Counseling Interventions (Free Access)
Psychodynamics: A brief overview
- There are four
major schools of psychoanalytic theory:
- Classical Freudian
- Ego Psychology
- Object Relations
- Self Psychology
- Psychodynamic theorists adhere to the notion of unconscious influences on conscious behaviours
- Psychodynamic theorists use introspective methods as a way to tap into internal thoughts and images
- Sigmund Freud used the analogy of the iceberg to depict the complex interplay of conscious and unconscious forces
- Freud believed that only 10% of personality is available to conscious awareness
- Components of the Psyche
- Freud’s theory outlines three mental components:
- Id : Hedonistic
- Ego: Realistic
- Superego: Moralistic
- Unconscious; operates according to the pleasure principle with no regard for moral principles
- Primary process thinking achieves momentary satisfaction and wish fulfillment
- Insight (catharsis) reduces tension
- Freud termed the libido ‘eros’, and termed aggression ‘thanatos’
- Mostly conscious; operates according to the reality principle
- Tries to align the urge of the id with reality using secondary process thinking
- The ego considers the situation and past experience to engage in behaviour
- Mostly conscious; operates according to the perfection principle
- Tries to uphold morality by a strict adherence to societal standards
- Guilt and shame result from immoral behaviour for those having a strong superego
- Freud developed a series of four psychosexual stages:
- Oral Stage
- Anal Stage
- Phallic Stage
- Genital Stage
- Too little or too much gratification within each stage can result in fixations
- Defense Mechanisms are the ego’s protective methods of reducing anxiety by unconsciously distorting reality
- Repression – the basic defense mechanism that banishes anxiety-arousing thoughts, feelings, and memories from consciousness
- Regression- defense mechanism in which an individual faced with anxiety retreats to a more infantile psychosexual stage, where some psychic energy remains fixated
- Reaction Formation – defense mechanism by which the ego unconsciously switches unacceptable impulses into their opposites. People may express feelings that are the opposite of their anxiety-arousing unconscious feelings
- Projection- defense mechanism by which people disguise their own threatening impulses by attributing them to others
- Rationalization – defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one’s actions
- Displacement- defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person. As when redirecting anger toward a safer outlet
- Free Association – is a method of exploring the unconscious
- person relaxes and says whatever comes to mind, no matter how trivial or embarrassing
- Dream analysis:
Dreams express unconscious issues
- Manifest content: the actual content of a dream
- Latent content: symbols that are disguised unconscious issues or motives
- Resistance: Therapist looks for evidence that the patient is avoiding an issue
- Transference: Does the patient treat the therapist in ways that are similar to their parents?
- Interpretation: Therapist provides analysis of the meaning of the thoughts, behaviors, and dreams of the patient.
- meaning in life
- personal responsibility
- Precursors of existentialism: Soren Kierkegaard, Friedrich Nietzsche, Fyodor Dostoevsky.
- Founding of ‘existentialism’ credited to Jean Paul Sartre.
- Notable figures: Martin Heidegger, Maurice Merlau Ponty, Karl Jaspers, Martin Buber, Edmund Husserl (Phenomenology).
- Nature of anxiety, despair, grief, loneliness, isolation and death
- Attempts to reconstruct the patient’s way of being himself in the world.
- The therapeutic relationship as the psychotherapy in itself.
- Aim is to enable the clients to reflect upon their lived experience in order to explore meaning of choices.
- Existential approach does not have many specified techniques and must be adapted by the therapist for every new client.
- Viktor Emil Frankl, M.D., Ph.D. (1905 –1997) was an Austrian neurologist and psychiatrist as well as a Holocaust survivor.
- Frankl was the founder of logo therapy, which is a form of existential analysis, the “Third Viennese School of Psychotherapy”.
- His best-selling book Man’s Search for Meaning (published under a different title in 1959: From Death-Camp to Existentialism, and originally published in 1946) chronicles his experiences as a concentration camp inmate, which led him to discover the importance of finding meaning in all forms of existence.
- Logotherapy is founded upon the belief that it is the striving to find a meaning in one’s life that is the primary, most powerful motivating and driving force in humans.
