CNPS 365

Sept 10:

KEY TERMS

Bracketing: ability of counsellors to manage their personal values so they do not contaminate
the counselling process
-> putting aside own personal thoughts

Countertransference: therapists seeing in their clients’ patterns of their own behaviour,

overidentifying with clients, or meeting their own needs through clients
Eg. wanting to rage at client because they remind you of someone else (ex husband)

Culture: values and behaviours shared by a group of individuals

Diversity-competent practitioner: ongoing process that involves developing awareness of

beliefs and attitudes, acquiring knowledge about race and culture, and learning
skills/intervention strategies necessary to work effectively with culturally diverse populations

Professional burnout: when helpers feel drained as a result of their work

-> constantly giving without expecting much in return can sap motivation
-> self-care to prevent this

Self-monitoring: paying attention to what one is thinking, feeling, doing

-> crucial first step in self-care

Value imposition: trying to define a client’s values, attitudes, beliefs, and behaviours

Aspirational ethics: a higher level of ethical practice that addresses doing what is in the best
interests of clients.

Assessment: evaluating the relevant factors in a client’s life to identify themes for further
exploration in the counseling process.

Boundary crossing: a departure from a commonly accepted practice that could potentially
benefit a client
Eg. attending a client’s wedding

Boundary violation: a boundary crossing that takes the practitioner out of the professional
role, which generally involves exploitation. It is a serious breach that harms the client and is
therefore unethical.
Confidentiality: this is an ethical concept, and in most states therapists also have a legal duty
not to disclose information about a client.

Diagnosis: the analysis and explanation of a client’s problems. It may include an explanation of
the causes of the client’s difficulties, an account of how these problems developed over time, a
classification of any disorders, a specification of preferred treatment procedure, and an
estimate of the chances for a successful resolution.

Dual or multiple relationships: when a counsellor assumes two (or more) roles simultaneously
or sequentially with a client. This may involve assuming more than one professional role or
combining professional and nonprofessional roles.

Ethical decisions: to make ethical decisions, consult with colleagues, keep yourself informed
about laws affecting your practice, keep up to date in your specialty field, stay abreast of
developments in ethical practice, reflect on the impact your values have on your practice, and
be willing to engage in honest self-examination.

Evidence-based practice (EBP): psychotherapists are required to base their practice on

techniques that have empirical evidence to support their efficacy.

Informed consent: the right of clients to be informed about their therapy and to make
autonomous decisions pertaining to it.

Mandatory ethics: the view of ethical practice that deals with the minimum level of
professional practice.

Nonprofessional interactions: additional relationships with clients other than sexual ones.

Positive ethics: an approach taken by practitioners who want to do their best for clients rather
than simply meet minimum standards to stay out of trouble.

Practice-based evidence: using data generated during treatment to inform the process and
outcome of treatment.

Privileged communication: a legal concept that generally bars the disclosure of confidential
communications in a legal proceeding. Clients are protected from having their confidential
communications revealed in court without their permission.

The Effective Counsellor

-the most important instrument is YOU (need to take care of yourself first)
-> your living example of who you are and how you struggle to live up to your potential
is powerful
-being authentic and not hiding behind your role
-> leaving your reactions and self out of work may result in ineffective counselling
-be a therapeutic person
-> be willing to grow, risk, care, and be involved

Research on Psychotherapy Outcomes

-abundant research indicates the centrality of the person of the therapist and therapeutic
relationship as key factors in successful therapy
-> understand who you are as a person at your core
-the contextual factors, not techniques, are the primary determinants of therapeutic outcome

Managing Value Conflicts

-bracketing can be used to help manage value conflicts
-counselors should not refuse to offer services to clients because of differing values
-seek supervision to learn to effectively manage value differences with your clients

Counselling for the Counsellor

-helps you explore your motivations for being a counsellor, countertransference, and other
issues that are triggered by clinical work
-important to counsellors’ personal/professional development
-need to be committed personally to the value of examining our own life so we can inspire
clients to examine their life

The Counsellor’s Values

-avoid value imposition either directly or indirectly
-invest time in exploring your personal values and recognize that you are not value-neutral
-assist clients in creating goals and finding answers that are most congruent with their own
values

Becoming Multiculturally Competent

-become aware of your own biases, values, cultural norms, and expectations
-attempt to understand the world from your client’s vantage point (perspective)
-gain a knowledge of the dynamics of oppression, racism, discrimination, and stereotyping
-study the historical background, traditions, and values of your client and be open to learning
from them
-expand your vantage point to explore your client’s ways of life that are different from your
own
-develop an awareness of acculturation strategies

Types of Ethics
Mandatory Ethics: minimum level of professional practice
Aspirational Ethics: highest standards of thinking and conduct
Positive Ethics: doing the best for client and not just doing the minimum to stay out of trouble
Ethical Decision Making
-the principles that underlie our professional codes benefit others, do no harm, and respect
other’s autonomy
-the role of ethical codes educates us about responsibilities and are the basis of accountability
-making ethical decisions:
-identify the problem, review codes/laws, seek consultation, document your actions
-include the client in your decision making process

