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In Freudian psychoanalytic theory, defense mechanisms (or defense mechanisms) are psychological strategies brought into play by the

unconscious mind[1] tomanipulate, deny, or distort reality (through processes including, but not limited to, repression, identification, or rationalization),[2] and to maintain a socially acceptableself-image or self-schema.[3] Healthy persons normally use different defenses throughout life. An ego defense mechanism becomes pathological only when its persistent use leads to maladaptive behavior such that the physical and/or mental health of the individual is adversely affected. The purpose of ego defense mechanisms is to protect the mind/self/ego from anxiety and/or social sanctions and/or to provide a refuge from a situation with which one cannot currently cope.[4] Defence mechanisms are unconscious coping mechanisms that reduce anxiety generated by threats from unacceptable impulses. [5] Defence mechanisms are sometimes confused with coping strategies.[6] One resource used to evaluate these mechanisms is the Defense Style Questionnaire (DSQ-40).[7][8] [edit]Structural

model: Id, ego, and superego

The concept of id impulses comes from Sigmund Freuds structural model. According to this theory, id impulses are based on the pleasure principle: instant gratification of one's own desires and needs. Sigmund Freud believed that the id represents biological instinctual impulses in ourselves, such as aggression (Thanatos or the Death instinct) and sexuality (Eros or the Life instinct). For example, when the id impulses (e.g. desire to have sexual relations with a stranger) conflict with the superego (e.g. belief in societal conventions of not having sex with unknown persons), unsatisfied feelings of anxiousness or feelings of anxiety come to the surface. To reduce these negative feelings, the ego might use defence mechanisms (conscious or unconscious blockage of the id impulses). Freud believed that conflicts between these two structures resulted in conflicts associated with psychosexual stages.

The iceberg metaphor is often used to explain the psyche's parts in relation to one another.

[edit]Definitions

of individual psyche structures

Freud proposed three structures of the psyche or personality:

Id: The id is the unconscious reservoir of the libido, the psychic energy that fuels instincts and psychic processes. It is a selfish, childish, pleasure-oriented part of the personality with no ability to delay gratification.

Superego: It is making decision regarding the pleasure perceived by the id and the morals of superego. Internalized societal and parental standards of "good" and "bad", "right" and "wrong" behaviour.

Ego: Individual's morals divided into the conscious - security rules and regulations. the moderator between the id and superego which seeks compromises to pacify both. It can be viewed as our "sense of time and place",

[edit]Primary

and secondary processes

In the ego, there are two ongoing processes. First there is the unconscious primary process, where the thoughts are not organized in a coherent way, the feelings can shift, contradictions are not in conflict or are just not perceived that way, and condensations arise. There is no logic and no time line. Lust is important for this process. By contrast, there is the conscious secondary process, where strong boundaries are set and thoughts must be organized in a coherent way. Most conscious thoughts originate here. [edit]The

reality principle

Id impulses are not appropriate in civilized society, so society presses us to modify the pleasure principle in favour of the reality principle; that is, the requirements of the external world. [edit]Formation

of the superego

The superego forms as the child grows and learns parental and social standards. The superego consists of two structures: the conscience, which stores information about what is "bad" and what has been punished, and the ego ideal, which stores information about what is "good" and what one "should" do or be. [edit]The

ego's use of defence mechanisms

When anxiety becomes too overwhelming, it is then the place of the ego to employ defence mechanisms to protect the individual. Feelings of guilt, embarrassment and shame often accompany the feeling of anxiety. In the first definitive book on defence mechanisms, The Ego and the Mechanisms of Defense (1936),[9] Anna Freud introduced the concept of signal anxiety; she stated that it was "not directly a conflicted instinctual tension but a signal occurring in the ego of an anticipated instinctual tension". [10] The signaling function of anxiety is thus seen as a crucial one and biologically adapted to warn the organism of danger or a threat to its equilibrium. The anxiety is felt as an increase in bodily or mental tension and the signal that the organism receives in this way allows it the possibility of taking defensive action regarding the perceived danger. Defence mechanisms work by distorting the id impulses into acceptable forms, or by unconscious or conscious blockage of these impulses.[11] [edit]Theories

and classifications

The list of defence mechanisms is huge and there is no theoretical consensus on the number of defence mechanisms. Classifying defence mechanisms according to some of their properties (i.e. underlying mechanisms, similarities or connections with personality) has been attempted. Different theorists have different categorizations and conceptualizations of defence mechanisms. Large reviews of theories of defence mechanisms are available from Paulhus, Fridhandler and Hayes (1997) [12] and Cramer (1991).[13] The Journal of Personality published a special issue on defence mechanisms (1998).[14] Otto F. Kernberg (1967) developed a theory of borderline personality organization of which one consequence may be borderline personality disorder. His theory is based on ego psychological object relations theory. Borderline personality organization develops when the child cannot integrate positive and negative mental objects together. Kernberg views the use of primitive defence mechanisms as central to this personality organization. Primitive psychological defences are projection, denial, dissociation or splitting and they are called borderline defence mechanisms. Also, devaluation and projective identification are seen as borderline defences.[15] In George Eman Vaillant's (1977) categorization, defences form a continuum related to their psychoanalytical developmental level.[16] Vaillant's levels are:

Level I - pathological defences (i.e. psychotic denial, delusional projection) Level II - immature defences (i.e. fantasy, projection, passive aggression, acting out) Level III - neurotic defences (i.e. intellectualization, reaction formation, dissociation, displacement, repression) Level IV - mature defences (i.e. humour, sublimation, suppression, altruism, anticipation)

Robert Plutchik's (1979) theory views defences as derivatives of basic emotions. Defence mechanisms in his theory are (in order of placement in circumplex model): reaction formation, denial, repression, regression, compensation, projection, displacement, intellectualization. [17] The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association (1994) includes a tentative diagnostic axis for defence mechanisms.[18] This classification is largely based on Vaillant's hierarchical view of defences, but has some modifications. Examples include: denial, fantasy, rationalization, regression, isolation, projection, and displacement. [edit]Vaillant's [edit]Level

categorization of defence mechanisms

1: Pathological

The mechanisms on this level, when predominating, almost always are severely pathological. These six defences, in conjunction, permit one to effectively rearrange external experiences to eliminate the need to cope with reality. The pathological users of these mechanisms frequently appear irrational or insane to others. These are the "psychotic" defences, common in overt psychosis. However, they are found indreams and throughout childhood as well. They include:

Delusional Projection: Delusions about external reality, usually of a persecutory nature.

Conversion: the expression of an intrapsychic conflict as a physical symptom; some examples include blindness, deafness, paralysis, or numbness. This phenomena is sometimes called hysteria.[19] Denial: Refusal to accept external reality because it is too threatening; arguing against an anxiety-provoking stimulus by stating it doesn't exist; resolution of emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality. Distortion: A gross reshaping of external reality to meet internal needs. Splitting: A primitive defence. Negative and positive impulses are split off and unintegrated. Extreme projection: The blatant denial of a moral or psychological deficiency, which is perceived as a deficiency in another individual or group.

[edit]Level

2: Immature

These mechanisms are often present in adults. These mechanisms lessen distress and anxiety provoked by threatening people or by uncomfortable reality. Excessive use of such defences is seen as socially undesirable in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature" defences and overuse almost always leads to serious problems in a person's ability to cope effectively. These defences are often seen in major depression and personality disorders. They include:

Acting out: Direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives that expressive behaviour. Fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts. Idealization: Unconsciously choosing to perceive another individual as having more positive qualities than he or she may actually have.[20] Passive aggression: Aggression towards others expressed indirectly or passively such as using procrastination. Projection: Projection is a primitive form of paranoia. Projection also reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming consciously aware of them; attributing one's own unacknowledged unacceptable/unwanted thoughts and emotions to another; includes severe prejudice, severe jealousy, hypervigilance to external danger, and "injustice collecting". It is shifting one's unacceptable thoughts, feelings and impulses within oneself onto someone else, such that those same thoughts, feelings, beliefs and motivations are perceived as being possessed by the other.


[edit]Level

Projective identification: The object of projection invokes in that person precisely the thoughts, feelings or behaviours projected. Somatization: The transformation of negative feelings towards others into negative feelings toward self, pain, illness, and anxiety.

3: Neurotic

These mechanisms are considered neurotic, but fairly common in adults. Such defences have short-term advantages in coping, but can often cause long-term problems in relationships, work and in enjoying life when used as one's primary style of coping with the world. They include:

Displacement: Defence mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet; separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening. For example, a mother may yell at her child because she is angry with her husband.

Dissociation: Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that normally would accompany a situation or thought. Hypochondriasis: An excessive preoccupation or worry about having a serious illness. Intellectualization: A form of isolation; concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions; separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable emotions by focusing on the intellectual aspects (e.g. isolation, rationalization, ritual, undoing,compensation, magical thinking). Isolation: Separation of feelings from ideas and events, for example, describing a murder with graphic details with no emotional response.

Rationalization (making excuses): Where a person convinces him or herself that no wrong was done and that all is or was all right through faulty and false reasoning. An indicator of this defence mechanism can be seen socially as the formulation of convenient excuses making excuses. Reaction formation: Converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites; behaviour that is completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety. This defence can work effectively for coping in the short term, but will eventually break down. Regression: Temporary reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way. (ex. Using whining as a method of communicating despite already having acquired the ability to speak with appropriate grammar)[21]


[edit]Level

Repression: The process of attempting to repel desires towards pleasurable instincts, caused by a threat of suffering if the desire is satisfied; the desire is moved to the unconscious in the attempt to prevent it from entering consciousness;[22] seemingly unexplainable naivety, memory lapse or lack of awareness of one's own situation and condition; the emotion is conscious, but the idea behind it is absent. [citation needed] Undoing: A person tries to 'undo' an unhealthy, destructive or otherwise threatening thought by acting out the reverse of unacceptable. Involves symbolically nullifying an unacceptable or guilt provoking thought, idea, or feeling by confession or atonement. Withdrawal: Withdrawal is a more severe form of defence. It entails removing oneself from events, stimuli, interactions, etc. under the fear of being reminded of painful thoughts and feelings.

4: Mature

These are commonly found among emotionally healthy adults and are considered mature, even though many have their origins in an immature stage of development. They have been adapted through the years in order to optimize success in life and relationships. The use of these defences enhances pleasure and feelings of control. These defences help us to integrate conflicting emotions and thoughts, whilst still remaining effective. Those who use these mechanisms are usually considered virtuous. They include:

Altruism: Constructive service to others that brings pleasure and personal satisfaction. Anticipation: Realistic planning for future discomfort. Humour: Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about) that gives pleasure to others. The thoughts retain a portion of their innate distress, but they are "skirted round" by witticism, for example Self-deprecation. Identification: The unconscious modelling of one's self upon another person's character and behaviour. Introjection: Identifying with some idea or object so deeply that it becomes a part of that person. Sublimation: Transformation of negative emotions or instincts into positive actions, behaviour, or emotion. (ex. Playing a heavy contact sport such as football or rugby can transform aggression into a game) [23] Thought suppression: The conscious process of pushing thoughts into the preconscious; the conscious decision to delay paying attention to an emotion or need in order to cope with the present reality; making it possible to later access uncomfortable or distressing emotions whilst accepting them.

