Psychotherapy and Counseling Essentials: An Introduction

Chapter One

• This class is about the mysteries of human distress, human growth, why people change, and how we can help them.

• We’ll be doing an overview of 9 counseling and psychotherapy theories and applications—with a special emphasis on historical context and practical contemporary applications.

Background and Overview

• Psychotherapy theories can explain and predict ways we treat each other, including how we define mental health and mental illness, our ideas about helping , rehabilitation, and personal responsibility.

Background and OverviewThey help us answer the questions like:What motivates people to do what they do?What disturbs thinking processes, triggers unmanageable anger, lowers individual productivity, and destroys relationships?What makes or breaks an individual?What makes some people resilience after facing traumatic event, while others are weakened or deeply damaged?

Background and Overview

• There’s no single answer to these questions. It’s common for mental health professionals to strongly disagree with each other on just about every topic.

Human Suffering and Hope

Psychotherapy is an imperfect science, because every human is unique with his/her idiosyncratic ways of being. There is much we don’t know about human behavior, the brain, emotions and interpersonal relationships.

• Determining why people suffer, how they change, and how to help them live more satisfying and gratifying lives is a huge and important task.

Historical Context

• Every human behavior or set of beliefs has its own particular historical context. This is related to psychotherapy and its close relatives: counseling, therapy, mental health consultation and clinical social work.

Historical Context

• Contemporary psychology originated in Europe and the United States in the late 1800s. During that time, women and other minorities were excluded from higher education. Much of psychotherapy’s history is written from the perspective of white man advocating a particular theory.

Historical Context

• Who is the father of psychotherapy?

• Who is the mother of psychotherapy?

• What is meant by the following statement?“In psychology, even the rats are white and male.”

Who is the father of psychotherapy?

• Sigmund Freud.

• This claim is truth. But it’s impossible to give a single individual the credit or blame for an enterprise as huge as psychotherapy.

Alternative Historical-Cultural Realities

Early treatments for human distress and disturbance consisted of a combination of these four perspectives:

– The biomedical perspective (then: trephining; now: serotonin hypothesis)

– The religious/spiritual perspective (then: evil spirits; now: ??)

– The social-psychological-biomedical perspective (then: ??; now: ??)

– Feminist and multicultural perspectives emphasize relationship and community over individuality. (How do people with these perspectives define pathology and approach the counseling process?)

The Biomedical Perspective

Trephining and lobotomies: Early archaeological findings provide evidence of a treatment procedure, now called trephining. This hole opening was a treatment by a shaman or healer to release and evil spirit from the brain. This is biomedical perspective. About a half million years later, a similar physical intervention , prefrontal lobotomy emerged as a popular treatment for mental patients in the USA.

The Religious/Spiritual Perspective

• Human looked for clergy, shamans, mystics, monks and other religious leaders for advice and counsel over the ages.

• For many Native American tribes, spiritual authorities are still important for healing. Many Asian and African cultures also believe spiritual practices.

• Modern pyschosocial interventions include elements of spirituality. Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) use Buddhist approaches to facilitate emotional regulation.

• Most clinicians know the emotional healing potential of spiritual practices and beliefs. Spiritual leaders have great wisdom and insight into the human condition.

The social-psychological-biomedical perspective

During the trephining period, about 500,000 years ago, human have probably understood that verbal interactions and relationship alterations can change thinking patterns, mood and behavior. Wise healers from different cultures and traditions use psychological and relational techniques. Siddhartha Gautama (Buddha) and Epictetus are forebears to modern cognitive theory and therapy. Avicenna seems to have been an early strategic or constructive theorist.

Feminist And Multicultural Perspectives

Traditional historical voices have generally been white and male, but mental health professionals must be aware of minority voices. Feminist mind set differs from traditional male mind. Last 40 years, feminist approaches have been integrated into psychotherapy approaches. Cultural sensitivity is important to positive therapy outcomes with diverse client populations.

Feminist and multi-cultural perspectives emphasize relationship and community over individuality. These are human values. The mental health professionals are beginning to recognise these values as different ways of being and not as pathological.

Definitions of Counseling and Psychotherapy

Should I get a PhD in psychology, a master’s degree in counseling or a master’s in social work? This disscusion leads to the confusing topic of the differences between counseling and psychotherapy.

Definitions of Counseling and Psychotherapy

• What is psychotherapy?

• What is counseling?

• What are the differences between counseling and psychotherapy?

Counseling versus Psychotherapy I

• The Histories

– Psychotherapy: Freud + Recovery from serious personal problems

– Counseling: Out of guidance movement, which was/is about helping people with choosing or decision making

What Is Psychotherapy?

Anna O., Breuer’s patient, called to the treatment she received as the ‘’talking cure’’. Talking, expressing, verbalizing or sharing one’s pain is potentially healing.

How should psychotherapy be practiced? This question is relevent to how psychotherapy is defined.

