1
Q
What is the difference in Professional and Personal counseling?
A
- Professional – guided by ethics, scientifically informed, measurable, accountable
- Personal – Based on relationship, guided by client, vulnerable, sensitive to individual difference
2
Q
Describe Eysenck’s (1952) famous study.
A
- Reviewed 24 studies (1952)
- Psychodynamic therapy (44%)
- Eclectic psychotherapy (64%)
- Those who received therapy improved less than those in the comparison group (hospitals)
3
Q
What were the field’s response to Eysenck’s claims?
A
- Supporters said empirical research couldn’t measure benefits
- Skeptics said any improvement was a placebo effect
4
Q
List the scope of counseling.
A
- Relationship Dysfunction
- Family Dysfunction
- Life Stage Transitions
- Existential Crisis
- Personal Growth
- Spiritual Direction
5
Q
What is the “true nature” of psychotherapy ?
A
- Fewer therapist identify with a single therapy
- Professional answer to what approach they use:
1. Integrative Psychodynamic Therapy (IPT)
2. Cognitive Behavioral Therapy (CBT) → This includes ICBT, psychodynamic and so on
6
Q
Describe the Therapy “journey”
A
- Assessment/Diagnosis – “The Traveler”
- Case Conceptualization – “The map”
- Theory and Treatment Plan – “The route”
- Goals – “The destination”
7
Q
What is the Dodo Bird Conjecture?
A
Wampold’s & Smith & Glass
- Diverse approaches to psychotherapy appeared to be rather similar in their effectiveness
- “Everyone has won, and all must have prizes”
- Most forms of psychotherapy tend to have similar rates of efficacy
8
Q
What are the phases of counseling?
A
- Relationship building
- Assessment/Diagnosis
- Planning
- Intervention
- Termination
- Follow-up (if possible)
9
Q
During the assessment/diagnosis phase of counseling, what do the client and counselor work to develop an understanding of?
A
- The problems or concerns the client wants to address
- The ways in which the client’s cognitive and emotional attitudes, decision-making, capabilities, and behaviors are contributing to the problems or concerns troubling the client;
- The changes that might be necessary to address the problems;
- What needs to happen for the desired change to take place
10
Q
What does the planning phase of counseling, include?
A
- Development of treatment plan
- Prioritize concerns
- Establish a mutually agreed-upon set of goals
11
Q
What does the intervention phase of counseling, include?
A
- Work to achieve the agreed upon goals
- Establish a number of specific, measurable objectives
- Monitor and discuss the client’s progress
SMART
specific, measurable, attainable, reliable, time bound
12
Q
Describe the termination phase of counseling.
A
- The therapist or the client initiate discussion of termination
- Termination begins before the final session
- The progress that has been made in achieving the goals they set for therapy
- The personal assets/growth the client has developed for dealing with future problems
- Plan for future issues
13
Q
What is the most important phase of counseling?
A
Relationship building
14
Q
What are the three elements of counseling according to Frank & Frank (1993)?
A
- “Healing” agent = therapist
- “Sufferer” = individual, couple, family, group
- Healing relationship = series of structured contact
15
Q
What are the the three historical contributions to counseling?
A
- Religiomagical
- Rhetorical
- Empirical/Naturalistic
16
Q
Describe Religiomagical contribution to counseling.
A
- Priests, Shamans, Religious healers
- Emphasized ritual, community connection, and introspection
- Connection: to each other, to ancestors, to spirits, etc.
- Value of culture and belief
17
Q
Describe Rhetorical contribution to counseling.
A
- *Reason & Logic could be used to persuade for the good
- Greek “noble” rhetoric – aimed at persuading toward the “good”
- Plato “noble” rhetoric sought out sophrosyne: “ a beautiful harmonic and rightful ordering of all ingredients of psychic life, by strengthening will, reorganizing beliefs, or by eliciting new beliefs more noble than the old.”
- Aristotle: rhetoric: involves:
• Emotional stimulation
• Logic based argument
18
Q
Describe Empirical/Naturalistic contribution to counseling.
A
- Value “sensory evidence”
- Hippocrates – “mental-illness” can be “cured” like all other ailments
- Mental illness not personal/spiritual deficit – should be “treated”
- Science should guide our practices - systematic
- Freud, Jung, Pavlov, Skinner, Watson, etc.
19
Q
Describe the original context in which Freud’s work began.
