1 Lec1:WhatisCounselling?..................................................................................................................................................51.1 Whydopeoplegotocounselling?.......................................................................................................................51.2 Definitionofcounselling.....................................................................................................................................51.3 PACFA–fromdefinitiontodescription...............................................................................................................51.4 Thethreecomponents........................................................................................................................................51.5 WhatisCounselling?...........................................................................................................................................6

1.5.1 Counsellingis….......................................................................................................................................................61.5.2 HistoryofCounselling..............................................................................................................................................61.5.3 Counsellingworks....................................................................................................................................................61.5.4 Whatweusedtothink….........................................................................................................................................61.5.5 Whatwenowknow….............................................................................................................................................61.5.6 WhatWorksinTherapy...........................................................................................................................................71.5.7 Whatisanoutcome?...............................................................................................................................................7

1.5.7.1 Factorsthatcontributetoapositiveoutcome.................................................................................................................71.5.7.2 ReasonspeoplegiveforNOTattendingcounselling….....................................................................................................8

1.6 GoalsoftheUnit.................................................................................................................................................81.7 Readings.............................................................................................................................................................8

2 Lec2:CounsellingMicroskills–basic...................................................................................................................................92.1 HOWdoyoucounsel?.........................................................................................................................................92.2 Atypicalcommunication.....................................................................................................................................92.3 ReflectiveCommunicationis...............................................................................................................................9

2.3.1 ActiveListening........................................................................................................................................................92.3.2 MicroSkills:thebuildingblocksofActiveListening.Basicskills(forthepurposeofthisunit)..............................9

2.4 ListeningVariables..............................................................................................................................................92.4.1 PhysiologicalInfluencers.........................................................................................................................................92.4.2 PsychologicalInfluencers.......................................................................................................................................102.4.3 ContextualInfluencers...........................................................................................................................................10

2.5 Attending..........................................................................................................................................................102.6 Observing.........................................................................................................................................................102.7 MinimalResponses...........................................................................................................................................112.8 Paraphrasing:reflectingcontent......................................................................................................................112.9 ReflectingFeeling..............................................................................................................................................112.10 ReflectingFeelingandContent..........................................................................................................................112.11 Questions.........................................................................................................................................................12

2.11.1 TypesofQuestions............................................................................................................................................122.11.2 Summarising......................................................................................................................................................12

2.12 Responsestoavoid...........................................................................................................................................132.13 ReadingsGerald_chapter5-8............................................................................................................................13

3 Lec3:AdvancedMicroSkills................................................................................................................................................143.1 AdvancedSkills.................................................................................................................................................143.2 AdvancedMicroSkills.......................................................................................................................................14

3.2.1 Normalising............................................................................................................................................................143.2.1.1 Examples.........................................................................................................................................................................14

3.2.2 Reframing..............................................................................................................................................................143.2.2.1 example...........................................................................................................................................................................15

3.2.3 Challenging............................................................................................................................................................153.2.3.1 WhentoChallenge?........................................................................................................................................................163.2.3.2 Howtochallenge….........................................................................................................................................................16

3.2.4 ExploringOptions..................................................................................................................................................163.2.4.1 GeneratingOptions.........................................................................................................................................................16

3.2.5 Thesignificanceof‘Choice’...................................................................................................................................173.2.6 TherapistSelf-Disclosure.......................................................................................................................................17

3.2.6.1 HistoricalcontextandTherapeuticOrientation.............................................................................................................173.2.6.2 IntentionalSelf-Disclosure..............................................................................................................................................173.2.6.3 Usefulforcertaincohorts...............................................................................................................................................183.2.6.4 Questionstoaskyourself-…............................................................................................................................................18

3.3 Readings...........................................................................................................................................................18

4 Lec4:GOALING/GOAL-SETTINGINCOUNSELLING...............................................................................................................19

4.1 THEPURPOSEOFGOALSETTING…....................................................................................................................194.2 TWOASPECTSTOGOALSETTING…....................................................................................................................194.3 FUNCTIONSOFCOUNSELLINGGOALS….............................................................................................................194.4 WHATSHOULDANEFFECTIVEGOALINVOLVE?.................................................................................................19

4.4.1 EXAMPLESOFOUTCOMEGOAL(EGAN,2010)......................................................................................................194.4.2 MOVINGFROMAGOODINTENTIONTOASPECIFICGOAL(EGAN,2010).............................................................204.4.3 REALISTICANDCONGRUENTGOALS.....................................................................................................................204.4.4 SUBSTANTIVEANDCHALLENGINGGOALS.............................................................................................................204.4.5 NEGOTIATINGATIMEFRAME...............................................................................................................................204.4.6 FLEXIBILITYANDEVALUATION...............................................................................................................................204.4.7 THEFIRSTSTEP......................................................................................................................................................20

4.5 THESHADOWSIDEOFGOALSETTING(EGAN)...................................................................................................204.6 SKILLSASSOCIATEDWITHGOALSETTING..........................................................................................................214.7 Acommonconcept...........................................................................................................................................224.8 ADDITIONALTIPS(ARINANIKITINA)..................................................................................................................224.9 GOALSETTINGINDIFFERENTCONTEXTS...........................................................................................................234.10 THERAPEUTICMODELSANDGOAL-SETTING......................................................................................................23

5 Lec5:RationalEmotiveBehaviourTherapyandCognitiveTherapy.....................................................................................245.1 AlbertEllis(1913-2007).....................................................................................................................................245.2 Self-experimentation........................................................................................................................................245.3 REBTPhilosophy...............................................................................................................................................24

5.3.1 TheA-B-CTheory(Irrationalbeliefs).....................................................................................................................245.3.2 TheA-B-Csofdisputingirrationalbeliefs..............................................................................................................255.3.3 IrrationalBeliefs[Ellis,1975].................................................................................................................................255.3.4 TheoryofrestructuringIrrationalBeliefs..............................................................................................................265.3.5 TheTherapeuticProcess........................................................................................................................................265.3.6 TherapeuticTechniques........................................................................................................................................265.3.7 CognitiveTechniques.............................................................................................................................................265.3.8 EmotiveTechniques..............................................................................................................................................265.3.9 BehaviouralTechniques.........................................................................................................................................275.3.10 TheTherapeuticRelationship............................................................................................................................27

5.4 CognitiveTherapyAaronBeck(1921-stillalive).................................................................................................275.4.1 BasicPhilosophy....................................................................................................................................................275.4.2 CognitiveDistortions(AaronBeck)........................................................................................................................285.4.3 TherapeuticRelationship.......................................................................................................................................295.4.4 TherapeuticProcess..............................................................................................................................................295.4.5 SocraticDialogue...................................................................................................................................................295.4.6 TherapeuticTechniques........................................................................................................................................30

5.5 REBTVSCBT......................................................................................................................................................305.6 FeelingGood.....................................................................................................................................................30

6 Lec6:PsychodynamicTheory..............................................................................................................................................326.1 PsychoanalyticPsychodynamicTheory..............................................................................................................326.2 SigmundFreud(1856-1939)..............................................................................................................................326.3 ModelofPersonality.........................................................................................................................................326.4 ThePsychicEntities...........................................................................................................................................336.5 Centralconstructs.............................................................................................................................................336.6 ConsciousandUnconscious...............................................................................................................................336.7 Anxiety.............................................................................................................................................................33

6.7.1 Egodefensemechanisms......................................................................................................................................346.7.2 EgoDefenseMechanisms......................................................................................................................................34

6.8 PsychosexualDevelopment...............................................................................................................................356.8.1 PsychosexualStages..............................................................................................................................................36

6.9 Therapeutictechniques.....................................................................................................................................366.9.1 GoalsofTherapy....................................................................................................................................................36

6.10 ProcessofPsychodynamicTherapy...................................................................................................................376.11 Videoclip..........................................................................................................................................................37

6.11.1 Questionstovideo............................................................................................................................................376.12 TutorialWeek7................................................................................................................................................38

6.12.1 Secondtriangle..................................................................................................................................................38

6.12.2 PsychosexualStages..........................................................................................................................................386.12.3 Anxiety/defencemechanism.............................................................................................................................38

7 Lec7:PersonCenteredTherapy..........................................................................................................................................397.1 CarlRogers[1902-1987]Backgroundandstudies..............................................................................................397.2 AcademicandProfessionalpath.......................................................................................................................397.3 Humanisticpsychology.....................................................................................................................................397.4 MajorEmphasesinRogeriantherapy................................................................................................................39

7.4.1 CentralConstructs.................................................................................................................................................397.4.2 TheTherapeuticProcess.......................................................................................................................................40

7.4.2.1 Empathy..........................................................................................................................................................................407.4.2.2 Unconditionalpositiveregard.......................................................................................................................................407.4.2.3 Genuineness/Congruence............................................................................................................................................41

7.5 TherapeuticGoals.............................................................................................................................................417.6 Maslow’shierarchyofneeds.............................................................................................................................41

7.6.1 Self-Actualisation...................................................................................................................................................417.6.2 Self-Actualisation-towardsgreatercongruency..................................................................................................41

7.7 MotivationalInterviewing.................................................................................................................................417.7.1 BasicPrinciplesofMI............................................................................................................................................427.7.2 TheProcessofChangeinCounselling...........................................................................................................427.7.3 WiderimpactofPCconcepts................................................................................................................................42

7.8 Questionstovideoclip......................................................................................................................................427.9 Tutorial.............................................................................................................................................................42

8 Lec8:ExistentialTherapy....................................................................................................................................................448.1 BasicPhilosophy...............................................................................................................................................448.2 FundamentalConcepts(ExistentialDimensions)...............................................................................................448.3 ExistentialDimensions......................................................................................................................................45

8.3.1 SearchforMeaninginexistence...........................................................................................................................458.3.2 Anxiety...................................................................................................................................................................458.3.3 Self-Awareness......................................................................................................................................................458.3.4 SearchofIdentity..................................................................................................................................................468.3.5 Finiteness...............................................................................................................................................................46

8.4 TheTherapeuticProcess...................................................................................................................................468.5 TherapeuticTechniques....................................................................................................................................468.6 TherapeuticElements.......................................................................................................................................478.7 GoalsofExistentialTherapy..............................................................................................................................478.8 VideoClipQuestions.........................................................................................................................................478.9 Tutorial.............................................................................................................................................................48

9 Lec9:SolutionFocusedTherapy.........................................................................................................................................499.1 ConstructionistTherapies.................................................................................................................................49

9.1.1 ViewofHumanNature..........................................................................................................................................499.1.2 KeyAssumptionsofCT..........................................................................................................................................49

