeelingandContent
u withexperienceitisoftenconvenienttolinkfeelingwithcontentinasingleresponseo Eg,you’refeelingbetrayed(feeling)becauseyoursisterwentbehindyourback
andspoketoyourhusbandaboutyourissues(information).u theresponsemustbeskillfullyintegrated;succinctandnotwordy
u reflectionoffeelingcanattimesbemorepowerful:helpsclientstaywiththeemotionalexperienceratherthanmovetoaheadlevel
o movefromheartleveltoheadlevel,whenclientstalksaboutthefeeling,counsellorsreplywiththecontent
u helpfulincheckingcongruencebetweenclient’sthoughtsandfeelingsu helpfulinmirroringtheintensityoftheclient’sexperience-cognitiveoremotional
2.11 Questions u gatheringrelevantinformation
u clarifyingclient’sthoughtsandfeelingsu heightenclientawarenessu usedsparingly
o toomanyquestionscanbeoff-putting,makeclientsfeltlikeinterrogationo thiscanbehardwithclientswhoarenottalkative,thereforeaskilltobe
comfortablewithsilenceisimportantu moreonthe‘open’(requiresresponsethatismorethanjustyes/no)endofthe
continuumthanonthe‘closed’u assistsclienttoopenup,disclosemore:tobemorespecificorbehaviourallyexplicitu helpwithgettingabetterunderstandingoftheclient’sexperienceu helptoaccessspecificandrelevantinformationu avoid‘why’questions;focuson‘what’,‘when’,‘where’,‘how’
o questionsstartwithwhyoftenhaveajudgementtone,e.g.whydidyouquitthejobbeforeanewone?
Notu intrusive;tosatisfycounsellor’scuriosity;gatherirrelevantinformation
o canbetemptingtowanttofindoutirrelevantinfobecauseyouareinterestedinpeople
u leading,directing,suggestingu interrogating
2.11.1 TypesofQuestions u transitional-establishingconnections,links;oftentoanearlierpartofthediscussion.Eg,
earlieryoumentioned***,I’mwonderinghowyouarefeelingaboutthatnow?o usedwhenyouarestuckandunsurewhattosay
u exploringchoice–Eg,inwhatotherwayscouldyourespondtothat?u circular–perspectiveoftheother.Eg,howdoyouimagineyourbrotherwouldfeelabout
***u scaling–trackingchangeEg,onascaleof1–10,howusefulwasthatstrategy?u goaling-establishingdirection.Eg,ifcouldimaginenotfeelingstressedatwork,what
wouldthefirstimprovementbe?u leading–pointstheprospectiveanswerinaparticulardirection
o e.g.forsomeonewantstoloseweighto Closeleadingquestion:haveyouthoughtaboutgettingupearlytogoforawalk?o Thisisaleadingquestionbecausecounselloristellingtheclientonwhattodo.
Close:yes/noo Ratherthanexplorethefeelingandtalkaboutit,whytheyaredepressedafter
gain5kg.Counsellorscomeupwithideasontipsandanswersonhowtoloseweight
Avoid….(Ivey&Ivey,2003)
u Bombardment/grilling:askingtoomanyquestionsoneaftertheother.Thecounsellorissettingtheagenda.
u Multiplequestions:Thisoccurswhencounsellorsaskseveralquestionsatonce.E.g.“Pleasetellmeaboutyourself-–howoldareyou,wherewereyouborn,doyouhaveanychildrenandwhatdoyoudoforaliving?”
u Questionsasstatements:Usingquestionstosellyourownpointsofview.Forexample,“Don’tyouthinkitwouldbehelpfulifyoustudiedmore?”“Whatdoyouthinkoftryingrelaxationexercisesinsteadofwhatyouaredoingnow?”Alsoknownasclosedleadingquestions.Judgementalquestions.
u Whyquestions:Generally,justdon’tdoit…
2.11.2 Summarising u helpsclientstopandreviewthegroundtraversedu reflectingbacktotheclientsalientaspectsofhis/herpresentingissuesu helpstomakeconnections,buildbridges,identifythemes
u sortsoutdisconnectedmaterialintomoremanageableunits:helpsclient‘seeapathwaythroughtheforest’
u couldindicateaturningpoint,amomentofself-evaluation,identificationofagoal,astrategicpause
u timingandcontextarevital;o don’tdoitevery5minutes,itcandisruptstheflow
Notu alwaysessentialu are-runofwhathasbeencoveredu atabulationofeveryissuethathasbeenraised
o notarecordingofeveryissues
2.12 Responsestoavoid u Moralising,preachingo Becarefulon
givingyourownopinion
u Advising,givingsolutions,lecturing,logicalarguments,debatingo Generally
speaking,thisisnotcounsellor’sjob
u Interpreting,Analysing,Diagnosing,labellingo Oktohypothesis,
ratherthanadiagnosistypeofanalysis.E.g.afewweeksagoyoumentionedthat,andnowyouaretellingmethis.Iwonderiftheremightbeaconnection
u Reassuring,sympathising,consoling,minimisingo Carisawriteoff
butyouareoku Interrogating,probingu Humouring,divertingu Completingsentencesu Praising,applaudingu Judging,evaluating
disagreeing,blaming
2.13 ReadingsGerald_chapter5-8
• Chapters5:JoiningandListeningpp.41-50• Chapter6:ReflectionofContent(Paraphrasing)pp.51-60• Chapter7:ReflectionofFeelingspp.61-70• Chapter8:ReflectionofContentandFeelingspp.71-78
3 Lec3:AdvancedMicroSkills3.1 AdvancedSkills ´ primaryskillsareessentialbutnotnecessarilysufficient
´ atrusting,empathictherapeuticrelationshipisanecessarypre-requisite´ advancedskillsarerequiredwherethereisan‘impasse’,afeelingofbeing‘stuck’or
‘goingaroundincircles’´ mustbeusedselectively,withcareandsensitivityandattimes,afterconsultation
3.2 AdvancedMicroSkills ´ normalising
´ reframing´ challenging(confrontation)´ exploringoptions´ highlightingchoice´ therapistself-disclosure
3.2.1 Normalising Makingaparticularsituationseem/confirmnormal.
EmotionalStates
´ reducesanxietyandbringsemotionalrelief(no,you’renotcrazy/odd/dysfunctional)´ allays(diminish)fearsof‘fallingapart’´ asensitiveresponsecanpavethewayforreferralwherenecessary
DevelopmentalandExistentialCrisese.g.