- The aim of Existential Analysis is to help each person find a way of living to which s/he can give his/her inner consent to his/her own actions (“affirmation of life”). In short, to find and live out an inner ‘yes’ to one’s life.
- Existential Analysis can be defined as a phenomenological and person-oriented psychotherapy, with the aim of leading the person to (mentally and emotionally) free experiences, to facilitate authentic decisions and to bring about a truly responsible way of dealing with life and the world.
- Biographical work and empathic listening by the therapist contribute to an improvement in emotional understanding and accessibility.
- Four Fundamental Motivations (FM).
- Need to be able to accept the basic conditions of life.
- Need to feel values and to have relationships.
- Quest to becoming one’s own person.
- Need to achieve something meaningful in the world.
- Goals of Therapy
- Understand the client and their situation, their values and beliefs;
- Negotiate coming to terms with past, present and future crises
- Develop truthfulness with themselves
- Widen their perspective on themselves and the world around them;
- Clarity on their purpose of life and learn from the past
- Find ways of effectively communicating and being with others;
- Make sense of the paradoxes conflicts and dilemmas of their, existence.
- Anti-technique orientation
- Description, understanding and exploration of reality compared to diagnosis, treatment and prognosis.
- Anti-technique orientation
- Themes- The client’s attention is drawn to personal myths and stories that they have created
- Assumptions- Clarifying implicit assumptions about people and world can be very revealing and may throw new light on a dilemma.
- Values- Getting clarity about which aspects of life are most important and deserve making sacrifices for is a key step
- Vicious circles- Making vicious circles of self-fulfilling prophecies explicit can be a crucial step forward.
- Meaning- often people assume that they know what they mean but the words they use can hide underlying emotions – questioning the superficial meaning of the client’s words and asking him/her to think of what s/he wants to express.
- “The whole is greater than the sum of it’s parts”
- Gestalt Therapy became an acknowledged therapeutic practice in the early 1950s and has been evolving ever since.
- Frederick and Laura Perls,
- Clients open to working towards self-awareness and for those who want natural mastery of their awareness process.
- Most appropriate for persons who create anxiety, depression, and so forth by rejecting themselves, alienating aspects of themselves, and deceiving themselves
- Every individual is a whole and must be understood in terms of current situation
- Self-awareness is key to self-growth and fulfilling
- If self-awareness is blocked by negative thought, people become dissatisfied and unhappy in life.
- Aim of a therapist is to promote environment of non-judgmental self-awareness.
- Wholeness- Whole person or the individual’s mind and body as unit rather than parts.
- Integration- how these parts fit together and how individual integrates into the environment
- “Contact is the lifeblood of growth, means for changing oneself and one’s experiences of the world.
- People not aware of the contact they have with others and only with objects
- Levels of contact (neuroses levels)
- Phony- reacting in unauthentic or patterned ways. Eg: being nice in expectation of something
- Phobic- avoidance of psych pain. Eg: denial of important relationship
- Impasse- afraid of change or movement. Eg: being stuck in a bad marriage not knowing what to do. Individuals feel no internal or external support- significant for change
- Implosive- experience feelings and becoming aware. No action on said feelings
- Explosive- authentic and most intense. Experience of this leads to individual becoming alive and authentic.
- Contact boundaries
- Process of
connecting to or separating from other or objects.
- I- boundaries- those that distinguish between one person and other/object/quality
- Body-boundaries- those that restrict sensations or place them off limits
- Value-boundaries- those values that we hold that are resistant to change
- c. Familiarity boundaries– events repeated everyday but not thought about or challenged.
- d. Expressive boundaries– learned at early age regarding what is expected and what is not.
- Contact within individual themselves as well as with others/objects
- To become fully aware- becoming in contact with one’s boundaries.
- What is happening now rather than what is remembered.