9.2 AlternativeTitles...............................................................................................................................................499.2.1 DevelopmentofSFT..............................................................................................................................................499.2.2 FundamentalPrinciples.........................................................................................................................................499.2.3 BasicAssumptions.................................................................................................................................................50

9.2.3.1 Tutorialvideos................................................................................................................................................................509.2.4 TherapeuticRelationship.......................................................................................................................................51

9.2.4.1 Threekindsofrelationships............................................................................................................................................519.2.5 Goaling...................................................................................................................................................................519.2.6 BuildingBlocksofSFT............................................................................................................................................529.2.7 SFTProcess............................................................................................................................................................529.2.8 thedifferences.......................................................................................................................................................539.2.9 Contradictions.......................................................................................................................................................549.2.10 Evidence............................................................................................................................................................54

9.3 KeyConceptsinNarrativeTherapy...................................................................................................................549.3.1 TheTherapeuticProcessinNarrativeTherapy......................................................................................................549.3.2 TherapeuticGoals..................................................................................................................................................549.3.3 NarrativeTherapist’sFunctionandRole...............................................................................................................559.3.4 TherapeuticRelationship.......................................................................................................................................55

9.3.5 TherapeuticTechniques........................................................................................................................................559.4 Tutorial.............................................................................................................................................................55

9.4.1 Video......................................................................................................................................................................56

10 Lec10:Systemictherapy.....................................................................................................................................................5710.1 FAMILYSYSTEMS..............................................................................................................................................5710.2 BASICASSUMPTIONS........................................................................................................................................5710.3 CIRCULARCAUSALITY........................................................................................................................................5710.4 HISTORY............................................................................................................................................................57

10.4.1 MULTIGENERATIONALFTMURRAYBOWEN1913-1990...................................................................................5810.5 CENTRALCONSTRUCTS.....................................................................................................................................58

10.5.1 HOWDIFFERENTIATEDAREYOUFROMYOURFAMILYOFORIGIN?.................................................................5910.6 THERAPEUTICPROCESS.....................................................................................................................................5910.7 HUMANVALIDATIONPROCESSMODELVIRGINIASATIR1916-1988..................................................................60

10.7.1 CENTRALCONSTRUCTS.....................................................................................................................................6010.7.2 CommunicationStyles.......................................................................................................................................6110.7.3 FAMILYROLES...................................................................................................................................................6110.7.4 FAMILYRULES...................................................................................................................................................6110.7.5 THERAPEUTICPROCESS.....................................................................................................................................6110.7.6 THERAPEUTICTECHNIQUES..............................................................................................................................62

10.8 STRUCTURALFAMILYTHERAPYSALVADORMINUCHIN1960-............................................................................6310.8.1 STRUCTURALCONCEPTOFTHEFAMILY............................................................................................................6310.8.2 STRUCTURALCOMPONENTS.............................................................................................................................6310.8.3 THERAPEUTICPROCESS.....................................................................................................................................63

10.9 Howdoyourateyoufamilyoforigin/procreationonthesetwoscales?...........................................................6310.10 Tutorial.........................................................................................................................................................65

11 Lec11:BehaviourTherapy..................................................................................................................................................6711.1 Behaviourtherapy(BT).....................................................................................................................................6711.2 TheStimulus-ResponseLaw..............................................................................................................................6711.3 ContemporaryBehaviouralTherapy(basedonLearningTheory)......................................................................68

11.3.1 KeyConcepts.....................................................................................................................................................6811.3.2 UseofClassicalConditioning.............................................................................................................................69

11.4 Operantconditioning........................................................................................................................................7011.4.1 UseofOperantConditioningreinforcement.....................................................................................................7011.4.2 SocialLearning...................................................................................................................................................70

11.5 Self-ManagementPrograms..............................................................................................................................7111.6 Behavioural(FunctionalAnalysis).....................................................................................................................7111.7 GoalinginBehaviouralTherapy........................................................................................................................7111.8 TherapeuticTechniques....................................................................................................................................7211.9 ContemporaryBehaviouralTherapies...............................................................................................................7211.10 Tutorial.........................................................................................................................................................73

11.10.1 Justabouteverythingweareislearnt,exceptthree........................................................................................7311.10.2 Video.................................................................................................................................................................7311.10.3 Druguser...........................................................................................................................................................73

12 Exam...................................................................................................................................................................................74

1 Lec1:WhatisCounselling?1.1 Whydopeoplegoto

counselling?Tovent

1.2 Definitionofcounselling

Counsellingistheskilledandprincipleduseofarelationshiptofacilitateself-knowledge,emotionalacceptanceandgrowth,andtheoptimaldevelopmentofpersonalresources.Theoverallaimistoprovideanopportunitytoworktowardslivingmoresatisfyinglyandresourcefully.Counsellingrelationshipswillvaryaccordingtoneed,butmaybeconcernedwithdevelopmentalissues,addressingandresolvingspecificproblems,makingdecisions,copingwithcrisis,developingpersonalinsightsandknowledge,workingthroughfeelingsofinnerconflictorimprovingrelationshipswithothers.Thecounsellor’sroleistofacilitatetheclient’sworkinwaysthatrespecttheclient’svalues,personalresourcesandcapacityforself-determination(BAC1989)Aprincipledrelationshipcharacterizedbytheapplicationofoneormorepsychologicaltheoriesandarecognizedsetofcommunicationskills,modifiedbyexperience,intuitionandotherinterpersonalfactors,toclient’sintimateconcerns,problemsandaspirations.Itspredominantethosisoneoffacilitationratherthanofadvice-givingorcoercion.Itmaybeofverybrieforlongduration,takeplaceinanorganizationalorprivatepracticesettingandmayormaynotoverlapwithpractical,medicalandothermattersofpersonalwelfare.Itisbothadistinctiveactivityundertakenbypeopleagreeingtooccupytheroleofcounsellorandclient…anditisanemergingprofession…Itisaservicesoughtbypeopleindistressorinsomedegreeofconfusionwhowishtodiscussandresolvetheseinarelationshipwhichismoredisciplinedandconfidentialthanfriendship,andperhapslessstigmatizingthanhelpingrelationshipsofferedintraditionalmedicalorpsychiatricsettings(FelthamandDryden1993)Counsellorsarenottheretotellclientswhattodo,itisforthemtofigureoutwhattodointheirowntime/pace.

1.3 PACFA–fromdefinitiontodescription

PsychotherapyandCounsellingareprofessionalactivitiesthatutiliseaninterpersonalrelationshiptoenablepeopletodevelopunderstandingaboutthemselvesandtomakechangesintheirlives.ProfessionalPsychotherapistsandCounsellorsworkwithinaclearlycontracted,principledrelationshipthatenablesindividualstoobtainassistanceinexploringandresolvingissuesofaninterpersonal,intrapsychic,orpersonalnature.PACFA:PsychotherapyandCounsellingFederationAustralia

1.4 Thethreecomponents

´ ReflectiveCommunication:theacquisitionofarangeofmicroskills,bothbasicandadvanced,thatpromotesclientself-reflectionandautonomousthinking

´ TheoriesofHumanBehaviour:thatseektoexplainhowhumansthink,feelandactandtheconsequencesofsuchbehavioursforthemselves,othersandsociety

´ TherapeuticRelationship:thebuildingofauniquenon-judgmentalrelationshipbetweenclientandcounsellorbasedontrust,respectandempathy

CounsellingReflective

Communication

TheoriesofHumanBehaviour

TherapeuticRelationship

1.5 WhatisCounselling? ´ Helping:oftendonebyrelatives,friends,supportworkers,humanservicepersonnel;oftenspontaneously.Involvesadvising,caring,problemsolving,teaching

´ Counselling:aprofessionalactivitythatusesareflectivestyleofcommunication,withinaninterpersonalrelationshiptohelpindividualsdevelopself-awarenessandmakechangesintheirlives

´ Psychotherapy:anindepthandintensiveprocesswhichinvolvestherestructuringofthepersonality

1.5.1 Counsellingis….. ´ aprocess

´ aself-helpprocess´ empoweringandliberating´ arelationship´ presentfocused´ forchange´ actionoriented(notrealactionassuch,butjustbeinginacertainway)´ realitybased´ interactional´ aboutproblembehaviournotproblempeople

1.5.2 HistoryofCounselling ´ Counsellingemergedinthelate1800sandearly1900s

´ EventsincludingWWI,WWIIandtheGreatDepressioninfluencedtheevolutionofcounsellingthroughouttheearly20thcentury.

´ The1950ssawaprofoundchangeincounsellingwiththeestablishmentofassociationsincludingtheAmericanPersonnelandGuidanceAssociationandtheSocietyofCounsellingPsychology,alongwiththenewguidanceandcounsellingtheories(suchasbehaviouraltheoriesandcognitivetheories).

´ Counsellingasadistinctprofessionincreasedsteadilyfromthe1960s.´ Throughoutthe1980s,counsellingdiversifiedandcounsellorsbegantobeemployedin

significantnumbersinschools.´ Currenttrends

´ 400-500different‘theories’´ practicedinavarietyofsettings´ variousmodesofdelivery´ stepstowardsregulationinthelast20years(moreonthislaterinthesemester)

https://prezi.com/lpdsqf1h6n75/trinity540-counseling-history-timeline/

• Hippocrateso Developed1stcounsellingtechniquesandinterventionso Introducedtheconceptofprognosis

§ Thinkingaboutwhattheoutcomemightbe• DorotheaDix

o StartedSocialreformof1880sinUSsystemo Bekindtopeoplewhoaresuffering

• Moderndaycounselling:earlybeginningsinvocationsandtestingo Gettingtoknowtheperson

1.5.3 Counsellingworks ´ counsellingalwaysworksmuchbetterthannocounselling

´ someclientsrecoverfasterthanothers´ allapproachesachieveequivalentresultsforgenerallifeissues´ counsellingcanmakeaminorityofclientsworse

1.5.4 Whatweusedto

think…• Thattheefficiencyofaparticularapproachtotherapyisduetotheuniqueaspectsofthat

therapy• Psychoanalytic–interpretation• CBT–Modificationofcognitions• EMDR–Eyemovement• Narrativetherapy–externalisation• Gestalt–Emptychair

1.5.5 Whatwenow • Thecurativepropertiesofagivenpsychotherapylienotinitsuniquecomponentsbutin

Counselling

Psycho-therapyHelping

know… commoncomponentssharedbyalltherapies.• FrankandFrank(1991–PersuasionandHealing)identifiedfoureffectivecharacteristics

(sharedbyalltherapies)• Anemotionallycharged,confidingrelationshipwithahelpingperson• Ahealingsetting