- developmentalcrisis• puberty,movingoutofhomeat35
- existentialcrises• diagnosisalife-threateningdiseaseatageof23
´ raisesawarenessoftheinevitabilityoflifecrises´ reducestheaccompanyinghighlevelsofstress´ instills(establish)hopeandoptimismandhelpsintegration
´ whenusedskilfullycanintegrateintoabroadernarrativeofpeople’slife´ facilitates‘meaningmaking’andre-visioning
Mustnotinvolvetheminimisingordevaluingoftheclient’sexperience(Oh,everyonefeelslikethatwhen***happens)…usingtentativelanguagecanassist–“I’mthinkingit’sprobablynotunusualtofeel/thinkthatinthissituation”(suggestiveratherthanimposing).
3.2.1.1 Examples ´ Amothercomestoseeyouandsheisupsetbecauseher15yearolddaughterwantstogooutonSaturdaynightwithherfriendsinsteadofstayingathomewiththefamily.
´ Possible“normalising”response:´ “alotofteenagegirlsarewantingtoestablishpeerrelationships,whichis
important,howeveritmakessensethatthereisabitofasenseoflossastheybecomemoreindependent”.
´ Kidsatthatagedowanttohangoutwiththeirfriends´ So,stillacknowledgingthemother’sfeelingsaswellasnormalisingthesituation.
´ Aclientcomestoseeyouregardingafollowuplettershereceivedfromherdaughter’s
therapist(cc’dtoviolentex-partner)whereherchildren’snamesweremixedupandmisspelled,sentenceswereincomplete,personalinformation(fromthemother–notthechild/client)wasnotesandanincorrectdiagnosisprovided.Shesayssheisfuriousandwondersifshe‘shouldbe’
´ Whenyouareprofessionalbetrayed,it’snotunreasonabletobebotheredbyit.
3.2.2 Reframing
´ Sometimesaclient’sperspectivecanbecloudedbypessimism,negativity,poorself-esteem,depressionetc.Thesefactorswillimpactupontheclient’sjourneytowardimprovement/shifting.
´ helpingclienttoseeadifferentperspective´ presentinganexpandedviewofthesituation´ reframingbehaviourinanadaptiveway
´ morepositiveandhelpful
´ highlightingalternativepossibilities´ reframingloadedwordsandphrases
´ maybesheisnottryingtogetonyournerves,butjustwanttomakesureeverythingisdoneproperlyandthat’sherpriority
´ expandingperspectivesoftheself´ drawingattentiontothedifferencebetweenintentandimpact
´ Iwonderifyourparentswanttoshieldyoufromtheembarrasementofwalkingintoclasslate
´ offeringa‘positivespin’onperceivedfailuresTutorialnotes• sharingnewlight,differentidea/meaning,butalsovalidateexistingone• changesomeone’sframe
o yourparentsdon’thateyou,theyjustreallycareforyouUnderstandthedifference• reflectionofcontent:differentwords,samemeaning• reframing:differentmeaning
3.2.2.1 example ´ It’sallinthelanguage…´ Aproblemasanopportunity´ Aweaknessasastrength
´ Shifttheframeof‘thinkingbeingused’,topeoplesawthatasastrengthofyourshencewhypeoplecometoyou
´ Animpossibilityasadistantpossibility´ Adistantpossibilityasanearpossibility´ Oppression('againstme')asneutral('doesn'tcareaboutme')´ Unkindnessaslackofunderstanding
´ Whenayoungboycomplainshowsomeoneisbeingunkind´ Reframeitto‘whotaughtyouhowtobeaniceboy’,maybeheisnotas
fortunatetohavesomeoneinteachinghimhowtobekind.TextbookexamplesInitialframe ReframeIaminatunnelandIcan’tseeawayout. EverytunnelhasanentranceandexitIknowIwillneverbeconfident Beingconfidentstartswithhavinginsights
aboutourlimitsHe/sheisoutatnightandthatmeansthathe/shedoesnotlovemeanymore.
Privatetimeawaycanhelpyoutoappreciateeachothermuchmore.
Client:Clientinvolvedincaraccidenthasrecentlyreturnedtoworkandnoticesthatsheistriggeredbycarsounds.Reframebycounsellor:accidenthasmadeyoumoreawareoftheneedtopayattentionwhenyouhearacar.• Sometimesisabouttakingsomeofthestingsoutofclients’statementExamtip:importanttounderstandthedifferencebetweennormalisingandreframingAclientcomestoseeyoushortlyafterseparatingfromalong-termrelationship.Theydiscoveredtheirpartnerhadbeenhavingan‘extra-marital’affairforaboutayearand‘cannotbelieveIwassostupid…suchanidiot’Reframe:Iwonderifyourdevoteandcarewithherwasyourpriority,ratherthanbeingsufficient.Iwonderifyourpersonalityisbeingmoretrustworthythansuspicious.Normalising:it’snotunreasonablethatyouwouldtrustyourpartnerafter18years.
3.2.3 Challenging ´ Challenging/confrontationisoftenassociatedwithaggression–tendstobepoorly-utilised.
´ Incounsellingit’saboutraisingawareness(whereaprimaryskillhasfailed).Usedtohighlightdiscrepanciesthattheclientisunawareof.
´ mustberespectfulandnon-threatening´ counsellormustbeawareofhis/herfeelings,motives,goals
´ isityourfrustrationthatclientsshouldhavegotitbynow?
´ skilfulconfrontationhelpsclientsreceiveso-callednegativemessage´ contextandtimingiscritical
canbeusedforself-understanding,curiositydon’tuseitasbeingjudgementalasclientscouldsensethat
3.2.3.1 WhentoChallenge? Useitwhenyoufeltastrongtherapeuticrelationshipisestablished.´ clientisindenial´ failuretorecogniseself-destructiveandself-defeatingbehaviours´ notacceptingthepossibilityofseriousconsequences
´ whathappensifyouareinvolvedinacaraccidentundertheinfluenceofalcoholanddrugs,andthepersonkilledisyourloveone?
´ Andwhathappensifclients’responseis–Iwillbetoooffmyfacetocareaboutit.(whentheaddictionistoodeep,peoplewon’tchangeover-night.Theyarecomfortablewithwhattheyaredoingandcounsellingmaynotworkiftheattendancewasduetoexternalfactor,e.g.amothermadeherchildtoseethecounsellor.)
´ Keepinmindyoumaynotalwaysgetthedesirableoutcomewhenyouchallengetheclient
´ Clientsdobetterwithchallengingareclientsthatareverycommittedtopersonalgrowth.Theyarenottherejusttofixtheissue,buttogetanybenefittheycanfromtherapy.Theywouldembracetheentireexperience.