- 2 causes for lacking SA- preoccupation with past, low self esteem
4 types of awareness:
- Of sensations and actions– sensing through sense organs and expressing oneself through movement or vocal expression
- Of feelings– emotional and physical feelings
- Of wants– desires for future events to take place
- Of values and assessments– larger units of experience if how values another, social and spiritual issues
- Five major styles of contact resistance
- Introjection – We passively incorporate what the environment provides & do not know what we want or need
- Projection – We disown certain aspects of ourselves by assigning them to the environment; and put them on others (e.g. see quality in others, we avoid responsibility of who we are)
- Confluence – A blurring of the differentiation between the self and the environment (e.g. High need to be accepted and liked)
- Retroflection – Turning back to ourselves what we would like someone else do to us (e.g. Lash out and injure self because fearful of directing toward others)
- Devaluation – resistance between contact and satisfaction
When you devalue yourself, you make contact, but experience it as being less satisfying than it actually is.
Techniques of gestalt therapy
- The “experiment” in Gestalt therapy
- Therapy sessions are viewed as a series of
experiments, which provide for the client to experientially learn
- Experiments are therapy techniques that develop from the therapeutic process and client/therapist relationship
- Authenticity of therapist
- Interaction between therapist and client
- Spontaneity of experiments leads to many forms:
-dramatization of painful memory
-setting up interaction between the client and a significant person in their life
- Enactment: Bringing struggles to life by enacting
them out in the present
- Experiments will be tailored and focused to each individual and used when in a timely manner
- The experiments must be carried out in a context that allows for balance between support and risk
- The “exercise” in gestalt therapy
- Pre-existing techniques that are used to induce change or progress in a therapy session
- The purpose of an exercise is to elicit emotion, produce action, or achieve a specific goal.
- The therapist and person in therapy can then examine the result of the exercise in order to increase awareness and help the person understand the “here and now” of the experience.
• Internal dialogue exercise – the “top dog” and the “under dog”
• Making the rounds – go to each person in the group and talk to them
• “I take responsibility for” – can be added to one of the client’s statements
• Rehearsal exercise – to rehearse with the therapist out loud.
• Reversal technique – asking the client to do the opposite of their behaviors
• Staying with feeling – so that you can work through the fears
- Empty-Chair Technique:
– When client speaks to an empty chair as if it were another person or another part of the client
– Used to help the client get in touch with other views or other aspects of self
- Exaggeration Exercise:
– Counselor exaggerates mannerism of client or asks client to exaggerate mannerism in order to make client aware of true feelings
- Guided Fantasy:
– Client is encouraged to visualize here & now experiences
- Playing the Projection:
– Client is asked to play the role of the person who they are not connecting with
- Gestalt approach to dream work
- Does not interpret & analyze dreams
• Instead intent is to bring back to life & relive them as though they were happening now
• Dream is acted out in the present & dreamer becomes a part of his or her dream
It is based on a scientific view of overt human behaviour and the usage of systematic and structured approach to counselling.
It assumes that the person is the result and creator of his/ her environment.
- Basic Characteristics and Assumptions
- Behavior therapy analyses a client’s current problems and its causes based on ideas of reinforcement, punishment, or conditioning and not a deep dive into the individuals history.
- Behavior therapists look to the current environmental events that maintain problem behaviors and help clients produce behavior change by changing environmental events, through a process called behavioral analysis.
- Clients assume an active role by engaging in activities that deal with their problems.
- Clients are self-dependent and are asked to monitor their behaviors, learn and practice coping skills, carry out homework assignments.
- Clients learn new and adaptive behaviors to replace old and maladaptive behaviors.
- The focus is on a similar platform to the experimental method where assessment of overt behavior directly leads to identifying the problem, finding possible reasons, targeting those variables and evaluating change.
- Behavioral treatment interventions are individually tailored to specific problems experienced by clients.
- Problems must be clear, concrete, understood, and measurable and agreed on by the client and the counselor.
- The aim is to modify or eliminate maladaptive behaviours and aid to acquire healthy, constructive ways of acting.
- Continual assessment takes place throughout therapy to assess if identified goals are being met. Accordingly therapists and clients alter goals throughout the therapeutic process.
Therapist’s Function and Role
- The ABC model – This model suggests that behavior (B) is influenced by some particular events that precede it, called antecedents (A), and by certain events that follow it called consequences (C).
- Techniques used such as summarizing, reflection, clarification, and open-ended questioning.
- Based on functional assessment, the therapist formulates initial treatment goals and designs and implements a treatment plan to accomplish these goals.
- A large part of the therapist’s role is to teach concrete skills through the provision of instructions, modeling, and performance feedback.