• E.g.bedroomisnotone• Arationale,conceptualschemeormyththatprovidesaplausibleexplanationfor

thepatient’ssymptomsandprescribesaritualorprocedureforresolvingthem• Aritualorprocedurethatrequirestheactiveparticipationofbothpatientand

therapistthatisbelievedbybothtobethemeansofrestoringthepatient’shealth.(pp42,43)

• Lambertassignedpercentagestocommonfactors…

1.5.6 WhatWorksinTherapy

client,extra-therapeutic:• Client’sintelligent,opennesstochangeplacebo,hopeandexpectancy• justbygoingtocounsellingwillhelpyoufeelbetter

1.5.7 Whatisanoutcome? ´ ResolutionoftheoriginalproblemØ newunderstandingorperspectiveontheproblemØ acceptanceoftheproblemØ takingactiontochangeproblemsituation

´ LearningØ newunderstanding,skillsandstrategiestobetterhandlesimilarproblemsinthe

future´ Interpersonalimpact

Ø betterequippedtocontributetohealthyrelationshipsandwell-beingofothers

1.5.7.1 Factorsthatcontributetoa

1. Support–providingreassurance,empathy,trustandcarthasis(releaseofemotions,notjustaboutventing,butcryingetc).

positiveoutcome 2. Facilitationoflearningwhichincludescognitivelearning,payingattentiontofeelingsandfeedback(fromothers)

• Knowledgetypeoflearning3. Action,includingbehaviourregulation,cognitivemastery,realitytesting,andpractising

newbehaviours(LambertandBergin,1994).4. Reflectivepractice,supportedbysupervision,afocusonchangeprocesses,and

awarenessofthesocialandculturalcontextsofindividualproblemsarealsoimportant(Boswelletal.,2010).

• Engageinself-reflectionØ WhatdidIsay/dothatstrengthen/weakentherelationship

• Continuesprofessionalsupervisionthroughoutcareer5. Beingempathic…https://www.youtube.com/watch?v=5O11_Ma20Rk

• Notproblemsolve,evenifyouthinkyouknowtheanswer

1.5.7.2 ReasonspeoplegiveforNOTattendingcounselling…

1. Havingcounsellingisasignofweakness2. Counsellingisforcrazypeople–I’mnotcrazy3. PeoplewillendupfindingoutI’mhavingcounselling4. Iwouldn’tknowwhattosay/talkabout5. Icanjusttalktomyfriends6. Idon’tknowhow“justtalking”toacompletestrangercouldhelp7. I’dfeellikeIwasbetrayingmyfamily/friend/partner8. Talkingaboutmyproblemswilljustmakeitworse–it’llopenacanofworms9. Whatifmyprofessionalindemnityinsurerfindsout?

Stigmasingettinghelpinemotionalproblems

1.6 GoalsoftheUnit • enhancedself-awareness• insightintoyourdevelopmentalhistory• developingself-monitoringskills• matureunderstandingofhumanbehaviour• moreskilledasahelper• helpdiscoveryofyourpotential• beingagoodadvocateforthecounsellingprofession• assistinthechoiceofacareerpathincounselling

1.7 ReadingsChapter1:WhatisCounselling;Chapter2:TheCounsellingRelationship-Geldard,David,Geldard,Kathryn

• Geldard,D&K.BasicPersonalCounselling,Part1• McLeod,J.AnIntroductiontoCounselling,Chapter1

2 Lec2:CounsellingMicroskills–basic2.1 HOWdoyoucounsel? u It’saboutjoiningwithaclientandcommunicatingeffectivelywithintheparametersof

facilitatingashiftorchange.u Specificcommunicationtoolsareusedtoassistthecounsellorinunderstandingwhatthe

clientisREALLYsaying.u TheunderlyingprincipleshouldalwaysbeoneofBeneficence–“First,donoharm”.Isthe

tool/strategy/microskilltherightoneforthisclient,atthistime,inthesecircumstances.

2.2 Atypicalcommunication

Notpartofeverydaycommunication:hastobelearntthrough:

u readingappropriatetextsu modelingbycompetentcounsellorsu videotapeddemonstrationsu observingreallifecounsellingsessionsu intensivepractice

2.3 Reflective

Communicationisa) Tuningintotheclient’sagenda,gettingontheclient’swavelength,perceivingthe

experiencefromwithinhis/her‘frameofreference’b) Reflectingthatexperiencebacktotheclient;holdingitupinamannerthattheclient

beginstogetaclearer,sharperpictureofhis/herexperience/thought(s)/feelingsItistherefore….

u activelisteningu clientcenteredu exploratoryu Non(overtly)evaluative/non-judgmentalu Non-directiveu empathic

2.3.1 ActiveListening u Notjusthearing

u Notpolitesilenceu Listeningwithyoureyesu Enteringtheclient’s‘frameofreference’u Communicatingtotheclientsthatyouarefullypresentu Requiresarangeofspecificcommunicationskills.Micro-skillsare“individualskillsthat

canbelearntwhichgreatlyenhancethequalityandeffectivenessofthecounsellingrelationship”.

https://www.youtube.com/watch?v=OS0Tg0IjCp4

2.3.2 MicroSkills:thebuildingblocksofActiveListening.Basicskills(forthepurposeofthisunit)

Non-Verbalu attendingu observing

Verbal

u minimalresponses(verbalandnon-verbal)u paraphrasing–reflectingcontentu reflectingfeelingsu reflectingfeelingandcontentu effectivequestioningu summarising

2.4 ListeningVariables 2.4.1 Physiological

Influencersu Sensoryacuity,especiallyauditoryandvisual,isbasictolistening.Age-related

deteriorationofsensorymechanismscanleadtolossofboththeverbalcontentandthenonverbaldimensionsofthecommunication.

u Agealsoisanimportantlisteningvariable.Children,adolescents,youngadults,olderadults,andeldersreportdifferentlisteningneeds,differentlisteninggoals,anddifferentlisteningstrategiesastheyaccountforlisteningexpectationsandforlisteningexperiencesalike.

o Dependsonwhatyourneedsareiswhatyouwillhear(selectivehearing)

u Gender:Brainimagingresearch(Phillips,Lowe,Lurito,Dzemidzic,&Mathews,2001)demonstratethatmenandwomenhavedifferentattentionstylesandcognitiveprocessingstylestothecommunicativeinteraction.

u Menandwomen“learntolistenfordifferentpurposesandhavedifferentlisteninggoals.Theprimarycontrastappearsintaskversusinterpersonalunderstanding:Malestendtohearfacts,whilefemalesaremoreawareofthemoodofthecommunication”(Booth-Butterfield,1984,p.39).

2.4.2 Psychological

Influencers

u Attitudinalstate:Apositivelisteningattitude,alongwithlisteningknowledge,isacriticalingredientofeffectivelistening.Beinterested!

u Beingopentohearingdifferingpointsofviewandtospeakerswhosestylesarenotnecessarilyattractiveorengaging.

o Somepeople’sstylecanbeloudandharsh,andifcounsellorsletthisaffecttheirfeeling,thentheywillnotbeabletohearexactlywhatthesepeoplearesaying

u Positivelisteningattitudesarenotoftencommunicated:“You'renotlistening.”“Youneverlistentome.”“Bequietandlisten.”Wehearthesecommentsmoreoftenthan:“Thanksforlistening”or“You'reagoodlistener.”

u Communicationapprehension:“thefearofmisinterpreting,inadequatelyprocessing,and/ornotbeingabletoadjustpsychologicallytomessagessentbyothers”.Listeninganxietystemmingfromstressfulsituationscanleadtodistortedmessagesandmisunderstandings.

o E.g.notrememberingwhatyousaidandhearafterajobinterviewu RobertsandVinson(1998)determinedthattheimportanceofthetopicisthecrucial

factorinestablishingalistener'swillingnesstolisten.u Listeningpreferences.Listenerschoosedifferentwaystolisten:

o (1)apeople-orientedstyle,whichfocusesontheemotionalandrelationalaspectsofacommunication;broadlyspeaking,womentendtohavethisstyle

o (2)acontent-orientedstyle,centredonprocessingcomplexinformation;o (3)anaction-orientedstyle,wherethelistenerprefersclear,efficient

information;o (4)atime-orientedstyle,wherethelistenerhasapreferenceforshort,limited

messages.o agoodtherapistshouldhavealltheseskills

2.4.3 Contextual

Influencersu Roles,culture,andtime.u Welistendifferentlyindifferentcontexts:familymembers,friends,students,workers,or

managers.u Culture.AnthropologistEdwardHall(Hall&Hall,1989)describedhowdifferentcultures

manageinformationindifferentways.o Low-contextcultures,suchastheUnitedStatesandAustralia,require

communicatorstogiveandreceiveaconsiderableamountofverbalinformation,o High-contextcultures,suchasJapanandSaudiArabia,requireslessextensive

verbalmessagesu Time.Peopledealwithinformationdifferentlyatdifferenttimesoftheday.Information

presentedintheafternoonmayberetainedlongerthanthatofferedinthemorning.(Wolvin,2009)

u Listenerscanlisten(andthink)aboutfourtimesfasterthanthenormalconversationrate.Thereisa“timegap”inthesystemforattentiontowanderandtolosefocus.

2.5 Attending u checkingcomfortlevel

o physicalcomfort,e.g.chair,water,temperature,tissuesu physicalattending–SOLER

o "Sitsquarely";"Openposture";"Leantowardstheother";"Eyecontact;"Relax"u conveyingavailabilityandpresence

o makingclientsfeellikeyouarelisteningtotheirmessagesu expressivenessu mirroringposture

o wehavemirrorneurons,soifweareconnectedwithsomeone,wewillnaturallymirrorwhatothersaredoing

u avoidstereotypicalcounsellormannerisms

2.6 Observing u bodylanguage

u verbal-nonverbalcongruenceo mismatchonwhatisbeingsaidandclient’saffect

u facialexpressionsu para-language

o clients’gesturemaychangewhenaparticulartopicistouchedu movementsu physicalattireu emotionalstateu energylevelu dyadicinteraction(couplecounselling)

2.7 MinimalResponses Byshowingsubtleactioncanencourageclientstokeeptalkingasyouareshowingthatyouare

payingattention.• Verbal–oneortwowords,aphrase,anutterance.eg,uhhuh,mmmm,yes,and,ok,…• Non-verbal–amovement,eg,anodoftheheadormovementofthearmsorhands

u confirmsactivelisteningu encouragesclienttokeeptalkingu emphasisessignificanceu establishesclarity

not:useminimalresponsestomake(wrong)assumption

u endorsingu agreeingu sympathising,consolingu pattingontheback

2.8 Paraphrasing:

reflectingcontentu isolatingthesalientcontentoftheclient’sresponseu reflectingthatbacktotheclientinaclear,moresuccinctmanneru mustbebrief,notanexpansionorarandomconvolutedsummaryofcontentu inaccurateparaphrases?

