INTRODUCTION TO PSYCHOTHERAPY.pptx

Psychotherapy is a process of engagement between two persons, both of whom are bound to change through the therapeutic venture.
It is a collaborative process that involves both the therapist and the client in co-constructing solutions to concerns
(theory and practice of counselling and psychotherapy- Gerald Corey)

As a counsellor, you need to remain open to your growth and to address your personal problems if your clients are to believe in you and the therapeutic process .
Your personal characteristics are of primary importance in becoming a counselor, but it is not sufficient to be merely a good person with good intentions. To be effective you must have supervised experience in counseling and sound knowledge of counseling theory and techniques

1. INTRODUCTION TO PSYCHOTHERAPY September-2010

2. What is Psychotherapy Psychotherapy is a process of engagement between two persons, both of whom are bound to change through the therapeutic venture. It is a collaborative process that involves both the therapist and the client in co-constructing solutions to concerns (theory and practice of counselling and psychotherapy- Gerald Corey) As a counsellor, you need to remain open to your growth and to address your personal problems if your clients are to believe in you and the therapeutic process . 11/29/2014 2

3. Your personal characteristics are of primary importance in becoming a counselor, but it is not sufficient to be merely a good person with good intentions. To be effective you must have supervised experience in counseling and sound knowledge of counseling theory and techniques 11/29/2014 3

4. Counselor as a therapeutic person Counseling is an intimate form of learning, it demands a practitioner who is willing to shed stereotypes and be an authentic person in the therapeutic relationship. Therapists serve as models for our clients. If we model incongruent behaviour , low risk activity, and remain distant, we can expect our clients to imitate this behaviour . If we model realness by engaging in appropriate self disclosure, our client will tend to be honest with us in the therapeutic relationship 11/29/2014 4

5. Basic counseling/psychotherapy skills ACTIVE LISTENING PROCESSING RESPONDING TEACHING 11/29/2014 5

6. Personal characteristics of effective counselors Effective therapists have an identity Effective therapists respect and appreciate themselves Effective therapists are open to change Effective therapists make choices that are life oriented Effective therapists are authentic, sincere, and honest Effective therapists have a sense of humor Effective therapists make mistakes and are willing to admit them. Effective therapists generally live in the present Effective therapists appreciate the influence of culture Effective therapists have a sincere interest in the welfare of others. 11/29/2014 6

7. effective therapists possess effective interpersonal skills Effective therapists become deeply involved in their work and derive meaning from it. Effective therapists are passionate Effective therapist are able to maintain healthy boundaries. 11/29/2014 7

8. Counselor’s values and the therapeutic process The role of values in counseling Counselors need to guard against the tendency to assume either of the two extreme positions. At one extreme are counselors who hold definite and absolute beliefs and see it as their job to exert influence on clients to adopt their values- these counselor tend to direct their clients towards the attitudes and values they judge to be “right”. 11/29/2014 8

9. At the other extreme are counselors who maintain that they should keep their values out of their work and that ideal is to strive for value-free counseling Because such counselors are so intent on not influencing their clients, they run the risk of immobilizing themselves. Research has shown that counselor’ values influence all aspects of the therapeutic process, including assessment strategies, therapy goals, identifying what client problems will be the focus of treatment, choice of techniques and evaluation of therapeutic outcomes 11/29/2014 9

10. Becoming an effective multicultural counselor A major part of becoming a diversity-competent counselor involves challenging the idea that the values we hold are automatically true for others, we also need to understand how our values likely to influence our practice with diverse clients who embrace different values 11/29/2014 10

11. Sue, Arredondo, and McDavis (1992) and Arredondo and her colleagues(1996) have developed a conceptual framework for competencies and standards in multicultural counseling, their dimensions of competency involve three areas: Beliefs and attitudes Knowledge Skill and intervention strategies 11/29/2014 11

12. Issues faced by beginning therapists Dealing with our anxieties Being ourselves and disclosing our experiences Avoiding perfectionism Being honest about our limitations Understanding silence Dealing with demands from clients Dealing with clients who lack commitment Tolerating ambiguity Avoiding losing ourselves in our clients 11/29/2014 12

13. Cont. Developing a sense of humor Sharing responsibility with the client Declining to give advice Defining your role as a counselor Learning to use techniques appropriately Developing your own counseling style Staying vital as a person and as a professional 11/29/2014 13

14. 11/29/2014 14

15. Ethical issues in psychotherapy practice Discussion of these issues is aimed at stimulating you to think further about these issues so that you can form a sound basis for making ethical decisions. Topics addressed include: 11/29/2014 15

16. Putting the clients needs before you own The right of informed consent Dimensions of confidentiality Ethical issues in the assessment process Considering ethical and cultural factors in assessment and diagnosis 11/29/2014 16

17. Dual and multiple relationships in counseling [sexual/nonsexual] 11/29/2014 17

18. Theories & techniques of psychotherapy Psychoanalytic therapy Adlerian therapy Existential therapy Person-centered therapy Gestalt therapy Behavioural therapy Cognitive behavioral therapy Reality therapy 11/29/2014 18

19. Common factors in psychotherapy Listening and talking Release of emotions Giving information Providing rationale Restoration of morale Suggestion Guidance and advice The therapeutic relationship 11/29/2014 19

20. QUESTIONS ? COMMENTS ? 11/29/2014 20

21. Psychoanalytic therapy

22. overview System of psychology originating from work of Sigmund Freud Originally used to treat psycho-neurotic disorders 11/29/2014 22

23. According to Ernst Kris(1950)-psychoanalysis may be defined as Human nature seen from a vantage point of conflict Psychoanalysis views the mind as the expression of conflicting forces. some of these forces are conscious; other perhaps the majors ones are unconscious. 11/29/2014 23