Informed Consent
-clients need enough information about the counselling process to make informed choices
-educate clients about their rights and responsibilities
-address privacy issues with clients, including the use of technology for communication
-empowers clients and helps to build trust
-should include information such as: cost, therapeutic procedures, length of treatment, risks

Limits of Confidentiality
-exceptions:
-client poses a danger to self or others
-clients who are children/minors, dependent adults, or older adults are victims of abuse
-client needs to be hospitalized
-information is made an issue in a court action
-client requests a release of record

Technology and Privacy

-confidentiality and privacy can become more complicated when technology is involved
-ACA Code of Ethics (2014) contains new set of standards regarding the use of technology and
social media
-CCPA and BCAA both have new ethics around the use of technology for communication

Assessment
-ongoing process designed to help the counselor evaluate key elements of a client’s
psychological functioning
-> Influenced by the therapist's theoretical orientation
-> Requires cultural sensitivity
-> Can be helpful in treatment planning

Diagnosis
-process of identifying a pattern of symptoms which fit the criteria for a specific mental
disorder
-> Requires cultural sensitivity
-> Practitioners debate whether a diagnosis is necessary
-> Can be helpful in treatment planning
-> If used only for insurance purposes, can lead to ethical dilemmas
 -> Counsellors have limitations around providing a diagnosis, and must be extremely
cautionary in this area

Evidence-Based Practice (EBP)

-Strengths:
-treatments have been validated by empirical research
-treatments are brief and standardized
-preferred by many insurance companies
-calls for accountability among mental health providers to use effective treatment
approaches

-Criticisms:
-mechanistic and insensitive to individual differences
-not well-suited to work with existential concerns
-difficult to measure both relational and technical aspects of a psychological treatment
-Can be misused as a method of cost containment for insurance companies rather than
as a way of improving the quality of services

Multiple or Dual Relationships

-not inherently unethical, but must be managed ethically to protect client’s well-being
eg. starting a business with a former client, borrowing money
-no sexual relationships with former clients

-A few helpful questions:

 Will the dual relationship keep me from confronting and challenging the client?
 Will my needs for the relationship become more important than therapeutic
activities?
 Can my client manage the dual relationship?
 Whose needs are being met?

Social Media and Boundaries

-social media raises many ethical concerns for practitioners regarding boundaries, dual
relationships, confidentiality, and privacy
-Counselors and therapists should:
 Limit what is shared online
 Include social networking policies as part of informed consent
 Regularly update protective settings because privacy rules change

Sept 17:

Chapter 4: Psychoanalytic Therapy

Chapter 5: Alder Theory
-we hold onto memories for a reason

-individualistic psychology****
-inferiority feelings: inferior feelings can be positive (encourage to seek superiority) -> Alder
saw it as a good thing, inferior complex is not a good thing, you feel trapped in the inferiority
complex/feeling stuck and cannot move forward

-lifestyle: about your core beliefs and assumptions

-> “Fictional finalism” = imagining the best version of yourself in the future, guiding us to
the end-goal
-> “private logic” = faulty interpretations
eg. never wanting to be late anymore, almost maladaptive
-early recollection: whatever the client thinks of when the therapist asks them, whatever they
say and how they tell it is a projection of bigger themes
-> pre-12 year olds = critical in forming beliefs

-individual psychology = indivisible psychology

-> but based on the concept of holism
-phenomenological approach = approach from the client’s perspective/their thoughts & beliefs
-teleological explanation = people are goal-oriented, when we strive toward a goal and it
doesn’t work out, our whole purpose of life is gone

-therapeutic relationship = freud was interpretive, Adler is collaborative

Phenomenological approach
-if the client interprets it as such, that is most important (not as focused on if it actually
happened)

Social Interest
-community focused, supporting people in community

The Life Task

3 universal life tasks = social, love-marriage, occupational
-Alder was open to things not being in order, but these were important tasks

Superiority Feelings
-not necessarily narcissistic, but a sense of accomplishment and moving on in our goal-oriented
behaviour
-healthy feelings

4 phases of therapy
-not important for psychoanalytic
phase 3 = taking information from data the client said and interpret/help client gain insight
phase 4 = client encouraged to act as if they were people they want to be
clients are reoriented towards the useful side of life

CBT = can change thoughts, thoughts are what influence our behaviour

Discouragement = basic condition that prevents people from functioning

-paradoxical intention = discrepancy between what you think and how you behave
-> giving a direction that is in opposition of the norm
eg. asking “why don’t you go back” to woman after divorce

-how can the theories be applied to group counselling?