´ makingcontradictorystatements´ goingaroundincircles´ unableorrefusaltofocusonthepresent´ verbal–nonverbalincongruence
´ whenapracticaljoketurnedintoadisastrousinjury,andtheclientislaughingwhentalkingaboutit.Thecounsellorcouldchallengetheincongruenceforhisowncuriosity.Sometimestheanswercanhaveitsreason–ourfamilyagreedonastrategytodealwithtraumaistomakeajoke
´ ruptureoftherapeuticrelationship´ notreadytochange–pre-contemplativestage
3.2.3.2 Howtochallenge… ´ (Perhaps)beginwithabriefsummaryofwhathasbeencommunicated(clientfeelsheard)
´ Communicationofthecounsellor’sfeelings(maybe)´ Clearstatementaboutwhatthecounsellorhasnoticedthatisincongruent.´ Examples
´ Couplewhoagreedtohomeworkthendidn’tdoit.´ Clientcommittedtolongevitywhosmokes.´ 19yearoldwhowantstoberichandwon’tmakeaphonecalltogetadifferent
job.´ Clientwhodoesn’twanttobecontrollingbutinsistsonexacttimeshiswifewill
visithersister
3.2.4 ExploringOptions ´ whenclientsmakeapreemptiveconclusionthatthereis‘nosolution’oronlytwopolarpossibilities
´ reflectingfeelingsofbeing‘stuck’,‘trapped’,‘imprisoned’,‘frozen’´ usinganopenquestiontofacilitateexplorationofoptions´ nottheofferingofoptionsexceptinatentativewayandasacontribution
´ NOT–whydon’tyoujustdothisorthat(judgmental,it’sbasicallylikesayingIcan’tbelievethatyouhaven’t…)
´ Tentative-Iamwonderingifthereissomething….´ Notrightorwrong,butdifferent
3.2.4.1 GeneratingOptions ´ facilitateawidespectrumofoptions
´ summarisetobringclarity´ explorepositiveandnegativeoutcomesofalloptions´ rankorderintermsofpreference´ encouragetheuseofbothrationalityandemotionindecisionmaking´ emphasizeautonomyandtheelementof‘choice’(Glasser,1998.ChoiceTheory)
Onceyougivepermissiontosomeonetodosomething,theinitialragemaygoaway,e.g.
• Initialrage:Iwanttodestroymywifefinancially• Andifyoutellclientsthattheycan’t/shouldn’t,theyaremoreinclinetodoit• Butifyougeneratesomeoptions:
o Ithinkit’spossibleonedayyoumayhavelovingrelationshipwithyourchildreno Ithinkmaybedownthetrackyouwon’twanttofinanciallydestroyhero Maybeonedayyouwon’tcareaboutanyofthisandgotravellingfortherestofyourlifeo Idon’tknowbutIfeellikethereareotheroptions.
3.2.5 Thesignificanceof
‘Choice’´ thereisalwaysachoice´ thedifferencebetweenwhat‘I
shoulddo’andwhat‘Iwanttodo’´ themythofa‘rightchoice’as
opposedtoaresponsiblechoice´ itisthemostdesirable,sensible,
appropriate,effectivechoiceinacontext
´ validatingthechoice‘nottochoose’theinevitabilityofintrapersonaltension(inphysiologicalsense)inmakingchoices,e.g.head-tension,heatrisingontheface
´ canbeusefulwhenflagthefeelingofsensationappropriatelywiththeclient,anadvanceskillofnormalisingthefeeling.Messageofempathy.
3.2.6 TherapistSelf-
Disclosure´ Indirectself-disclosureisunavoidable
´ Age,gender,roomdécor,weddingring,certainjewellery,forthcomingholidays´ Directdisclosurerelatestointentionalverbaldisclosures
Self-involvingdisclosure´ affirmationofclientawareness
´ Iamawareofyouarealwaysmakinganefforttodoyourhomeworktogetmostofthebenefit,justlikemychildren
´ disclosuresaboutthetherapeuticprocess´ Commentonnatureoftherapport
´ ‘cheerleading’and‘benevolentcuriosity’´ tobeavoided,butcanbeusedifdoinglifecoaching
Self-Disclosingresponses´ intentionalsharingofthetherapist’sfeelings,thoughtsandlifeexperiences
´ becarefulwhenusingthis,e.g.yoursistersoundssomuchlikemysister
3.2.6.1 HistoricalcontextandTherapeuticOrientation
´ 1912,Freud:“thephysicianshouldbeimpenetrabletothepatientandlikeamirror(blankscreen),reflectnothingbutthatwhichisshowntohim”.
´ Humanistmovementinthelate60’s,self-help&feministmovementsin70’sand80’sresultedinanovertshiftaroundfosteringanegalitarianrelationshipbetweentheclientandtherapist.
´ Humanisticandexistentialtherapistshighlightimportanceoftransparency.´ 1990s.Influenceofhighprofileindividualsself-disclosure.E.g.,Oprahself-disclosingher
lifestories.´ Grouppsychotherapy:Yalom:“grouppsychotherapistsmay–justlikeanyothermembers
inthegroup–openlysharetheirthoughtsandfeelingsinajudiciousandresponsiblemanner,respondtoothersauthenticallyandacknowledgeorrefutemotivesandfeelingsattributedtothem”.
´ CBT&BT(behaviouraltherapy):manybelieveitisproblematictoanswerquestionswithaquestion:
´ E.g.doyouhaveanykids?´ “Canyoutellmewhyyouwanttoknowthat”.
´ theydon’tpromoteself-disclosure´ NarrativeTherapy–refertoself-disclosureas“transparency”.
3.2.6.2 IntentionalSelf-
Disclosure´ theresearchshowsmixedresults;mustbeusedwithcare´ canbeburdensometoclient
´ addanotherworryforclient
´ detractsfromtheclient’sstory´ canbecomeexhibitionistic´ awarenessofcounter-transferenceissues
´ whatimpactdoesthishaveontheclient,whattheythinkaboutyou,andtheimpactonthetherapeuticrelationship
´ notforthenovice/traineecounsellor
3.2.6.3 Usefulforcertaincohorts
´ Self-helpand12stepprograms´ Self-disclosureofyourownaddictionjourney,andself-disclosureispartofthe
successtorecovery´ onereason:theyarenotalone,becausebeforedisclosing,thesepeopleareliving
intheshame.AfterAAmeeting,theydiscoverotherssuchasdoctors,lawyers.´ Childrenandthosewithcognitiveimpairment
´ Kidsliketohearadult’srebelliousbehaviours´ Adolescents–canassistinclientsfeelingmorerespectedthanjudgedand/orpatronised´ Religiousandspiritualbasedtherapies´ LGBTI´ WarveteranswithPTSD´ Marginalisedindividuals
Usefulwhenclientsfeltyouhaveunderstandingaboutwhattheyaregoingthroughandhowtheyarefeeling.