24. Conflict is an inexorable dimension of the human condition. It reflects the humans as biological animals and social beings The functioning of the mind is related to events in the body. The boy is the substrate of all psychology, including psychoanalysis. Basic responses to stimuli are part of man’s biological inheritance 11/29/2014 24

25. A fundamental principle of psychoanalytic theory is that human psychology is governed by a tendency to seek pleasure and to avoid pain The earliest experiences of pleasure and pain play a crucial role in shaping each individual’s psychological structure 11/29/2014 25

26. Psychoanalysis is the most extensive, inclusive, and comprehensive system of psychology. It encompasses humans’ inner experiences and outer behavior. Their biological nature and social roles, how they function individually and how they function in groups.. 11/29/2014 26

27. As far as the individual is concerned, the sources of his neurotic suffering are by their very nature “unknowable” they reside outside the realm of consciousness, barred from awareness by virtue of their painful, unacceptable quality. By enabling the patient to understand how his neurotic symptoms and behavior represent derivatives of unconscious conflict, psychoanalysis permits the patient to make rational choices instead of responding automatically 11/29/2014 27

28. History Psychoanalysis originates from freud’s works 1 Studies on hysteria (1895) 2 The interpretation of dreams 3 On narcissism 4 papers of metapsychology 5 dual instinct theory 6 Structural theory 11/29/2014 28

29. Current status Under the leadership of Melanie Klein(1932)the English school of psychoanalysis emerged It emphasizes the importance of primitive fantasies of loss ( the depressive position ) and persecution( the paranoid position ) in the pathogenesis of mental illness. 11/29/2014 29

30. View of human nature According to Freud,our behaviour is determined by irrational forces, unconscious motivations and biological and instinctual drives as these evolve through key psychosexual stages in the first six years of life 11/29/2014 30

31. Onset of neurosis In children: Neurotic disorders in children stem from conflicts resulting from wishes of the oedipal phase Usually childhood neurosis assumes the form of general apprehensiveness, nightmares, phobias, tics, mannerisms or ritualistic practices 11/29/2014 31

32. In adults: Neurosis in adults may develop anew when the balance between the pressures of the id drives and the defensive forces of the ego is upset There are 3 typical situation in which this can occur 11/29/2014 32

33. 1 An individual may be unable to cope with the additional psychological burden of normal development 11/29/2014 33

34. 2 Disappointment, defeat, loss of love, physical illness, or some other consequence of the human condition may lead an individual to turn away from current reality and unconsciously seek gratification in the world of fantasy 11/29/2014 34

35. 3 By a combination of circumstances, an individual may find himself in adult life in a situation that corresponds in its essential features to some childhood trauma or conflict-laden fantasy. Current reality is then misperceived in terms of the childhood conflict and the individual responds as he did in childhood, by forming symptoms eg crying in cases of problems 11/29/2014 35

36. ANXIETY Reality anxiety Neurotic anxiety Moral anxiety 11/29/2014 36

37. Ego-defense mechanism Repression Denial Reaction formation Projection Displacement Rationalizations Sublimation Regression 11/29/2014 37

38. Introjections Identification Compensation 11/29/2014 38

39. Theory of Personality The psychoanalytic theory of personality is based on a number of fundamental principles: 11/29/2014 39

40. 1. Determinism Psychoanalytic theory assumes that mental events are not random, haphazard, accidental, unrelated phenomena. Thoughts, feelings, and impulses are events in a chain of causally related phenomena. They result from antecedent experience in the life of the individual. 11/29/2014 40

41. 2. Topographic viewpoint Every mental element is judged according to its accessibility to consciousness. The process by which certain mental contents are barred from consciousness is called repression- it is an active effort to keep certain thoughts out of awareness to avoid pain or unpleasure. 11/29/2014 41

42. 3. Dynamic viewpoint This pertains to the interaction of libidinal and aggressive impulses. Instinct vs. drive 11/29/2014 42

43. 4. Genetic viewpoint Tracing the origins of later conflicts, character traits, neurotic symptoms, and psychological structure to the crucial events and wishes of childhood and the fantasies they generated. The genetic approach is not a theory; it is an empirical finding confirmed in every psychoanalysis. It states that in many ways, we never get over our childhood. 11/29/2014 43

44. Personality evolves out of the interaction between inherent biological factors and the vicissitudes of experience. For any individual, given an average expectable environment, one may anticipate a more or less predictable sequence of events constituting the steps in the maturation of the drives and the other components of the psychic apparatus. Whatever happens to the individual—illness, accidents, deprivation, abuse, seduction, abandonment—in someway will alter the native endowment and will contribute towards determining the ultimate personality structure. 11/29/2014 44

45. Structure of personality ID EGO SUPER-EGO 11/29/2014 45

46. Psychosexual stages of development Stage Period Oral phase Birth to 2yrs Libidinal Gratification centres around feeding and the organs connected with that function Gratification of oral needs in the form of satiety brings about a state of freedom from tension and induces sleep. Many disturbances of sleep seem to be connected with unconscious fantasies of an oral libidinal Nature( Lewin , 1946, 1949). People whose early oral needs have been excessively frustrated turn out to be pessimists. On the other hand, individuals whose oral needs have been gratified tend to have a more optimistic view of the world. 11/29/2014 46

47. Anal phase 2yrs-4yrs Libidinal gratification comes from retraining and passing feces-during this phase interest in bodily processes, in smelling, touching, and playing with feces are paramount. The disgust that those who train the child evince and the shame the child is made to feel may contribute towards a lowered sense of self esteem. In reaction, the child may respond by stubborn assertiveness, contrary rebelliousness, and the determination to be in control of whatever happens to him Through reaction formation the child may overcome the impulse to soil by becoming meticulously clean, excessively punctual, and quite parsimonious in handling possesions [Freud 1917] 11/29/2014 47