A
1856-1939
- In 1985 he wrote “ Project for a Scientific Psychology” with the intention of developing a psychology that would be a natural science.
- In 1885, Freud went to Paris to study under Jean Martin Charcot who implemented Hypnotic Suggestion.
- He watched Charcot induce, and then cure, hysterical paralyses in patients through “hypnotic suggestion”
- Freud came to the states to use this technique on his own client’s but found it wasn’t working. Some of his patients resisted even his attempts to hypnotize them.
- Freud realized that hysterical symptoms, such as nervous coughs or partial paralysis, disappeared through the patient’s recall of repressed memories and expressing them.
- Freud was an early proponent of hypnotic therapy, but he gradually abandoned that practice in favor or a treatment based on intensive introspection using free association, a practice where the client is encouraged to say whatever comes to mind with as little censorship as possible.
- Freud’s treatment involved the analysis of defenses to bring unconscious pathogenic ideas into consciousness, where they can be integrated with the rest of mental life.
• He called this PSYCHOANALYSIS
20
Q
Describe Freud’s work with Anna O.
A
Anna O. → Hysteria symptoms
- absences: gap in her train of conscious thought
- Psychotic conflict: one part conscious, one part unconscious
- Aim for psychoanalytic treatment became bringing what had been repressed, unconscious, and forgotten to conscious recognition.
21
Q
Describe the original context in which Jung’s work began.
A
(1875 - 1961)
- Dissertation on the “Psychology and Pathology of So-Called Occult Phenomena”
- Argued that psychic powers emerge from psychological states and have nothing to do with the supernatural.
- Was the first to apply psychoanalysis to severe mental illness
• More structured than freud. - Jung developed a perspective that assumed a cultural-historical and methodological orientation.
- Jung read about Freud’s free association and later hypothesized that the longer the association took, the more distress the client became in relation to that specific word.
- Jung read Freud’s Interpretation of Dreams (1903) and realized that the concept of repression, matched his own ideas.
22
Q
Jung uses the word “complex” define this term as he would.
A
Cause of patients distress
23
Q
What are the basic tenets of Freudian psychotherapy?
A
- Psychoanalysis
- Concentration: Unconscious of Individual
- Unconscious, Preconscious, Conscious
- Dreams as window into unconscious
- Drives: attached to somatic functions (oral, anal, and genital)
- Defense Mechanisms
- Reversal into its opposite
- Turning Round
- Repression
- Sublimation
- Structure of the Mind
- id, ego, superego
24
Q
What are the basic tenets of Jungian psychotherapy?
A
- Analytical Psychology
- Concentration: Collective Unconscious (archetypes)
- Structure of Unconscious
- Personal
- Collective
- Archetypes
- Dreams: a way to compensate for all that the conscious mind is not aware of
- Personality Development
- Psychological Types: Extravert & Introvert
- Four rational types
1. extraverted thinking/introverted thinking
2. extraverted feeling/ introverted feeling
25
List Freud's Basic Model of the mind
1. unconscious → Not available to consciousness; we are unaware of it
2. preconscious → available to the conscious, if we turn our attention to it.
i. e. Memory of weather on the day we worked on an assignment
3. conscious → We are aware of the thought or feeling
26
List Freud's Basic Psychosexual Development
- Oral
- Anal
- Phallic
- Genital
27
What happens in the Oral phase of Freud's Basic Psychosexual Development?
- 0 -1 year
- Mouth, lips, and tongue
- Nursing from mother's breast
- Self-preservation instinct of feeding and nourishment blends with the pleasure of feeding
- Later in life this pleasure is repeated in thumb sucking and cigarette smoking
28
What happens in the Anal phase of Freud's Basic Psychosexual Development?
- 1 - 3 years
- Toilet Training
- Person who is controlling, orderly, stingy, and often obsession with cleanliness
29
What happens in the Oral Phallic of Freud's Basic Psychosexual Development?
- 3 - 6 years
- Resolve Oedipus
- Oedipus complex occurs during the phallic phase, roughly between five and seven years of age, and represents the peak of infantile sexuality.
30
What happens in the Genital of Freud's Basic Psychosexual Development?
- 12 + years
- Develops more fully in adolescence
- Gathering and unification of the partial or competent drives under the primacy of the genital zone in the service of reproduction
31
List Freud's neurotic character types.