Relationship between the Client and the Therapist
- A therapeutic relationship, is important in the process of behavior change (Granvold & Wodarski, 1994).
- Use of the client–therapist relationship in facilitating change is important
- Most behavioral practitioners contend that factors such as warmth, empathy, authenticity and acceptance are necessary, but not sufficient, for behavior change to occur.
- The client–therapist relationship is a foundation on which therapeutic strategies are built to help clients change in the direction they wish.
- Behavior therapists assume that clients make progress primarily because of the specific behavioral techniques used rather than because of the relationship with the therapist.
- Flooding: it’s a type of exposure therapy that involves either in vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time, without the occurrence of the feared consequence.
- In vivo: In vivo flooding consists of intense and prolonged exposure to the actual anxiety-producing stimuli.
- Imaginal: the client is exposed
to the mental image of a frightening or anxiety-producing object or event and
continues to experience the image of the event until the anxiety gradually
- Implosive therapy: An imaginal flooding approach in which the scenes are exaggerated rather than realistic and hypotheses are made about stimuli in the scene that may cause the fear or anxiety.
- Systematic desensitization: a type of exposure therapy developed by Wolpe, in which, clients imagine successively more anxiety-arousing situations at the same time that they engage in a behavior that competes with anxiety. Gradually, or systematically, clients become less sensitive to the anxiety-arousing situation.
- Covert sensitization: “Covert sensitization” associates an aversive stimulus with a behavior the client wishes to reduce or eliminate. This is done by imagining the target behavior followed by imagining an aversive consequence. It has been used to stop smoking, overeating, alcohol consumption, sexual deviations.
- Token economy: is a system of behavior modification based on the systematic reinforcement of target behavior. The reinforcers are symbols or “tokens” that can be exchanged for other reinforcers. E.g. children may be provided tokens for good performance that can later be exchanged for valued materials.
- Shaping: gradual movement from original to desired behaviour by reinforcing successive approximations of the desired behaviour. E.g. strengthening behaviour of playing on monkey bars by reinforcing each successive approximation towards it.
- Pre mack: If high-probability behaviors (more desirable behaviors) are made contingent upon lower-probability behaviors (less desirable behaviors), then the lower-probability behaviors are more likely to occur. E.g. giving a child a banana (less desirable) to eat while he’s watching TV.(more desirable)
- Aversive therapy works on this principle. E.g. mixing a substance that causes stomach ache in alcohol to decrease alcohol drinking behaviour.
- Time out: client is separated from the opportunity to receive positive reinforcement.
Modeling is frequently used in situations that involve interpersonal communication.
Social Skills training:
Social skills training is a broad category that deals with an individual’s ability to interact effectively with others in various social situations; it is used to correct deficits clients have in interpersonal competencies.
It includes psychoeducation, modeling, reinforcement, behavioral rehearsal, role playing, and feedback.
Anger management training & assertion training are popular variations of social skills training.
Assertion training is for people who lack assertive skills
Self modification programs:
Psychologists share their knowledge so that “consumers” can increasingly lead self-directed lives and not be dependent on experts to deal with their problems.
Self-modification strategies include self-monitoring, self-reward, selfcontracting, stimulus control, and self-as-model. The basic idea of self-modification assessments and interventions is that change can be brought about by teaching people to use coping skills in problematic situations.
Cognitive Behavioural Therapy (Aaron Beck) (CBT)
Techniques of cognitive behavioral therapy
- The therapist and the client work together as an investigative team.
- Beck termed this form of therapeutic relationship collaborative empiricism.
- The cognitive interventions used in CBT are designed first to identify and then to modify dysfunctional thinking at two main levels of cognitive processing—automatic thoughts and core beliefs schemas.
- Guided discovery involves gentle eliciting, exploring, and questioning of the patient’s thinking. Therapists ask Socratic-type questions that encourage the patient to expand his or her perspective and become actively involved in the learning process.
- A shift in mood during the therapy session can be an opportune time for the therapist to facilitate the identification of automatic thoughts. When the therapist observes that a strong emotion such as sadness, anxiety, or anger has appeared, she or he can ask the patient to describe the thoughts that “went through your head“ just prior to the mood shift.
and role play
- Is used in generating suspected automatic thinking.
for automatic thought
- checklists of thought provide an additional method to help patients identify their dysfunctional cognitions.