48. Phallic phase 4yrs-6yrs At this stage libidinal gratification shifts to the genitals. Both boys and girls, the penis becomes the principal object of interest in the phallic phase. At this time the clitoris,embryologically an analogue of the penis, begin to be appreciated for pleasure During this time, children may entertain intensely hostile wishes with the penis serving as an instrument for aggression. Also prominent at this stage are exhibitionistic and voyeuristic wishes. Latency period 11/29/2014 48

49. Genital phase 12yrs + 11/29/2014 49

50. Psychotherapy The principles and techniques of psychoanalytic therapy are based upon the psychoanalytic theory of neurosis:[ the theory of neurosis changed so did the techniques ] Originally Freud felt that neurotic symptoms were a result of pent up, undischarged emotional tension connected with the repressed memory of a traumatic childhood sexual experience. 11/29/2014 50

51. Techniques At first he used hypnosis to bring about emotional catharsis and abreaction of the trauma Forced suggestion- a technique of recollection fostered by the insistent demanding pressure of the therapist 11/29/2014 51

52. Free association: in this technique he asked his patients to report freely and without criticism whatever came into their mind To Freud the principal goal was to make the contents of the unconscious conscious 11/29/2014 52

53. Changes in psychoanalytic theory of pathology and treatment Regulation of self-esteem and the vicissitudes of what is called the “self state” are perhaps the primary factors in pathology and dictate the analysts approach Very early dissonance in a mother/child interaction creates the basis for narcissistic vulnerability. 11/29/2014 53

54. Object relations Theory[ Kernberg ]- he emphasizes how the relations with the earliest significant objects in the individual’s life leave a residue of internalized relationship concepts that may continue throughout the individual’s life. Later trauma may evoke latent object relations and lead the individual to respond in an unrealistic way to present-day situations. 11/29/2014 54

55. Therapeutic techniques and procedures Modern psychoanalysis has these features Therapy is geared more to limited objectives than to restructuring ones personality Therapist is less likely to use the couch There are probably fewer sessions There is more frequent use of supportive interventions—such as reassurance, expression of empathy, and support, and suggestions and more self disclosure by the therapist The focus is more on pressing practical issues than on working with fantasy 11/29/2014 55

56. Maintaining the analytic framework Free Association Interpretation Dream analysis Analysis and interpretation of resistance Analysis and interpretation of transference 11/29/2014 56

57. Maintaining the analytic framework Psychoanalytic process stresses maintaining a particular framework aimed at accomplishing the goals of this type of therapy. analyst’s relative anonymity, the regularity and consistency of meetings, and starting and ending the sessions on time. , 11/29/2014 57

58. Free Association Clients are encouraged to say whatever comes to mind, regardless of how painful, silly, trivial, illogical, or irrelevant it may be. In essence, clients flow with any feelings or thoughts by reporting them immediately without censorship. As the therapy progresses, most clients will occasionally depart from this basic rule, and these resistances will be interpreted by the therapist when its is timely to do so. 11/29/2014 58

59. interpretation Interpretation consists of the analyst’s pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistances and the therapeutic relationship itself. 11/29/2014 59

60. Dream analysis This is used to uncover unconscious material and giving the client insight into some areas of unresolved problems. During sleep, defenses are lowered and repressed feelings surface. Dreams have two levels of content Latent content Manifest content 11/29/2014 60

61. Analysis and interpretation of transference TRANSFERENCE – Core of psychoanalytical therapy Unconsciously projecting old, unresolved feelings and attitudes onto the therapist EX: stern father old lover mother excellent father 11/29/2014 61

62. Goal of therapy is to work through transferences Explore unconscious, defenses, and repressed material Interpret client behavior Help client make new choices Help client see how past experiences are effecting their current behaviors 11/29/2014 62

63. Help clients see how problems are effecting client in their daily lives Reveals childhood motivations Counselor: all powerful Client/child: please, angry, acceptance 11/29/2014 63

64. COUNTERTRANSFERENCE Therapist projects unconscious material onto client Therapist responds irrationally and subjectively to client Therapists own conflicts are triggered 11/29/2014 64

65. EX: Unresolved issues with father>when counseling an old man Dislike of adolescents, ethnic group Client example/house 11/29/2014 65

66. Therapist loses objectivity, and becomes emotional Serious detriment to therapeutic relationship Refer client, get supervision 11/29/2014 66

67. Adlerian therapy 11/29/2014 67

68. 11/29/2014 68

69. Brief biography 1870-1937 Vienna family of six boys two girls Early child hood experience had an impact on formation of theory 11/29/2014 69

70. Historical context Freud and Adler met in 1902, Freud invited Adler after he made strong defense to his paper “interpretation of dreams” Adler[a president of PS] was expelled from psychoanalytic society in 1911, after presenting a paper “masculine protest” this was a controversial paper to Freud’s earlier works. Instead of focusing on biological and psychological factors on masculine behaviors in males and female- Adler emphasized the power of culture and socialization 11/29/2014 70

71. Cont. Adler together with five other people[former members of psychoanalytic society] formed the society for individual psychology Later a number of psychoanalysts deviated from Freud’s orthodox position. These included: Karen Horney, Erich Fromm, and Harry Stack Sullivan. They believed that social and cultural factors were of great significance in shaping personality 11/29/2014 71

72. Cont. Although they are referred to as neo Freudians, the three psychoanalysts who crossed from Freud would best be called neo Adlerian. Because they moved away from Freud's biological and deterministic point of view and towards the Adler's social-psychological and teleological(or goal oriented) view of human nature 11/29/2014 72

73. Cont. Adler saw human as both the creators and creations of their own lives People develop a unique style of living that is both a movement toward and an expression of their selected goals. In this sense we create ourselves rather than being merely shaped by our childhood experiences 11/29/2014 73