Murray's system of needs


From Wikipedia, the free encyclopedia

In 1938 Henry Murray published Explorations in Personality,[1] his system describing personality in terms of needs. For Murray, human nature involved a set of universal basic needs, with individual differences on these needs leading to the uniqueness of personality through varying dispositional tendencies for each need. In other words, specific needs are more important to some than to others. Frustration of these psychogenic (or psychological) needs plays a central role in the origin of psychological pain.[2] Murray differentiated each need as unique, but recognised commonalities among the needs. Behaviors may meet more than one need: for instance, performing a difficult task for your fraternity may meet the needs of both achievement and affiliation.
Contents
[hide]

1 List of psychogenic needs


[edit]List

2 See also 3 References 4 External links

of psychogenic needs

This is a (partial) list of Murray's needs.

Domain Human power Ambition Materialism Affection between people Human power Human power Human power Exchange of information Materialism Human power

Need for Abasement Achievement Acquisition Affiliation Aggression Autonomy Blame avoidance Cognizance Construction Contrariance

Representative behavior To surrender and submit to others, accept blame and punishment. To enjoy pain and misfortune To accomplish difficult tasks, overcoming obstacles and becoming expert Obtaining things To be close and loyal to another person, pleasing them and winning their friendship and attention To forcefully overcome an opponent, controlling, taking revenge or punishing them To break free from constraints, resisting coercion and dominating authority. To be irresponsible and independent Stifling blameworthy impulses Understanding: To be curious, ask questions and find answers Building something Being oppositional To make up for failure by trying again, seeking pridefully to overcome obstacles. To defend oneself against attack or blame, hiding any failure of the self. Explain or excuse To admire a superior person, praising them and yielding to them and following their rules. To control one's environment, controlling other people through command or persuasion To impress others through one's actions and words, even if these are shocking. Delivering information to others To escape or avoid pain, injury and death.

Defense of status Counteraction Defense of status Defendance Human power Human power Ambition Exchange of information Human power Deference Dominance Exhibition Exposition * Harm

Domain

Need for avoidance

Representative behavior Concealing a handicap or a failing To avoid being humiliated or embarrassed. To help the helpless, feeding them and keeping them from danger To make things clean, neat and tidy To have fun, laugh and relax, enjoying oneself

Defense of status Infavoidance Human power Affection between people Materialism Affection between people Ambition Affection between people Materialism Exchange of information Affection between people Affection between people Infavoidance Nurturance Order Play

Recognition * Describing accomplishments Rejection Retention Sentience Sex Succorance To separate oneself from a negatively viewed object or person, excluding or abandoning it. Hoarding things To seek out and enjoy sensual experiences. To form relationships that lead to sexual intercourse. To have one's needs satisfied by someone or something. Includes being loved, nursed, helped, forgiven and consoled

Chapter 8 - Cognitive Therapy


My Lecture Notes Current Psychotherapies Chapter 8 Cognitive Therapy Aaron T. Beck and Marjorie E. Weishaar

Instructor: Jeff Garrett Ph.D.

Research on depression in the 1960s, which served as the foundation of cognitive therapy, was conducted by Aaron Beck.

Beck Depression Inventory - 2. (In class).

Seven Basic Assumptions Beck et al (1979) provided a list of general assumptions that underlie the theory.

1. Perception and experiencing in general are active processes which involve both inspective and introspective data.

2. The patient's cognitions represent a synthesis of internal and external stimuli.

3. How a person appraises a situation is generally evident in his cognitions (thoughts and visual images).

4. These cognitions constitute the person's stream of consciousness or phenomenal field, which reflects the person's configuration of himself, his world, his past and future.

5. Alterations in the content of the person's underlying cognitive structures affect his or her affective state and behavioural pattern.

6. Through psychological therapy a patient can become aware of his cognitive distortions.

7. Correction of these faulty dysfunctional constructs can lead to clinical improvement. [p. 8 Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.]

Basic Concepts. CT is based on the role information processing plays in survival. The theory behind cognitive therapy asserts that altering thoughts influences feelings, motivations and behaviors. The theory states cognition, behavior, affect, and motivation are intertwined and co-occurring. Therapeutic intervention focuses on the primacy of cognition. Cognitive Schema a structure containing self-perceptions; thoughts about others and the world; our memories, goals, fantasies; and everything weve learned. (Structures that contain an individual's core beliefs and assumptions are labeled Cognitive Schemas) Cognitive Theory states that an individual's fundamental beliefs and assumptions are contained in structures termed cognitive schemas.)

Cognitive Shift a systematic bias in information processing. Cognitive Vulnerabilities specific attitudes predisposing the interpretation of experiences. Cognitive Distortion - refers to a systematic error in reasoning. A cognitive therapist relies on collaborative empiricism and guided discovery. Focus is on patients testing beliefs and behaviors. Cognitive and behavioral techniques are both employed. The preferred method of dialoguing with a patient in cognitive therapy is through the use of Socratic questions.

Mode. Networks of cognitive, affective, motivational, and behavioral schemas. Primal modes are universal and related to survival. They include primal thinking which is rigid, absolute, automatic and bias. Dysfunctional modes are treated by deactivating them, altering their structure and content and developing more adaptive modes.

CTs Cognitive Triad. Pattern that triggers depression: 1. Client holds negative view of themselves and blames themselves. 2. Selective abstraction: Client has tendency to interpret experiences in a negative manner. 3. Client has a gloomy vision and projections about the future.

Basic Characteristics of CT. Practical. Symptom focused. Empirically derived techniques. Collaboration. Acknowledges underlying precursors of symptoms while remaining in present. Case conceptualization drives treatment. Primary Roles of the CBT Therapist. Conceptualizing the patient in cognitive terms. Structuring the sessions. Using collaborative empiricism and guided discovery to specify problems and set goals.

The Cognitive Model - see diagram from class notes.

The Cognitive Model. Automatic thoughts influence not only ones emotional response, but also ones behavioral, motivational, and physiological responses. The relationship is bi-directional (all systems act together as a mode) therefore simultaneously biology, emotions, behavior (and motivation) influence thoughts. Subsequently, biological treatments can change thoughts and CBT can change biological processes. We all have cognitive vulnerabilities (i.e., core beliefs) which predispose us to interpret information a certain way. These vulnerabilities are developed early. When these beliefs are rigid, negative, and ingrained we are predisposed to pathology. These core beliefs give rise to conditional assumptions, i.e., rules for living, as we mature. In psychopathology there are systematic biases toward selectively interpreting information in a certain manner which are disorder specific.

Strategies of Cognitive Therapy. Collaborative Empiricism. Guided Discovery (Guided discovery refers to the process by which a therapist serves as a guide to clarify problem behaviors and thoughts). Deactivation of Dysfunctional Modes. Techniques which directly deactivate them. Modifying their content and structure. Constructing more adaptive modes to neutralize them.

Comparing CT to other Therapies. CT Compared to Psychoanalysis. Both assume behavior is influenced by beliefs of which we may be unaware. CT focuses on linkages among symptoms, conscious beliefs and current experiences; little concern with unconscious feelings or

repressed emotions as in psychoanalysis. CT has minimal focus on childhood or developmental issues except in terms of assessment or when addressing core beliefs. CT is highly structured and generally short term (12-16 weeks) whereas psychoanalysis is unstructured and long-term. In CT the therapist actively collaborates with the patient.

CT Compared to REBT. CT labels thoughts as dysfunctional while REBT labels thoughts as irrational. CT uses inductive reasoning while REBT uses deductive reasoning. CT proposes cognitive specificity for each disorder while REBT proposes a core set of irrational beliefs (In contrast to REBT cognitive therapists hypothesize that each mental disorder has its specific cognitive content). CTs view of the problem is functional; pathology arises from multiple cognitive distortions while REBTs view of the problem is philosophical; pathology arises from shoulds, musts, and oughts. CT therapists are more collaborative while REBT therapists are more confrontive. CT therapists emphasize psychoeducation as an early critical component of treatment while REBT therapists have a higher reliance on psychoeducation throughout. CT focuses on "hot cognitions" as critical, but obtain them in a less aggressive manner while REBT is more aggressive. CT therapists encourage clients to use inductive reasoning whereas REBT therapists rely on deductive reasoning.

CT Compared to BT. CT is very different from Applied Behavioral Analysis. CT is the most commonly practice form of CBT, an overarching term to represent therapies. which integrate cognitive and behavioral theories and techniques. CT sees the individual as more active rather than passive in the change process. CT stresses expectations, interpretations, and reactions.

CT Compared to MMT. Cognitive therapy, in contrast to multimodal therapy (MMT) stresses the primacy of cognition.

CT Compared to Medication

Studies generally show CT to be equivalent to psychotropic medications for depression, bulimia, and some anxiety disorders. General research suggests the combination of the two approaches is superior to either used in isolation. CT shows longer efficacy (less relapse) and increased likelihood of continuing gains when treatment is discontinued. CT and antidepressants (TCAs/1st Generation SSRIs) show equal efficacy rates.

History. Developed by Aaron T. Beck M.D. He was investigating the "anger turned inward" psychoanalytic concept regarding depression in the 1960s and found evidence of negative cognitions. Bandura, Ellis, Mahoney, and Mechenbaum ideas were all influential in the development of CT as they were developing their approaches simultaneously.

Other major influences were Phenomenological approaches. Structural theory and Depth Psychology. Cognitive Psychology.

Current Status of CT. Controlled Studies have shown the efficacy of CT with: Depression. Panic Disorder. Social Phobias. Generalized Anxiety Disorders. Substance Abuse. Eating Disorders. Marital Problems. OCD. Post-traumatic Stress Disorder. Schizophrena.

Resources in CT. Center for CT (U/Penn) and Beck Institute are the Major Training Sites (Both in Philadelphia). Multiple other training sites in the US and internationally. Cognitive Therapy and Research and Journal of Cognitive Psychotherapy. Academy of Cognitive Therapy (for more information go to www.academyofct.org).

CTs View of Personality. Thinking is Problematic or Distorted when it is very ... Extreme. Broad. Catastrophic. Negative. Unscientific. Pollyanish. Idealistic. Demanding. Judgmental. Comfort Seeking. Obsessive. Confusing.

Belief Hierarchy. The belief hierarchy proposed in cognitive theory goes from core beliefs or assumptions which are the most stable, least accessible cognitions to voluntary thoughts which are the least stable but most accessible cognitions.

