COUNSELING

THEORIES

CHAPTER 7

I. INTRODUCTION**A. Definition of and Need for Counseling

• Counseling is a helping relationship that involves one party who needs help, another party that provides help, and a setting that allows the process to occur.

• Frequently, we are helping people deal with the feelings or emotions surrounding a communication disorder

• We are also providing guidance

Often, I have found that:**

• As the SLP, I am the key person parents turn to when they need to vent their emotions or talk over their worry, fear, and stress

• As a student, I was never ready for this—I thought my job ended with assessment and treatment

B. Guidance, Counseling, and Psychotherapy

Counseling:

Guidance:

II. THEORIES OF COUNSELING**

A. Psychodynamic Theory

– based on psychoanalytic theory

– created by Freud– behavior is the product of

conflicts between the id, ego, and superego

– 5 psychosexual stages

B. Client-Centered Theory

The counselor (you, the SLP) needs to be fully present:**

• You have to be in touch with your own needs and experiences

• You enter into a therapeutic alliance with the client so as to release the client’s self-actualizing drive

• With the right therapeutic environment, the client’s self-actualizing drive will bubble up and they will actively choose to make changes

• Step 1:

• Step 2:

• Step 3:

• Step 4:

DiLollo & Neimeyer, 2014

For example: **• Me to Kiree: “You’re really bored right now,

aren’t you? I’m pretty boring!”

• “It must be make you mad when kids make fun of you because you talk different.”

• Me to Eddie: “You really don’t want to do this test, huh? Feels like the same ol’ same ol,’ right?”

Some multicultural clients might not like this…**

• They often expect advice and specific solutions, not just a shoulder to cry on

• The more educated the client, the more they will want the list of action steps

Robinson, 2014:

C. Behavioral Theory

• All behavior is caused by environmental stimuli**

• human behavior is the product of external reinforcement

• behavior is shaped and maintained by immediate consequences

• reinforcement must be given immediately after a particular behavior has occurred

• **Rather than focusing on feelings, the clinician focuses on specific outcomes

• Goal: emphasize client’s identifiable behaviors and make positive changes

• Danger: “fruit loop therapy”

• May be most effective after a client-centered approach, esp. in the beginning where clients have strong emotions

• **Many multicultural clients appreciate this

• Behavioral therapy does not rely on having people get in touch with and express their feelings

• Provides specific and practical steps for positive change

DiLollo and Neimeyer 2014:

DiLollo & Neimeyer 2014:

Robinson, 2014

D. Cognitive-Behavioral Theory

Luterman states that:

There are some irrational thoughts that can cause pain to clinicians and

clients:**• I must be universally liked

• It is awful when things are not just the way I want them to be

• Or, as Mark McKibbin said in Europe, “I don’t believe this. In the States, the customer is always right.”

• To be worthwhile, a person must be competent and high-achieving in all areas

Mistakes are not OK, and I must be stupid to have done this—it’s awful!

• **A person’s past history is an all-powerful determinant of his present behavior; because something once strongly affected his life, it should continue to do so

• A person should become very upset over other people’s problems and disturbances

• There is always a perfect solution to problems, and it is catastrophic if this solution is not found

A cognitive therapist…

• 1)

• 2)

• 3)

• 4)

For example: hearing impaired client:**• 1. “So you don’t want to wear your hearing aid because you’re

afraid people will avoid you at social gatherings.”

• 2.”When you go to the party Sat. PM, see if you think this is true. Observe people’s reactions to you.”

• 3. (next session) “How did people react? Oh, no one avoided you? You had fun?”

• 4. “Now that we know this, would you be willing to wear your hearing aid more often?”

Severe stutterer—23 yrs—afraid to ask a girl out:

E. Reality Therapy

Like a breath of fresh air…. **• This approach involves helping people take more

effective control of their lives

Accomplished by helping them choose effective, responsible behaviors

• SLP confronts inconsistencies openly and directly

• 8 steps

8 Steps• 1.

• 2.

• 3.

• 4.

• 5.

• 6.

• 7.

• 8.

F. Eclectic Approach• 1)

• 2)

• 3)

Again, remember…

III. DEALING WITH CLIENTS’ COGNITIVE DISTORTIONS• 1.

• 2.

• 3.

• 4.

• 5.

6.

7. Catastrophizing**• People believe the worst that can happen,

and that it will happen to them

• If my child is retained in 4th grade, he’ll become a behavior problem and maybe eventually turn to a life of crime

Mindsets that Inspire Procrastination

Many Americans have low frustration tolerance…**• Because our society emphasizes instant

gratification

• The LA-Z boy culture

• Everything should be easy, fast, effortless, and comfortable!

Youtube

IV. REACHING RESOLUTION**

• Sometimes people cannot come to a conclusion or agree upon a course of action

• In these cases, I use a little “Roseberry magic”

A technique I have sometimes used:**

• First present a solution that’s really unpalatable

• “We could not enroll Neil for stuttering therapy, and just let him go. Of course, the danger is, that when he gets to junior high, the other kids might really make fun of him and ostracize him.”

Next…**

• Present another unpalatable extreme

• “I could see Neil daily for 20-30 minute sessions, but he would always miss social studies and probably fall behind.”

Lastly…**

• Present a “middle of the road” option that is very palatable

• “A third option is that I could see Neil twice a week for 20 minutes, and send home brief assignments for you to do with him. In this way, he wouldn’t miss too much class and we could work on strategies for him to be more fluent, especially as he goes into junior high.”

• “Which one of these sounds best to you?”