3.2.6.4 Questionstoaskyourself-…
´ Whatisyourreasonforself-disclosingtothisclientatthistime?´ Whatisyourneedto“getcloser”totheclientabout?´ Whatareyoutryingtoachieveviaself-disclosure?´ Willthisself-disclosuredetractfromtheclient’sissues?´ Willthisself-disclosuredisempowertheclient?´ Willthisself-disclosurealtertheclient’sexpectationsofthecounsellor?´ Isthereanypossibilitythatthisself-disclosurewillbeusedagainsttheclientatalater
stage?´ Istheclientemotionallystableenoughto“hear”theself-disclosureinthewayitis
intended.´ Whatwillhappenifyoudon’tself-disclose?
3.3 Readings Geldard,D&K(2011)SelectedChapters
fromPartIV(seeCMD)
4 Lec4:GOALING/GOAL-SETTINGINCOUNSELLINGLEARNINGOBJECTIVES…•Identifythepurposeofgoalsettingwithclientsandtheformsthesegoalsmaytake•Discussthefunctionsofcounsellinggoals•Identifywhataneffectivegoalwouldlooklike•Distinguishbetweenoutcomegoalsandprocessgoals•Discussgoalsasmovingfromgoodintentionstospecificbehaviours•Discussthecharacteristicsofaneffectivegoalandhowtohelpclientsdevelopeffectivegoals•Considertheskillsassociatedwithgoalsetting•Discussthecontextsinwhichgoalsettingmaybemorechallenging4.1 THEPURPOSEOF
GOALSETTING…
•Clientscanexperiencepsychologicalblocks,theymaylackconfidenceornecessaryskillstomoveforward->requirehelptomovetoaction•Wecanfacilitateclients’progressbyhelpingthemdesign,choose,craft,shapeanddevelopgoals
4.2 TWOASPECTSTOGOALSETTING…
•Tohelpclients(andyou)determinewhattheywanttogetfromtheirsessionswithyou•Tohelpclientsidentifyhowtheywillachieveataskorgoaloutsideofthetherapeuticcontext
4.3 FUNCTIONSOFCOUNSELLINGGOALS…
(HACKNEY&CORMIER,2013)
•Goalscanbemotivational•Goalscanbeeducational•Goalscanserveanevaluativefunction•Goalscanbemadeacrossarangeofcontexts•MaterialGoals•FamilyandFriendsGoals•Educational/Intellectual/ProfessionalGoals•HealthGoals•LeisureGoals•SpiritualGoals•CreativeGoals•Emotional/PsychologicalGrowth
4.4 WHATSHOULDANEFFECTIVEGOALINVOLVE?
(EGAN,2010)
•Outcome-oriented•Specific•Substantiveandchallenging•Venturesomeandprudent•Realistic•Sustainable•Flexible•Congruentwithvalues•Reasonabletimeframe
4.4.1 EXAMPLESOFOUTCOMEGOAL
•“Iwanttostartdoingsomeexercise”•“Within6monthsIwillberunning5kminlessthan40minutesatleastfourtimesaweek”
(EGAN,2010) •Thinkaboutgoalsasaccomplishments
4.4.2 MOVINGFROMAGOODINTENTIONTOASPECIFICGOAL(EGAN,2010)
•“Thissessionhasbeenaneyeopener.Irealisedthatmywifeandkidsdon'tseemyinvestment-oroverinvestment-inworkassomethingIamdoingforthem.Ihavebeenfoolingmyself-tellingmyself-thatIamworkinghardtogetthemalltheywantandneed.IjustrealisedthatInfactIamspendingmostofmytimeatworkbecauseIlikeit.Myworkismainlyforme.It’stimetorealignsomeofmypriorities.“•Declarationofintent:“Idon’tthinkI’mspendingsomuchtimeatworkinordertorunawayfromfamilylife.ButfamilylifeisdeterioratingbecauseI’mjustnotaroundenough.Imustspendmoretimewithmywifeandkids.Actually,it’snotjustacaseofmust.Iwantto.”•Broadaim•Counsellor:“Tellmewhatspendingmoretimeathomewilllooklike?”•“Iamgoingtoconsistentlyspend3outof4weekendsamonthathome.•DuringtheweekI’llworknomorethantwoevenings.”(Specificgoal)•Counsellor:whatwillyoubedoingwithallthistimeathome?•“Iwillbedoingthingswithmywifeandkids–qualitytime…doingthings,picnics…takingthemfishing…playingfooty…”(Breakingdowngoalintoactions/tasks)
4.4.3 REALISTICANDCONGRUENTGOALS
•Undertheclient’scontrol•Attainablewithintheclient’slifecontext(Icancomehomeearly3timesaweek…)•Congruentwiththeclient’svaluesandbeliefs(Myfamilyisimportant,Iwantthemtohavesharedmemories…)•Clienthasaccesstothenecessaryskillsandresources•Clienthasexploredconsequencesofchange(willworkless–ormaybemoresustainably…)
4.4.4 SUBSTANTIVEANDCHALLENGINGGOALS
•Makesasignificantcontributiontowardsthedesiredoutcome(createsqualitytime,memories…)•Requirescommitmentandeffortfromtheclient–stretcheshim/her•Balancebetween‘goaldifficulty’and‘goalperformance’–relatestoclientself-efficacyaboutmakingwiseandpurposivechoices
4.4.5 NEGOTIATINGATIMEFRAME
•Not‘sometimeorother’;‘whenready’(“whendoyouthinkyouwillbereadytodothis?”)•Identifyingimmediateoutcomesinthecontextoftherapy(“howwillourworktogetherherehelpyou?”)•Facilitatingintermediateoutcomes–transferringmodifiedbehaviourstoreallifesituations(“Whatkindofchangesinyoureverydaylifewillyounoticeinthenexttwoweeks?”)•Affirmingfinaloutcomes–constructiveandsustainablechange(“youhaveachieved…howwillthiscontinuetobepartofyourlife..?)