-> time-effective
-> Adler works well in group counselling, but freud doesn’t really

-working with parents to avoid things

limitations = focus on the self, but it’s supposed to be from a holistic perspective
if client expects the therapist to be expert -> better to go with psychoanalyst
focused on teaching his theory rather than systematically documenting it

Chapter 6: Existential Theory

Family, friends, relationships, God, feeling connected, having a sense of purpose, feeling loved,
doing good in the world, wanting to become a mother in the future, loving others, having a
career, eating good food, doing things I like, finding new hobbies, trying new things, always
learning new things

-focus on Yalom, Frankl, May

-supposed to be a theory that encompasses all cultures

-best described as a philosophical approach

-> it’s more of a lens into the human condition -> suffering, tragedy
-> existential theorists believe people are whole whereas freud believed people are
broken
-> existential people look forward/future more than the past
-> existential people believe people are connected rather than freud who focused more
on the individual themselves

-existential therapy doesn’t really have a concrete theory -> how do we say this is valid?
-> subjective reality -> not important to establish data but more important to evaluate
client by how they interpret their lives
Basic dimension of the human condition
-capacity for self-awareness
-> often advantaged people/privileged enough to think about these questions
(existential questions)
-> BUT the poorest people also ask these questions too
-accepting anxiety as a condition of living
-> freud, adler, and existential theory all look at anxiety
-awareness is realizing that we are finite and time is limited
-inaction is also a choice
-there is the assumption that we have the power to seek our meaning
-> therapists need to help guide client to find meaning
-> Adlerian would say we are driven by social interest and that is what gives us meaning
-we are subject to loneliness, meaningless, emptiness, guilt, and isolation

-freedom and responsibility:

-we don’t choose the circumstances into which we are born, but we create our own
destiny through our choices
-freedom implies that we are responsible for our lives, for our actions, and for our
failure to take action
-freedom and responsibility go hand in hand; assuming responsibility is a basic condition
for change
-> the responsibility is on the CLIENT to produce change
-> change can mean different things for different clients
-guilt can be positive, but there is true guilt/false guilt (which isn’t motivating)

-identity and relationship:

-identity is the “courage to be” -> we must trust ourselves to search within and find our
own answers
-> adolescence often struggle with identity, more applicable to indivualistic
cultures
-> important to understand that its okay to be alone and not feel lonely
-> being alone helps us existentially discover ourselves
-we need to balance aloneness and relatedness
-relationships are based on our desire for fulfillment, not based on deprivation
-> Alder says that we can’t be alone but people around us won’t necessarily bring
us happiness

-the search for meaning:

-very important for therapist to find out what gives the client meaning
-meaninglessness (existential neurosis) can lead to emptiness and hollowness
-> key things in depression
-> key factor is hope, when we see a void of hope = very worrying
 -logotherapy can provide the conceptual framework for helping clients find meaning in
their lives

-anxiety: a condition of living:

-4 givens of existence create anxiety (death, freedom, choice, isolation, and
meaninglessness)
-existential anxiety is normal -> life cannot be lived nor can death be faced without
anxiety
-neurotic anxiety, of which we are typically unaware, is anxiety about concrete things
that is out of proportion to the situation
-> realization is client’s responsibility
-anxiety can be a stimulus for growth as we become aware of and accept our freedom
(healthy anxiety)
-> Alder also believes this, & CBT = need to face the reality

-awareness of death and non-being:

-death gives significance to living; it is necessary to think about death if we are to think
significantly about life
-> a lot of counselors don’t talk about this, not much training on grief & loss
-our awareness of death is the source of zest for life and creativity
-we can turn our fear of death into a positive force when we accept the reality of our
mortality

Goals of Existential psychotherapy

-assisting clients in moving toward authenticity and learning to recognize when they are
deceiving themselves

4 aims of therapy:
-identified by later theories (not the original existentialists)
-help clients be more present to themselves/others, identify ways they block themselves
from fuller presence, challenge clients to assume responsibility for designing their present lives,
encourage clients to choose more expanded ways of being in their daily lives
-> encouraging internal locus of control rather than focusing on “responsibility”
-> teaching them how to regain their power back

Relationship between therapist and client

-always think about where the therapist and client position is
-> freud empowers the therapist (therapist is the expert)
-the person-to-person relationship is key
-the relationship demands that therapists be in contact with their own phenomenological world
-at the core of the therapeutic relationship:
-> respect and faith in the clients’ potential to cope
-> sharing reactions with genuine concern and empathy (regardless of background)
-someone’s age is not as important as experience and maturity
-> someone who is 21 can be much more mature than someone at 30

Role of Techniques
-NOT technique-oriented, but techniques from other models can be used within the context
-when the deepest self of the therapist meets the deepest part of the client, the counselling
process is at its best

Phases of Existential Therapy

1) initial phase: identifying and clarifying assumptions about the world
2) middle phase: examining the source and authority of their present value system
3) final phase: translating what they have learned about themselves into action
-these phases are broad and general and can move in and out, but this is not seen in
freud/adler (they believe you should only be moving forward)

Application to Group Counselling

-can do group counselling with
-provides an ideal environment for the therapeutic work on responsibility
-> clients are responsible for their behaviour in a group
-> group setting provides a mirror of how clients may act in the world
-builds interpersonal skills
-> creates an opportunity to relate to others in a meaningful way