- Hysterical = Somatic
- Obsessive-compulsive = rumination
- Narcissistic = self-absorbed
- Sadomasochistic = “It hurts… and I like it”
32
Discuss the differences between Freud & Jung.
Freud:
• Focused on the unconscious individual
* Psychoanalysis
* Believed dreams are the window into the unconscious; in addition to being fulfillments of wishes
* Understanding of drives are attached to somatic functions (oral, anal, and genital)
Jung:
• Focused on the collective individual
• Analytical Psychology
* Viewed dreams as compensatory, in that the functioned to maintain psychic equilibrium
* Archetypes
* Based on an inherited predisposition to create significant myths out of ordinary everyday human experiences
* Dreams are residues of archaic modes of functioning rooted in the collective past of humankind rather than the individual’s past
* A way to compensate for all that the conscious mind is not aware of
33
What is the BIG DIFFERENCE between Freud & Jung...
- Freud concentrated on the unconscious of the individual and
- Jung’s focus was on the collective unconscious and the imaginative life of the humanity as a whole
- Another difference between them was that Jung never had an interest in the study of animal behavior or physiology, whereas Freud continued to draw on these disciplines.
34
What are the criticisms of early psychoanalysis.
- very little evidence to support many claims
- I.e. all boys lust after their mother
- Misogynistic
- Over emphasis on sex and aggression
- Absence of “relationship”
• Therapists should be a “blank screen”
- No limits to therapy
- Big commitment for both therapist and client.
35
Describe treatment efficacy
How treatment performs in controlled clinical research (RCT)
36
Describe treatment effectiveness.
How the treatment actually works in the community with real clients and real psychotherapists (i.e. effective)
37
What do we "KNOW" about counseling from research?
1. Clients in psychotherapy benefit medically → Mind & body
2. Psychotherapy improves to clinically significant levels
3. Psychotherapy can have negative effects ****
4. Treatment may offer better long term gain than other Tx
38
What do we "NOT KNOW" about counseling from research?
- What therapist factors influence therapy outcomes?
- Are different therapists more “efficient”?
- What client factors influence therapy outcomes?
- How does the therapeutic process influence change?
39
Discuss Norcross and Lambert’s (2011) Model One of causal agents of improvement in clients in therapy
*areas of explained variance*
* Client extratherapeutic change (40%),
* Common Factors (30%)
* Techniques (15%)
* Placebo Effect(15%)
40
Discuss Norcross and Lambert’s (2011) Model Two of causal agents of improvement in clients in therapy
*areas of total variance*
* Unexplained variance (40%)
* Patient contribution (30%)
* Therapy relationship(12%)
* treatment method (8%)
* Individual therapist (7%)
* Other factors (3%)
41
What did Wampold and Budge (2012) suggest that change outcomes were due to?
(a) the initial therapeutic bond
(b) real relationship
(c) the creation of expectations
(d) client participation in healthy actions
42
What are the qualities of a good therapist?
(P.E.A.C.E.)
1. Empathy
2. Positive Regard
3. Affirmation
4. Congruence/Genuineness
…Good therapists also regularly Elicit feedback from clients
43
What are the the fundamental assumptions of psychodynamic therapy?
- Biological basis of disease
- how each individual life story connects to the individual’s emotional suffering
- make aware of aspects of his or her life story that are not within consciousness.
- Time limited vs open ended
- free association
- Emphasis on the Therapeutic Alliance
- Theory of Mind
44
Define rationalization.
Justifying one's behaviors and motivations by substituting "good", acceptable reasons for these real motivations
45
Define sublimation
Redirecting unacceptable, instinctual drives into personally and socially acceptable channels
Intense rage redirected in the form of participation in sports such as boxing or football
46
Define suppression
The effort to hide and control unacceptable thoughts or feelings
You are attracted to someone but say that you really don't like the person at all
47
Define projection
Attributing your own unacceptable thoughts or feelings to someone or something else
You get really mad at your husband but scream that he's the one mad at you.
48
Define denial
Not accepting reality because it is too painful.
You are arrested for drunk driving several times but don't believe you have a problem with alcohol.
49
Define repression
Burying a painful feeling or thought from your awareness though it may resurface in symbolic form. Sometimes considered a basis of other defense mechanisms.