4.4.6 FLEXIBILITYANDEVALUATION
•Goalsadaptedtochangingcircumstances(“withthenewbabycoming,whatwillyouneedtochangeoradaptwithyourexerciseregime?”)•Opentotradeoffsbetweengoalspecificityandgoalflexibility(“willyouneedabitmoretimetoachieveyourgoal?”)•Maximizingachievements–‘cheer-leading’(“Youhavebeendoingsowellwith…keepgoing”…usedinlife-coaching)•Buildinginandidentifyingpotentialrewards,reassessingandevaluatingoutcomes
4.4.7 THEFIRSTSTEP •Emphasisehereandnowaction(“whatsmallthingcanyoustartdoingtoday..?”)•Assessinglevelofmotivation(“tellmeonascaleof1-10howmotivatedyouaretodothis….?”)•Identifyingpotentialhurdles(“Whatcouldgetinthewayofyouspendingmoretimewithyourfamily?”)•Exploresecondarygains•Relapsepreventionstrategies(“Whatwillhelpyoutogetbacktobeingwithyourkidsmore?”)•Exploringconsequences(“Aretherethingsyouwillsacrifice…?Aretherepeopleinyourlifewhowillsupport/notsupportyou?“)•Recognizingmeta-goals/super-ordinategoals(“Whatwillbeimportanttoyoutokeepyougoing?”)
4.5 THESHADOWSIDEOFGOALSETTING(EGAN)
•Goalsettingpushesclientsoutof“safe”/familiarplaceoftalking,exploring,“caringandsharing”.Bothcounsellorandclientmayresisttheshift.•Somepeopleare“happier”livinginvictimhood.“Victimhoodandself-responsibilitymakepoor
bed-fellows”.•Goal-settingcaninvolveswork,effort,pain,struggle.•Althoughachievingagoalcanbeliberating,itcanbesubsequentlycauseanunwantedconsequence–eg,achievingacareergoalmightresultinlostfamilyrelationship
4.6 SKILLSASSOCIATEDWITHGOALSETTING
(HACKNEY&CORMIER,2013)
•Verbalskills•Visualisingactivities•Verbalconfrontations•Affirmingresponses•Structuringskills(Usefultoolswhenclientsneedhelpunderstandingthegoal-settingprocess)•Goal-settingmap•Timelines•Successiveapproximation(shaping)–useofrewards
Ofcourseyoucanaddinotherareasoflifethatwillbeimpactedbythedecision:•Workplace•Sportingteam
4.7 Acommonconcept
4.8 ADDITIONALTIPS •Createapersonalmantra.2–5wordsthatcapturetheessenceofthegoal.Usepositive
(ARINANIKITINA) language.Writeitdownandlookatitoften.•Setupmotivating,inspirationalenvironment(open,clutter-free,breaks)•Useinevitabilitythinking–setconditionsthatmakeitdifficulttofail(eg,givingsomeone$20everytimeyoumissgym)
4.9 GOALSETTINGINDIFFERENTCONTEXTS
•Goalsettingwithchildren•Considerdevelopmentalstage•Crisesandgoalsetting• Donotsetgoalsduringthemiddleofcrisis•Thecounsellorwillhavetherapeuticgoals.Mutualgoal-settingisnotpossible•Multiculturalcontexts•Monk,Winslade,Sinclair(2008)–refertoSueandSue(2007)–AsianAmericans,AfricanAmericans,Latinos,NativeAmericans–haveshortterm/immediategoals;whites–long-rangegoals.“Goalsettingisaproductofclassdifferencesandeconomicadvantage”.
4.10 THERAPEUTICMODELSANDGOAL-SETTING
•Differentmodelsoftherapywillseektoachievebroadgoalswithclients.Psychoanalysis Resolveunconsciousconflict;healthydefensesPerson-centredTx Resolveincongruencebetweenself-andexperienceExistentialTx Understandingoflife;authenticity,freedomREBT Rationalthoughts/lifephilosophy,knowledgeofABCsRealityTx Healthychoicesthatsatisfybasicneeds–espattachment
needsSFT(SolutionFocusedTherapist)
Resolvethecomplaint
NarrativeTx Reauthorpreferrednarrative
5 Lec5:RationalEmotiveBehaviourTherapyandCognitiveTherapy
5.1 AlbertEllis(1913-2007)
Ø Dysfunctionalfamilybackground.GrewupintheBronx.NotafanofschoolØ Health(diabetes)andemotionalproblemsinearlyyearsØ Variedcareerbackground,struggledtostickwithonecareerpathØ Reactiontoearlypsychoanalytictrainingdevelopedatherapeuticapproachthatwouldhelp
himpersonally–insightaloneisnotcurative…whycountsfor…Ø Ucanunderstandandknowwhy,butitdoesn’tnecessaryevokechange
Ø LongandcontroversialprofessionalcareerØ Prolificwriter(sexuality,relationships)(lotsoffriends/peoplesoughthiscounsel,whichled
himtodevelopREBT)andenergetic,flamboyantpractitioner
5.2 Self-experimentation
• Shywithgirls(andpublicspeaking):o “ifIfail,Ifail.IfIdieofdiscomfort,Idie”,sobeit,butI’mgoingtodothis
• SitinBronxgardens–100+girls/montho Didn’tgetadateinthefirstmonth,butnoticedfearhadreducedsignificantlyo Bytheendofsecondmonth–threedates
• Practiceandpracticeuntilhebecamesomeonewhoisknownasgoodatpublicspeaking• InitiallyknownasRationalTherapy.Hewouldhavecalledtheresultanttherapy–Cognitive-
EmotiveBehaviourTherapy
5.3 REBTPhilosophy
Ø precededbyearlyschoolsofthoughtthatprioritisedcognition
Ø psychologicaldistresslargelyduetodefectivecognitiveprocessing
Ø distorted/incorrectthinkingØ humansarebiologicallyprogrammedtobeboth
rationalandirrationalintheirthinkingØ affirmstheintrinsicworthofhumannature;
distinguishedbehaviourfrombeingØ insteadofsaying,youareanaughtyboy,burningdownthehousewasthenaughty
thingtodoØ lookatthebehaviour,nottheperson
Ø emphasisedhumanfallibilityandpersonalresponsibilityØ evenfornonCBT/REBTtherapist,theywouldstillusetheconceptfromthistherapy
Ø emphasisedhedonism:humansseekpleasureandavoidpain
5.3.1 TheA-B-CTheory(Irrationalbeliefs)
Acouplehadamassivefightbecausethewifewenttosleepinthespareroombecausehusbandwassnoringaloud.