Strengths from a Diversity Perspective

-does not dictate a particular way of viewing or relating to reality
-has a focus on universality and on human experiences that transcend the boundaries that
separate cultures
-considers the degree to which behaviour is influenced by social and cultural conditioning

Limitations from a Diversity Perspective

-approach may be too individualistic and insensitive to social factors that cause problems (but
this is beginning to change)
-social injustices may lead clients to feel patronized and if the therapist moves too quickly
-some clients may prefer more direction

Contributions of Existential Therapy

-contributed a new dimension to the understanding of DEATH, LONELINESS, anxiety, guilt,
frustration, and alienation
-emphasis on the human quality of the therapeutic relationship is a strength
-concepts of the existential approach can be applied to others

Limitations of Existential Therapy

-the individualistic focus may not fit within the world of some people
-some practitioners view existential concepts as elusive and may lack in the level of
maturity/life experience

sample mc:
-finding the “courage to be” involves
a) confronting a specific phobia
b) learning to be alone
c) discarding old values
d) developing a will to move forward in spite of anxiety producing situations

-> sometimes the more correct answer is the more comprehensive answer

for each theory, you must know:

1) basic assumptions (6)
2) key terms
3) client & therapist -> where are they situated (which one is the focus/expert)
4) strengths/limitations
5) application to diversity
6) group application -> how applicable is this theory?
7) compare and contrast between the theories -> overlap/major differences in them
8) the key figures (eg. rogers is person-centred theory, freud is psychoanalytic)

Chapter 7: Person-Centered Theory

-person-centered and gestalt had a lot of existential theory
-> both of them look at the person as a whole and that they’re their own expert
-> client being the expert = has some concepts of adler too
-> MI is not typically placed in humanistic theory (there is some crossover with CBT)

-Rogers = nominated for Nobel peace prize

-> put emphasis on client-therapist relationship
-> empathy, caring relationship, place where the client can be 100% themselves
-> genuineness, authenticity

View of Human Nature

-cross-over between gestalt, existentialism, person-centered
-people are good people and capable of making changes
-we gravitate toward concept of self-actualization
-more spiritual emphasis with gestalt

Person-Centered Therapy
-counsellor is NOT who knows best, the client knows best
-should not be giving advice, suggestions, persuasion, teaching, diagnosis to client
-> clients can resolve own problems without help, but therapist guides them
-focus on problems over persons
-personal characteristics of the therapist -> be congruent with how they feel and what they say
-> being authentic
-> being the same person in real life and in the counselling room
-quality of the therapeutic relationship is the FOCUS
-> doesn’t care about techniques, the client-therapist relationship is the most important

Growth-Promoting Climate
3 attributes create a growth-promoting climate:
1) congruence -> genuineness or realness
2) unconditional positive regard -> acceptance and caring
-> we are naturally judgemental
3) accurate empathic understanding -> helps therapist make connections with client
-> we don’t really practice empathy in our day-to-day lives

Therapeutic Core Conditions

6 conditions necessary for a good therapeutic relationship
1) 2 persons in psychological contact -> interacting/being present with each other
2) client is experiencing incongruence
-> if they weren’t they wouldn’t need counselling
3) therapist is congruent
4) therapist experiences unconditional positive regard or real caring
5) therapist shows empathy for client’s internal frame of reference, communicates this
to client -> express what you need to
6)

-therapist engages in co-assessment with client -> work together to understand what the issue
is -> person-centered theory says formal assessment is not necessary and it happens
throughout the counselling process
-integrated = looking at the whole picture, holistic approach
-therapist is invested in developing life experiences to reach self-actualization

existentialism vs. humanism

commonalities:
-client’s subjective experience (phenomenological)
-respect for client’s capacity to make changes
-less value on techniques and more on relationship
-> Alder focuses on techniques, but existentialism/humanistic theories do not

differences:
-face the bigger issues -> death, isolation, meaninglessness

Application to crisis intervention

-cathartic expression, client needs to express their initial thoughts/feelings
-containing = help client function in their daily life while they deal with problem
-genuine support, caring, warmth is critical for someone in crisis

Application to Group Counselling

-no specific techniques, about trust in group membership
-individuals are not facing problems alone, they grow along with group members

Expressive Arts Therapy

-extension of father’s work -> Natalie (daughter)
-everyone has the innate ability to be creative
-client explores new facets of the self and insights -> creates wholeness
-conditions for creativity -> acceptance, non-judgement, empathy, psychological freedom

Maslow’s contribution to Humanism

-Maslow criticized Freud for focusing on the “dark side” of life
-> Maslow was concerned with positive aspects = joy, fulfillment, self-fulfillment
-self-actualizing -> biopsychosocial model
-> thinking about what people are doing well instead of focus on problem
-very few people attain self-actualization, but we reach components of it