74. Overview Individual psychology views the person holistically as a creative, responsible, “becoming” individual moving toward fictional goals within his or her phenomenal field. It holds that one’s lifestyle is sometimes self defeating because of inferiority feelings. The individual with psychopathology is discouraged rather than sick, and the therapeutic task is to encourage the person, to activate his/her social interest and develop a new lifestyle through relationship, analysis and action methods 11/29/2014 74

75. Key concepts View of human nature Subjective perception of reality Unity & patterns of human personality Behaviour as purposeful and goal oriented Striving for significance and superiority lifestyle Social interest &Community feeling Birth order and sibling relationship 11/29/2014 75

76. View of human nature Humans are motivated primarily by social relatedness rather than by sexual urges; behaviour is purposeful and goal-directed and consciousness, more than unconsciousness, is the focus of therapy. From the Adlerian perspective, human behaviour is not determined solely by heredity and environment. Instead we have the capacity to interpret, influence, and create events. 11/29/2014 76

77. Subjective perception of reality Adlerians attempt to view the world from the client's subjective frame of reference. An orientation described as phenomenological. This “subjective reality” includes the individual’s perceptions, thoughts, feelings, values, beliefs, convictions, and conclusions. Behavior is understood from a vantage point of this subjective perspective. 11/29/2014 77

78. Unity & patterns of human personality A basic premise of Adlerian individual psychology is that personality can only be understood holistically and systematically The individual is seen as an indivisible whole, born, reared, and living in specific familial, social and cultural contexts 11/29/2014 78

79. An individual’s thoughts, feelings, beliefs, convictions, attitudes, character, and actions are expressions of his or her uniqueness, and all reflect a plan of life that allows for movement toward a self-selected life goal. An implication of the holistic view of personality is that the client is an integral part of a social system. 11/29/2014 79

80. Behaviour as purposeful and goal oriented Individual psychology assumes that all human behaviour has a purpose. Adler referred to the endpoint of our future purposeful striving as fictional finalism because the endpoint is each individual’s subjective fiction. Ex. If I become depressed, I can communicate my anger and dissatisfaction indirectly. I will be taken care of and thereby in control of the household. 11/29/2014 80

81. Striving for significance and superiority Adler stresses that striving for perfection and coping with inferiority by seeking mastery are innate. Inferiority is not a negative factor in life. The moment we experience inferiority we are pulled by striving for superiority. He maintained that the goal of success pulls people forward toward mastery and enables them to overcome obstacles. 11/29/2014 81

82. It is important to understand that superiority as used by Adler does not mean one being superior to others. Rather it means moving from a perceived lower position to a perceived higher position, from a felt minus to a felt plus. People cope with feelings of helplessness by striving for competence, mastery, and perfection. They seek to change the weakness into strength. For example one strives to excel in one area of concentration to compensate for defects in other areas. 11/29/2014 82

83. Lifestyle An individual’s core beliefs and assumptions through which the person organizes his/her reality and finds meaning in life events constitutes the individual’s lifestyle. [read current psychotherapies pg 77-78] These styles of life consist of people’s views about themselves and the world and their distinctive behaviors and habits as they pursue personal goals. Everything we do is influenced by these unique lifestyles 11/29/2014 83

84. Social interest &Community feeling Social interest & Community feeling: one of the basic assumption is that individual psychology is an interpersonal psychology-how individuals interact with others sharing “this crust earth” is paramount. These concepts refer to an individual’s awareness of being part of the human community and to individual’s attitudes in dealing with the social world. Social interest includes striving for a better future for humanity. Social interest is the central indicator of mental health. those with social interest tend to direct the striving toward the healthy and socially useful side of life. Individual psychology rests on the a central belief that our happiness and success are largely related to this social connectedness. 11/29/2014 84

85. Birth order & sibling relationship Adler identified five psychological positions: Oldest child Second of only two Middle child Youngest child Only child 11/29/2014 85

86. Tasks of life Work or occupation Social relationships Love and marriage Self Spirituality Parenting and family ( Dreikurs & Mosak, 1966,1967 ) ( Dinkmeyer , 1987 ) ( Adlers ,) 1956 11/29/2014 86

87. When clients come to therapy, they almost always come because they have had difficulty with one or more basic life tasks. The difficulties arise from inaccuracies, mistakes, and maladaptive perceptions associated with their lifestyles. Therefore, the overarching goal of therapy is to help clients adjust or modify their lifestyles in ways that help them more effectively complete their life tasks. 11/29/2014 87

88. Work or occupation Adler believed the best way to solve the life task of work or occupation was by solving the second life task, social relationships, through “friendship, social feeling, and cooperation”(Adler, 1958, p. 239). If a person is unable to work cooperatively, divide labor responsibilities, and maintain friendly relations, he or she is likely to struggle in the area of work. 11/29/2014 88

89. Social relationship Adler was a strong proponent of positive social relationships. As has been noted, he felt that establishing healthy social relationships was the key to solving the work or occupational problem. In essence, humans are interdependent. from the Adlerian perspective, clients’ social problems stem from inappropriate expectations, beliefs, and interpersonal habits imbedded in their individual lifestyles. 11/29/2014 89

90. Love and marriage Some theorists refer to this life task as love and others refer to it as sex (Mosak, 1999). Many clients come to therapy with intimacy problems, both sexual and nonsexual. For Adlerians, the road to recovery for these clients is the same as we have suggested previously: Modify the lifestyle, develop empathy for others (community feeling), and take decisive action by thinking and acting differently in everyday life. 11/29/2014 90

91. Self Essentially, this task emphasizes that everyone has a relationship with himself or herself. The nature of your relationship with yourself is established during childhood. Mosak and Maniacci (1999) describe four dimensions of the self life task: 11/29/2014 91