Cognitive Distortions 1. Arbitrary Inference: Drawing a conclusion without evidence or in the face of contradictory evidence. Example - a young woman with anorexia nervosa believes that she is fat although she is dying of starvation. 2. Selective Abstraction: Dwelling on a single negative detail taken out of context. Example While on a date you say one thing

you wish you could have said differently and now see the entire evening as a disaster. 3. Overgeneralization: A single negative event is viewed as a never-ending pattern of defeat. Example - Following a job interview an accountant does not receive the job. She/he begins thinking that they will never find a job despite their qualifications. 4. Magnification and/or Minimization: The binocular trick. Things seem bigger or smaller than they truly are (depending on which lens you are looking through). Example: An employee believes that a minor mistake will lead to being fire vs. an alcoholic who believes he/she doesnt have a problem. 5. Personalization: Assuming personal responsibility for something for which you are not responsible. (Attributing external events to oneself without evidence supporting a causal connection is termed Personalization.). Example sometimes seen in patients who have been sexually or physically abused. 6. Dichotomous Thinking: Is All or Nothing Thinking. Things are seen as black or white, there is no gray (middle ground). Example 1. Things are wonderful or awful, good or bad, perfect or a failure. Example 2. - Kate has anorexia nervosa and when she gains one pound she believes she is fat. If she loses one pound she can perceive herself as thin. Kate's thought process reflects Dichotomous Thinking. Example 3. - A patient with anorexia nervosa believes that she is thin when she exercises, but fat if she eats. This would be an example of the all or nothing thinking cognitive distortion 7. Mind Reading: Assuming you know the motives, thoughts, intentions of others. Example If your friend is in a bad mood you assume its your fault and dont asked what is wrong. 8. Fortune Teller Error: Creating a negative self fulfilling prophesy. Example: You believe you will fail an important exam so you do not study and fail. 9. Emotional Reasoning: You assume your negative feelings result from the fact that things are negative. Example If you feel bad, then that means that the world or situation is bad. You dont consider that your feelings are a misrepresentation of the facts. 10. Should Statements: The use of words like should, ought, must rather than "it would be preferred" to guilt self. Example: "I should be perfect". 11. Labeling and Mislabeling: Labeling yourself or others in a demeaning way. Example: Name calling "I am worthless" or "Hes a total failure".

Process of Psychotherapy in CT. Early in treatment a cognitive therapist may rely more on behavioral techniques whereas later in treatment the focus shifts towards cognitive techniques. Through the process of guided discovery cognitive therapy patients create homework. assignments for themselves called "behavioral experiments" with input from their therapist.

Structure of a CBT Session.

Mood check. Setting the Agenda. Bridging from last session. Todays agenda items. Homework assignment. Summarizing throughout and at the end. Feedback from patient.

General Principles of CT. Goal Is to correct dysfunctional thinking and help patients modify erroneous assumptions. Patient is taught to be a scientist who generate and tests hypotheses. Relationship between patient and therapist is collaborative.

Fundamental Concepts. Collaborative Empiricism goal is to demystify therapy by helping the client search for empirical evidence that supports beliefs. Socratic Dialogue form of questioning used to help patients come to their own conclusions about their thoughts and behaviors. Guided Discovery therapist collaborates with patient to develop behavioral experiments to test hypothesis.

Process of Therapy. Initial Sessions essential to build rapport, focus on problem definition, goal setting, and symptom relief, psychoeducation, behavior interventions. (Symptom relief is a primary goal in the initial cognitive therapy interview). Middle Sessions emphasis shifts from symptom/behaviors to patterns of thinking. Termination Expectation that therapy is time-limited.

Examples of Behavioral Interventions in CT. Weekly Activity Monitoring. Activity Schedule. Graded Tasked Assignments. (Assisting a patient in initiating a task at a nonthreatening level and then gradually increasing the task difficulty).

Behavioral Experiments. Exposure Techniques. Role Plays.

More Details about a Specific Behavior Technique: Weekly Activity Monitoring. Patient records activities and rates them for pleasure and Mastery. Can be used in several different ways, the activity monitoring form allows the therapist and patient to: Assess how pt is spending time. Measure a sense of accomplishment and/or pleasure received by certain activities. Evaluate automatic thoughts or emotional shifts. Fill in specific times with planned activities such as pleasant activities for depressed pts or activities that must be accomplished for procrastinating pts. Compare predicted ratings of accomplishment and pleasure with actual ratings.

Examples of Cognitive Interventions in CT. Eliciting automatic thoughts through Dysfunctional Thought Records. Identifying whether thoughts represent distortions in information processing. Using Socratic questions to evaluate thought process. Generating alternatives in terms of how to think or how to behave differently. More Details about a Specific Cognitive Technique. Basic Question: What just went through your mind? Ask when an emotional shift is noted in session. Create an emotional shift by having the pt describe or visualize a recent situation when they felt intense emotions and then answer the question. If pt still cannot answer the question try asking. Do you think you were thinking of _____________? If someone else was in the situation what do you think they might have been thinking? Where you thinking _____________? (insert something paradoxical).

More Details about a Specific Cognitive Technique.

Using Socratic Questioning to have pt examine and refute their dysfunctional thoughts. What evidence do you have to support the belief? What evidence do you have to refute it? What would your spouse, best friend sibling (or anyone whom you admire greatly) say in this situation? What would you say to your spouse, friend, or sibling if they were thinking the same thing you are thinking. How could you look at this situation so you would feel less depressed? Is this view as reasonable as your first choice?

Downward Arrow Technique. Use the downward arrow technique to obtain less accessible beliefs. If that were true what would it mean to you (about you)? And, then what? What then?

Principles for Setting Effective Homework. Make sure rationale is clear. When feasible, have client choose task. Personalize task to therapy goals. Begin where client is, not where client thinks he/she should be. Be specific and concrete: where, when, with whom, etc. Formalize the task e.g., write on paper. Plan ahead for potential obstacles and "trouble shoot". Practice the task in session. Review homework at the beginning of each session.

Other CT Techniques De-catastrophizing Asking a patient to ponder "what if" scenarios about feared consequences is known as De-catastrophizing. Reattribution Alternative explanations systematically explained. Redefining Help client define the problem differently e.g., "Nobody ever talks to me" becomes "I need to try to initiate conversations so other people become interested in me." Decentering Used with social anxiety to shift focus: Client is taught to see that thoughts are just thoughts and not "them" or

"reality". Modifying Core Beliefs creates the most significant change in a dysfunctional mode for a client.
POSTED BY JGARRETT43MU AT 8:55 AM

Chapter 9 Existential Therapy


My Lecture Notes. Current Psychotherapies. Chapter 9 Existential Psychotherapy Rollo May and Irvin Yalom Instructor: Jeff Garrett Ph.D. Introduction: Existential psychotherapy is not a specific technique or set of techniques. It is more philosophical in nature. Existential psychotherapy is a philosophy about human nature. Proponents of existential psychotherapy have not advocated specific training institutes because its presuppositions can underlie any form of therapy. In existential terms, the conflicts individuals experience are regarding the givens of existence. From the existential perspective "deep" conflict means the most fundamental concern at that moment.

Key Figures Viktor Frankl. Rollo May. Irvin Yalom.

Viktor Frankl: Viktor Frankl's approach to existential theory is known as logotherapy. Rollo May: Rollo May has been instrumental in translating some concepts drawn from existential philosophy and applying them to psychotherapy. Irvin Yalom: According to Yalom, the concerns that make up the core of existential psychodynamics are death. freedom.

isolation. meaninglessness.

Basic Concepts: Existential psychotherapy is more philosophical in nature. Existential psychotherapy is not a specific technique. Focuses on issues central to human existence.

Existential therapy is basically an experiential approach to therapy. It is based on a personal relationship between client and therapist. It stresses personal freedom in deciding one's fate. It places primary value on self-awareness.

View of Human Nature: The basic dimensions of the human condition are The capacity for self-awareness. The tension between freedom & responsibility. The creation of an identity & establishing meaningful relationships. The search for meaning, purpose, and values of life. Accepting anxiety as a condition of living: The awareness of death and nonbeing. The Capacity for Self-Awareness. We can reflect and make choices because we are capable of self-awareness. Expanding our awareness in realizing that: We are finite - time is limited. We have the potential, the choice, to act or not to act. Meaning is not automatic - we must seek it. We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation. Freedom and Responsibility: The central issue in therapy is freedom and responsibility. A concept ultimately associated with freedom is assuming responsibility. The existential concept of freedom refers to the fact that we are the authors of our own world The bridge between wishing and action is decision.

We are free to choose among alternatives. We are responsible for our lives, for our action, and for our failure to take action. Blaming others for their problems--Recognize how they allowed others to decide for them and the price they pay. Encourage them to consider the alternative options. We Cannot Escape Freedom and Responsibility: Existential therapy is rooted in the premise that humans cannot escape from freedom and responsibility. Freedom and Responsibility involves the notion that our freedom requires us to accept responsibility for directing our own life. we are free to choose who we will be. they go hand in hand.

Question What are the possible reasons that people tend to blame others for their problems?

The Concept of "Bad Faith" : The concept of "bad faith" refers to leading an inauthentic existence. An Example of Bad Faith. A example statement that illustrates "bad faith" is - naturally I'm this way, because I grew up in an alcoholic family. The creation of Identity and Establishing Meaningful Relationships

Striving for Identity: Identity is "the courage to be". We must trust ourselves to search within and find our own answers. Our great fear is that we will discover that there is no core, no self.

Struggling with our identity: Challenging clients---in what ways that they have lost touch with they identity and letting others to design their life. Relationship to others: Aloneness. We are alone---So, we must give a sense of meaning to life, decide how we will live, have a relationship with ourselves, and learn to listen to ourselves.

Relatedness. We need to create a close relationship with others. Challenging clients----What they get from they relationship? How they avoid close relationship? Relatedness can be Therapeutic. Existentialists contend that the experience of relatedness to other human beings can be therapeutic. The search for meaning, purpose, and values of life.

Question. What is the meaning or purpose of your life? What do you want from life? Where is the source of meaning for you in life?

The Search for Meaning: Meaninglessness in life leads to emptiness and hollowness (existential vacuum). Existentialists believe that the major solution to meaninglessness is engagement. Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.

Accepting Anxiety as a Condition of Living. Anxiety A Condition of Living. Existential therapists define anxiety as a threat to our existence. Anxiety arises from ones strivings to survive. If anxiety is proportionate to the situation confronted, existentialists would consider it normal anxiety. In contrast to normal anxiety, neurotic anxiety is repressed anxiety. Existential anxiety is normal. An outcome of being confronted with the four given of existence: death, freedom, existential isolation, and meaninglessness. Anxiety can be a stimulus for growth as we become aware of and accept our freedom.

Two Types of Anxiety. 1. Normal Anxiety. 2. Neurotic Anxiety. Question: What is the positive motivation of being anxious?

Normal Anxiety. Normal Anxiety appropriate response to an event being faced. (motivation). e.g., Existential Anxiety is a constructive form of normal anxiety we experience as we become increasingly aware of our freedom and responsibility. According to May, freedom and anxiety are two sides of the same coin. Existential anxiety is seen as a function of our acceptance of our aloneness. From the existential viewpoint, the aim of therapy is NOT to eliminate anxiety so clients can live comfortably.

Neurotic Anxiety. Neurotic Anxiety out of proportion to the situation. Out of awareeness. Tends to immobilize the person.

The Awareness of Death and Nonbeing. Death. According to the existential viewpoint, death gives significance to living.

Question: If you only have 30 days left, whats your feelings? What will you do?

Awareness of Death: Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful.