- A:partnerismissing- B:shemustbecrossedathimforsomething
- C:hewenttothespareroomandsaidtoher“whatisyourproblem”Hisbeliefinwhattheactivatingeventwasresultedinthisconsequence.
5.3.2 TheA-B-Csofdisputingirrationalbeliefs
REBTwantstodisputeirrational/false/unprovenbelief
- D:Iwonderifthereisanotherreasonwhysheiscrossedatme.
- E:Iwonderedifit’smy20yearsofsnoring.
- F:WhatasensiblethoughtfulcaringpartnerIhave
5.3.3 IrrationalBeliefs[Ellis,1975]
- Must- Should- Ought
• Imustbelovedorapprovedofbyeverysignificantpersoninmylifeo Dispute:doyoulikeeverypersonyoucomeacross?Andisitreasonablethateveryperson
likesyou?• Imustbecompetent,adequate,andachievinginallrespectsifIamtoconsidermyself-
worthwhile• itisterribleandcatastrophicwhenthingsarenotthewaytheyoughttobe;it’snotfair• IshouldgetwhatIwant,whenIwantit.IfIdon’tgetwhatIwant,it’sterrible,andIcan’tstand
it;itfrustratesmeo Thereisnoruleabout:ifI’mnicetoyou,thenyoushouldbenicetome
• oneoughttobeabletorelyonothersandexpectthemtoactincertainways• Ishouldbequiteupset/concernedaboutotherpeoples’problems
o Ijustdon’tcareisthatwrong?(again,norulesaboutthis)• otherpeoplemusttreatmeconsiderately,fairly,kindly;exactlythewayIwantthemtotreatme
o nicetohave,butholdingontothisbeliefwouldonlycausespainWhatareyourthoughtsontheabove.Doyouattimesthinkinasimilarmanner?Ifyousubscribedtotheseirrationalbeliefs,youcangetfrustrated,disappointedFirsttimehearingthesebeliefscanbeshocking.Wemaybemodelledatayoungage.
5.3.4 TheoryofrestructuringIrrationalBeliefs
Ø ClientscreatetheirownemotionalreactionsanddysfunctionalresponsesØ TheystemfromirrationalbeliefsØ ClientshavetheabilitytochangethewaytheyreactandrespondØ SteponeistorecognizeandidentifytheirrationalbeliefsØ ClientsmustseethevalueofdisputingthesebeliefsØ Changedemandshardwork
Ø Changeyearsofentrenchedthinking/responseØ Undoingneuropathway
Ø ItrequiresthepracticeofREBTfortherestoflifeØ Justwhenyouthinkyouhavefixedit,somethingelsewillsurface
5.3.5 TheTherapeutic
Process
Ø DemonstratethroughteachingtheA-B-C’sofhowclientscreatetheiremotionalreactionsanddysfunctionalbehaviours
Ø ToteachpeopletonoticewhattheyaresayingtothemselvesabouttheeventØ Therapist:tellmewhenthathappens,whatareyousayingtoyourself?Ø E.g.Husband:Notgoingtothegymtoday?Wifeheard:Youareanelephant,youare
lazyandneedtogotothegym(wife’shistoricalviewofherself)Ø Assistclientswithidentifyinganddisputingtheirirrationalbeliefsandmodifyingtheir
thinking–cognitiverestructuringØ Wife:Yes,I’mgoingrightnowandyoucancookyourowndinner
Ø Demonstratehowclientsmaintaintheiremotionalreactionsanddysfunctionalbehavioursthroughre-indoctrinating(teachtoacceptsetofbeliefs)themselves
Ø ChallengetoeveryirrationalbeliefØ EncourageandassistclientstoengageinactivitiesthatwillcountertheirirrationalbeliefsØ Challengeclientstodeveloparationalphilosophyoflife
5.3.6 Therapeutic
Techniques
Amultimodalandintegrativeapproachtailoredtosuittheindividualclientwithacontinuingemphasisoncognitionasopposedtoaffect
- Focusonwhattheywerethinking- Whatareyouthinking/internaldialogue?Whatareyousayingtoyourself?- Therapistmayassistbygivingsomeoptions,andkeepsgoingbacktothatcognition
5.3.7 Cognitive
Techniques
Ø TeachingclientsaboutREBTandABCDEFØ Canworkwithyoungchildren,teachthemthelinkbetweenthoughtsand
behavioursØ Ifyouthinkyouareabully,andyoubehavelikeabully,howmayyoufeel?Probably
feellikeabully(changethewordfrombullytogoodperson)Ø Assistclientsinactivelydisputingtheirirrationalbeliefs
Ø Should/mustØ Emphasisingthevalueoffunctional,realistic,rational,logicalthinking
Ø DifficultwhenemotionsarestrongØ REBTshouldnotbeusedingriefØ REBTisabsurdanddisrespectfulwhenaclientjustlostaloveone
Ø E.g.saying,uknoweveryonediesØ Encouragingclientstochangetheirabsolutisticandmusturbatorythinkingbylearningnew
‘self-statements’Ø Insteadofsaying,Ineedtobegoodateverything,otherwiseImnogoodØ Changeto,ImsomeoneputsreasonableeffortandfeelcomfortablewiththeeffortI
putinØ Useofhumourtocounteracttheoverserioussideofaclient’sthinkingØ Cognitivehome-worktotransferREBTtechniquestoreallifesituations
Ø Toteachpeopletoquicklynoticewhattheirinternaldialoguesare
5.3.8 EmotiveTechniques
Helpclientsknowthevalueofunconditionalself-acceptance(USA)andunconditionalotheracceptance(UOA)–evenifthebehaviourishardtoaccept–via:
• Rational-emotiveimageryo Frequentpracticeofchallengingclientstoimagine“theworstpossiblethingthat
couldhappen”–e.g.feelingdevastated,feelingstupidetc.Changethoseintensefeelingstomorepositiveones.
o Toastudentwhomhavehighanxietyaboutwalkingintoclasslate:whatistheworstthingthatcouldhappen?Maybetheteachwouldfaintandthewholeclasswould
laugho Worsepossiblethingsaremanageableo Exercise:writedownonethingpeopledon’twanttoknowaboutyou,onethingthe
worlddon’twanttoknowaboutyou.Thenwewillthrowinthefire,asasymbolicreleaseofshame.Theninstructpeopletoreaditoutbeforethrewinthefire.Twothingslearnt:
• Theworlddidnotend• Itdidnotalterpeople’sopinionaboutanyoneelseinthegroup(UOA)
• roleplayingandrolereversalo Usefulforpeoplesufferwithanxietyo Rehearsescenarios.Practicefocusingonunhelpfulself-talko Roleplay5minspresentationinfrontoffakeobjects
• CLIENT:peoplearethinkingIamstupid.THERAPIST:really,howdoyouknowthat?Andwhatotherpeoplethinkisnoneofyourbusiness
• shame/guilt/embarrassmentattackingexerciseso Designedtoincreaseself-acceptanceandreallyknowthatallegedlyembarrassing
experiencesarenotsocatastrophic,examples:• clienttoweartoiletpaperbehindtheirpantsandwalkaroundshopping
centre• wearT-shirtinsideout• leavespinacharoundteethandhaveconversations
o gettheclienttorecognisewhattheyaresayingtothemselves,andafterafewminutes,howarethethoughtsshifted?