92. Survival of self: Am I taking good care of my physical self ? Am I taking good care of my psychological self ? Am I taking good care of my social self ? Body image: Is my perception of my body reasonable and congruent with my actual body? Opinion: What is my opinion of me? To evaluate this in an interview, Adlerians often ask clients to complete the incomplete sentence, “I me” (Mosak & Maniacci , 1999, p. 107). Evaluation: Some clients have various extreme perspectives of the self. From the object relations perspective, the question would be “Am I good or am I bad?” 11/29/2014 92

93. The optimal resolution of the self task is characterized by good self-care, an accurate perception and expectations of one’s body, a reasonably accurate and positive opinion of oneself, and a balanced view of oneself as not overly good or overly bad. 11/29/2014 93

94. Spirituality Mosak and Maniacci (1999) describe five specific issues related to the spirituality task. As individuals grow up and face life, they must approach and deal with each of these issues: Relationship to God Religion Relationship to the universe Metaphysical issues Meaning of life 11/29/2014 94

95. 11/29/2014 95

96. Parenting and family Giving birth to and raising children, and functioning as a family, are extensions of the love and marriage task discussed previously. However, these things also constitute a task in and of themselves. Some individuals function as single parents and raise children outside marriage. Individual parents also develop strong feelings and beliefs about how children should be raised. How individuals face the parenting and family task is both a function of and a challenge to the lifestyle. 11/29/2014 96

97. Psychopathology and human change Adlerians define psychopathology as “discouragement,” but of course there’s much more to it than that. The discouraged individual is one who is unable or unwilling to approach and deal with essential life tasks. 11/29/2014 97

98. With regard to psychopathology and life tasks, Adler stated: 11/29/2014 98

99. In the case of mental dysfunction, one or more of the life tasks have become overwhelming. This is where the concept of discouragement fits in. The person struggling to adequately face a life task becomes discouraged. He or she feels inferior or unable to successfully manage the life task demands, and therefore symptoms arise. Symptomatic patients are suffering from the effects of their inaccurate or mistaken lifestyles. 11/29/2014 99

100. Mosak (1989) also makes a clear statement about psychopathology from the Adlerian perspective when he says, “poor interpersonal relationships are products of misperceptions, inaccurate conclusions, and unwarranted anticipations incorporated in the life-style” (p. 86). The maladaptive lifestyle and its associated interpersonal dysfunctions cause the client to experience disappointments, feelings of inferiority, and eventually discouragement. 11/29/2014 100

101. Therapy process Therapeutic techniques and procedures 11/29/2014 101

102. Therapeutic goals The main aim of therapy is to develop the client’s sense of belonging and to assist in the adoption of behaviors and processes characterized by community feeling and social interest. Adlerian do not see clients as sick- they are just discouraged. Symptoms are attempted solutions. The goal is to re-educate clients so that they can live in society as equals, both giving society and receiving from others. 11/29/2014 102

103. Mosak (2000) lists these goals for the educational process of therapy Fostering social interest Helping clients overcome feelings of discouragement and inferiority Modifying clients’ views and goals—that is changing their lifestyle Changing faulty motivation Assisting clients to feel a sense of equality with others Helping people to become contributing members of society 11/29/2014 103

104. Therapist’s function and role Therapists tend to look for major mistakes in thinking and valuing such as mistrust, selfishness, unrealistic ambitions, and lack of confidence. A major function of the therapist is to make comprehensive assessment of the client’s functioning. They assist clients in better understanding, challenging, and changing their life story 11/29/2014 104

105. Client’s experience in therapy Relationship between therapist and client 11/29/2014 105

106. General Therapeutic Strategy Therapeutic strategy from an Adlerian perspective can be boiled down to a few simple components. Use these as a general guide: • Be a friendly, supportive model for your clients. • Use encouragement to help clients have more success potential and faith in themselves. • Help clients have insight into their style of life and fictional finalism. • Help clients modify their basic mistakes using a broad range of educational procedures 11/29/2014 106

107. Counseling or psychotherapy is a friendly and collaborative process consisting of four phases ( Dreikurs , 1969). These phases include: Forming the therapeutic relationship Lifestyle assessment and analysis Interpretation and insight Reorientation 11/29/2014 107

108. Phase1: Establishing the relationship Work in a collaborative way with clients- this relationship is based on a sense of deep caring, involvement, and friendship. Progress is possible only when there are clearly defined goals between therapist and client. Adlerian therapists seek to make person-to-person contact with clients rather than starting with the problem. 11/29/2014 108

109. Pay more attention to the subjective experience of the client than you do to using techniques. Adlerian attempt to grasp both the verbal and nonverbal messages of the client 11/29/2014 109

110. Phase 2: Exploring the individual’s dynamics Exploring the psychological dynamics operating in the client This second phase of Adlerian counseling proceeds from two interview forms: Subjective interview Objective interview 11/29/2014 110

111. In the subjective interview—the counselor helps the client to tell his/her story as completely as possible Process facilitated generous use of empathetic listening and responding Throughout the interview the therapist is listening for clues to purposive aspects of the client’s coping and approaches to life Adlerians often end the subjective interview with this question “how would your life be different, and what would you do differently, if you did not have this symptom or problem? 11/29/2014 111

112. The objective interview seeks to discover information about: How problems in the client’s life began Any precipitating events A medical history-including current and past medications A Social history The reasons the client chose therapy at this time The person’s coping with life tasks A lifestyle assessment 11/29/2014 112

113. Family constellation Early recollection Personality priorities 11/29/2014 113

114. Phase 3: Interpretation and insight Based on the belief that everything in human life is purposeful- self understanding is only possible when hidden purposes and goals of behavior are made conscious Disclosure and interpretations are techniques that facilitate the process of gaining insight. They are focused on here and now behavior and on the expectations and anticipations that arise from one’s intentions 11/29/2014 114

115. Reorientation The encouragement process Change and the search for new possibilities Making a difference 11/29/2014 115