More Basic Concepts. The Basic "I-Am" Experience. The "I-Am" experience is about being i.e., the realization of one's being. The term ontological means science of being (or the nature of being). Existentialists consider the "I am" experience as a precondition for a solution in life and feel that this is an ontological experience. "I am now living and I could take my life". "The idea of suicide has saved my life many times." Nietzsche. Existential psychotherapy seeks a deeper and more discerning type of therapy. The "I am" experience is no a solution in itself it is a precondition for a solution.

An ontological experience; Ontis = "to be" and Logical = "the science of". Nonbeing is illustrated in the experience of fear of death, destructive hostility, severe anxiety and critical illness.

Existential Model of Anxiety. Anxiety is more basic than fear. Anxiety arises from our personal need to survive, to preserve our being, and to assert our being. Normal anxiety is proportionate to the situation. It does not require repression and can be used for creativity. Neurotic anxiety exceeds or minimizes the situation, is repressed and destructive. (Normal anxiety is seen as proportionate to the situation involved. When the anxiety exceeds the situation present, it is considered neurotic). Existential Model of Anxiety (see the power point slide in class). Awareness of Ultimate Concern ---> Anxiety ---> Defenses

Existential Model of Guilt: Normal guilt is proportionate to the situation, sensitizes us to the ethical aspects of behavior and can be used for creativity. Neurotic guilt is about fantasized transgressions, leads to "Forgetting being" and is destructive.

The Three Forms of Being-in-the-World. Unwelt world around, biological world. Mitwelt with world, world of ones fellow human beings. Eignewelt own world; relationship to ones self.

Significance of Time. Human experiences like joy, depression and anxiety occur in the dimension of time rather than space. Love cannot be measured by the number of years one has known a loved one.

Two Types of Guilt. 1. Neurotic Guilt. Guilt that arises out of fantasized transgressions is called neurotic guilt. 2. Normal Guilt. A characteristic of normal guilt is that it sensitizes us to ethical behavior.

Human Capacity to Transcend the Immediate Situation: Transcend means "to climb over and beyond". Existing involves a continual emerging. A transcending of ones past and present must occur in order to reach the future. When an individual can move past a situation in order to move towards their future, it is said that the person has transcended the immediate situation.

Comparing Existential Psychotherapy to Other Systems. Contrasts of Existential Theory to Humanistic Approaches. Humanistic therapies overlap with existential psychotherapy. Both emphasize growth and fulfillment of self. Goals are for self mastery, self-examination and creativity (A primary goal of existential therapy is to help the patient accept personal responsibility).

Comparing Existential Psychotherapy to Other Systems. (see power point slid in class). Other Key Contrasts. Existentialists reject concept of the person as propelled by drives and instincts. Existentialists feel Jungians quickly avoid the patients immediate crises by being too focused on theory. Rollo May's major criticism of client-centered therapists was that they overidentified with the patient. Client-Centered Therapists do not confront the client directly and firmly.

History. Existential thinking has occurred throughout history. Exemplified by Augustine, Pascal, Kierkegaard, Nietzsche. Fundamental questions leading to the development of existential psychotherapy included: Where was the actual immediate person to whom these things were happening? Are we seeing clients as they really are, or are we simply seeing a projection of our theories about them? In 1958 existential psychotherapy introduced to the US with publication of Existence: A New Dimension in Psychiatry and Psychology by Rollo May, Ernest Angel, and Henri Ellenberger In 1981 Yalom published the first comprehensive textbook in existential psychiatry entitled Existential Psychotherapy.

Other Important Writings.

Rollo Mays The Meaning of Anxiety (1977); Mans Search for Himself (1953); Existential Psychology (1961). James Bugentals The Search for Existential Identity (1976). Victor Frankls Mans Search for Meaning (1963).

Six Ontological Principles 1. Humans are centered in self and derive meaning from that center. 2. Humans are responsible for mobilizing the courage to protect, affirm, and enhance the self. 3. People need other people with whom they can empathize and learn. 4. People are vigilant about potential dangers to self. 5. Humans can be aware of themselves thinking and feeling at one moment and my be aware of. themselves as the person who thinks and feels in the next moment. 6. Anxiety originates out of awareness that ones being can end.

Existential Psychotherapy. A form of dynamic psychotherapy. Holds a different view of inner conflict. Conflict is between the individual and the "givens" of existence termed ultimate concerns. 1. Death. 2. Freedom. 3. Isolation. 4. Meaninglessness. _____________________________ Death: The most obvious ultimate concern. "A terrible truth". Conflict between awareness of death and desire to live. To cope we erect defenses against death awareness. Psychopathology in part is due to failure to deal with the inevitability of death.

Freedom Refers to the fact that humans are the authors of their own world. We are responsible for our own choices. Conflict is between groundlessness and desire for ground/structure.

Implications for therapy. Responsibility. Willing. Impulsivity. Compulsivity. Decision. Existential Psychotherapy.

Isolation. - The fact that we are isolated from parts of ourselves is termed intrapersonal isolation Intrapersonal isolation = Fact we are isolated from parts of ourselves. A form of isolation that refers to the fact that each of us enters and departs the world alone is existential. Existential isolation differs from Interpersonal isolation = Divide between self and others. Intrapersonal isolation = Fact we are isolated from parts of ourselves.

Meaninglessness. Meaning creates hierarchal order of our values. From a schema regarding the meaning of life an individual generates a hierarchy of values. Tells us how to live not why to live. Conflict stems from "How does a being who requires meaning find meaning in a universe that has no meaning?"

Existential Frame of Reference. Specialness. Despite rationality we often believe the laws of biology are no applicable to us.

Ultimate Rescuer. Belief in a personal omnipotent servant to guard and protect us. (To cope with ultimate concerns regarding death individuals will often use the defense mechanism of creating an ultimate rescuer).

Ultimate concerns have implications for therapy process (Existentialists hypothesize that anxiety is the result of awareness of ultimate concerns). Psychodynamic treatment is followed.

Ultimate concerns boundary situations which are experiences which force individuals to confront an existential situation. (Ultimate concerns create experiences, which force us to confront an existential situation called boundary situations). An experience which forces an individual to confront an existential issue is known as a boundary situation. Examples might be diagnosis of a terminal illness or death of a family member or friend. Psychotherapy can address existential isolation. Jung suggested 30% of patients seek treatment because of personal meaninglessness.

Therapeutic Goals: To expand self-awareness. To increase potential choices. To help client accept the responsibility for their choice. To help the client experience authentic existence. Expanding Awareness: Expanding awareness is a basic goal of existential therapy. Fully Human. The existential emphasis is based on the philosophical concerns of what it means to be fully human.

Therapists Function and Role: Understand the clients subjective world. Encourage clients to accept personal responsibility. When clients blame others, therapist is likely to ask them how they contributed to their situation.

A Prime Factor in Determining the Outcomes of Therapy. The existential approach puts emphasis on the therapist as a person and the quality of the client/therapist relationship as one of the prime factors in determining the outcomes of therapy. Clients Experience in Therapy. They are challenged to take responsibility. Major themes in therapy sessions are anxiety, freedom and responsibility, isolation, death, and the search for meaning. Assist client in facing life with courage, hope, and a willingness to find meaning in life. Philosophically, the existentialist would agree that the final decisions and choices rest with the client. people redefine themselves by their choices. a person can go beyond early conditioning. making choices can create anxiety.

Relationship Between Therapist and Client. Therapy is a journey taken by therapist and client. The person-to-person relationship is key. The relationship demands that therapists be in contact with their own world. The core of the therapeutic relationship. Respect and faith in the clients potential to cope and discover alternative ways of being. Therapists share their reactions to clients with genuine concern and empathy as one way of deepening the therapeutic relationship.

I/Thou Relationships in Therapy: (Martin Buber). Martin Buber stressed the importance of presence, which allows for the creation of I/Thou relationships in therapy.

Therapeutic techniques and procedures: It is not technique-oriented. The interventions are based on philosophical views about the nature of human existence. Free for draw techniques from other orientations. The use of therapist self is the core of therapy.

Techniques are not emphasized: Existential therapy is not considered as a system of highly developed techniques. Subjective understanding of clients is primary. In the existential approach subjective understanding of clients is primary and techniques are secondary. The term unfolding refers to the therapist's attempt to uncover with the patient what was there all along. Questions: Which populations is existential therapy particularly useful? Which issues is existential therapy particularly useful?

Existential Group Psychotherapy. Clients learn how their behavior is viewed by others, makes others feel, creates opinions others have of them and influences their opinions of self.

Applications of Existential Psychotherapy. The clinical setting determines the applicability of the existential approach. Most applicable when clients are dealing with a phase of life issue or a boundary situation. A comprehensive existential approach is most feasible in long term therapy. Existential therapy is especially appropriate for clients who are struggling with developmental crises. Identity in adolescents. Coping with disappoints in family and career. Grief counseling. Coping with physical limitations as one ages. From a multicultural perspective: Contributions. Applicable to diverse clients to search for meaning for life. Be able to examine the behavior is influenced by social and cultural factors. Help clients to weigh the alternatives and consequences. Change external environment and recognize how they contribute.

From a multicultural perspective. Limitations. Excessively individualistic. Ignore social factors that cause human problems. Even if clients change internally, they see little hope the external realities of racism or discrimination will change. For many cultures, it is not possible to talk about self and self-determination apart from the context of the social network. Many clients expect a structured and problem-oriented approach instead of discussion of philosophical questions.

Major Criticisms Vague and global approach. Lofty and elusive concepts. It lacks a systematic statement of the principles and practices of psychotherapy.
POSTED BY JGARRETT43MU AT 1:47 P

Chapter 10 Gestalt Therapy - Updated 3/21/06


Current Psychotherapies. Chapter 10. Gestalt Therapy.

Gary Yontef and Lynne Jacobs. Instructor: Jeff Garrett Ph.D.

Founders of Gestalt Therapy. Fritz Perls and Laura Perls.

Three founders of Gestalt Psychology. Max Wertheimer. Kurt Koffka. Wolfgang Kohler.

"Gestalt" is a German word that means "whole" (shape or form). "Gestalt" - A physical, biological, psychological, or symbolic configuration or pattern of elements so unified as a whole that its properties cannot be derived from a simple summation of its parts.

Tension between Gestalt Psychology and Gestalt Therapy "Perlss Gestalt therapy should not be considered a clinical application or the development of Gestalt psychology." (p.254 History and Systems of Psychology. David Hothersall).

Field Theory Kurt Lewin (1890-1947) adopted a Gestalt approach in developing an innovative field theory which addressed . Child development. Industrial management. Social Psychology.

Comparison of Gestalt Therapy to Other Therapies.

Most Different = Behavioral Therapies

Most Similar = Humanistic Theories

Comparison to Other Therapies. Although similar in some ways to rational emotive behavior therapy (REBT) and cognitive therapy (CT), a gestalt therapist does not imply that they know the rational way to think.

In contrast to psychoanalysis, gestalt therapy emphasized the potential of the here and now.

History. Frederick "Fritz" Salomon Perls. Trained as a psychiatrist. Worked with Kurt Goldstein, a principal figure of the holistic school of psychology, who studied the effects of brain injuries on WWI veterans. Trained in psychoanalysis with Karen Horney and Wilhelm Reich.

Laura Perls. Trained as a psychologist. Worked with Gestalt psychologist Max Wethheimer.