Motivational Interviewing
-placed in humanism
-client-centered, psychosocial, directive counselling approach
-applied to clinical problems but was initially designed as BRIEF intervention for problem
drinking, now eating disorders too
-client can find their inner motivations through questions
-> therapist believes in client’s abilities, strengths, resources
-honouring the “MI spirit” -> respect that clients will come in with all levels and where they
finish

Emotion-Focused Therapy
-evidence-based approach
-used in couples counselling
-synthesizes aspects of Gestalt and existential therapies
-emphasizes awareness, acceptance, and understanding of emotions
-treating anxiety, intimate partner violence

Strengths from a Diversity Perspective

-applicable to all cultures, acceptance of diversity
-therapist is viewed as a “follower explorer” who attempts to understand the client’s
phenomenological world -> being accepting and open

Limitations from a Diversity Perspective

-some clients want more directive approaches/techniques
-difficult to translate core therapeutic conditions into actual practice in certain cultures
 -> some cultures aren’t used to genuineness, empathy
-focus on individual autonomy may be seen as “selfish” in cultures that stress the common
good

Chapter 8: Gestalt Therapy

-slight philosophical approach
-unfinished business -> can incorporate the empty chair technique
-I/Thou relationship
-holism: full range of human functioning including thoughts, dreams, feelings, behaviours…etc
-field theory: greater context, not just the environment
-> all of the things that can be considered
-> understand that it’s constantly changing environment

-figure formation process: how an individual organizes their experiences

-foregroup: figure
-background: ground
-> assimilate things into schemas, organizing things that make sense/meaning to us

-organismic self regulation: there is a self-regulating process in all of us

-> Jung, PCT

The Now
-power is in the present day
-mindfulness -> focusing on the present
-nothing exists except for the now

Unfinished Business
-feelings about the past that are unexpressed
-> these feelings are associated with distinct memories and fantasies
-> emotional cut-offs, divorce

Energy and Blocks to Energy

-focus on where energy is located, how it is used, and how it can be blocked
-blocked energy is a form of defensive behaviour that may result in unfinished business
-mental blockage/physical blockage

Contact and Resistance to Contact

-contact: interacting with nature and with other people without losing one’s individuality
-PCT discussed about psychological contact

Contact Boundary Phenomena

5 different kinds of contact boundary
-introjection, projection, retroflection, deflection, confluence
Paradoxical Theory of Change
-who we are and who we should be
-who we are in the current condition before trying to change

-focus on language in Gestalt

-> IT/You talk -> shifting language off of “I”
-> taking responsibility for what you can take responsibility for
-> listening to language

Therapeutic Techniques
-exercises

Application to Group Counselling

-encourages direct experience and action
-can practice and learn from others in the group
-design experiences for groups focusing on awareness and contact
-> using the group as an extension of the self
eg. meditation

Strengths from a Diversity Perspective

-experiments can be tailored to fit the unique ways in which clients perceive and interpret their
culture
-helps people integrate the polarities within themselves -> assist bicultural clients
-> third culture kids who don’t identity with a single culture
-emphasizes non-verbal behaviour
-> congruence between what is said and body language

Limitations from a Diversity Perspective

-clients who are culturally conditioned to be emotionally reserved
-using Gestalt techniques in a mechanical way to elicit certain effects -> can make clients
terminate therapy prematurely

Contributions of Gestalt Therapy

-creative and lively approach that uses experiments to move clients to talk about
experiences/thoughts
-attempt to integrate theory, practice, and research

Limitations of Gestalt Therapy

-has potential for the therapist to abuse power by using powerful techniques without proper
training
FINAL EXAM:

Chapter 9: Behaviour Therapy

-Key People: Bandura and Skinner

-classical conditioning: associate an involuntary response as a stimulus

eg. Pavlov’s dog (bell and food)
-operant conditioning: associate a voluntary behaviour an a consequence
-> reward or punish behaviour
-> eg. rewarding kid with money for good grades, spanking

1) Social-Learning Approach
2) CBT

Behaviour Therapy
-set of clinical procedures
-based on principles of learning that are systematically applied
-focus is on the client’s current problems and on assessing behaviour through
observation or self-monitoring
-the focus is on the PRESENT
-focusing on behaviour, operationalizing everything
-therapist teaches clients skills of self-management
-behaviour is operationally defined -> overt actions and internal processes
-> means we can measure these processes
-change can take place without insight into underlying dynamics and the origins of the
psychological problem
-goals: increase personal choice, create new conditions for learning

ABC MODEL
-antecedent: what sets/trigger the behaviour to happen (eg. her friend saying something)
behaviour: friend socially isolates herself and apologizes for behaviour
consequence: feeling/behaviour of shame

Operant Conditioning
-can work quite well, but it doesn’t sustain -> often used in parenting
-positive and negative reinforcement: goal is to increase target behaviour
-extinction: goal is to decrease or eliminate a behaviour by withholding reinforcement from a
previously reinforced response
-positive and negative punishment: goal is to decrease target behaviour