116. Existential therapy 11/29/2014 116

117. Introduction Existential therapy can best be described as a philosophical approach that influences a counselors therapeutic practice. Therefore existential psychotherapy is neither an independent nor a separate school of therapy, nor is it a neatly defined model with specific techniques The existential approach rejects the deterministic view of human nature espoused by orthodox psychoanalysis and radical behaviourism . 11/29/2014 117

118. Psychoanalysis sees freedom as restricted by unconscious forces, irrational drives, and past events; behaviorists see freedom as restricted by sociocultural conditioning. 11/29/2014 118

119. “we are authors of our lives, and we design the signposts to follow” Existential therapists acknowledge some of these facts about human situation but emphasize our freedom to choose what to make of our circumstances. This is based on the assumption that we are free and therefore responsible for our choices and actions 11/29/2014 119

120. Major aim in therapy Is to encourage people/clients to reflect on life, to recognize their range of alternatives and to decide among them. Once clients begin on the process of recognizing the ways in which they have passively accepted circumstances and surrendered control, they can start on a path of consciously shaping their own lives. 11/29/2014 120

121. Yalom (2003) emphasizes that the 1 st step in the therapeutic journey is for the client to accept responsibility; “once the individual recognize their role in creating their own life predicament, they also realize that they, and only they have the power to change that situation” 11/29/2014 121

122. Key figures in contemporary existential psychotherapy Viktor Frankl , Rollo May James Bugental Irvin Yalom 11/29/2014 122

123. View of human nature The existential view of human nature is captured, in part, by the notion that the significance our existence is never fixed once and for all; rather, we continually re-create ourselves through our projects. Human are in a constant state of transition, emerging, evolving, and becoming. 11/29/2014 123

124. The basic dimensions of the human condition, according to the existential approach, include: The capacity for self-awareness Freedom and responsibility Creating one’s identity and establishing meaningful relationships with others The search for meaning, purpose, values, and goals Anxiety as a condition of living, and Awareness of death and non-being. 11/29/2014 124

125. Proposition1: the capacity for self awareness As human beings, we can reflect and make choices because we are capable of self-awareness. The greater our awareness, the greater our possibility for freedom. Thus we increase our capacity to live fully as we expand our awareness in the following areas: 11/29/2014 125

126. We are finite and do not have unlimited time to do what w want in life. We have the potential to take action or not to act; inaction is a decision W choose our actions, and therefore we can partially create our own destiny. Meaning is the product of discovering how we are thrown or situated in the world and then, through commitment, living creatively. Existential anxiety, which is basically a consciousness of our own freedom, is an essential part of living; as we increase our awareness of the choices available to us, we increase our sense of responsibility for consequences of these choices. 11/29/2014 126

127. We are subject to loneliness, meaningfulness, emptiness, guilt, and isolation. We are basically alone, yet we have an opportunity to relate to other beings. 11/29/2014 127

128. Proposition 2: Freedom and Responsibility A characteristic existential theme is that people are free to choose among alternatives and therefore have a large role of shaping their destinies. “Freedom is existence, and in its existence precedes essence” and “Man’s essence is his existence” (Sartre, 1953, p. 5). 11/29/2014 128

129. Proposition 3: Striving for identity and relationship to others People are concerned about preserving their uniqueness and centeredness, yet at the same time they have an interest in going outside of themselves to relate to other beings and to nature. Many existential writers discuss loneliness, uprootedness , and alienation, which can be seen as the failure to develop ties with others and with nature 11/29/2014 129

130. The courage to be The experience of aloneness The experience of relatedness Struggling with our identity 11/29/2014 130

131. Proposition 4: The Search for Meaning A distinctly human characteristic is the struggle for a sense of significance and purpose in life. Existential therapy can provide the conceptual framework for helping clients challenge the meaning in their lives 11/29/2014 131

132. Common challenges in process of striving for identity The problem of discarding old values Meaninglessness Creating new meaning 11/29/2014 132

133. Proposition 5: Anxiety as a Condition of Living Anxiety arises from ones personal striving to survive and to maintain and assert one's being, and the feelings anxiety generates are an inevitable aspect of the human condition. Existential anxiety is conceptualized as the unavoidable result of being confronted with the “givens of existence” –death, freedom, existential isolation, and meaninglessness 11/29/2014 133

134. Existential therapists see anxiety as a potential source of growth. Normal anxiety is an appropriate response to an event being faced, neurotic anxiety in contrast is out of proportion to the situation. It is typically out of awareness, and it tends to immobilize the person. Because Humans could not survive without some anxiety, it is not a therapeutic goal to eliminate normal anxiety 11/29/2014 134

135. Freedom and anxiety are two sides of the same coin- we experience anxiety when we use our freedom to move out of the known into the realm of the unknown. Out fear, many of us try to avoid taking such a leap into the unknown. Existential therapy helps clients come to terms with the paradoxes of existence—life and death, success and failure, freedom and limitations, and certainty and doubt. 11/29/2014 135

136. Existential therapist does not aim at eliminating anxiety, --to do that would be to cut off a source of vitality. Counselors have the task of encouraging clients to develop the courage to face life squarely, largely, by taking a stance, performing an action, or making a decision. 11/29/2014 136

137. Proposition 6: Awareness of death and nonbeing The existentialist does not view death negatively but holds that awareness of death as a basic human condition gives significance to living. It is necessary to think about death if we are to think significantly about life. 11/29/2014 137

138. A ssignment Read about the therapeutic process under existential therapy Watch “the secret” and compare the principle of existentialism to “the secret”. 11/29/2014 138

139. THERAPEUTIC TECHNIQUES AND PROCEDURES APPLICATION 11/29/2014 139

140. APPLICATION EXISTENTIAL THERAPY is a collaborative adventure in which both the therapist and client will be transformed if they allow themselves to be touched by life. When the deepest self of the therapist meets the deepest part of the client, the counseling process is at its best. Therapy is a creative, evolving process of discovery that can be conceptualized in three general phases 11/29/2014 140