The Perls. Because of Nazism the Perls fled Western Europe in 1933 to South Africa, where they practiced until 1945. In 1947 Ego, Hunger and Aggression: A Revision of Psychoanalysis was published in London under F.S. Perls name and included text reevaluating the psychoanalytical view on aggression At the end of the war, the Perls emigrated to New York City. Collaboration began with artists and intellectuals versed in philosophy, psychology, medicine, and education resulting in elaboration of Gestalt Theory, Gestalt Therapy and Gestalt Therapist. In 1951 Julian Press published Gestalt Therapy: Excitement and Growth in the Human Personality by F.S. Perls, Ralph Hefferline, and Paul Goodman.

Current Status. Gestalt Therapy Institutes internationally. Virtually every major city in the U.S. has at least one Gestalt Institute. Association for the Advancement of Gestalt Therapy formed to govern adherence to gestalt principles. International Gestalt Therapy Association newly formed. Four Major Journals.

International Gestalt Journal. British Gestalt Journal. Gestalt Review. Australian Gestalt Journal.

Some Basic Principles of Gestalt Therapy Theory.

Focused on process (what is happening) rather than on content (what is being discussed). "Gestalt" comes from the German word for "whole". Focused on the persons experience in the here and now. Holism and field theory are interrelated in gestalt theory. Organismic self-regulation requires knowing and owning.

Holism. All of nature is seen as a unified whole. The whole is different from the sum of its parts. We can only be understood to the extent that we consider all the dimensions of human functioning. No superior value is place on any one aspect of the individual. Gestalt therapy attends to clients thoughts, feelings, behav iors, body, relationships, and dreams.

Field Theory. Field - A set of mutually interdependent elements. The organism must be seen in its environment (context), as part of the constantly changing field. Everything is relational, in flux, interrelated, and in process. Gestalt therapists pay attention to what is occurring at the boundary between the person and the environment. The purpose of a boundary is to separate and connect us to others Lewin thought of an individual as a complex energy field, a dynamic system of needs and tensions that directs perceptions and actions. Behavior (B) is a function (f) of a person (P) interacting with an environment (E). B = f(P,E)

Basic Concepts (Continued).

Phenomenological. The phenomenological perspective asserts that all reality is subjectively interpreted.

Objective reality, as defined by a gestalt therapist, is non-existent.

Gestalt (Figure-Ground) Formation "Insight is a patterning of the perceptual field in such a way that the significant realities are apparent; it is the formation of a gestalt in which the relevant factors fall into place with the respect to the whole" Heidbreder, 1933

Gestalt Theory recognizes that background and forefront change fluidly Patients conflicts are regulated to background and are brought to forefront through therapy

Describes how the individual organizes the environment from moment to moment. The undifferentiated field is called the background (or ground), and the emerging focus of attention is called the figure. The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individuals attention. The dominant needs of an individual at a given moment influence this process.

Holism The idea that individuals are growth oriented, self-regulating and only understandable within the context of their environment

Gestalt Therapy is best considered as a form of existential therapy The focus is on the what and how of behavior (not why). here-and-now. integrating fragmented parts of the personality. unfinished business from the past.

Boundaries. Disturbances at the Boundaries. Experiences that are blocked creates isolation.

Creative Adjustment. Creative balance between changing the environment and adjusting to current conditions According to Gestalt therapy psychological adjustment requires an awareness of our need states Achieving a balance between

individual needs and the environment reflects creative adjustment.

Maturity. Good gestalt describes a perceptual field organized with clarity and good form. Results from creative adjustment.

Disrupted Personality Functioning. Mental illness is the inability to form clear figures in the moment. Polarities Maladjustment occurs when polarities become rigid and are seen in dichotomies. Positive mental health is seen as the ability for an individual to shift between figure and ground, in other words to be able to deal with competing concepts like life and death which are considered polarities.

Resistance Gestalt Therapists see resistance as the process of opposing the formation of a threatening figure. A gestalt therapist would view resistance as an attempt to maintain psychological integrity

The impasse is the point in therapy at which clients: avoid experiencing threatening feelings. experience a sense of "being stuck." imagine something terrible will happen. When a client remains stuck in nonfunctional ways of thinking and behaving a gestalt therapist would say the client is experiencing impasse.

People are inclined to towards growth and self regulation. Conditions can impede growth. People define themselves in relation to others.

The essential nature of the individuals relationship with the environment is interdependence, not independence. Individuals have the capacity to self-regulate in their environment. Individuals can reown the parts of themselves they have disowned.

View of human nature is rooted in

- existential philosophy. - phenomenology. - field theory.

Gestalt Therapys Theory of Personality Organismic Self-regulation. "There is only one thing that should control: the situation If you understand the situation you are in and let the situatio n you are in control actions, then you learn to cope with life." Fritz Perls Human regulation is either organismic or shouldistic. Organismic. Acknowledgement of what is. Choosing and learning happen holistically A natural integration of mind and body Shouldistic What one things should or should not be Cognition reigns Gestalt Therapys Theory of Personality

Consciousness and Unconsciousness View is radically different from Freudian view In gestalt therapy, the concept of unconscious is replaced by the concepts of awareness and unawareness Concepts of awareness and unawareness replace the unconscious

Gestalt Therapy Goal is for the client to have increased awareness of what they do, how they do it and how they can change or accept themselves

The Figure-Formation Process The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individuals attention. The dominant needs of an individual at a given moment influence this process.

The Now Initial goal is for clients to gain awareness of what they are experiencing and doing now

Promotes direct experiencing rather than the abstractness of talking about situations Therapist directs clients to "bring the fantasy here" Rather than talk about a childhood trauma the client is encouraged to become the hurt child Ask "what" and "how" instead of "why" Our "power is in the present" Nothing exists except the "now" The past is gone and the future has not yet arrived For many people, the power of the present is lost They may focus on their past mistakes or engage in endless resolutions and plans for the future

Unfinished Business Feelings about the past are unexpressed These feelings are associated with distinct memories and fantasies Feelings not fully experienced linger in the background and interfere with effective contact Pay attention on the bodily experience because if feelings are unexpressed they tend to result in physical symptom Result: Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior Solution: get in touch with the stuck point (impasse).

Contact and Resistances to Contact CONTACT The gestalt term describing an individual's ability to focus on the here and now Interacting with nature and with other people without losing ones individuality Contact (connect) and Withdrawal (separate) RESISTANCE TO CONTACT the defenses we develop to prevent us from experiencing the present fully

Five major channels of resistance: 1. Introjection: uncritically accept others belief and standards without thinking whether they are congruent with who we are 2. Projection: the reverse of introjection; we disown certain aspect of ourselves by assigning them to the environment 3. Retroflection: turning back to ourselves what we would like to do to someone else Directing aggression inward that we are fearful to directing toward others. 4. Deflection: The process of distraction, or fleeting awareness that makes it difficult to maintain sustained contact. A way of avoiding contact and awareness by being vague or indirect. e.g., overuse of humor

5. Confluence: less differentiation between the self and the environment. e.g., a need to be accepted---to stay safe by going alone with other and not expressing ones true feeling and opinions. e.g., A parent and a child become so enmeshed that the child can no longer experience a sense of separate identity.

Clients are encouraged to become increasingly aware of their dominant style of blocking contact

Energy and blocks to energy Pay attention to where energy is located, how it is used, and how it can be blocked Blocked energy (resistance): Tension some part of the body; numbing feelings, looking away from people when speaking, speaking with a restricted voice Recognize how their resistance is being expressed in their body Exaggerate their tension and tightness in order to discover themselves

Gestalt psychotherapy is focused on process rather than on content

Main Gestalt Therapy Principles Awareness Direct experience Contact Relationship Experimentation Phenomenological focusing

Four Dialogue Characteristics

1. Inclusion Putting oneself as fully as possible into the experience of the other without judging, analyzing or interpreting while simultaneously retaining a sense of ones separate, autonomous presence Represents phenomenological trust in immediate experience Provides a safe environment and strengthens the clients self-awareness

2. Presence The Gestalt Therapist expresses their observations, preferences, feelings, personal experience and thoughts to the client

Therapist is modeling phenomenological reporting Enhances clients trust and use of immediate experience to raise awareness

3. Commitment to dialogue Contact refers to something that happens in an interaction Therapist allows contact to happen rather than making contact happen

4. Dialogue is lived Dialogue is something done "Lived" emphasizes the excitement/immediacy of the process Mode of dialogue can vary. Examples might include dance, song, art, words, movement

Techniques

Techniques of Client Focusing elaborations of "What are you aware of (experiencing) now? And "Try this experiment and see what you become aware of (experience) or learn." The Gestalt therapist pays attention to the client's nonverbal language.

Main Tools of Gestalt Therapy

Awareness Being in touch with ones existence, with what is Gestalt Therapy focuses on creation of an awareness continuum where what is of primary concern and interest to the organism, the relationship, the group or society becomes the gestalt and into the foreground Primary concerns are fully faced, worked through, sorted out, changed, or eliminated As one becomes aware of and faces concerns they can become the background which leaves the foreground free for the next primary gestalt

Stay with it Therapist encourages client to follow a report of awareness with the instruction: "Stay with it" or "Feel it out"

Enactment Therapist asks the client to act out feelings or thoughts to increase awareness

Gestalt therapy's empty chair technique, in which a patient is encouraged to express feelings to others or themselves in a symbolic manner enactment

Exaggeration A special form of enactment where the therapist asks the client to exaggerate some feeling, thought, or movement to feel it more intensely Main Tools of Gestalt Therapy

Loosening and Integrating Therapist asks the client to imagine the opposite of whatever is believed to be true Integrating techniques bring together processes the client keeps alert Examples might include asking a client to put words to crying; identifying where in the body one feels an emotion; Or asking a client to express positive and negative feelings about the same person

Guided Fantasy Therapist encourages visualizing rather than enacting

Body Techniques Therapist provides ideas about how the client can increase awareness of their body functioning Examples would be teaching the client breathing exercises or to hold the body in a certain posture while feeling a certain emotion

Therapist Disclosures Therapist uses "I" statements judiciously to enhance therapeutic contact and the clients awareness Requires wisdom to know when to self disclose Therapists may share what they are experiencing in their senses or emotions In most types of therapy, the therapist may not reveal considerable amounts of information about themselves. In gestalt therapy, therapist disclosure is considered appropriate if done judiciously

Reversal technique A Gestalt technique that is most useful when a person attempts to deny an aspect of his or her personality (such as tenderness)

The Gestalt approach to dreams Ask the client to become all parts of his or her own dream. The client interprets and discovers the meaning of the dream for himself or herself.

Therapeutic Goals The basic goal of Gestalt therapy is attaining awareness, and with it greater choice. Awareness includes knowing the environment, knowing oneself, accepting oneself, and being able to make contact. Stay with their awareness, unfinished business will emerge.