Notu parrotingu interpretingu labeling

o e.g.youareinthesunbecauseyouarefitu puttingnewideas/thoughtsintotheclient’shead

2.9 ReflectingFeeling u isolatingwhattheclientisexperiencingemotionally

u sensitivereflectingbacktotheclientthesefeeling/su identifyingbothexplicitandimplicitexpressionoffeelingu identifyingthelevelofintensityu facilitatingtheexpressionoffeelingsandprovidinga‘space’forcatharsisu watcharbitrarylabeling;givingclientsfeelingsu counsellorneedstodealwithhis/herfeelings

o whataretheappropriateandinappropriatefeelingsu contributesmosttobuildinganempathicrelationshipu it’simportanttopractice,e.g.

o whenIfeelangryIfeel…..e.g.itconsumesme/impulsive/outofcontrolo whenIfeelacceptedIfeel….E.g.valued

TIPforcounselling:• startlookingforandlearningaboutfeelingwords,e.g.

http://www.psychpage.com/learning/library/assess/feelings.html• Emotionallexicon:wordsassociatewithbasicemotions(anger,fear,anticipation,trust,

surprise,sadness,joy,anddisgust)andtwosentiments(negativeandpositive)

2.10 ReflectingFeelingandContent

u withexperienceitisoftenconvenienttolinkfeelingwithcontentinasingleresponseo Eg,you’refeelingbetrayed(feeling)becauseyoursisterwentbehindyourback

andspoketoyourhusbandaboutyourissues(information).u theresponsemustbeskillfullyintegrated;succinctandnotwordy

u reflectionoffeelingcanattimesbemorepowerful:helpsclientstaywiththeemotionalexperienceratherthanmovetoaheadlevel

o movefromheartleveltoheadlevel,whenclientstalksaboutthefeeling,counsellorsreplywiththecontent

u helpfulincheckingcongruencebetweenclient’sthoughtsandfeelingsu helpfulinmirroringtheintensityoftheclient’sexperience-cognitiveoremotional

2.11 Questions u gatheringrelevantinformation

u clarifyingclient’sthoughtsandfeelingsu heightenclientawarenessu usedsparingly

o toomanyquestionscanbeoff-putting,makeclientsfeltlikeinterrogationo thiscanbehardwithclientswhoarenottalkative,thereforeaskilltobe

comfortablewithsilenceisimportantu moreonthe‘open’(requiresresponsethatismorethanjustyes/no)endofthe

continuumthanonthe‘closed’u assistsclienttoopenup,disclosemore:tobemorespecificorbehaviourallyexplicitu helpwithgettingabetterunderstandingoftheclient’sexperienceu helptoaccessspecificandrelevantinformationu avoid‘why’questions;focuson‘what’,‘when’,‘where’,‘how’

o questionsstartwithwhyoftenhaveajudgementtone,e.g.whydidyouquitthejobbeforeanewone?

Notu intrusive;tosatisfycounsellor’scuriosity;gatherirrelevantinformation

o canbetemptingtowanttofindoutirrelevantinfobecauseyouareinterestedinpeople

u leading,directing,suggestingu interrogating

2.11.1 TypesofQuestions u transitional-establishingconnections,links;oftentoanearlierpartofthediscussion.Eg,

earlieryoumentioned***,I’mwonderinghowyouarefeelingaboutthatnow?o usedwhenyouarestuckandunsurewhattosay

u exploringchoice–Eg,inwhatotherwayscouldyourespondtothat?u circular–perspectiveoftheother.Eg,howdoyouimagineyourbrotherwouldfeelabout

***u scaling–trackingchangeEg,onascaleof1–10,howusefulwasthatstrategy?u goaling-establishingdirection.Eg,ifcouldimaginenotfeelingstressedatwork,what

wouldthefirstimprovementbe?u leading–pointstheprospectiveanswerinaparticulardirection

o e.g.forsomeonewantstoloseweighto Closeleadingquestion:haveyouthoughtaboutgettingupearlytogoforawalk?o Thisisaleadingquestionbecausecounselloristellingtheclientonwhattodo.

Close:yes/noo Ratherthanexplorethefeelingandtalkaboutit,whytheyaredepressedafter

gain5kg.Counsellorscomeupwithideasontipsandanswersonhowtoloseweight

Avoid….(Ivey&Ivey,2003)

u Bombardment/grilling:askingtoomanyquestionsoneaftertheother.Thecounsellorissettingtheagenda.

u Multiplequestions:Thisoccurswhencounsellorsaskseveralquestionsatonce.E.g.“Pleasetellmeaboutyourself-–howoldareyou,wherewereyouborn,doyouhaveanychildrenandwhatdoyoudoforaliving?”

u Questionsasstatements:Usingquestionstosellyourownpointsofview.Forexample,“Don’tyouthinkitwouldbehelpfulifyoustudiedmore?”“Whatdoyouthinkoftryingrelaxationexercisesinsteadofwhatyouaredoingnow?”Alsoknownasclosedleadingquestions.Judgementalquestions.

u Whyquestions:Generally,justdon’tdoit…

2.11.2 Summarising u helpsclientstopandreviewthegroundtraversedu reflectingbacktotheclientsalientaspectsofhis/herpresentingissuesu helpstomakeconnections,buildbridges,identifythemes

u sortsoutdisconnectedmaterialintomoremanageableunits:helpsclient‘seeapathwaythroughtheforest’

u couldindicateaturningpoint,amomentofself-evaluation,identificationofagoal,astrategicpause

u timingandcontextarevital;o don’tdoitevery5minutes,itcandisruptstheflow

Notu alwaysessentialu are-runofwhathasbeencoveredu atabulationofeveryissuethathasbeenraised

o notarecordingofeveryissues

2.12 Responsestoavoid u Moralising,preachingo Becarefulon

givingyourownopinion

u Advising,givingsolutions,lecturing,logicalarguments,debatingo Generally

speaking,thisisnotcounsellor’sjob

u Interpreting,Analysing,Diagnosing,labellingo Oktohypothesis,

ratherthanadiagnosistypeofanalysis.E.g.afewweeksagoyoumentionedthat,andnowyouaretellingmethis.Iwonderiftheremightbeaconnection

u Reassuring,sympathising,consoling,minimisingo Carisawriteoff

butyouareoku Interrogating,probingu Humouring,divertingu Completingsentencesu Praising,applaudingu Judging,evaluating

disagreeing,blaming

2.13 ReadingsGerald_chapter5-8

• Chapters5:JoiningandListeningpp.41-50• Chapter6:ReflectionofContent(Paraphrasing)pp.51-60• Chapter7:ReflectionofFeelingspp.61-70• Chapter8:ReflectionofContentandFeelingspp.71-78

3 Lec3:AdvancedMicroSkills3.1 AdvancedSkills ´ primaryskillsareessentialbutnotnecessarilysufficient

´ atrusting,empathictherapeuticrelationshipisanecessarypre-requisite´ advancedskillsarerequiredwherethereisan‘impasse’,afeelingofbeing‘stuck’or

‘goingaroundincircles’´ mustbeusedselectively,withcareandsensitivityandattimes,afterconsultation

3.2 AdvancedMicroSkills ´ normalising

´ reframing´ challenging(confrontation)´ exploringoptions´ highlightingchoice´ therapistself-disclosure

3.2.1 Normalising Makingaparticularsituationseem/confirmnormal.

EmotionalStates

´ reducesanxietyandbringsemotionalrelief(no,you’renotcrazy/odd/dysfunctional)´ allays(diminish)fearsof‘fallingapart’´ asensitiveresponsecanpavethewayforreferralwherenecessary

DevelopmentalandExistentialCrisese.g.

- developmentalcrisis• puberty,movingoutofhomeat35

- existentialcrises• diagnosisalife-threateningdiseaseatageof23

´ raisesawarenessoftheinevitabilityoflifecrises´ reducestheaccompanyinghighlevelsofstress´ instills(establish)hopeandoptimismandhelpsintegration

´ whenusedskilfullycanintegrateintoabroadernarrativeofpeople’slife´ facilitates‘meaningmaking’andre-visioning

Mustnotinvolvetheminimisingordevaluingoftheclient’sexperience(Oh,everyonefeelslikethatwhen***happens)…usingtentativelanguagecanassist–“I’mthinkingit’sprobablynotunusualtofeel/thinkthatinthissituation”(suggestiveratherthanimposing).

3.2.1.1 Examples ´ Amothercomestoseeyouandsheisupsetbecauseher15yearolddaughterwantstogooutonSaturdaynightwithherfriendsinsteadofstayingathomewiththefamily.

´ Possible“normalising”response:´ “alotofteenagegirlsarewantingtoestablishpeerrelationships,whichis

important,howeveritmakessensethatthereisabitofasenseoflossastheybecomemoreindependent”.

´ Kidsatthatagedowanttohangoutwiththeirfriends´ So,stillacknowledgingthemother’sfeelingsaswellasnormalisingthesituation.

´ Aclientcomestoseeyouregardingafollowuplettershereceivedfromherdaughter’s

therapist(cc’dtoviolentex-partner)whereherchildren’snamesweremixedupandmisspelled,sentenceswereincomplete,personalinformation(fromthemother–notthechild/client)wasnotesandanincorrectdiagnosisprovided.Shesayssheisfuriousandwondersifshe‘shouldbe’

´ Whenyouareprofessionalbetrayed,it’snotunreasonabletobebotheredbyit.

3.2.2 Reframing

´ Sometimesaclient’sperspectivecanbecloudedbypessimism,negativity,poorself-esteem,depressionetc.Thesefactorswillimpactupontheclient’sjourneytowardimprovement/shifting.