• Useofforce/vigourexerciseso Therapistadoptsclient’sunhelpfulbelief,clientactsastherapistandhastoconvince
“client”aboutirrationalityofthebelief• THERAPIST:IjustthinkthateveryoneshouldbeasniceasIam.CLIENTto
challengethebeliefo REBTbelievesitentrenchesthattheabilitytochallengeirrationalbelievesifyoudo
that
5.3.9 BehaviouralTechniques
Ø AdaptingmanytypicalbehaviouraltechniquestochangethinkingØ BehaviouralhomeworkassignmentsØ Self-monitoringirrationalthinkingusingbehaviourdiariesand/orcues
o SomeREBT/CBThaveworkbooksØ Bibliotherapy
o Encouragetoreadaboutrationalthinkingandirrationalbeliefs,continuespsychoeducation
5.3.10 TheTherapeutic
Relationship
Ø basedonanauthoritativestancecombinedwithfullacceptanceandtoleranceo therapististheteacher,butalsowithwarmth,acceptance,patience
Ø thetherapistasactiveteacherratherthananemphasisonwarmthandempathyØ avoids‘indulgencetherapy’;notaboutclientsfeelingbetterbutgettingbetter
o REBTdoesnotlikeclientonlytalksabouttheirfeeling,andspentmajorityofthesessioncomplainingandbeingupset
Ø avoidslengthydiscussionof‘A’sordwellingonC’so notsomuchdetailsoftheevento moreonwhatwereyousayingtoyourself
Ø collaborativeandskilleduseofavarietyoftechniqueso equalcommunication,unlikePersonCentredTherapywhereclientstalkmore
5.4 CognitiveTherapy
AaronBeck(1921-stillalive)
Ø BornintoaRussianpractisingJewishfamilyØ Childhoodtraumaandpoorself-worthØ PlaguedbyanxietyarisingfromnumerousphobiasØ QualifiedasapsychiatristtrainedinpsychoanalysisØ ImpactofearlyworkonanalysisofdreamsofdepressedclientsØ Prolificwriterandresearcher
5.4.1 BasicPhilosophy
Ø anevolutionaryperspectiveofhumannature:humanstryingtomakemeaningoftheirenvironmentthroughcognitiveprocessing
Ø wemakemeaningoftheworldbywhatwethinkØ inpartaderivativefromandinpartareactionagainstclassicalpsychoanalysis
Ø psychoanalysisdidnotworkinallcases,analysingdreamswasn’tusefulforsomedepressedpatients
Ø aconstructivistapproachthatassumesbothanexternal,objectiverealityaswellasapersonal,subjectiveone
Ø thereisrealityoutthere,butwealsoconstructourownreality/meaningØ insightfocusedinitsattentiontocognitiveprocessesthatareaccessibletointrospection
Ø notlookingatthesub-consciouslyofwhatyouarethinkingØ lookingatthoughtswecanaccesswithintrospectionØ needtoteachpeopletheintrospective
Ø mainlyatheoryofpsychologicaldysfunction
5.4.2 CognitiveDistortions(AaronBeck)
Ø arbitraryinferences(includingcatastrophising)o reachingconclusionswithoutsufficient/relevantevidenceo e.g.satnightpartyisgoingtobeterriblebecauseweatherisbad
Ø selectiveabstractiono formingconclusionsbasedonanisolateddetailo knowonethingabouttheevent/practiceandmakeglobalassumptiononhowit
supposedtobeo e.g.legalisesamesexmarriagemeansboyswillbewearingskirttoschool
Ø overgeneralisationo holdingextremebeliefonthebasisofasingleevent.Applyingrulesacrossdifferent
settings/contextso notvisitingdentisteveragain,becauselastdentistvisitcaused3weeksofpain
afterwards.(notconsideringothercontext/setting)Ø magnificationorminimisation
o over-estimatingsignificanceofnegativeeventso useofcatastrophescale,clientmaysayparentsdiedis100,misplacingabookfor
halfanhouris10(nobigdeal),goingonacamp(80).Clientinitiallydemonstratedanxietyisgoingonacamp.Therapistthenaddedmorehigherendevents,e.g.breakups.Everytimeaneventwasadded,goingonacampwoulddrop
Ø personalisationo automatedassumption:it’sallaboutME,Ihavedonesomethingwrong.o Challenge:whatifthishastodowithsomeoneelse,isthisapossibility?
Ø labellingandmislabellingo takeonecharacteristicaboutapersonandattributetothewholeperson
Ø polarised(dichotomous)thinkingo all-or-nothingthinkingo it’sallgood/right,orallbad/wrong
Ø emotionalreasoningo howIfeel=howitiso Ifeelterriblesoitmustbeterrible
Ø mindreadingo IKNOWwhatyou’rethinkingo Wealldoittosomedegree
Ø absolutisticthinking
- mindreading- dichotomousthinking- emotionalreasoning- magnification- personalisation
5.4.3 Therapeutic
Relationship
Ø coreperson-centredtherapeuticconditionsarenecessarybutnotsufficientØ CBTbelievestherapeuticrelationshipisn’tenoughtoaffectchange
Ø therapistmustbeactive,skilledincognitiveconceptualization,creativeandabletoengageinSocraticdialogue
Ø therapistfunctionsasacatalystandguideassistingclientsmakethenecessarylinksbetweentheirbehaviourandtheircognitions(thoughtpatterns)
Ø proactiveengagementwithclient:pointingoutdistortionhascausedaparticularbehaviour
Ø aneducativepartnershipwhichassistsclientsmaketheirowndiscoveriesthroughactiveengagement(collaborativeempiricism)
5.4.4 Therapeutic
Process
Ø establishlinkbetweenmaladaptivebehaviourandtheclient’sidiosyncraticthoughtsØ teachclienttoidentifythedistortedcognitionsthroughdeliberatethoughtmonitoring
Ø whatamIsayingtomyself?Ø tracethe‘streamofthought’identifyingtheactivatingschema(corebeliefs)–prevents
lapsesØ preventingrelapse,andchangeschemaØ CBT/REBT:changecorebeliefaboutself(USA/UOA)Ø Irrationalthinkingtoleave,andquicklylockingrationalmessagetoselfØ Bydoingthisquickly,clientsdevelopdifferentwaysofrespondingØ E.g.hearinghusbandsaying“notgoingtothegym”hasdifferentmeaningnow
compareto20yearsago–workingoffdifferentschemaØ through‘Socraticdialogue’assistclienttotestthefunctionalityoftheirthoughts/schema-
guideddiscoveryØ assistclientstorestructuretheirthoughts/schemasØ clientlearnsnewfunctionalself-statements,alternativeinterpretations,different
perspectives
5.4.5 SocraticDialogue Partofsocraticdialogueistotouchonhowthatbeliefcametoexist.Challengingtheorigincanassistinchangingthatschema.Conflictswithotherthoughtsandanswerstoobjections
- Constantchallengingandquestioning- Teachingclientstochallengetheirdistortedthinking- Howwouldyoufeelisyousaidthattoyourself?