Dialogue b/w client and therapist is stressed. The therapist has no agenda, no desire to get anywhere) The therapist understands that the essential nature of the individuals relationship with the environment is interdependent, not independent. Therapy is a spontaneous; here and now experience

Therapists function and Role Increase clients awareness Pay attention to the present moment Pay attention to clients body language, nonverbal language, and inconsistence b/w verbal and nonverbal message (e.g., anger and smile) "I" message Therapists function and Role Pay attention to language patterns. Language can both describe and conceal

Examples of the aspects of language that Gestalt therapist might focus on. 1. "It" talk "it" instead of "I" (depersonalizing language) e.g., "It is difficult to make friends" instead of "I have difficulty making friends" 2. "You" talk "you" instead of "I" (global and impersonal) 3. Questions - keep the questioner hidden, safe, and unknown. 4. Language that denies power qualifiers and disclaimers such as "perhaps", "sort of", "I guess", "possibly", "I suppose" 5. "I cant " talk instead of "I wont" 6. Listening to metaphors - Its hard for me to spill my guts - I dont have a leg to stand on - I feel like a have a hole in my soul - I feel ripped to shreds - I feel like Ive been put through a

meat grinder 6. Listening to metaphors Seek to translate the meaning of these metaphors into manifest content so that it can be dealt with in therapy. e.g., "What is your experience of being ground meat?" "Who is doing the grinding" 7. Listening to language that uncovers the story (fleshing out the flash). Clients often use language that is elusive yet significant clues to a story that illustrate their life struggles. Clients slide over pregnant phrases but alert therapist can help flesh out their story line.

Clients Experience in Therapy General orientation is dialogue Therapist no interpretation that explain why they are acting in certain ways. Client making their own interpretation Three-stage (Polster, 1987) Discovery (increasing awareness) Accommodation (recognizing that they have a choice) Assimilation (influencing their environment)

Relationship Between Therapist and Client

Person-to-person The quality of therapist-client relationship Therapists knowing themselves Therapists share their experience to clients in the here-and-now

Therapist's Use of self in therapy Therapeutic techniques and procedures The experiential work Use experiential work in therapy to work through the stuck points and get new insights

Preparing client for experiential work Get permission from clients Be sensitive to the cultural difference (e.g., Asian cultural value: emotional control). Know when to leave the client alone.

Respect resistance Therapeutic techniques and procedures Increase awareness about the incongruence between mind and body (verbal and nonverbal expression)

Therapeutic techniques and procedures

1. The internal dialogue exercise Pay close attention to splits in personality function. Top dog - is righteous, authoritarian, moralistic, demanding, bossy. The critical parent that badgers w/ "shoulds" &"oughts" Underdog manipulates by playing the role of a victim: defensive, apologetic, helpless, weak, and feigning powerlessness. The top dog demands thus-and-so while the underdog defiantly plays the role of disobedient child. As a result of this struggle for control, the individual becomes fragmented into controller and controlled. The conflict between top dog and underdog is rooted in the mechanism of introjection which involves incorporating aspects of others, usually parents, into ones ego system. It is essential that clients become aware of toxic introjects that poison the system and prevent personality integration.

The empty chair is one way of getting the client to externalize introjects. Use two empty chairs. Ask the client to sit in one chair and be fully the top dog and then shift to the other chair and become the underdog. As introjects surface the client can experience the conflict more fully. The conflict can be resolved by the clients acceptance and integration of both sides. This technique helps clients get in touch with a feeling or a side of themselves that they may be denying. Rather than talking about the conflicted feeling, they intensify the feeling and experience it fully. Further, by helping the clients realize that the feeling is a very real part of themselves, the intervention discourages them from disassociating the feeling. The goal of this exercise is to promote a higher level of integration between the polarities and conflicts that exist in everyone. The aim is not to ride oneself of certain traits but to learn to accept and live with the polarities.

2. Making the rounds The purpose is to confront, to risk, to disclose the self, to experiment with new behavior, and to grow and change. Is most useful when a person attempts to deny an aspect of his or her personality (such as tenderness) Therapeutic techniques and procedures

Example A group member does not participate. Experiment - Go around to each person and say "What makes it hard for me trust you is" OR "Id like to make contact with you but Im afraid of being rejected [or accepted]"

3. Rehearsal exercise Reverse the typical style (e.g., a pessimist is directed to act like an optimist, a critical negative client is directed to act positive) Plunge into the very thing that is fraught with anxiety and make contact with those parts of themselves that have been denied. Goal e.g., accept positive and negative side. May get stuck when rehearsing silently or internally Share the rehearsals out load with a therapist

4. Exaggeration exercise Helps client become aware of the subtle signals and cues they are sending through body language. Exaggerate a gesture or movement repeatedly, which usually intensified the feelings attached to the behavior and makes the inner meaning clearer.

4. Exaggeration exercise Movements, postures, and gestures may communicate significant meanings, yet the cues may be incomplete. So the client is asked to exaggerate the movement or gesture repeatedly, which usually intensifies the feeling attached to the behaviors and makes the meaning clearer. e.g., trembling (shaking hands, legs), slouched posture, clenched fists, tight frowning, crossed arms, etc. Then the therapist asks the client to put words to the movements.

5. Staying with the feeling Clients may want to avoid unpleasant feelings. At key moments when the client attempt to flee from the feeling the therapist may ask the client to stay with the feeling they wish to avoid. Go deeper into the feelings they wish to avoid Facing, confronting, and experiencing feelings not only takes courage but is also a mark of a willingness to endure the pain necessary for unblocking and making way for newer levels of growth.

6. The Gestalt approach to dream work Not interpret or analyze dreams Bring dream back to life as though they were happening now The dream is acted out in the present to become different parts of the dream Projection: every person or object in the dream represents a projected aspect of the dreamer. Royal road to integration

Dreams serve as an excellent way to discover personality No remember- refuse to face what it is at that time

From a multicultural perspective Must work with clients from their cultural perspectives

Limitations Focus on "affect" Asian cultural value: emotional control Prohibiting to directly express the negative feelings to their parents.

A contribution of this therapeutic approach is that it enables intense experiencing to occur quickly. it can be a relatively brief therapy. it stresses doing and experiencing, as opposed to talking about problems.

Summary and Evaluation

Gestalt therapy encourages clients to experience feelings intensely. stay in the here-and-now. work through the impasse. pay attention to their own nonverbal messages.

According to Gestalt theory, people use avoidance in order to: keep themselves from facing unfinished business. keep from feeling uncomfortable emotions. keep from having to change.

In Gestalt therapy, the relationship between client and counselor is seen as A joint venture An existential encounter An I/Thou interaction

Limitations of Gestalt Therapy Clients who have been culturally conditioned to be emotionally reserved might not see value in experiential techniques. Clients may be "put off" by a focus on catharsis. Clients may believe that to show one's vulnerability is to be weak. Ineffective therapists may manipulate the clients with powerful experiential work.

Some people may need psycho-education.

Application Anxiety Depression Perfection driven Phobic Crisis intervention Groups Couples

Psychosomatic disorders including migraine, spastic neck and back pain Does not rely heavily on formal diagnostic evaluations and research methodology Gestalt Therapists do not believe that a statistical approach can tell the individual client or therapist what works for him or her All interactions are seen as experiments involving calculated risk taking Caution when attempting to treat psychotic, disorganized, personality disorders, or severe mental illness. Should not be used with these disorders unless a long-term commitment is possible

POSTED BY JGARRETT43MU AT 4:18 AM 2 COMMENTS:

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Chapter 9 Existential Therapy


My Lecture Notes. Current Psychotherapies. Chapter 9 Existential Psychotherapy Rollo May and Irvin Yalom Instructor: Jeff Garrett Ph.D.

Introduction: Existential psychotherapy is not a specific technique or set of techniques. It is more philosophical in nature. Existential psychotherapy is a philosophy about human nature. Proponents of existential psychotherapy have not advocated specific training institutes because its presuppositions can underlie any form of therapy. In existential terms, the conflicts individuals experience are regarding the givens of existence. From the existential perspective "deep" conflict means the most fundamental concern at that moment.

Key Figures Viktor Frankl. Rollo May. Irvin Yalom.

Viktor Frankl: Viktor Frankl's approach to existential theory is known as logotherapy. Rollo May: Rollo May has been instrumental in translating some concepts drawn from existential philosophy and applying them to psychotherapy. Irvin Yalom: According to Yalom, the concerns that make up the core of existential psychodynamics are death. freedom. isolation. meaninglessness.

Basic Concepts: Existential psychotherapy is more philosophical in nature. Existential psychotherapy is not a specific technique. Focuses on issues central to human existence.

Existential therapy is basically an experiential approach to therapy. It is based on a personal relationship between client and therapist.

It stresses personal freedom in deciding one's fate. It places primary value on self-awareness.

View of Human Nature: The basic dimensions of the human condition are The capacity for self-awareness. The tension between freedom & responsibility. The creation of an identity & establishing meaningful relationships. The search for meaning, purpose, and values of life. Accepting anxiety as a condition of living: The awareness of death and nonbeing. The Capacity for Self-Awareness. We can reflect and make choices because we are capable of self-awareness. Expanding our awareness in realizing that: We are finite - time is limited. We have the potential, the choice, to act or not to act. Meaning is not automatic - we must seek it. We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation. Freedom and Responsibility: The central issue in therapy is freedom and responsibility. A concept ultimately associated with freedom is assuming responsibility. The existential concept of freedom refers to the fact that we are the authors of our own world The bridge between wishing and action is decision. We are free to choose among alternatives. We are responsible for our lives, for our action, and for our failure to take action. Blaming others for their problems--Recognize how they allowed others to decide for them and the price they pay. Encourage them to consider the alternative options. We Cannot Escape Freedom and Responsibility: Existential therapy is rooted in the premise that humans cannot escape from freedom and responsibility. Freedom and Responsibility involves the notion that our freedom requires us to accept responsibility for directing our own life.

we are free to choose who we will be. they go hand in hand.

Question What are the possible reasons that people tend to blame others for their problems?

The Concept of "Bad Faith" : The concept of "bad faith" refers to leading an inauthentic existence. An Example of Bad Faith. A example statement that illustrates "bad faith" is - naturally I'm this way, because I grew up in an alcoholic family. The creation of Identity and Establishing Meaningful Relationships

Striving for Identity: Identity is "the courage to be". We must trust ourselves to search within and find our own answers. Our great fear is that we will discover that there is no core, no self.

Struggling with our identity: Challenging clients---in what ways that they have lost touch with they identity and letting others to design their life. Relationship to others: Aloneness. We are alone---So, we must give a sense of meaning to life, decide how we will live, have a relationship with ourselves, and learn to listen to ourselves.

Relatedness. We need to create a close relationship with others. Challenging clients----What they get from they relationship? How they avoid close relationship? Relatedness can be Therapeutic. Existentialists contend that the experience of relatedness to other human beings can be therapeutic. The search for meaning, purpose, and values of life.

Question. What is the meaning or purpose of your life?

What do you want from life? Where is the source of meaning for you in life?

The Search for Meaning: Meaninglessness in life leads to emptiness and hollowness (existential vacuum). Existentialists believe that the major solution to meaninglessness is engagement. Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.

Accepting Anxiety as a Condition of Living. Anxiety A Condition of Living. Existential therapists define anxiety as a threat to our existence. Anxiety arises from ones strivings to survive. If anxiety is proportionate to the situation confronted, existentialists would consider it normal anxiety. In contrast to normal anxiety, neurotic anxiety is repressed anxiety. Existential anxiety is normal. An outcome of being confronted with the four given of existence: death, freedom, existential isolation, and meaninglessness. Anxiety can be a stimulus for growth as we become aware of and accept our freedom.