´ helpingclienttoseeadifferentperspective´ presentinganexpandedviewofthesituation´ reframingbehaviourinanadaptiveway

´ morepositiveandhelpful

´ highlightingalternativepossibilities´ reframingloadedwordsandphrases

´ maybesheisnottryingtogetonyournerves,butjustwanttomakesureeverythingisdoneproperlyandthat’sherpriority

´ expandingperspectivesoftheself´ drawingattentiontothedifferencebetweenintentandimpact

´ Iwonderifyourparentswanttoshieldyoufromtheembarrasementofwalkingintoclasslate

´ offeringa‘positivespin’onperceivedfailuresTutorialnotes• sharingnewlight,differentidea/meaning,butalsovalidateexistingone• changesomeone’sframe

o yourparentsdon’thateyou,theyjustreallycareforyouUnderstandthedifference• reflectionofcontent:differentwords,samemeaning• reframing:differentmeaning

3.2.2.1 example ´ It’sallinthelanguage…´ Aproblemasanopportunity´ Aweaknessasastrength

´ Shifttheframeof‘thinkingbeingused’,topeoplesawthatasastrengthofyourshencewhypeoplecometoyou

´ Animpossibilityasadistantpossibility´ Adistantpossibilityasanearpossibility´ Oppression('againstme')asneutral('doesn'tcareaboutme')´ Unkindnessaslackofunderstanding

´ Whenayoungboycomplainshowsomeoneisbeingunkind´ Reframeitto‘whotaughtyouhowtobeaniceboy’,maybeheisnotas

fortunatetohavesomeoneinteachinghimhowtobekind.TextbookexamplesInitialframe ReframeIaminatunnelandIcan’tseeawayout. EverytunnelhasanentranceandexitIknowIwillneverbeconfident Beingconfidentstartswithhavinginsights

aboutourlimitsHe/sheisoutatnightandthatmeansthathe/shedoesnotlovemeanymore.

Privatetimeawaycanhelpyoutoappreciateeachothermuchmore.

Client:Clientinvolvedincaraccidenthasrecentlyreturnedtoworkandnoticesthatsheistriggeredbycarsounds.Reframebycounsellor:accidenthasmadeyoumoreawareoftheneedtopayattentionwhenyouhearacar.• Sometimesisabouttakingsomeofthestingsoutofclients’statementExamtip:importanttounderstandthedifferencebetweennormalisingandreframingAclientcomestoseeyoushortlyafterseparatingfromalong-termrelationship.Theydiscoveredtheirpartnerhadbeenhavingan‘extra-marital’affairforaboutayearand‘cannotbelieveIwassostupid…suchanidiot’Reframe:Iwonderifyourdevoteandcarewithherwasyourpriority,ratherthanbeingsufficient.Iwonderifyourpersonalityisbeingmoretrustworthythansuspicious.Normalising:it’snotunreasonablethatyouwouldtrustyourpartnerafter18years.

3.2.3 Challenging ´ Challenging/confrontationisoftenassociatedwithaggression–tendstobepoorly-utilised.

´ Incounsellingit’saboutraisingawareness(whereaprimaryskillhasfailed).Usedtohighlightdiscrepanciesthattheclientisunawareof.

´ mustberespectfulandnon-threatening´ counsellormustbeawareofhis/herfeelings,motives,goals

´ isityourfrustrationthatclientsshouldhavegotitbynow?

´ skilfulconfrontationhelpsclientsreceiveso-callednegativemessage´ contextandtimingiscritical

canbeusedforself-understanding,curiositydon’tuseitasbeingjudgementalasclientscouldsensethat

3.2.3.1 WhentoChallenge? Useitwhenyoufeltastrongtherapeuticrelationshipisestablished.´ clientisindenial´ failuretorecogniseself-destructiveandself-defeatingbehaviours´ notacceptingthepossibilityofseriousconsequences

´ whathappensifyouareinvolvedinacaraccidentundertheinfluenceofalcoholanddrugs,andthepersonkilledisyourloveone?

´ Andwhathappensifclients’responseis–Iwillbetoooffmyfacetocareaboutit.(whentheaddictionistoodeep,peoplewon’tchangeover-night.Theyarecomfortablewithwhattheyaredoingandcounsellingmaynotworkiftheattendancewasduetoexternalfactor,e.g.amothermadeherchildtoseethecounsellor.)

´ Keepinmindyoumaynotalwaysgetthedesirableoutcomewhenyouchallengetheclient

´ Clientsdobetterwithchallengingareclientsthatareverycommittedtopersonalgrowth.Theyarenottherejusttofixtheissue,buttogetanybenefittheycanfromtherapy.Theywouldembracetheentireexperience.

´ makingcontradictorystatements´ goingaroundincircles´ unableorrefusaltofocusonthepresent´ verbal–nonverbalincongruence

´ whenapracticaljoketurnedintoadisastrousinjury,andtheclientislaughingwhentalkingaboutit.Thecounsellorcouldchallengetheincongruenceforhisowncuriosity.Sometimestheanswercanhaveitsreason–ourfamilyagreedonastrategytodealwithtraumaistomakeajoke

´ ruptureoftherapeuticrelationship´ notreadytochange–pre-contemplativestage

3.2.3.2 Howtochallenge… ´ (Perhaps)beginwithabriefsummaryofwhathasbeencommunicated(clientfeelsheard)

´ Communicationofthecounsellor’sfeelings(maybe)´ Clearstatementaboutwhatthecounsellorhasnoticedthatisincongruent.´ Examples

´ Couplewhoagreedtohomeworkthendidn’tdoit.´ Clientcommittedtolongevitywhosmokes.´ 19yearoldwhowantstoberichandwon’tmakeaphonecalltogetadifferent

job.´ Clientwhodoesn’twanttobecontrollingbutinsistsonexacttimeshiswifewill

visithersister

3.2.4 ExploringOptions ´ whenclientsmakeapreemptiveconclusionthatthereis‘nosolution’oronlytwopolarpossibilities

´ reflectingfeelingsofbeing‘stuck’,‘trapped’,‘imprisoned’,‘frozen’´ usinganopenquestiontofacilitateexplorationofoptions´ nottheofferingofoptionsexceptinatentativewayandasacontribution

´ NOT–whydon’tyoujustdothisorthat(judgmental,it’sbasicallylikesayingIcan’tbelievethatyouhaven’t…)

´ Tentative-Iamwonderingifthereissomething….´ Notrightorwrong,butdifferent

3.2.4.1 GeneratingOptions ´ facilitateawidespectrumofoptions

´ summarisetobringclarity´ explorepositiveandnegativeoutcomesofalloptions´ rankorderintermsofpreference´ encouragetheuseofbothrationalityandemotionindecisionmaking´ emphasizeautonomyandtheelementof‘choice’(Glasser,1998.ChoiceTheory)

Onceyougivepermissiontosomeonetodosomething,theinitialragemaygoaway,e.g.

• Initialrage:Iwanttodestroymywifefinancially• Andifyoutellclientsthattheycan’t/shouldn’t,theyaremoreinclinetodoit• Butifyougeneratesomeoptions:

o Ithinkit’spossibleonedayyoumayhavelovingrelationshipwithyourchildreno Ithinkmaybedownthetrackyouwon’twanttofinanciallydestroyhero Maybeonedayyouwon’tcareaboutanyofthisandgotravellingfortherestofyourlifeo Idon’tknowbutIfeellikethereareotheroptions.

3.2.5 Thesignificanceof

‘Choice’´ thereisalwaysachoice´ thedifferencebetweenwhat‘I

shoulddo’andwhat‘Iwanttodo’´ themythofa‘rightchoice’as

opposedtoaresponsiblechoice´ itisthemostdesirable,sensible,

appropriate,effectivechoiceinacontext

´ validatingthechoice‘nottochoose’theinevitabilityofintrapersonaltension(inphysiologicalsense)inmakingchoices,e.g.head-tension,heatrisingontheface

´ canbeusefulwhenflagthefeelingofsensationappropriatelywiththeclient,anadvanceskillofnormalisingthefeeling.Messageofempathy.

3.2.6 TherapistSelf-

Disclosure´ Indirectself-disclosureisunavoidable

´ Age,gender,roomdécor,weddingring,certainjewellery,forthcomingholidays´ Directdisclosurerelatestointentionalverbaldisclosures

Self-involvingdisclosure´ affirmationofclientawareness

´ Iamawareofyouarealwaysmakinganefforttodoyourhomeworktogetmostofthebenefit,justlikemychildren

´ disclosuresaboutthetherapeuticprocess´ Commentonnatureoftherapport

´ ‘cheerleading’and‘benevolentcuriosity’´ tobeavoided,butcanbeusedifdoinglifecoaching

Self-Disclosingresponses´ intentionalsharingofthetherapist’sfeelings,thoughtsandlifeexperiences

´ becarefulwhenusingthis,e.g.yoursistersoundssomuchlikemysister

3.2.6.1 HistoricalcontextandTherapeuticOrientation

´ 1912,Freud:“thephysicianshouldbeimpenetrabletothepatientandlikeamirror(blankscreen),reflectnothingbutthatwhichisshowntohim”.

´ Humanistmovementinthelate60’s,self-help&feministmovementsin70’sand80’sresultedinanovertshiftaroundfosteringanegalitarianrelationshipbetweentheclientandtherapist.

´ Humanisticandexistentialtherapistshighlightimportanceoftransparency.´ 1990s.Influenceofhighprofileindividualsself-disclosure.E.g.,Oprahself-disclosingher

lifestories.´ Grouppsychotherapy:Yalom:“grouppsychotherapistsmay–justlikeanyothermembers

inthegroup–openlysharetheirthoughtsandfeelingsinajudiciousandresponsiblemanner,respondtoothersauthenticallyandacknowledgeorrefutemotivesandfeelingsattributedtothem”.

´ CBT&BT(behaviouraltherapy):manybelieveitisproblematictoanswerquestionswithaquestion:

´ E.g.doyouhaveanykids?´ “Canyoutellmewhyyouwanttoknowthat”.

´ theydon’tpromoteself-disclosure´ NarrativeTherapy–refertoself-disclosureas“transparency”.

3.2.6.2 IntentionalSelf-

Disclosure´ theresearchshowsmixedresults;mustbeusedwithcare´ canbeburdensometoclient

´ addanotherworryforclient

´ detractsfromtheclient’sstory´ canbecomeexhibitionistic´ awarenessofcounter-transferenceissues

´ whatimpactdoesthishaveontheclient,whattheythinkaboutyou,andtheimpactonthetherapeuticrelationship

´ notforthenovice/traineecounsellor

3.2.6.3 Usefulforcertaincohorts

´ Self-helpand12stepprograms´ Self-disclosureofyourownaddictionjourney,andself-disclosureispartofthe

successtorecovery´ onereason:theyarenotalone,becausebeforedisclosing,thesepeopleareliving

intheshame.AfterAAmeeting,theydiscoverotherssuchasdoctors,lawyers.´ Childrenandthosewithcognitiveimpairment

´ Kidsliketohearadult’srebelliousbehaviours´ Adolescents–canassistinclientsfeelingmorerespectedthanjudgedand/orpatronised´ Religiousandspiritualbasedtherapies´ LGBTI´ WarveteranswithPTSD´ Marginalisedindividuals

Usefulwhenclientsfeltyouhaveunderstandingaboutwhattheyaregoingthroughandhowtheyarefeeling.