141. Initial phase: counselor assists client in identifying and clarifying their assumptions about the world. Client are invited to define and question the ways in which they perceive and make sense of their experience. They examine their values, beliefs and assumptions to determine their validity 11/29/2014 141

142. Middle phase: Clients are encouraged to more fully examine the source and authority of their present value system. 11/29/2014 142

143. Final phase: Counseling focuses on helping client take what they are learning about themselves and put it into action. The aim of therapy is to enable clients to find ways of implementing their examined and internalized values in a concrete way. Clients typically discover their strengths and find ways to put them to the service of living a purposeful existence. 11/29/2014 143

144. Areas of application For clients who are struggling with developmental crises, doing grief work, confronting death, or facing a significant decision, existential therapy is especially appropriate. Duerzen -smith (1990) suggests that this form of therapy is best suited for clients who are committed to dealing with their problems about living, for people who feel alienated from the current expectations of society, or for those who are searching for meaning in their lives. 11/29/2014 144

145. It tends to work well for people who are on the crossroads and who question the state of affairs in the world and a re willing to challenge the status quo. It can be useful for people who are on the edge of existence, such as those who are dying, who are working through a developmental or situational crisis, or who are starting a new phase of life 11/29/2014 145

146. Person Centered Therapy Carl Rogers 1902-1987

147. Introduction The person centered approached is based on concepts from humanistic psychology. Roger’s basic assumptions: People are essentially trustworthy People have a vast potential for understanding themselves and resolving their own problems without direct intervention on the side of the therapist. People are capable of self-directed growth 11/29/2014 147

148. Determinants of therapy outcome Rogers emphasized Attitudes Personal characteristics of the therapist Quality of the client-therapist relationship 11/29/2014 148

149. Existentialism and Humanism In 1960s and 1970s- saw the development of a “third force” an alternative to psychoanalytic and behavioral approaches. Person-centered therapy is an experiential and relationship oriented treatment. Both humanism and existentialism share a respect for the client’s subjective experience and a trust in the capacity of the client to make positive and constructive conscious choices. 11/29/2014 149

150. Emphasize concepts like Freedom Choice Values Personal responsibility Autonomy Purpose and Meaning 11/29/2014 150

151. Differences btn humanistic and existentialists Existentialists take the position that we are faced with the anxiety of choosing to create an identity in a world that lacks intrinsic meaning Humanists, in contrast, take the somewhat less anxiety invoking position that each of us has a natural potential that we can actualize and through which we can find meaning Refer to metaphor of an acorn 11/29/2014 151

152. The underlying vision of humanistic philosophy is captured in the metaphor of an acorn, if provided with the appropriate conditions, will automatically grow in positive ways, pushed naturally towards its actualization as an oak. The humanistic philosophy on which the person-centered approach rests is expressed in attitudes and behaviors that create a growth- producing climate 11/29/2014 152

153. Key concepts View of Human Nature Rogers maintains that people are trustworthy, resourceful, capable of self –understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. When therapists are able to experience and communicate their realness, caring and nonjudgmental understanding, significant changes in the client are most likely to occur. 11/29/2014 153

154. Roger expresses little sympathy for approaches based on the assumption that the individual cannot be trusted and instead needs to be directed, motivated, instructed, punished, rewarded, controlled, and managed by others who are in a superior and expert position. 11/29/2014 154

155. Therapist attributes that create a growth-promoting climate Congruence(genuineness, or realness) Unconditional positive regard(acceptance and caring) Accurate empathetic understanding(an ability to deeply grasp the subjective world of another person) If therapist communicates these attitudes the client will become less defensive and more open to themselves and their world and they will behave in more prosocial and constructive ways. 11/29/2014 155

156. The person centered therapist focuses on the constructive side of human nature, on what is right with the person, and on the assets the individual brings to therapy 11/29/2014 156

157. Therapeutic Process Goals – person centered approach aims towards a greater degree of independence and integration of the individual. Its focus is on the person not the person’s presenting problem. People who enter psychotherapy often ask: How can I discover my real self? How can I become what I deeply wish to become? How can I get behind my facades and become myself? 11/29/2014 157

158. Therapy aims to provide a conducive climate to help the individual become a more fully functioning person. The client must first get behind the masks they wear, which they develop through the process of socialization. Clients come to recognize that they have lost contact with themselves by using facades. 11/29/2014 158

159. Rogers describes people who are becoming increasingly actualized as having: An openness to experience A trust in themselves An internal source of evaluation A willingness to continue growing 11/29/2014 159

160. Therapist’s Function and Role The role of the therapist is rooted in their ways of being and attitudes. Research indicate that the attitude of therapists rather than their knowledge, theories, or techniques, facilitate personality change in the client. Therapists do not aim to manage, conduct, regulate or control the client. Therapist does not intend to diagnose, create treatment plans, strategize, employ treatment techniques or take responsibility of the client in any way 11/29/2014 160

161. Person centered theory holds that the therapists function is to be present and accessible to clients and to focus on their immediate experience. 11/29/2014 161

162. Application: Therapeutic Techniques and Procedures Early emphasis on reflection of feelings Yes! When I get home in the evening, my house is a mess. The kids are dirty… My husband does not care about dinner...I do not feel like going home at all. You are not satisfied with the way the house chores are organized. That irritates you. 11/29/2014 162

163. Person centered therapy from multicultural perspective Discussion 11/29/2014 163

164. Behaviour therapy B.F. Skinner (1904-1990)

165. Introduction 11/29/2014 165

166. Key concepts View of Human Nature 11/29/2014 166

167. Key concepts 2 Basic characteristics and assumptions Behaviour therapy is based on the principle and procedures of the scientific method . Devotion to Empiricism Adherence to precision and empirical evaluation Behavior therapists state treatment goals in concrete objective terms to make replication of their interventions possible. Behavioural concepts and procedures are stated explicitly, tested empirically, and revised continually. 11/29/2014 167