50
Define dissociation
Disrupting the continuity of mental experience. Involves any narrowing of consciousness as defense
51
Define Transference
occurs when the client reacts to the therapist as he or she did to an earlier “significant other”
Tablua Rosa, Blank Slate
52
Define Countertransference
is the reaction of the therapist toward the client that may interfere with objectivity
53
Define Resistance
is anything that works against the progress of therapy and prevents the production of unconscious material
54
Define Object-relations
-A model of “self” that emphasizes how we see ourselves in relationship to others.
"Object" = person that is the object of another's feelings.
"Relations" refers to interpersonal relations that affect a person in the present.
Therapist as “object”
55
How does object relations contribute to psychodynamic therapy?
- Stresses the importance of early mother child bonding
| - a way of conceptualizing interpersonal relations and extending psychoanalytic thinking into the interpersonal realm
56
What does the Object-relations stress the importance of>
early mother-child bonding (or lack of).
infants form mental representations of themselves in relation to others and that these internal images significantly influence interpersonal relationships later in life
Gives rise to attachment theory
57
List the research around psychodynamic therapy.
Outcome Research
- Has “lagged behind” – methodological “problems”
- Evidence that it is “as good” as others
Process Research
- Attachment, reflective function, transference
Research on the Underlying Model of Personality
- Attachment research and neuroscience
Brief and Manualized Treatments
- Exist…but difficult.
58
What is the role of the therapist?
1. Neutrality – the therapist refuses to “take sides” in regards to patient’s conflict.
2. Anonymity – therapist uses little (preferably no) self-disclosure in session.
3. Abstinence – recognizing patient's transference, but not “playing into them”
4. Personal therapy is “mandated” for therapists as they work through their own resistance and countertransference.
59
List the Limitations of Psychodynamic Psychotherapy
1. Substantial time investment
2. Emphasizes an exploration of the patient’s internal mental life rather than external considerations such as cultural, societal, interpersonal, or traumatic factors
3. Not be active enough for patients who need immediate behavioral change
4. Requires subjective interpretation
60
List the Limitations from a Diversity Perspective
1. Perceived as being based on upper- and middle-class values
2. Cost of treatment is prohibitive for many people
3. Cultural expectations may lead clients to want more
direction and structure from the professional
4. Generally more concerned with long-term personality reconstruction than with short-term problem solving
5. Approach fails to address social, cultural, and political factors that are oppressive to clients
61
Describe Adler's personal life growing up
2nd of 6 siblings
Very sickly
Struggled in school, but his determination led him to be the top in his class
→ Development of Inferiority Complex Concept
→ belief that People are holistic beings who want to belong
62
Adler's development inspired him to contribute how?
- Advocate for social justice and equality for all people
- Advocated for the rights of all individuals
- Outspoken against prejudice
- Concerned about the welfare of others
- A speaker: instructed others on how to improve their quality of life by acknowledging problematic behaviors and taking responsibility for change.
- Developed programs for teachers and parents:
- believed that teaching these concepts to children → a better society
63
Although Adler was a colleague of Freud, what did Adler disagree with Freud about?
the notion that humans are helpless victims of their unconscious desires.
64
Define Lifestyle.
- The way we make sense of environment; the way we see the world;
- Set of values, attitudes, aspirations, assumptions and needs that help you make sense of life
- outlook, beliefs and attitudes
- Develops early in childhood
65
What are basic mistakes?
faulty interpretations
Adlerian Therapy helps clients to effectively navigate lifestyle tasks
66
Define Private logic.
the way he/she sees self
67
What is family constellation?
How we are situated within the family determines who we are
1. Relationship with others → influence personality
2. Family members, age, birth order, relationship
3. Emotional relationships
4. Alliances
5. Inferiority
68
Define Social interest
1. Psychological Health= interest in and sense of Belonging
2. High Social Interest →
- caring about others, compassion
- Acting prosocially, giving back to community without expectation
- Egalitarian- respect and dignity
3. Low Social Interest → personal superiority/inferiority
pathological → problems
69
What are the basic techniques and interventions used by Adlerian therapists?
Mechanism of Change
70
What are the Mechanisms of change?
Mechanism of change= How we get someone from A to B
- Social Interest
- Life Tasks
- Courage
- Encouragement (#1 technique used)
71
Describe the technique and intervention: Encouragement
- it is a fundamental attitude more than a technique
- Instilling courage in our clients
- foster responsibility
- Be open to revision- let the client correct you, but don’t stop encouraging
- Focus on strengths
- Discouragement- is the basic condition that prevents people from functioning
- Challenge the faulty private logic- the way he/she sees self
72
What are the stages of Adlerian Therapy?