Two Types of Anxiety. 1. Normal Anxiety. 2. Neurotic Anxiety. Question: What is the positive motivation of being anxious? Normal Anxiety. Normal Anxiety appropriate response to an event being faced. (motivation). e.g., Existential Anxiety is a constructive form of normal anxiety we experience as we become increasingly aware of our freedom and responsibility. According to May, freedom and anxiety are two sides of the same coin. Existential anxiety is seen as a function of our acceptance of our aloneness. From the existential viewpoint, the aim of therapy is NOT to eliminate anxiety so clients can live comfortably.

Neurotic Anxiety. Neurotic Anxiety out of proportion to the situation.

Out of awareeness. Tends to immobilize the person.

The Awareness of Death and Nonbeing. Death. According to the existential viewpoint, death gives significance to living.

Question: If you only have 30 days left, whats your feelings? What will you do?

Awareness of Death: Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful.

More Basic Concepts. The Basic "I-Am" Experience. The "I-Am" experience is about being i.e., the realization of one's being. The term ontological means science of being (or the nature of being). Existentialists consider the "I am" experience as a precondition for a solution in life and feel that this is an ontological experience. "I am now living and I could take my life". "The idea of suicide has saved my life many times." Nietzsche. Existential psychotherapy seeks a deeper and more discerning type of therapy. The "I am" experience is no a solution in itself it is a precondition for a solution.

An ontological experience; Ontis = "to be" and Logical = "the science of". Nonbeing is illustrated in the experience of fear of death, destructive hostility, severe anxiety and critical illness.

Existential Model of Anxiety. Anxiety is more basic than fear. Anxiety arises from our personal need to survive, to preserve our being, and to assert our being. Normal anxiety is proportionate to the situation. It does not require repression and can be used for creativity. Neurotic anxiety exceeds or minimizes the situation, is repressed and destructive.

(Normal anxiety is seen as proportionate to the situation involved. When the anxiety exceeds the situation present, it is considered neurotic). Existential Model of Anxiety (see the power point slide in class). Awareness of Ultimate Concern ---> Anxiety ---> Defenses

Existential Model of Guilt: Normal guilt is proportionate to the situation, sensitizes us to the ethical aspects of behavior and can be used for creativity. Neurotic guilt is about fantasized transgressions, leads to "Forgetting being" and is destructive.

The Three Forms of Being-in-the-World. Unwelt world around, biological world. Mitwelt with world, world of ones fellow human beings. Eignewelt own world; relationship to ones self.

Significance of Time. Human experiences like joy, depression and anxiety occur in the dimension of time rather than space. Love cannot be measured by the number of years one has known a loved one.

Two Types of Guilt. 1. Neurotic Guilt. Guilt that arises out of fantasized transgressions is called neurotic guilt. 2. Normal Guilt. A characteristic of normal guilt is that it sensitizes us to ethical behavior.

Human Capacity to Transcend the Immediate Situation: Transcend means "to climb over and beyond". Existing involves a continual emerging. A transcending of ones past and present must occur in order to reach the future. When an individual can move past a situation in order to move towards their future, it is said that the person has transcended the immediate situation.

Comparing Existential Psychotherapy to Other Systems. Contrasts of Existential Theory to Humanistic Approaches.

Humanistic therapies overlap with existential psychotherapy. Both emphasize growth and fulfillment of self. Goals are for self mastery, self-examination and creativity (A primary goal of existential therapy is to help the patient accept personal responsibility).

Comparing Existential Psychotherapy to Other Systems. (see power point slid in class). Other Key Contrasts. Existentialists reject concept of the person as propelled by drives and instincts. Existentialists feel Jungians quickly avoid the patients immediate crises by being too focused on theory. Rollo May's major criticism of client-centered therapists was that they overidentified with the patient. Client-Centered Therapists do not confront the client directly and firmly.

History. Existential thinking has occurred throughout history. Exemplified by Augustine, Pascal, Kierkegaard, Nietzsche. Fundamental questions leading to the development of existential psychotherapy included: Where was the actual immediate person to whom these things were happening? Are we seeing clients as they really are, or are we simply seeing a projection of our theories about them? In 1958 existential psychotherapy introduced to the US with publication of Existence: A New Dimension in Psychiatry and Psychology by Rollo May, Ernest Angel, and Henri Ellenberger In 1981 Yalom published the first comprehensive textbook in existential psychiatry entitled Existential Psychotherapy.

Other Important Writings. Rollo Mays The Meaning of Anxiety (1977); Mans Search for Himself (1953); Existential Psychology (1961). James Bugentals The Search for Existential Identity (1976). Victor Frankls Mans Search for Meaning (1963).

Six Ontological Principles 1. Humans are centered in self and derive meaning from that center. 2. Humans are responsible for mobilizing the courage to protect, affirm, and enhance the self. 3. People need other people with whom they can empathize and learn. 4. People are vigilant about potential dangers to self.

5. Humans can be aware of themselves thinking and feeling at one moment and my be aware of. themselves as the person who thinks and feels in the next moment. 6. Anxiety originates out of awareness that ones being can end.

Existential Psychotherapy. A form of dynamic psychotherapy. Holds a different view of inner conflict. Conflict is between the individual and the "givens" of existence termed ultimate concerns. 1. Death. 2. Freedom. 3. Isolation. 4. Meaninglessness. _____________________________ Death: The most obvious ultimate concern. "A terrible truth". Conflict between awareness of death and desire to live. To cope we erect defenses against death awareness. Psychopathology in part is due to failure to deal with the inevitability of death.

Freedom Refers to the fact that humans are the authors of their own world. We are responsible for our own choices. Conflict is between groundlessness and desire for ground/structure. Implications for therapy. Responsibility. Willing. Impulsivity. Compulsivity. Decision. Existential Psychotherapy.

Isolation. - The fact that we are isolated from parts of ourselves is termed intrapersonal isolation Intrapersonal isolation = Fact we are isolated from parts of ourselves. A form of isolation that refers to the fact that each of us enters and departs the world alone is existential. Existential isolation differs from Interpersonal isolation = Divide between self and others. Intrapersonal isolation = Fact we are isolated from parts of ourselves.

Meaninglessness. Meaning creates hierarchal order of our values. From a schema regarding the meaning of life an individual generates a hierarchy of values. Tells us how to live not why to live. Conflict stems from "How does a being who requires meaning find meaning in a universe that has no meaning?"

Existential Frame of Reference. Specialness. Despite rationality we often believe the laws of biology are no applicable to us.

Ultimate Rescuer. Belief in a personal omnipotent servant to guard and protect us. (To cope with ultimate concerns regarding death individuals will often use the defense mechanism of creating an ultimate rescuer).

Ultimate concerns have implications for therapy process (Existentialists hypothesize that anxiety is the result of awareness of ultimate concerns). Psychodynamic treatment is followed. Ultimate concerns boundary situations which are experiences which force individuals to confront an existential situation. (Ultimate concerns create experiences, which force us to confront an existential situation called boundary situations). An experience which forces an individual to confront an existential issue is known as a boundary situation. Examples might be diagnosis of a terminal illness or death of a family member or friend. Psychotherapy can address existential isolation. Jung suggested 30% of patients seek treatment because of personal meaninglessness.

Therapeutic Goals:

To expand self-awareness. To increase potential choices. To help client accept the responsibility for their choice. To help the client experience authentic existence. Expanding Awareness: Expanding awareness is a basic goal of existential therapy. Fully Human. The existential emphasis is based on the philosophical concerns of what it means to be fully human.

Therapists Function and Role: Understand the clients subjective world. Encourage clients to accept personal responsibility. When clients blame others, therapist is likely to ask them how they contributed to their situation.

A Prime Factor in Determining the Outcomes of Therapy. The existential approach puts emphasis on the therapist as a person and the quality of the client/therapist relationship as one of the prime factors in determining the outcomes of therapy. Clients Experience in Therapy. They are challenged to take responsibility. Major themes in therapy sessions are anxiety, freedom and responsibility, isolation, death, and the search for meaning. Assist client in facing life with courage, hope, and a willingness to find meaning in life. Philosophically, the existentialist would agree that the final decisions and choices rest with the client. people redefine themselves by their choices. a person can go beyond early conditioning. making choices can create anxiety.

Relationship Between Therapist and Client. Therapy is a journey taken by therapist and client. The person-to-person relationship is key. The relationship demands that therapists be in contact with their own world. The core of the therapeutic relationship. Respect and faith in the clients potential to cope and discover alternative ways of being.

Therapists share their reactions to clients with genuine concern and empathy as one way of deepening the therapeutic relationship.

I/Thou Relationships in Therapy: (Martin Buber). Martin Buber stressed the importance of presence, which allows for the creation of I/Thou relationships in therapy.

Therapeutic techniques and procedures: It is not technique-oriented. The interventions are based on philosophical views about the nature of human existence. Free for draw techniques from other orientations. The use of therapist self is the core of therapy.

Techniques are not emphasized: Existential therapy is not considered as a system of highly developed techniques. Subjective understanding of clients is primary. In the existential approach subjective understanding of clients is primary and techniques are secondary. The term unfolding refers to the therapist's attempt to uncover with the patient what was there all along. Questions: Which populations is existential therapy particularly useful? Which issues is existential therapy particularly useful?

Existential Group Psychotherapy. Clients learn how their behavior is viewed by others, makes others feel, creates opinions others have of them and influences their opinions of self. Applications of Existential Psychotherapy. The clinical setting determines the applicability of the existential approach. Most applicable when clients are dealing with a phase of life issue or a boundary situation. A comprehensive existential approach is most feasible in long term therapy. Existential therapy is especially appropriate for clients who are struggling with developmental crises. Identity in adolescents. Coping with disappoints in family and career.

Grief counseling. Coping with physical limitations as one ages. From a multicultural perspective: Contributions. Applicable to diverse clients to search for meaning for life. Be able to examine the behavior is influenced by social and cultural factors. Help clients to weigh the alternatives and consequences. Change external environment and recognize how they contribute.

From a multicultural perspective. Limitations. Excessively individualistic. Ignore social factors that cause human problems. Even if clients change internally, they see little hope the external realities of racism or discrimination will change. For many cultures, it is not possible to talk about self and self-determination apart from the context of the social network. Many clients expect a structured and problem-oriented approach instead of discussion of philosophical questions.

Major Criticisms Vague and global approach. Lofty and elusive concepts. It lacks a systematic statement of the principles and practices of psychotherapy.
POSTED BY JGARRETT43MU AT 1:47 PM 5 COMMENTS:

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Chapter 8 - Cognitive Therapy


My Lecture Notes Current Psychotherapies Chapter 8 Cognitive Therapy Aaron T. Beck and Marjorie E. Weishaar

Instructor: Jeff Garrett Ph.D.

Research on depression in the 1960s, which served as the foundation of cognitive therapy, was conducted by Aaron Beck.

Beck Depression Inventory - 2. (In class).