- Thought recording is a standard CBT procedure for identifying automatic thoughts.
- Although patients can log their thoughts in several ways, most begin by using the two-column technique. In this example, the patient was asked to write down automatic thoughts that occurred in situations that he associated with his depressed mood.
- Using guided discovery
- Identifying the cognitive errors
- A. T. Beck and others described six main
categories of cognitive errors:
- Selective abstraction,
- Arbitrary inference,
- Absolutistic (dichotomous or all-or-nothing) thinking,
- Magnification and minimization,
- Personalization, and
- Catastrophic thinking.
Family Systems Theory
- Biological Origins
- Family systems theory (FST) emerged from the work of Viennese Biologist Ludwig Von Bertalanffy’s work on general systems theory.
- General systems theory argued that organisms are complex, organized, and interactive.
- General Systems Theory
- Focused attention on the pattern of relationships within a system, instead of studying parts in isolation.
- A system is organized around relationships.
- Elements (units) interact with each other in a predictable, organized fashion.
- No element can be understood in isolation.
– Psychiatrist by profession
- Human relationships driven by two counterbalancing life forces: individuality and togetherness
- Different perspective on schizophrenia
- NIMH Project (1954)
- People were emotional prisoners of the way the others behaved.
- The hallmark of these emotionally stuck-together, or fused, relationships was a lack of personal autonomy.
- Anxious Attachment
- Family is system of interacting parts mutually influencing one another
- FST allows one to understand the organizational complexity of families, as well as the interactive patterns that guide family interactions.
- Basic Assumptions
- Each family is unique, due to the infinite variations in personal characteristics and cultural and ideological styles
- The family is an interactional system.
- Families must fulfil a variety of functions for each member, both collectively and individually.
- Families pass through developmental and non-developmental changes that produce varying amounts of stress affecting all members.
- Differentiation of Self
- The capacity to think and reflect, to not respond automatically to emotional pressures
- A differentiated person is able to balance thinking and feeling
- Experience and regulation of expression
- Emotional Triangles
- Dyads are inherently unstable, as two people will vacillate between closeness and distance.
- Triangle is the smallest stable relationship system
- Triangles are maladaptive if
- Attention is drawn away from important issues in a two-person relationship.
- The third member of the relationship feels pressured, overtaxed, or manipulated as a result of being brought into the conflict.
- One of the three people in the relationship begins to feel ignored, excluded, or rejected.
- Triangulation pulls a third party into an inappropriate role (for example, when a child becomes a mediator of conflict between two parents or a friend outside a conflicted relationship becomes a confidant for one of the partners).
- Family Projection Process
- Primary way parents transmit their
emotional problems to a child.
- the parent focuses on a child out of fear that something is wrong with the child
- the parent interprets the child’s behavior as confirming the fear; and
- the parent treats the child as if something is really wrong with the child
- Emotional Cut off
- Managing unresolved emotional issues by distancing themselves
- Moving away, avoiding intimacy, insulating themselves with the presence of third parties
- Mistaking emotional cutoff to maturity
- Nuclear Family Emotional Process
- Marital Conflict
- Dysfunction in one spouse
- Dysfunction in one more children
- Emotional Distance
- Multigenerational Transmission
- Differences in Levels of Differentiation transmitted across generations
- Societal Emotional Processes
- Tendency of people within a society to be more anxious and unstable at certain times than others.