Progressive Muscle Relaxation

-to teach people to cope with the stresses produced by daily living
-relaxation becomes a well-learned response -> can be habitual if practiced daily
-do with someone who is anxious

Systematic Desensitization
-create a hierarchy of what is going to feel safe to the client

-in vivo desensitization: client exposure to the actual anxiety-evoking events rather than simply
imagining the situation
-> putting the spider closer and closer (gradual exposure)
-> a lot of imagination that goes on

-flooding: in vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time
without the feared consequences
-> enough stimulation = body will get to a point of comfort

-eye movement desensitization and reprocessing (EDMR):

-exposure-based therapy
-involves imaginal flooding, cognitive restructuring, and use of rhythmic eye movement
and other bilateral stimulation to treat traumatic stress disorders
-> based on your feedback
-> helpful with trauma

Social Skills Training

-autism
-help clients develop and achieve skills in interpersonal competence
-autism literature into general population -> behavioural therapy, school counsellor
-> emotional regulation

Self Management Programs

-SM programs make decisions concerning specific behaviours they want to control or change
-the process includes selecting goals, translating goals into target behaviours, self-monitoring,
working out a plan for change, and evaluating an action plan

Multimodal Therapy
-holistic approach to behavioural therapy

Multimodal Therapy: BASIC ID

-complex personality of human beings can be divided into seven major areas of functioning

Dialectical Behaviour Therapy

-treating borderline personality disorders
-> focus on emotion
-includes both acceptance-oriented and change-oriented strategies
-skills are taught in four modules: mindfulness, interpersonal effectiveness, emotional
regulation, and distress tolerance
Mindfulness-Based Stress Reduction
-just being aware of your emotions, living in the present
-assists people in learning to live more fully in the present
-sitting meditation, mindful yoga, cultivating mindfulness
-didactic instruction is minimized an experiential learning and self-discovery are emphasized
-not a form of psychotherapy, but it can be an adjunct to therapy
-clients learn to respond in skillful and intentional ways to their automatic negative thought
patterns

Acceptance and Commitment Therapy

-emphasis on acceptance (non-judgemental awareness) of cognitions

Applications to Group Counseling

-treatments: rely on empirical support and tend to be brief
-leaders: use a brief, directive, psychoeducational approach -> conduct behavioural
assessments
-clear divide between leader and member
-> create collaborative, precise goals

-may appeal to culturally diverse clients

-behavioural therapy focuses on environmental, social, and political conditions that contribute
to a client’s problems

-a wide variety of specific behavioural techniques have been developed

-emphasizes ethical accountability
-behavioural interventions have been subjected to more rigorous evaluation than other
approaches

-possibility for therapist to manipulate the client using this approach

Chapter 10: CBT

-musturbation: telling ourselves that we should, must do something

Cognitive Behavioural Approaches

-CBT is collaborative relationship
-> behavioural therapy is directive
-the premise that psychological distress is often maintained by cognitive processes
-changing cognitions to produce desired changes in affect and behaviour
-present-centered, time-limited focus
-> trauma victims (focus on how the trauma has impacted you today and not the trauma
itself)
-educational treatment focusing on specific and structured target problems
Albert Ellis’s REBT (rational emotive behaviour therapy)
-assumes that cognitions, emotions, and behaviours interact and have a reciprocal cause-and-
effect
-highly didactic and directive (intended to teach)
-he’s the first of the CBT’s

REBT: An Educational Process

-clients learn to identify the interplay of their thoughts, feelings, and behaviours and to identify
and dispute irrational beliefs maintained by self-indoctrination
-clients need to stop absolutistic thinking, blaming, and repeating false beliefs

Irrational Beliefs
-3 basic MUSTS we internalize that inevitably lead to self-defeat:
1) I MUST do well and be loved and approved by others
2) other people MUST treat me fairly and kindly
3) the world and my living conditions MUST be comfortable

THE ABC Theory of Personality

Anticipating event -> belief -> consequence
I-> disputing intervention -> effective philosophy -> new feeling

Therapeutic Goals
-to help clients differentiate between realistic and unrealistic goals and between self-defeating
and life-enhancing goals
-help clients achieve: unconditional self-acceptance, other-acceptance, life-acceptance

TECHNIQUES
-disputing irrational beliefs -> therapist makes the decision that it’s an irrational belief
-doing cognitive homework
-bibliotherapy -> giving the client a book to read
-changing one’s language

REBT TECHNIQUES:
-rational emotive imagery -> similar to systematic desensitization
-using humor
-role playing
-shame-attacking exercises -> using guilt
-standard behaviour therapy procedures

Applications to Group Counseling

-tailored for specific diagnoses, such as anxiety, panic, eating disorders, and phobia
-treatments are standardized and based on empirical evidence
-use of homework allows lessons learned in group to generalize to the client’s daily
environment
-allows clients to:
-practice assertiveness skills