3.2.6.4 Questionstoaskyourself-…

´ Whatisyourreasonforself-disclosingtothisclientatthistime?´ Whatisyourneedto“getcloser”totheclientabout?´ Whatareyoutryingtoachieveviaself-disclosure?´ Willthisself-disclosuredetractfromtheclient’sissues?´ Willthisself-disclosuredisempowertheclient?´ Willthisself-disclosurealtertheclient’sexpectationsofthecounsellor?´ Isthereanypossibilitythatthisself-disclosurewillbeusedagainsttheclientatalater

stage?´ Istheclientemotionallystableenoughto“hear”theself-disclosureinthewayitis

intended.´ Whatwillhappenifyoudon’tself-disclose?

3.3 Readings Geldard,D&K(2011)SelectedChapters

fromPartIV(seeCMD)

4 Lec4:GOALING/GOAL-SETTINGINCOUNSELLINGLEARNINGOBJECTIVES…•Identifythepurposeofgoalsettingwithclientsandtheformsthesegoalsmaytake•Discussthefunctionsofcounsellinggoals•Identifywhataneffectivegoalwouldlooklike•Distinguishbetweenoutcomegoalsandprocessgoals•Discussgoalsasmovingfromgoodintentionstospecificbehaviours•Discussthecharacteristicsofaneffectivegoalandhowtohelpclientsdevelopeffectivegoals•Considertheskillsassociatedwithgoalsetting•Discussthecontextsinwhichgoalsettingmaybemorechallenging4.1 THEPURPOSEOF

GOALSETTING…

•Clientscanexperiencepsychologicalblocks,theymaylackconfidenceornecessaryskillstomoveforward->requirehelptomovetoaction•Wecanfacilitateclients’progressbyhelpingthemdesign,choose,craft,shapeanddevelopgoals

4.2 TWOASPECTSTOGOALSETTING…

•Tohelpclients(andyou)determinewhattheywanttogetfromtheirsessionswithyou•Tohelpclientsidentifyhowtheywillachieveataskorgoaloutsideofthetherapeuticcontext

4.3 FUNCTIONSOFCOUNSELLINGGOALS…

(HACKNEY&CORMIER,2013)

•Goalscanbemotivational•Goalscanbeeducational•Goalscanserveanevaluativefunction•Goalscanbemadeacrossarangeofcontexts•MaterialGoals•FamilyandFriendsGoals•Educational/Intellectual/ProfessionalGoals•HealthGoals•LeisureGoals•SpiritualGoals•CreativeGoals•Emotional/PsychologicalGrowth

4.4 WHATSHOULDANEFFECTIVEGOALINVOLVE?

(EGAN,2010)

•Outcome-oriented•Specific•Substantiveandchallenging•Venturesomeandprudent•Realistic•Sustainable•Flexible•Congruentwithvalues•Reasonabletimeframe

4.4.1 EXAMPLESOFOUTCOMEGOAL

•“Iwanttostartdoingsomeexercise”•“Within6monthsIwillberunning5kminlessthan40minutesatleastfourtimesaweek”

(EGAN,2010) •Thinkaboutgoalsasaccomplishments

4.4.2 MOVINGFROMAGOODINTENTIONTOASPECIFICGOAL(EGAN,2010)

•“Thissessionhasbeenaneyeopener.Irealisedthatmywifeandkidsdon'tseemyinvestment-oroverinvestment-inworkassomethingIamdoingforthem.Ihavebeenfoolingmyself-tellingmyself-thatIamworkinghardtogetthemalltheywantandneed.IjustrealisedthatInfactIamspendingmostofmytimeatworkbecauseIlikeit.Myworkismainlyforme.It’stimetorealignsomeofmypriorities.“•Declarationofintent:“Idon’tthinkI’mspendingsomuchtimeatworkinordertorunawayfromfamilylife.ButfamilylifeisdeterioratingbecauseI’mjustnotaroundenough.Imustspendmoretimewithmywifeandkids.Actually,it’snotjustacaseofmust.Iwantto.”•Broadaim•Counsellor:“Tellmewhatspendingmoretimeathomewilllooklike?”•“Iamgoingtoconsistentlyspend3outof4weekendsamonthathome.•DuringtheweekI’llworknomorethantwoevenings.”(Specificgoal)•Counsellor:whatwillyoubedoingwithallthistimeathome?•“Iwillbedoingthingswithmywifeandkids–qualitytime…doingthings,picnics…takingthemfishing…playingfooty…”(Breakingdowngoalintoactions/tasks)

4.4.3 REALISTICANDCONGRUENTGOALS

•Undertheclient’scontrol•Attainablewithintheclient’slifecontext(Icancomehomeearly3timesaweek…)•Congruentwiththeclient’svaluesandbeliefs(Myfamilyisimportant,Iwantthemtohavesharedmemories…)•Clienthasaccesstothenecessaryskillsandresources•Clienthasexploredconsequencesofchange(willworkless–ormaybemoresustainably…)

4.4.4 SUBSTANTIVEANDCHALLENGINGGOALS

•Makesasignificantcontributiontowardsthedesiredoutcome(createsqualitytime,memories…)•Requirescommitmentandeffortfromtheclient–stretcheshim/her•Balancebetween‘goaldifficulty’and‘goalperformance’–relatestoclientself-efficacyaboutmakingwiseandpurposivechoices

4.4.5 NEGOTIATINGATIMEFRAME

•Not‘sometimeorother’;‘whenready’(“whendoyouthinkyouwillbereadytodothis?”)•Identifyingimmediateoutcomesinthecontextoftherapy(“howwillourworktogetherherehelpyou?”)•Facilitatingintermediateoutcomes–transferringmodifiedbehaviourstoreallifesituations(“Whatkindofchangesinyoureverydaylifewillyounoticeinthenexttwoweeks?”)•Affirmingfinaloutcomes–constructiveandsustainablechange(“youhaveachieved…howwillthiscontinuetobepartofyourlife..?)

4.4.6 FLEXIBILITYANDEVALUATION

•Goalsadaptedtochangingcircumstances(“withthenewbabycoming,whatwillyouneedtochangeoradaptwithyourexerciseregime?”)•Opentotradeoffsbetweengoalspecificityandgoalflexibility(“willyouneedabitmoretimetoachieveyourgoal?”)•Maximizingachievements–‘cheer-leading’(“Youhavebeendoingsowellwith…keepgoing”…usedinlife-coaching)•Buildinginandidentifyingpotentialrewards,reassessingandevaluatingoutcomes

4.4.7 THEFIRSTSTEP •Emphasisehereandnowaction(“whatsmallthingcanyoustartdoingtoday..?”)•Assessinglevelofmotivation(“tellmeonascaleof1-10howmotivatedyouaretodothis….?”)•Identifyingpotentialhurdles(“Whatcouldgetinthewayofyouspendingmoretimewithyourfamily?”)•Exploresecondarygains•Relapsepreventionstrategies(“Whatwillhelpyoutogetbacktobeingwithyourkidsmore?”)•Exploringconsequences(“Aretherethingsyouwillsacrifice…?Aretherepeopleinyourlifewhowillsupport/notsupportyou?“)•Recognizingmeta-goals/super-ordinategoals(“Whatwillbeimportanttoyoutokeepyougoing?”)

4.5 THESHADOWSIDEOFGOALSETTING(EGAN)

•Goalsettingpushesclientsoutof“safe”/familiarplaceoftalking,exploring,“caringandsharing”.Bothcounsellorandclientmayresisttheshift.•Somepeopleare“happier”livinginvictimhood.“Victimhoodandself-responsibilitymakepoor

bed-fellows”.•Goal-settingcaninvolveswork,effort,pain,struggle.•Althoughachievingagoalcanbeliberating,itcanbesubsequentlycauseanunwantedconsequence–eg,achievingacareergoalmightresultinlostfamilyrelationship

4.6 SKILLSASSOCIATEDWITHGOALSETTING

(HACKNEY&CORMIER,2013)

•Verbalskills•Visualisingactivities•Verbalconfrontations•Affirmingresponses•Structuringskills(Usefultoolswhenclientsneedhelpunderstandingthegoal-settingprocess)•Goal-settingmap•Timelines•Successiveapproximation(shaping)–useofrewards

Ofcourseyoucanaddinotherareasoflifethatwillbeimpactedbythedecision:•Workplace•Sportingteam

4.7 Acommonconcept

4.8 ADDITIONALTIPS •Createapersonalmantra.2–5wordsthatcapturetheessenceofthegoal.Usepositive

(ARINANIKITINA) language.Writeitdownandlookatitoften.•Setupmotivating,inspirationalenvironment(open,clutter-free,breaks)•Useinevitabilitythinking–setconditionsthatmakeitdifficulttofail(eg,givingsomeone$20everytimeyoumissgym)

4.9 GOALSETTINGINDIFFERENTCONTEXTS

•Goalsettingwithchildren•Considerdevelopmentalstage•Crisesandgoalsetting• Donotsetgoalsduringthemiddleofcrisis•Thecounsellorwillhavetherapeuticgoals.Mutualgoal-settingisnotpossible•Multiculturalcontexts•Monk,Winslade,Sinclair(2008)–refertoSueandSue(2007)–AsianAmericans,AfricanAmericans,Latinos,NativeAmericans–haveshortterm/immediategoals;whites–long-rangegoals.“Goalsettingisaproductofclassdifferencesandeconomicadvantage”.