Theoriginorsource- Ifyouweretaughtbyyourparentsaboutthatbelief- Oruthinkpeoplefromthatcountryarebadtempered,whatifyourteamconsistofonly
thosepeople
Support,reasons,evidence,assumptions- Isthatassumptionahelpfulwayofthinking?- E.g.kidshavebeenseparatedfromparentsforalongtime,andtheyhavebeentoldtheir
parentsarenice.Beforemeetingthem,therapisttellthekidabout‘evidence’.SomeonesaidtheteacherMrs.Smithisnotnice,butshetreatsyouwell,andyouonlyseehertreatingothersnicelytoo.Sothatisevidence.Or,youaskedakidifsheatethebiscuits,shesaidno,youreplied,buttheevidencetellsmethatyoudidbecausethereiscrumpsonyourface
5.4.6 TherapeuticTechniques
Ø flexibleuseofanyethicaltechniquethatattackstheclient’sdysfunctionalthoughtsØ homeworkasessentialcomponentoftherapyØ cognitiverestructuringthrough:o deactivatingautomaticthoughts,beliefsandschemaso modifyingtheircontentandstructureo constructingmoreadaptivecognitivestructurestoneutralizethemo e.g.Therapistmaysay,inmyexperience,nooneisallgoodorallbadØ SocraticquestioningØ thought-recordingthroughuseofspecificinstruments
Ø diariesØ gradedassignmentstodealwithcomplexandoverwhelmingtasks
Ø startsmall,e.g.goingtoasmallshopfirst,iftheyareanxiousingoingtobigshops(homework,assignment)
5.5 REBTVSCBT REBT CBT• Directive,persuasive,confrontational
o Comfortableinchallengingclientsonwhatisgoingon
• Inductiveprocess• Therapistasexpertteacher• Psycho-educationalprocess• Targetingirrationalandnon-functional
thoughts• Technicalcompetence
• Socraticdialogue,openquestioning,facilitating
• Deductiveprocess–catalystandguide• Inaccurate,distorted,rigiddeepseated
beliefs• Empathy,sensitivity,therapeuticalliance
(notsufficientalong,needtohaveotherprocessesinplace)
5.6 FeelingGood GoodFeelingscontributesignificantlytoourwellbeingBUTwefeelthewaywethinkANDwedonothavetoexpresseverythoughtthatentersourheadTHEREFOREwecanchooseourthoughtswecanlearntothinkdifferently
wehavethepowertokeepathoughtorletitgoCruxofREBT/CBT
- Recognisingusefulnessofthoughts,unhelpfulnessofotherthoughts,knowingthatwedon’thavetoholdontoparticularthoughts/beliefsiftheyarenotservinguswell
6 Lec6:PsychodynamicTheory6.1 Psychoanalytic
PsychodynamicTheory
� IsbasedonFreudandfurtherdevelopedbyotherneo-Freudians(neo-analyticapproaches)majorimpactonsubsequenttheoriessignificantinfluenceonlaypersons’
� Freudiananalysis-understandingofthehumanpsycherequiresintensivelong-termtrainingoftheanalyst
� Analystneedstohavehadtheirowntherapy• Psychodynamic–psychologythatisinadynamicflux
o betweenconsciousandunconscious,knownandunknown,repressedoremergedfromunconscious
• Psychoanalytic–Freudusedanalysistofindoutwhatishappeningwithinaperson• Fullanalysisusuallyabout10years,twiceaweek.• Clientlearntaboutthemselvesthroughanalysis/interactionthroughFreudiantherapist.• Eveythingcomesupbetweentherapistandclientisimportant.Everyargumenthasavalue,it
willbedisected,analysed,understoodandlinkbacktothepast• Intensivetherapy:3-5days/week.Ifyoumissaday,youneedtotalkaboutit• Notsuitableforeveryone
6.2 SigmundFreud(1856-1939)
� BorninVietnam� FirstbornsonofaverypoorJewishparents� Hadmanyinterests–chosetostudyMedicine� OriginatorofPsychoanalysis� Devotedhislifetocreatethemodelofthehumanpsycheandpersonalityand
psychoanalysis� Prolificwriter(CollectedWorksin24Volumes)� Ardentworker–hadaextremelybusypractice� DiedinLondonin1939(endofWorldWar)
• Activeanddrivenmindfromanearlyage• Wantedtobeascientist,lookedandobservedpeopleinascientificway• StillusesmanyofFreudlanguagetoday,e.g.someoneisanal.Itcomesfromtheanalstage–
holdingontothings• Drivenpersonality,saw10clientsaday,restoftheawakingtimeshewouldwrite,11-12pmat
nighthehadtherapywithhisdaughter–AnaFreud.Sleep3-4hoursaday
6.3 ModelofPersonality Id• Pleasureprinciple• Primaryprocessthinking• Likeachild,noconscious
aboutothers,allaboutme,mydrive,e.g.Iamhungry/unhappy
• Basicdrives:hunger,sleep
Superego• Moralprinciplethat
guidesyou,thisiswherethe“should”comesfrom
• Imperativesideals• Ideologythatguidesus• Ishouldbelikethat,
workinghard.Thesuperegotalk
• IfyouareaPerfectionist,thatisyoursuperegodrivingyouEgo• Realityprinciple,theadultpartofus• Secondary