Aaron Beck’s Cognitive Therapy

-more collaborative, less directive than REBT
-insight-focused therapy with an emphasis on changing negative thoughts and maladaptive
-focused on client’s distorted beliefs that are the result of cognitive errors
-reflective questioning -> clients test the validity of their cognitions
-change results from re-evaluating faulty beliefs based on contradictory evidence that clients
have gathered

Theoretical Assumptions
-people’s internal communication is accessible to introspection
-clients’ beliefs have highly personal meanings

CT’s Cognitive Distortions -> teaching perspective

Negative Cognitive Triad

-pattern that triggers depression
1) client holds a negative view of themselves
2) selective abstraction -> client interprets life events through a negative filter
3) client holds a gloomy vision of the future

CT for depression: 16-20 sessions

CT for panic disorder 6-12 sessions

Christine Padesky -> mind over mood, strength therapy

-focusing on their strengths while challenging their distortions and beliefs

Applications for Strengths-Based CBT

-an add-on for classic CBT
-a 4-step model to build resilience and other positive qualities
-the new paradigm for chronic difficulties

Donald Meichenbaum
-more being aware of how you interact with other people
-CBM: cognitive behavioural modification
-executive processor -> brain is making decisions for us, decides when we continue or
change something

Behaviour Change in CBM

-3 phases of behaviour change
1) self-observation
2) starting a new internal dialogue
 -> need to alter our internal dialogue (developed a negative internal voice)
3) learning new skills

Stress Inoculation Training

-SIT is a 3 phase coping skills program
1) conceptual-educational phase
2) skills acquisition and skills consolidation phase
3) application and follow-through phase

Cognitive Narrative Approach to CBT

-focuses on plots, characters, and themes in the stories people tell about themselves and
others
-he claims we are all storytellers
-clients learn how they construct reality, examine the implications and conclusions they draw
from their stories
-develop resilient-engendering behaviours

Strengths from a Diversity Perspective

-CBT uses the individual’s belief system or worldview, as part of the method of self-exploration

Limitations
-rapid-fire approach -> alienates clinicians who value being reflective
-terms such as “irrational” and “maladaptive” may be insensitive
-confrontational style of REB may overwhelm clients
-some clinicians think CBT interventions overlook the value of exploring a client’s past
experiences

Ch 12: Feminist Therapy

-client knows what is best for her life and is the expert on her own life
-emphasis on educating clients about the therapy process
-traditional ways of assessing psychological health are challenged

Personality Development
-societal gender-role expectations influence a person’s identity
-development of women was judged by male norms
-females are raised in a culture grounded in sexism, and understanding internalized oppression
is central to this approach

Relational-Cultural Theory
-emphasizes the vital role that relationships and connectedness with others play in the lives on
women
-therapists who adopt this approach aim to:
-lesson the suffering caused by disconnection and isolation
 -increase clients’ capacity for relational resilience
-develop mutual empathy and mutual empowerment
-foster social justice

Principles of Feminist Therapy

-personal is political and critical consciousness are central concepts
-committed to social change
-the voices of others who have been oppressed are valued
-the counseling relationship is egalitarian (not always possible to be completely equal)
-> hope to make a space for the client to become more of the expert
-focus on strengths and offers a reformulated definition of psychological distress
-all types of oppression are recognized along with the connections among them

Goals of Feminist Therapy

-acquire skills to bring about change in the environment
-develop a wide range of behaviours that are freely chosen
-evaluate the impact of social factors on their lives
-restructure institutions to rid them of discriminatory practices
-develop a sense of personal and social power
-recognize the power of relationships and connectedness
-trust their own experience and their intuition

Role of Assessment and Diagnosis

-diagnoses cannot account for cultural differences
-very critical of the DSM-5
-gender, culture, and race may influence assessment of clients’ symptoms

Techniques & Strategies -> not much, more of a philosophical approach

-self-disclosure: considered a key part
-empowerment
-gender-role intervention
-power analysis
-bibliotherapy
-assertiveness training
-reframing and relabeling
-social action
-group work

Role of Men in Feminist Therapy

-male feminist therapists are willing to:
-understand and ‘own’ their male privilege
-confront sexist behaviour in themselves and others

Application to Group Work

-provides an outlet for social support and political action
-forms a diverse community where members share the goal of supporting womens’ experiences
-decreases feelings of isolation and loneliness
-self-disclosure is emphasized for both the leader and members as a mean of self-exploration

Strengths from a Diversity Perspective

-most in common with the multicultural and social justice perspectives
-clinicians strive to create an egalitarian relationship and collaborate with clients in setting goals
and choosing strategies
-belief that psychotherapy is bound to culture

Limitations from Diversity Perspective

-therapists run the risk of imposing their own values if they don’t understand and respect
cultural values of clients from diverse groups

Contributions of Feminist Therapy

-paved the way for gender-sensitive practice and an awareness of the impact of the cultural
context and multiple oppressions
-can incorporate principles and techniques of feminist therapy into many therapy models
-demanded action in cases of sexual misconduct at a time when male therapists misused the
trust placed in them by female clients