- Establishment of a Therapeutic Relationship
- Psychological Investigation (assessment)
- Interpretation (case conceptualization)
- Reorientation (move to action)
73
What are the "life tasks" of Adlerian Therapy?
1. Communal – connect with friends, enjoy social connection
2. Work – contribute to community: employment, volunteering, etc.
3. Love – highest degree of social interest/courage, faith in self and others
4. Self-Acceptance – foundational to other tasks, no social interaction without it
5. Spirituality – develop a framework for the world, higher purpose
6. Parenting – pass it on!
74
What are the limitations of Adlerian Therapy?
- Little empirical research
- Adlerian therapy is unlikely to advance until a more extensive body of research is available supporting its efficacy
- The emphasis on the past and the time-consuming process of lifestyle assessment
- Self as the locus of change and responsibility; emphasis on changing the autonomous self may be problematic for many clients
- Family therapy? Group Counseling?
75
What does Roger's Person-Centered Therapy emphasize?
Therapy as a journey shared by two fallible people
The person’s innate striving for self-actualization
The personal characteristics of the therapist and the quality of the therapeutic relationship
The counselor’s creation of a “growth-promoting” climate
People are capable of self-directed growth if involved in a therapeutic relationship.
76
What does Roger's idea challenge?
The assumption that “the counselor knows best”
The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation
The belief that clients cannot understand and resolve their own problems without direct help
The focus on problems over persons
77
What are the three core facilitating conditions in Person-Centered therapy?
Congruence
Unconditional Positive Regard
Accurate Empathetic Understanding
78
What is Congruence?
- A state in which our ideal-self and life experience coexist
- Ideal-self matches self-image
79
What is Unconditional Positive regard?
When other people live, accept, and value us without condition
Not withdrawn if the person does something wrong or makes a mistake
80
What is Self-image?
How we see ourselves at this point in time, influenced by our conditional worth
81
What is self-actualization?
What we think about ourselves;
Key to the foundations of person-centered therapy because it is the basis of both the therapist’s trust in the client’s knowledge and the therapist’s adoption of a nondirective stance.
82
What is ideal-self?
Who we want to be/become.
83
What are conditions of worth?
Or rules about one’s behavior
84
What does Roger's describe as a fully functioning person?
A growing openness to experience -- which includes negative feelings
An increasingly existential lifestyle - in touch with different experiences as they ocu in like, avoiding prejudging and preconceptions.
Increasing organismic trust - feelings and instincts are valued and trusted, little second guessing.
A rich full life - a general satisfaction that one is living mostly up to potential
85
What is the therapist's role in Person-Centered Therapy?
The overall goal for the person-centered therapist is to create a therapeutic climate in which the client can grow
The therapist strives to be genuine, integrated, and authentic, without a false front
This includes congruence, unconditional positive regard, and accurate empathetic understanding
86
What are the limitations of Person-Centered Therapy?
No specific techniques or manuals
- Difficult to standardize
- Criticism that it is a good start, but “not enough”
Challenging to provide both support and challenges to clients
Limits of the therapist as a person may interfere with developing a genuine therapeutic relationship
Over-emphasize on the “self” - Western ideal, doesn’t leave the room for the “communal”
* Notes: doesn’t feel like enough to make the change
87
A basic tenet of Jungian Psychotherapy is Archetypes... define this term.
Based on an inherited predisposition to create significant myths out of ordinary everyday human experiences; believed we had more than just genes passed down from our ancestors- we have direct knowledge passed as well.
88
What did Jung define dreams as?
- Dreams- residues of archaic modes of functioning rooted in the collective past of humankind rather than the individual’s past
89
How did Jung define personality development?
Personality: an achievement which gives the individual the greatest possible freedom for self-determination
90
What are the elements of "empirically validated" treatments according to APA?
- skill building or insight
- specific focus rather than a general one
- regular, ongoing assessment or progress (check-ins)
- relatively brief
91
Discuss the future directs of psychotherapy research.
- need to know why and how therapy works
- dissemination of effective evidence based practices throughout the system
- balance between accountability (outcomes) and personalization