4.10 THERAPEUTICMODELSANDGOAL-SETTING

•Differentmodelsoftherapywillseektoachievebroadgoalswithclients.Psychoanalysis Resolveunconsciousconflict;healthydefensesPerson-centredTx Resolveincongruencebetweenself-andexperienceExistentialTx Understandingoflife;authenticity,freedomREBT Rationalthoughts/lifephilosophy,knowledgeofABCsRealityTx Healthychoicesthatsatisfybasicneeds–espattachment

needsSFT(SolutionFocusedTherapist)

Resolvethecomplaint

NarrativeTx Reauthorpreferrednarrative

5 Lec5:RationalEmotiveBehaviourTherapyandCognitiveTherapy

5.1 AlbertEllis(1913-2007)

Ø Dysfunctionalfamilybackground.GrewupintheBronx.NotafanofschoolØ Health(diabetes)andemotionalproblemsinearlyyearsØ Variedcareerbackground,struggledtostickwithonecareerpathØ Reactiontoearlypsychoanalytictrainingdevelopedatherapeuticapproachthatwouldhelp

himpersonally–insightaloneisnotcurative…whycountsfor…Ø Ucanunderstandandknowwhy,butitdoesn’tnecessaryevokechange

Ø LongandcontroversialprofessionalcareerØ Prolificwriter(sexuality,relationships)(lotsoffriends/peoplesoughthiscounsel,whichled

himtodevelopREBT)andenergetic,flamboyantpractitioner

5.2 Self-experimentation

• Shywithgirls(andpublicspeaking):o “ifIfail,Ifail.IfIdieofdiscomfort,Idie”,sobeit,butI’mgoingtodothis

• SitinBronxgardens–100+girls/montho Didn’tgetadateinthefirstmonth,butnoticedfearhadreducedsignificantlyo Bytheendofsecondmonth–threedates

• Practiceandpracticeuntilhebecamesomeonewhoisknownasgoodatpublicspeaking• InitiallyknownasRationalTherapy.Hewouldhavecalledtheresultanttherapy–Cognitive-

EmotiveBehaviourTherapy

5.3 REBTPhilosophy

Ø precededbyearlyschoolsofthoughtthatprioritisedcognition

Ø psychologicaldistresslargelyduetodefectivecognitiveprocessing

Ø distorted/incorrectthinkingØ humansarebiologicallyprogrammedtobeboth

rationalandirrationalintheirthinkingØ affirmstheintrinsicworthofhumannature;

distinguishedbehaviourfrombeingØ insteadofsaying,youareanaughtyboy,burningdownthehousewasthenaughty

thingtodoØ lookatthebehaviour,nottheperson

Ø emphasisedhumanfallibilityandpersonalresponsibilityØ evenfornonCBT/REBTtherapist,theywouldstillusetheconceptfromthistherapy

Ø emphasisedhedonism:humansseekpleasureandavoidpain

5.3.1 TheA-B-CTheory(Irrationalbeliefs)

Acouplehadamassivefightbecausethewifewenttosleepinthespareroombecausehusbandwassnoringaloud.

- A:partnerismissing- B:shemustbecrossedathimforsomething

- C:hewenttothespareroomandsaidtoher“whatisyourproblem”Hisbeliefinwhattheactivatingeventwasresultedinthisconsequence.

5.3.2 TheA-B-Csofdisputingirrationalbeliefs

REBTwantstodisputeirrational/false/unprovenbelief

- D:Iwonderifthereisanotherreasonwhysheiscrossedatme.

- E:Iwonderedifit’smy20yearsofsnoring.

- F:WhatasensiblethoughtfulcaringpartnerIhave

5.3.3 IrrationalBeliefs[Ellis,1975]

- Must- Should- Ought

• Imustbelovedorapprovedofbyeverysignificantpersoninmylifeo Dispute:doyoulikeeverypersonyoucomeacross?Andisitreasonablethateveryperson

likesyou?• Imustbecompetent,adequate,andachievinginallrespectsifIamtoconsidermyself-

worthwhile• itisterribleandcatastrophicwhenthingsarenotthewaytheyoughttobe;it’snotfair• IshouldgetwhatIwant,whenIwantit.IfIdon’tgetwhatIwant,it’sterrible,andIcan’tstand

it;itfrustratesmeo Thereisnoruleabout:ifI’mnicetoyou,thenyoushouldbenicetome

• oneoughttobeabletorelyonothersandexpectthemtoactincertainways• Ishouldbequiteupset/concernedaboutotherpeoples’problems

o Ijustdon’tcareisthatwrong?(again,norulesaboutthis)• otherpeoplemusttreatmeconsiderately,fairly,kindly;exactlythewayIwantthemtotreatme

o nicetohave,butholdingontothisbeliefwouldonlycausespainWhatareyourthoughtsontheabove.Doyouattimesthinkinasimilarmanner?Ifyousubscribedtotheseirrationalbeliefs,youcangetfrustrated,disappointedFirsttimehearingthesebeliefscanbeshocking.Wemaybemodelledatayoungage.

5.3.4 TheoryofrestructuringIrrationalBeliefs

Ø ClientscreatetheirownemotionalreactionsanddysfunctionalresponsesØ TheystemfromirrationalbeliefsØ ClientshavetheabilitytochangethewaytheyreactandrespondØ SteponeistorecognizeandidentifytheirrationalbeliefsØ ClientsmustseethevalueofdisputingthesebeliefsØ Changedemandshardwork

Ø Changeyearsofentrenchedthinking/responseØ Undoingneuropathway

Ø ItrequiresthepracticeofREBTfortherestoflifeØ Justwhenyouthinkyouhavefixedit,somethingelsewillsurface

5.3.5 TheTherapeutic

Process

Ø DemonstratethroughteachingtheA-B-C’sofhowclientscreatetheiremotionalreactionsanddysfunctionalbehaviours

Ø ToteachpeopletonoticewhattheyaresayingtothemselvesabouttheeventØ Therapist:tellmewhenthathappens,whatareyousayingtoyourself?Ø E.g.Husband:Notgoingtothegymtoday?Wifeheard:Youareanelephant,youare

lazyandneedtogotothegym(wife’shistoricalviewofherself)Ø Assistclientswithidentifyinganddisputingtheirirrationalbeliefsandmodifyingtheir

thinking–cognitiverestructuringØ Wife:Yes,I’mgoingrightnowandyoucancookyourowndinner

Ø Demonstratehowclientsmaintaintheiremotionalreactionsanddysfunctionalbehavioursthroughre-indoctrinating(teachtoacceptsetofbeliefs)themselves

Ø ChallengetoeveryirrationalbeliefØ EncourageandassistclientstoengageinactivitiesthatwillcountertheirirrationalbeliefsØ Challengeclientstodeveloparationalphilosophyoflife

5.3.6 Therapeutic

Techniques

Amultimodalandintegrativeapproachtailoredtosuittheindividualclientwithacontinuingemphasisoncognitionasopposedtoaffect

- Focusonwhattheywerethinking- Whatareyouthinking/internaldialogue?Whatareyousayingtoyourself?- Therapistmayassistbygivingsomeoptions,andkeepsgoingbacktothatcognition

5.3.7 Cognitive

Techniques

Ø TeachingclientsaboutREBTandABCDEFØ Canworkwithyoungchildren,teachthemthelinkbetweenthoughtsand

behavioursØ Ifyouthinkyouareabully,andyoubehavelikeabully,howmayyoufeel?Probably

feellikeabully(changethewordfrombullytogoodperson)Ø Assistclientsinactivelydisputingtheirirrationalbeliefs

Ø Should/mustØ Emphasisingthevalueoffunctional,realistic,rational,logicalthinking

Ø DifficultwhenemotionsarestrongØ REBTshouldnotbeusedingriefØ REBTisabsurdanddisrespectfulwhenaclientjustlostaloveone

Ø E.g.saying,uknoweveryonediesØ Encouragingclientstochangetheirabsolutisticandmusturbatorythinkingbylearningnew

‘self-statements’Ø Insteadofsaying,Ineedtobegoodateverything,otherwiseImnogoodØ Changeto,ImsomeoneputsreasonableeffortandfeelcomfortablewiththeeffortI

putinØ Useofhumourtocounteracttheoverserioussideofaclient’sthinkingØ Cognitivehome-worktotransferREBTtechniquestoreallifesituations

Ø Toteachpeopletoquicklynoticewhattheirinternaldialoguesare

5.3.8 EmotiveTechniques

Helpclientsknowthevalueofunconditionalself-acceptance(USA)andunconditionalotheracceptance(UOA)–evenifthebehaviourishardtoaccept–via:

• Rational-emotiveimageryo Frequentpracticeofchallengingclientstoimagine“theworstpossiblethingthat

couldhappen”–e.g.feelingdevastated,feelingstupidetc.Changethoseintensefeelingstomorepositiveones.

o Toastudentwhomhavehighanxietyaboutwalkingintoclasslate:whatistheworstthingthatcouldhappen?Maybetheteachwouldfaintandthewholeclasswould

laugho Worsepossiblethingsaremanageableo Exercise:writedownonethingpeopledon’twanttoknowaboutyou,onethingthe

worlddon’twanttoknowaboutyou.Thenwewillthrowinthefire,asasymbolicreleaseofshame.Theninstructpeopletoreaditoutbeforethrewinthefire.Twothingslearnt:

• Theworlddidnotend• Itdidnotalterpeople’sopinionaboutanyoneelseinthegroup(UOA)

• roleplayingandrolereversalo Usefulforpeoplesufferwithanxietyo Rehearsescenarios.Practicefocusingonunhelpfulself-talko Roleplay5minspresentationinfrontoffakeobjects

• CLIENT:peoplearethinkingIamstupid.THERAPIST:really,howdoyouknowthat?Andwhatotherpeoplethinkisnoneofyourbusiness

• shame/guilt/embarrassmentattackingexerciseso Designedtoincreaseself-acceptanceandreallyknowthatallegedlyembarrassing

experiencesarenotsocatastrophic,examples:• clienttoweartoiletpaperbehindtheirpantsandwalkaroundshopping

centre• wearT-shirtinsideout• leavespinacharoundteethandhaveconversations

o gettheclienttorecognisewhattheyaresayingtothemselves,andafterafewminutes,howarethethoughtsshifted?