Limitations
-therapists do not take a value neutral stance
-must be careful not to impose their cultural values on a client
-therapists may alienate clients if they challenge societal values that subordinate certain groups
without first gaining a clear understanding of the clients’ culture

Ch 13: Postmodern Approaches

Social Constructionism Therapy Goals

-generate new meaning in the lives of clients
-co-develop with clients, solutions that are unique to the situation
-enhance awareness of the impact of various aspects of the dominant culture on the individual

Social Constructionism: Key Concepts

-reality is subjective and is based on the use of language
-strive for a collaborative and consultative stance
-assume there are multiple truths
-postmodern thought has an impact on the development of many theories

Solution-Focused Brief Therapy

-therapy grounded on a positive orientation – people are healthy and competent
-shares similarities with positive psychology
-past is downplayed, while present and future are highlighted
-therapy is concerned with looking for what is working
-emphasis on constructing solutions rather than problem solving

Questions in SFBT
-skillful questions allow people to utilize their resources
-asking “how questions” that imply change can be useful
-effective questions focus attention on solutions

Types of relationships in SFBT:

1) customer-type relationship: client and therapist jointly identify a problem and a solution to
work toward
2) complainant relationship: client describes a problem but is not able or willing to take an
active role in constructing a solution
3) visitors: clients come to therapy because someone else thinks they have a problem

Techniques used in SFBT:

-scaling questions: “on a scale of zero to 10, where are you with respect to ____?”
-therapist feedback to clients: therapist takes a short break during each session to write a
summary for clients
-terminating: termination begins at the first session

Application to Group Counseling

-group members can offer input and point out expectations to problematic situations in each
others’ lives
-questioning is used to facilitate client’s establishing goals early in the group process

Narrative Therapy
-listen to clients with an open mind
-encourage clients to share their stories
-listen to a problem-saturated story of a client without getting stuck
-demonstrate respectful curiosity and persistence
-believe the person is not the problem, but the problem is the problem

The Therapeutic process

-to believe in the client’s abilities, talents, and positive intentions
-demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination
-become active facilitators

Functions of the Narrative Therapist

-to adopt a not-knowing position that allows being guided by the client’s story
-to help clients construct a preferred story line
-to create a collaborative relationship – with the client being the senior partner
Questions in Narrative Therapy
-used to generate experience rather than to gather information
-always asked from a position of respect, curiosity, openness, and from a not-knowing stance
-used to assist clients in exploring dimensions of their life situations

Deconstruction and Creating Alternative Stories

-problem-saturated stories are deconstructed before new stories are co-created
-the assumption is that people can continually and actively re-author their lives
-unique possibility questions enable clients to focus on their future
-an appreciative audience helps new stories take root

Applications to Group Counseling

-anger management
-grief counseling
-academic management
-adventure-based program

Strengths from a Diversity Perspective

-social constructionism is congruent with the philosophy of multiculturalism

Limitations from a Diversity Perspective

-adopting a “not knowing” stance may lead clients from some cultures to lose confidence in the
therapist

Chapter 14: Family Systems Therapy

-individuals are best understood through assessing the interactions within an entire family
-a family is an interactional unit and a change in one member affects all members
-a systems orientation broadens the traditional emphasis on individual internal dynamics

-symptoms are viewed as an expression of a dysfunction within a family

-problematic behaviours:
-serve a purpose for the family
-are unintentionally maintained by family processes
-reflect the family’s inability to operate productively
-are symptomatic patterns handed down across generations
-there’s one person that brings the family to the family, but there’s other underlying problems

Adlerian Family Therapy

-based on an educational model that emphasizes family atmosphere and family constellation
-therapists are collaborators who seek to join the family
-parent interviews yield hunches about the purposes underlying children’s misbehaviour

Multigenerational Family Therapy

-a theoretical and clinical model that evolved from psychoanalytic principles and practices
-the family is viewed as an emotional unit
-unresolved emotional reactivity to one’s family must be addressed if one hopes to achieve a
mature personality

-differentiation of the self

-> a psychological separation from others
-triangulation
-> a third party is recruited to reduce anxiety and stabilize a couple’s relationship
-> not in a good way

MFT Treatment Goals

-to change the individuals within the context of the system
-to end generation-to-generation transmission of problems by resolving emotional attachments
-to lessen anxiety and relieve symptoms
-to increase the individual member’s level of differentiation

Structural Family Therapy

-symptoms are a by-product of structural feelings
-structural changes must occur in a family before an individual’s symptoms can be reduced
-techniques are active, directive, and well thought out

Strategic Family Therapy

-presenting problems are accepted as “real” and not a symptom of system dysfunction
-therapy is brief, process-focused, and solution-oriented

Treatment Goals of Strategic Family Therapy

-resolve presenting problems by focusing on behavioural sequences
-get people to behave differently
-shift the family organization so that the presenting problem is no longer functional