- Environmental stressors like overpopulation, scarcity of natural resources, epidemics, economic forces, and lack of skills for living in a diverse world
- Process questions
- Relationship experiments
- I positions
Strategic Family Therapy
- Double Bind Communication
- The communication involves two or more people who share an important emotional relationship
- The pattern of communication is repeated
- The communication involves a primary negative injunction or a command to not do something on threat of punishment
- The communication also involves a second abstract injunction also under threat of punishment that contradicts the primary injunction
- A third negative injunction both demands a response and prevents escape, effectively binding the recipient of the demand
- The recipient becomes conditioned to respond and as a result the entire sequence is no longer necessary to maintain the symptom (Nichols & Shwartz, 2004)
- Families encounter many difficulties; response to the problem determines whether it becomes a problem
- Misguided attempts to solve difficulties
- Positive feedback loops
- Solutions that perpetuate problems
- Denying that the problem exists
- Effort to solve something that is not really a problem
- Action is taken, but at the wrong level
- Define a resolvable complaint
- Identify attempted solutions that maintain
- Understand the client’s unique language for describing the problem
- The MRI Approach to problems
- Identify positive feedback loops that maintain the problems
- Determine the rules that support these interactions
- Find a way to change the rules
- First order and second order change
- Therapy Process
- Introducing the treatment set up
- Inquiring about and defining the problem
- Estimating the behavior that is maintaining the problem
- Setting goals for treatment
- Selecting and making behavioral interventions
- Terminating therapy
and Madanes Approach
- Haley: Part of Bateson’s Project, Moved to MRI, Philadelphia Child Guidance Clinic, 1976: Family Therapy Institute
- Cole Madanes: Had worked at both the MRI and Child Guidance Clinic
- Interviewing the entire family
- Social stage
- Problem stage
- Interaction stage
- Goal setting stage
- Interpersonal Payoff: Secondary gains
- Covert function of symptoms
- Metaphor: A symptom is seen as a metaphor for an underlying problem
Money, education, control of children,
- Partner with the least power develops the most emotional problems
- Negotiation: One makes a request, the other names a price
- Problems as a breakdown of negotiation processes
- Rules of negotiation
- Easy to more difficult issues
- People will often do something that they wouldn’t ordinarily do if it’s framed as play
- Encourage the symptomatic child to pretend to have the symptom and encourage the parents to pretend to help
- Ericksonian roots
- “If one makes it more difficult for a person to have a symptom than to give it up, the person will give up the symptom”
- Consequences of symptoms
Form: Strategic Humanism
- Still involves giving directives,
- Directives aimed at increasing the families abilities to soothe and love rather than gain control of power
Form: Strategic Humanism
- Encourages parents to be sympathetic and supportive
- After calming the child down, establish rules and enforce consequences
Experiential Family Therapy
of the Model
- Emerged from the humanistic school of psychology
- Here and now experience
- Focused on emotional experience than the dynamics of interaction
- Emotional Suppression: Root cause of family problems.
- Families try to regulate actions by controlling feelings
- Dysfunctional families are less tolerant of negative emotions
- Repressed affect: Boredom, anxiety, apathy
- Change can be brought about by getting in touch with their real feelings.
disinclination to theorize
- Whitaker: Self fulfilment and family cohesiveness
- Satir: Importance of communication and individual self-expression
- Individuals as whole persons and offered a positive model of humanity.
- Emphazised freedom and flexibility
- To promote individual growth and family cohesion, liberate affects and impulses.
- Efforts to unlock defenses and unlock deeper levels of experiencing
- Healthier families- If people are allowed to follow their instincts they tend to flourish
- Social pressures
- Parental control is not excessive, children grow in an atmosphere of support for their feelings and creative impulses.
- Accepting feelings and validating them.
- Experience and express emotions.
- Denial of impulses and suppression of feelings
- Self-protection and avoidance
- Couples who remain together: Accommodation
- Compromise/resignation: Lessens the friction
- Anxious to avoid conflict
- Seek support and safety in their routines
- Emotional deadness: Cold, stay together because of duties and habits
of warmth: Avoidance,
preoccupation with work and other things
- Four dishonest ways of communicating: Blaming, Placating, Being irrelevant, and being super-reasonable.
- Low self-esteem behind inauthentic patterns of communication.
- If people feel bad about themselves, it’s hard to tell the truth about their feelings and it’s threatening to let others tell them honestly what they feel
of experiential therapy
- Uncover deeper levels of experiencing
- Emphasize the feeling side of human nature: Creativity, spontaneity
- Alternately provocative and warmly supportive
borrowed from Gestalt Schools and art therapy: Family sculpting, family drawing,
animal attribution storytelling, Role Playing
- Clarify communication, supported the self-esteem of every family member, pointed out positive intentions, showed by example how to be affectionate.
- Use of touch, especially with children.