1. ‘’A conversation with a therapeutic purpose’’ (Korchin, 1976)

2. ‘’The purchase of friendship’’ (Schofield, 1964)

3. ‘’When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder’’ (J.Watkins, personal communication, October 13, 1983)

What Is Counseling?

Adler might claim that counseling has an inferiority complex with respect to its older sibling, psychotherapy. Or psychotherapy has a superiority complex with respect to its younger rival, counseling. ‘’Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior. (Burke, 1989)

What are the differences between counseling and psychotherapy?

Patterson (1973): ‘’There are no essential differences between counseling and psychotherapy’’“Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do (Corsini & Wedding, 2000, p. 2).”

• For Corsini and Wedding’s definiton, both of them engage in the same behaviors but may differ.

Counseling versus Psychotherapy III

What are the differences between psychotherapy and counseling?– Goals?– Shorter versus longer?– Problem versus person?– Guidance versus advice?– A little more on the surface versus a little deeper?– Cheaper versus more expensive?

• Psychotherapist: Less directive, go a little deeper, work a little longer, charge a higher fee.

• Counselor: Slightly more directive, work more on developmentally normal issues, work more briefly, charge a bit less fee.

The Goals of Counseling and Psychotherapy

People come to therapy to alleviate their painful symptoms (e.g., anxiety, depression, guilt) and undesirable behaviors (e.g., compulsions, impulsivity, etc.).

People come for assistance in decision making.

People also come to therapy to grow or improve themselves.

Counseling and Psychotherapy Defined

• A process that involves • a trained professional who abides by • accepted ethical guidelines and has • skills and competencies for working with• diverse individuals who are in distress or have

life problems that have led them to • seek help (possibly at the insistence of others)

or the individuals may be

C&P–Defined II

• choosing to seek personal growth, but either way, these parties

• establish an explicit agreement (informed consent) to

• work together (more or less collaboratively) toward

• mutually agreed upon or acceptable goals

C&P–Defined III

• using theoretically based or evidence-based procedures that, in the broadest sense, have been shown to

• facilitate human learning or human development or effectively reduce disturbing symptoms.

What Is a Theory?“A coherent group of general propositions used as principles of explanation for a class of phenomena” (Random House Dictionary, 1993, p. 1967).In psychology, theories are used to generate hypotheses about human thinking, emotion and behavior. For counseling and psychotherapy, a theory needs to accurately describe, explain, and predict a wide range of therapist and client behaviors.

What is a Theory? II

“A theory is not built on observation. In fact, the opposite is true. What we observe follows from our theory.”

“Without a guiding theory . . . , clinicians would be vulnerable, directionless creatures.” (Prochaska, 2003)

But with a guiding theory, what sorts of things are likely to happen?

The Scientific Context of Counseling and Psychotherapy

• Major Historical Developments: Eysenck’s (1952) Findings (24 studies)

– Analytic—44%

– Eclectic (Mishmash, hugger-mugger) —64%

– Custodial—72%

The Scientific Context of Counseling and Psychotherapy II

A Psychotherapy Research BoomSmith and Glass developed method of meta-analysis. Effect size is a statistic used to estimate how much change is produced by a particular intervention. Effect size represents the difference in efficacy between interventions and no treatment control groups. Smith, Glass&Miller, 1977 : Average person who gets counseling is better off than 75% of those untreated.What is the dodo bird effect?

The Scientific Context of Counseling and Psychotherapy IIIThe Great Psychotherapy Debate

Point: Research has demonstrated the superiority of a few select psychotherapy techniques over other specific techniques.

Counterpoint: Research doesn’t show that some specific techniques are better than others; instead, research shows there are common therapeutic factors operating across different therapy techniques.

Weinberger’s common therapeutic factors ???

The Scientific Context of Counseling and Psychotherapy IV

Common Therapeutic Factors—Lambert (1992)•Extratherapeutic change (40%) : Client Factors (motivation, severity of disturbance, ego strengths, psychological mindedness.)•Therapeutic relationship (30%): (Rogers: unconditional positive regard, empathy and congruence) (Freud: therapeutic alliances)•Expectancy (15%) : (hope)•Techniques (15%)

• Salvador Minuchin: «Don’t be too sure»• No theory holds the key to all problems. No

theory entirely explains what it means to be human.

• When we get too sure about a theory, we close ourselves off to different perspectives.

The Zeitgeist, the Ortgeist, and the Poltergeist

• Zeitgeist: The spirit of the time

• Ortgeist: The spirit of the place

• Poltergeist: A mischievous spirit or ghost—a mystery

Poltergeist

As a therapist, we should be ready for surprises. Sometimes your clients will say and do shocking things. Or we’ll suddenly feel the urge to say or do something inappropriate. In the therapy room, sitting cheek by jowl with another person for long time can make unusual experiences.

Five-Minute Discussion

• Groups of three or four.

• Up to now, according to your knowledge as a major, come up with three or four reasons why therapy can sometimes be harmful.

Concluding Comments and Review

•Homework: Start dating Freud this week.