• Useofforce/vigourexerciseso Therapistadoptsclient’sunhelpfulbelief,clientactsastherapistandhastoconvince

“client”aboutirrationalityofthebelief• THERAPIST:IjustthinkthateveryoneshouldbeasniceasIam.CLIENTto

challengethebeliefo REBTbelievesitentrenchesthattheabilitytochallengeirrationalbelievesifyoudo

that

5.3.9 BehaviouralTechniques

Ø AdaptingmanytypicalbehaviouraltechniquestochangethinkingØ BehaviouralhomeworkassignmentsØ Self-monitoringirrationalthinkingusingbehaviourdiariesand/orcues

o SomeREBT/CBThaveworkbooksØ Bibliotherapy

o Encouragetoreadaboutrationalthinkingandirrationalbeliefs,continuespsychoeducation

5.3.10 TheTherapeutic

Relationship

Ø basedonanauthoritativestancecombinedwithfullacceptanceandtoleranceo therapististheteacher,butalsowithwarmth,acceptance,patience

Ø thetherapistasactiveteacherratherthananemphasisonwarmthandempathyØ avoids‘indulgencetherapy’;notaboutclientsfeelingbetterbutgettingbetter

o REBTdoesnotlikeclientonlytalksabouttheirfeeling,andspentmajorityofthesessioncomplainingandbeingupset

Ø avoidslengthydiscussionof‘A’sordwellingonC’so notsomuchdetailsoftheevento moreonwhatwereyousayingtoyourself

Ø collaborativeandskilleduseofavarietyoftechniqueso equalcommunication,unlikePersonCentredTherapywhereclientstalkmore

5.4 CognitiveTherapy

AaronBeck(1921-stillalive)

Ø BornintoaRussianpractisingJewishfamilyØ Childhoodtraumaandpoorself-worthØ PlaguedbyanxietyarisingfromnumerousphobiasØ QualifiedasapsychiatristtrainedinpsychoanalysisØ ImpactofearlyworkonanalysisofdreamsofdepressedclientsØ Prolificwriterandresearcher

5.4.1 BasicPhilosophy

Ø anevolutionaryperspectiveofhumannature:humanstryingtomakemeaningoftheirenvironmentthroughcognitiveprocessing

Ø wemakemeaningoftheworldbywhatwethinkØ inpartaderivativefromandinpartareactionagainstclassicalpsychoanalysis

Ø psychoanalysisdidnotworkinallcases,analysingdreamswasn’tusefulforsomedepressedpatients

Ø aconstructivistapproachthatassumesbothanexternal,objectiverealityaswellasapersonal,subjectiveone

Ø thereisrealityoutthere,butwealsoconstructourownreality/meaningØ insightfocusedinitsattentiontocognitiveprocessesthatareaccessibletointrospection

Ø notlookingatthesub-consciouslyofwhatyouarethinkingØ lookingatthoughtswecanaccesswithintrospectionØ needtoteachpeopletheintrospective

Ø mainlyatheoryofpsychologicaldysfunction

5.4.2 CognitiveDistortions(AaronBeck)

Ø arbitraryinferences(includingcatastrophising)o reachingconclusionswithoutsufficient/relevantevidenceo e.g.satnightpartyisgoingtobeterriblebecauseweatherisbad

Ø selectiveabstractiono formingconclusionsbasedonanisolateddetailo knowonethingabouttheevent/practiceandmakeglobalassumptiononhowit

supposedtobeo e.g.legalisesamesexmarriagemeansboyswillbewearingskirttoschool

Ø overgeneralisationo holdingextremebeliefonthebasisofasingleevent.Applyingrulesacrossdifferent

settings/contextso notvisitingdentisteveragain,becauselastdentistvisitcaused3weeksofpain

afterwards.(notconsideringothercontext/setting)Ø magnificationorminimisation

o over-estimatingsignificanceofnegativeeventso useofcatastrophescale,clientmaysayparentsdiedis100,misplacingabookfor

halfanhouris10(nobigdeal),goingonacamp(80).Clientinitiallydemonstratedanxietyisgoingonacamp.Therapistthenaddedmorehigherendevents,e.g.breakups.Everytimeaneventwasadded,goingonacampwoulddrop

Ø personalisationo automatedassumption:it’sallaboutME,Ihavedonesomethingwrong.o Challenge:whatifthishastodowithsomeoneelse,isthisapossibility?

Ø labellingandmislabellingo takeonecharacteristicaboutapersonandattributetothewholeperson

Ø polarised(dichotomous)thinkingo all-or-nothingthinkingo it’sallgood/right,orallbad/wrong

Ø emotionalreasoningo howIfeel=howitiso Ifeelterriblesoitmustbeterrible

Ø mindreadingo IKNOWwhatyou’rethinkingo Wealldoittosomedegree

Ø absolutisticthinking

- mindreading- dichotomousthinking- emotionalreasoning- magnification- personalisation

5.4.3 Therapeutic

Relationship

Ø coreperson-centredtherapeuticconditionsarenecessarybutnotsufficientØ CBTbelievestherapeuticrelationshipisn’tenoughtoaffectchange

Ø therapistmustbeactive,skilledincognitiveconceptualization,creativeandabletoengageinSocraticdialogue

Ø therapistfunctionsasacatalystandguideassistingclientsmakethenecessarylinksbetweentheirbehaviourandtheircognitions(thoughtpatterns)

Ø proactiveengagementwithclient:pointingoutdistortionhascausedaparticularbehaviour

Ø aneducativepartnershipwhichassistsclientsmaketheirowndiscoveriesthroughactiveengagement(collaborativeempiricism)

5.4.4 Therapeutic

Process

Ø establishlinkbetweenmaladaptivebehaviourandtheclient’sidiosyncraticthoughtsØ teachclienttoidentifythedistortedcognitionsthroughdeliberatethoughtmonitoring

Ø whatamIsayingtomyself?Ø tracethe‘streamofthought’identifyingtheactivatingschema(corebeliefs)–prevents

lapsesØ preventingrelapse,andchangeschemaØ CBT/REBT:changecorebeliefaboutself(USA/UOA)Ø Irrationalthinkingtoleave,andquicklylockingrationalmessagetoselfØ Bydoingthisquickly,clientsdevelopdifferentwaysofrespondingØ E.g.hearinghusbandsaying“notgoingtothegym”hasdifferentmeaningnow

compareto20yearsago–workingoffdifferentschemaØ through‘Socraticdialogue’assistclienttotestthefunctionalityoftheirthoughts/schema-

guideddiscoveryØ assistclientstorestructuretheirthoughts/schemasØ clientlearnsnewfunctionalself-statements,alternativeinterpretations,different

perspectives

5.4.5 SocraticDialogue Partofsocraticdialogueistotouchonhowthatbeliefcametoexist.Challengingtheorigincanassistinchangingthatschema.Conflictswithotherthoughtsandanswerstoobjections

- Constantchallengingandquestioning- Teachingclientstochallengetheirdistortedthinking- Howwouldyoufeelisyousaidthattoyourself?

Theoriginorsource- Ifyouweretaughtbyyourparentsaboutthatbelief- Oruthinkpeoplefromthatcountryarebadtempered,whatifyourteamconsistofonly

thosepeople

Support,reasons,evidence,assumptions- Isthatassumptionahelpfulwayofthinking?- E.g.kidshavebeenseparatedfromparentsforalongtime,andtheyhavebeentoldtheir

parentsarenice.Beforemeetingthem,therapisttellthekidabout‘evidence’.SomeonesaidtheteacherMrs.Smithisnotnice,butshetreatsyouwell,andyouonlyseehertreatingothersnicelytoo.Sothatisevidence.Or,youaskedakidifsheatethebiscuits,shesaidno,youreplied,buttheevidencetellsmethatyoudidbecausethereiscrumpsonyourface

5.4.6 TherapeuticTechniques

Ø flexibleuseofanyethicaltechniquethatattackstheclient’sdysfunctionalthoughtsØ homeworkasessentialcomponentoftherapyØ cognitiverestructuringthrough:o deactivatingautomaticthoughts,beliefsandschemaso modifyingtheircontentandstructureo constructingmoreadaptivecognitivestructurestoneutralizethemo e.g.Therapistmaysay,inmyexperience,nooneisallgoodorallbadØ SocraticquestioningØ thought-recordingthroughuseofspecificinstruments

Ø diariesØ gradedassignmentstodealwithcomplexandoverwhelmingtasks

Ø startsmall,e.g.goingtoasmallshopfirst,iftheyareanxiousingoingtobigshops(homework,assignment)

5.5 REBTVSCBT REBT CBT• Directive,persuasive,confrontational

o Comfortableinchallengingclientsonwhatisgoingon

• Inductiveprocess• Therapistasexpertteacher• Psycho-educationalprocess• Targetingirrationalandnon-functional

thoughts• Technicalcompetence

• Socraticdialogue,openquestioning,facilitating

• Deductiveprocess–catalystandguide• Inaccurate,distorted,rigiddeepseated

beliefs• Empathy,sensitivity,therapeuticalliance

(notsufficientalong,needtohaveotherprocessesinplace)

5.6 FeelingGood GoodFeelingscontributesignificantlytoourwellbeingBUTwefeelthewaywethinkANDwedonothavetoexpresseverythoughtthatentersourheadTHEREFOREwecanchooseourthoughtswecanlearntothinkdifferently

wehavethepowertokeepathoughtorletitgoCruxofREBT/CBT

- Recognisingusefulnessofthoughts,unhelpfulnessofotherthoughts,knowingthatwedon’thavetoholdontoparticularthoughts/beliefsiftheyarenotservinguswell

6 Lec6:PsychodynamicTheory6.1 Psychoanalytic

PsychodynamicTheory

� IsbasedonFreudandfurtherdevelopedbyotherneo-Freudians(neo-analyticapproaches)majorimpactonsubsequenttheoriessignificantinfluenceonlaypersons’

� Freudiananalysis-understandingofthehumanpsycherequiresintensivelong-termtrainingoftheanalyst

� Analystneedstohavehadtheirowntherapy• Psychodynamic–psychologythatisinadynamicflux

o betweenconsciousandunconscious,knownandunknown,repressedoremergedfromunconscious

• Psychoanalytic–Freudusedanalysistofindoutwhatishappeningwithinaperson• Fullanalysisusuallyabout10years,twiceaweek.• Clientlearntaboutthemselvesthroughanalysis/interactionthroughFreudiantherapist.• Eveythingcomesupbetweentherapistandclientisimportant.Everyargumenthasavalue,it

willbedisected,analysed,understoodandlinkbacktothepast• Intensivetherapy:3-5days/week.Ifyoumissaday,youneedtotalkaboutit• Notsuitableforeveryone

6.2 SigmundFreud(1856-1939)

� BorninVietnam� FirstbornsonofaverypoorJewishparents� Hadmanyinterests–chosetostudyMedicine� OriginatorofPsychoanalysis� Devotedhislifetocreatethemodelofthehumanpsycheandpersonalityand

psychoanalysis� Prolificwriter(CollectedWorksin24Volumes)� Ardentworker–hadaextremelybusypractice� DiedinLondonin1939(endofWorldWar)

• Activeanddrivenmindfromanearlyage• Wantedtobeascientist,lookedandobservedpeopleinascientificway• StillusesmanyofFreudlanguagetoday,e.g.someoneisanal.Itcomesfromtheanalstage–

holdingontothings• Drivenpersonality,saw10clientsaday,restoftheawakingtimeshewouldwrite,11-12pmat

nighthehadtherapywithhisdaughter–AnaFreud.Sleep3-4hoursaday

6.3 ModelofPersonality Id• Pleasureprinciple• Primaryprocessthinking• Likeachild,noconscious

aboutothers,allaboutme,mydrive,e.g.Iamhungry/unhappy

• Basicdrives:hunger,sleep

Superego• Moralprinciplethat

guidesyou,thisiswherethe“should”comesfrom

• Imperativesideals• Ideologythatguidesus• Ishouldbelikethat,

workinghard.Thesuperegotalk

• IfyouareaPerfectionist,thatisyoursuperegodrivingyouEgo• Realityprinciple,theadultpartofus• Secondary