168. Behaviour therapy deals with the clients current problems and the factors influencing them-- as opposed to an analysis of the possible historical determinants. 11/29/2014 168

169. Clients involved in behaviour therapy are expected to assume an active role by engaging in specific actions to deal with their problem. They are required to do something to bring about change. Client monitor their behaviour both during and outside the therapy session , learn and practice coping skills and role play new behaviors. 11/29/2014 169

170. The behavioral approach emphasizes teaching clients skills of self management. Behaviour therapy is largely carried out in the clients natural environment. 11/29/2014 170

171. The focus is on assessing overt and covert behaviour directly, identifying the problem and evaluating change. 11/29/2014 171

172. Behaviour therapy emphasizes a self-control approach in which clients learn self-management strategies. Therapists train clients to initiate, conduct, and evaluate their own therapy. Clients are empowered through this process of being responsible for their changes 11/29/2014 172

173. Behavioural treatment interventions are individually tailored to specific problems experienced by clients 11/29/2014 173

174. The practice of behaviour therapy is based on a collaborative partnership between client and therapist and every attempt is made to inform clients about the nature and course of treatment. 11/29/2014 174

175. The emphasis is on practical applications. Interventions are applied to all facets of daily life in which maladaptive behaviour are to be decreased and adaptive behaviour are to be increased 11/29/2014 175

176. Therapists strive to develop culture-specific procedures and obtain their clients adherence and cooperation 11/29/2014 176

177. The therapeutic process Therapeutic goals The general goals of behaviour therapy are to increase personal choice and to create new conditions for learning. The client with the help of the therapist, defines specific goals at the outset of the therapeutic process. Although assessment and treatment occur together, a formal assessment takes place prior to treatment to determine behaviours that are target for change 11/29/2014 177

178. Therapist’s Function and Role Behaviour therapists tend to be active and directive and to function as consultants and problem solvers. Behavioural clinicians perform these other functions Conduct a thorough functional assessment. Formulate initial treatment goals, design and implement a treatment plan. Use strategies to promote generalization and maintenance of behaviour change Evaluate the success of the change plan by measuring progress towards the goals. Conduct follow up assessments 11/29/2014 178

179. APPLICATIONS THERAPEUTIC TECHNIQUES AND PROCEDURES Positive reinforcement Negative reinforcement Extinction Applied behaviour analysis: Operant conditioning techniques Positive punishment Negative punishment 11/29/2014 179

180. Operant conditioning: Addiction (1) Drug use is a behaviour that is reinforced by the positive reinforcement that occurs from the pharmacologic properties of the drug. 11/29/2014 180

181. Operant conditioning: Addiction (2) Once a person is addicted, drug use is reinforced by the negative reinforcement of removing or avoiding painful withdrawal symptoms. 11/29/2014 181

182. Operant conditions (1) Positive reinforcement strengthens a particular behaviour (e.g., pleasurable effects from the pharmacology of the drug; peer acceptance) 11/29/2014 182

183. Operant conditions (2) Punishment is a negative condition that decreases the occurrence of a particular behaviour (e.g., If you sell drugs, you will go to jail. If you take too large a dose of drugs, you can overdose.) 11/29/2014 183

184. Operant conditions (3) Negative reinforcement occurs when a particular behaviour gets stronger by avoiding or stopping a negative condition (e.g., If you are having unpleasant withdrawal symptoms, you can reduce them by taking drugs.). 11/29/2014 184

185. 11/29/2014 185

186. Functional assessment model 11/29/2014 186

187. The 5 Ws (functional analysis) The 5 Ws of a person’s drug use (also called a functional analysis) When? Where? Why? With / from whom? What happened? 11/29/2014 187

188. The 5 Ws Behavioural problems do not happen at random. It is important to know: The time periods when the client engages in the behaviour The places where the behaviour happens The external cues and internal emotional states that can trigger behaviour ( why ) The people with whom the client engages in the behaviour The effects the client receives from the behaviours ─ the psychological and physical benefits ( what happened ) 11/29/2014 188

189. Questions clinicians can use to learn the 5 Ws What was going on before you used? How were you feeling before you used? How / where did you obtain and use drugs? With whom did you use drugs? What happened after you used? Where were you when you began to think about using? 11/29/2014 189

190. Functional Analysis or High-Risk Situations Record Antecedent Situation Thoughts Feelings and Sensations Behaviour Consequences Where was I? Who was with me? What was happening? What was I thinking? How was I feeling? What signals did I get from my body? What did I do? What did I use? How much did I use? What paraphernalia did I use? What did other people around me do at the time? What happened after? How did I feel right after? How did other people react to my behaviour ? Any other consequences? 11/29/2014 190

191. Steps in doing functional assessment Step 1 Gather data about the antecedents and consequences that are functionally related to the occurrence of problematic behavior. The therapist uses the 5Ws to direct the client about the information to be gathered. Both indirect [ behavioural interview, questionnaires, diaries] and direct methods[observation] are used to gather information Step 2 From the functional assessment- Therapist and client collectively develop hypotheses about the nature of the problem behavior and the conditions contributing to this behavior. Step 3 Once the different functions of problem behavior are identified, functional treatments are devised to address the antecedents and consequences hypothesized to be maintaining the problem behavior. Operant techniques can be used to deal with the factors Differential reinforcement Extinction Antecedent control procedures 11/29/2014 191

192. Note Negative punishment procedures can be used to decrease problem behavior but only after functional approaches have been exhausted. After treatment methods have been used, it is very important to develop strategies for to promote the generalization and maintenance of behavioral change that have occurred. 11/29/2014 192

193. Other techniques Relaxation training Systematic desensitization Exposure therapies EMDR Assertion training Self management programs 11/29/2014 193