Seven Basic Assumptions Beck et al (1979) provided a list of general assumptions that underlie the theory.

1. Perception and experiencing in general are active processes which involve both inspective and introspective data.

2. The patient's cognitions represent a synthesis of internal and external stimuli.

3. How a person appraises a situation is generally evident in his cognitions (thoughts and visual images).

4. These cognitions constitute the person's stream of consciousness or phenomenal field, which reflects the person's configuration of himself, his world, his past and future.

5. Alterations in the content of the person's underlying cognitive structures affect his or her affective state and behavioural pattern.

6. Through psychological therapy a patient can become aware of his cognitive distortions.

7. Correction of these faulty dysfunctional constructs can lead to clinical improvement. [p. 8 Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.]

Basic Concepts. CT is based on the role information processing plays in survival. The theory behind cognitive therapy asserts that altering thoughts influences feelings, motivations and behaviors. The theory states cognition, behavior, affect, and motivation are intertwined and co-occurring. Therapeutic intervention focuses on the primacy of cognition. Cognitive Schema a structure containing self-perceptions; thoughts about others and the world; our memories, goals, fantasies; and everything weve learned. (Structures that contain an individual's core beliefs and assumptions are labeled Cognitive Sch emas)

Cognitive Theory states that an individual's fundamental beliefs and assumptions are contained in structures termed cognitive schemas.)

Cognitive Shift a systematic bias in information processing. Cognitive Vulnerabilities specific attitudes predisposing the interpretation of experiences. Cognitive Distortion - refers to a systematic error in reasoning. A cognitive therapist relies on collaborative empiricism and guided discovery. Focus is on patients testing beliefs and behaviors. Cognitive and behavioral techniques are both employed. The preferred method of dialoguing with a patient in cognitive therapy is through the use of Socratic questions.

Mode. Networks of cognitive, affective, motivational, and behavioral schemas. Primal modes are universal and related to survival. They include primal thinking which is rigid, absolute, automatic and bias. Dysfunctional modes are treated by deactivating them, altering their structure and content and developing more adaptive modes.

CTs Cognitive Triad. Pattern that triggers depression: 1. Client holds negative view of themselves and blames themselves. 2. Selective abstraction: Client has tendency to interpret experiences in a negative manner. 3. Client has a gloomy vision and projections about the future.

Basic Characteristics of CT. Practical. Symptom focused. Empirically derived techniques. Collaboration. Acknowledges underlying precursors of symptoms while remaining in present. Case conceptualization drives treatment. Primary Roles of the CBT Therapist.

Conceptualizing the patient in cognitive terms. Structuring the sessions. Using collaborative empiricism and guided discovery to specify problems and set goals.

The Cognitive Model - see diagram from class notes.

The Cognitive Model. Automatic thoughts influence not only ones emotional response, but also ones behavioral, motivational, and physiological responses. The relationship is bi-directional (all systems act together as a mode) therefore simultaneously biology, emotions, behavior (and motivation) influence thoughts. Subsequently, biological treatments can change thoughts and CBT can change biological processes. We all have cognitive vulnerabilities (i.e., core beliefs) which predispose us to interpret information a certain way. These vulnerabilities are developed early. When these beliefs are rigid, negative, and ingrained we are predisposed to pathology. These core beliefs give rise to conditional assumptions, i.e., rules for living, as we mature. In psychopathology there are systematic biases toward selectively interpreting information in a certain manner which are disorder specific.

Strategies of Cognitive Therapy. Collaborative Empiricism. Guided Discovery (Guided discovery refers to the process by which a therapist serves as a guide to clarify problem behaviors and thoughts). Deactivation of Dysfunctional Modes. Techniques which directly deactivate them. Modifying their content and structure. Constructing more adaptive modes to neutralize them.

Comparing CT to other Therapies.

CT Compared to Psychoanalysis. Both assume behavior is influenced by beliefs of which we may be unaware. CT focuses on linkages among symptoms, conscious beliefs and current experiences; little concern with unconscious feelings or repressed emotions as in psychoanalysis. CT has minimal focus on childhood or developmental issues except in terms of assessment or when addressing core beliefs. CT is highly structured and generally short term (12-16 weeks) whereas psychoanalysis is unstructured and long-term. In CT the therapist actively collaborates with the patient.

CT Compared to REBT. CT labels thoughts as dysfunctional while REBT labels thoughts as irrational. CT uses inductive reasoning while REBT uses deductive reasoning. CT proposes cognitive specificity for each disorder while REBT proposes a core set of irrational beliefs (In contrast to REBT cognitive therapists hypothesize that each mental disorder has its specific cognitive content). CTs view of the problem is functional; pathology arises from multiple cognitive distortions while REBTs view of the problem is philosophical; pathology arises from shoulds, musts, and oughts. CT therapists are more collaborative while REBT therapists are more confrontive. CT therapists emphasize psychoeducation as an early critical component of treatment while REBT therapists have a higher reliance on psychoeducation throughout. CT focuses on "hot cognitions" as critical, but obtain them in a less aggressive manner while REBT is more aggressive. CT therapists encourage clients to use inductive reasoning whereas REBT therapists rely on deductive reasoning.

CT Compared to BT. CT is very different from Applied Behavioral Analysis. CT is the most commonly practice form of CBT, an overarching term to represent therapies. which integrate cognitive and behavioral theories and techniques. CT sees the individual as more active rather than passive in the change process. CT stresses expectations, interpretations, and reactions.

CT Compared to MMT. Cognitive therapy, in contrast to multimodal therapy (MMT) stresses the primacy of cognition.

CT Compared to Medication Studies generally show CT to be equivalent to psychotropic medications for depression, bulimia, and some anxiety disorders. General research suggests the combination of the two approaches is superior to either used in isolation. CT shows longer efficacy (less relapse) and increased likelihood of continuing gains when treatment is discontinued. CT and antidepressants (TCAs/1st Generation SSRIs) show equal efficacy rates.

History. Developed by Aaron T. Beck M.D. He was investigating the "anger turned inward" psychoanalytic concept regarding depression in the 1960s and found evidence of negative cognitions. Bandura, Ellis, Mahoney, and Mechenbaum ideas were all influential in the development of CT as they were developing their approaches simultaneously.

Other major influences were Phenomenological approaches. Structural theory and Depth Psychology. Cognitive Psychology.

Current Status of CT. Controlled Studies have shown the efficacy of CT with: Depression. Panic Disorder. Social Phobias. Generalized Anxiety Disorders. Substance Abuse. Eating Disorders. Marital Problems. OCD.

Post-traumatic Stress Disorder. Schizophrena.

Resources in CT. Center for CT (U/Penn) and Beck Institute are the Major Training Sites (Both in Philadelphia). Multiple other training sites in the US and internationally. Cognitive Therapy and Research and Journal of Cognitive Psychotherapy. Academy of Cognitive Therapy (for more information go to www.academyofct.org).

CTs View of Personality. Thinking is Problematic or Distorted when it is very ... Extreme. Broad. Catastrophic. Negative. Unscientific. Pollyanish. Idealistic. Demanding. Judgmental. Comfort Seeking. Obsessive. Confusing.

Belief Hierarchy. The belief hierarchy proposed in cognitive theory goes from core beliefs or assumptions which are the most stable, least accessible cognitions to voluntary thoughts which are the least stable but most accessible cognitions.

Cognitive Distortions

1. Arbitrary Inference: Drawing a conclusion without evidence or in the face of contradictory evidence. Example - a young woman with anorexia nervosa believes that she is fat although she is dying of starvation. 2. Selective Abstraction: Dwelling on a single negative detail taken out of context. Example While on a date you say one thing you wish you could have said differently and now see the entire evening as a disaster. 3. Overgeneralization: A single negative event is viewed as a never-ending pattern of defeat. Example - Following a job interview an accountant does not receive the job. She/he begins thinking that they will never find a job despite their qualifications. 4. Magnification and/or Minimization: The binocular trick. Things seem bigger or smaller than they truly are (depending on which lens you are looking through). Example: An employee believes that a minor mistake will lead to being fire vs. an alcoholic who believes he/she doesnt have a problem. 5. Personalization: Assuming personal responsibility for something for which you are not responsible. (Attributing external events to oneself without evidence supporting a causal connection is termed Personalization.). Example sometimes seen in patients who have been sexually or physically abused. 6. Dichotomous Thinking: Is All or Nothing Thinking. Things are seen as black or white, there is no gray (middle ground). Example 1. Things are wonderful or awful, good or bad, perfect or a failure. Example 2. - Kate has anorexia nervosa and when she gains one pound she believes she is fat. If she loses one pound she can perceive herself as thin. Kate's thought process reflects Dichotomous Thinking. Example 3. - A patient with anorexia nervosa believes that she is thin when she exercises, but fat if she eats. This would be an example of the all or nothing thinking cognitive distortion 7. Mind Reading: Assuming you know the motives, thoughts, intentions of others. Example If your friend is in a bad mood you assume its your fault and dont asked what is wrong. 8. Fortune Teller Error: Creating a negative self fulfilling prophesy. Example: You believe you will fail an important exam so you do not study and fail. 9. Emotional Reasoning: You assume your negative feelings result from the fact that things are negative. Example If you feel bad, then that means that the world or situation is bad. You dont consider that your feelings are a misrepresentation of the facts. 10. Should Statements: The use of words like should, ought, must rather than "it would be preferred" to guilt self. Example: "I should be perfect". 11. Labeling and Mislabeling: Labeling yourself or others in a demeaning way. Example: Name calling "I am worthless" or "Hes a total failure".

Process of Psychotherapy in CT. Early in treatment a cognitive therapist may rely more on behavioral techniques whereas later in treatment the focus shifts towards cognitive techniques. Through the process of guided discovery cognitive therapy patients create homework. assignments for themselves called

"behavioral experiments" with input from their therapist.

Structure of a CBT Session. Mood check. Setting the Agenda. Bridging from last session. Todays agenda items. Homework assignment. Summarizing throughout and at the end. Feedback from patient.

General Principles of CT. Goal Is to correct dysfunctional thinking and help patients modify erroneous assumptions. Patient is taught to be a scientist who generate and tests hypotheses. Relationship between patient and therapist is collaborative.

Fundamental Concepts. Collaborative Empiricism goal is to demystify therapy by helping the client search for empirical evidence that supports beliefs. Socratic Dialogue form of questioning used to help patients come to their own conclusions about their thoughts and behaviors. Guided Discovery therapist collaborates with patient to develop behavioral experiments to test hypothesis.

Process of Therapy. Initial Sessions essential to build rapport, focus on problem definition, goal setting, and symptom relief, psychoeducation, behavior interventions. (Symptom relief is a primary goal in the initial cognitive therapy interview). Middle Sessions emphasis shifts from symptom/behaviors to patterns of thinking. Termination Expectation that therapy is time-limited.

Examples of Behavioral Interventions in CT. Weekly Activity Monitoring.

Activity Schedule. Graded Tasked Assignments. (Assisting a patient in initiating a task at a nonthreatening level and then gradually increasing the task difficulty). Behavioral Experiments. Exposure Techniques. Role Plays.

More Details about a Specific Behavior Technique: Weekly Activity Monitoring. Patient records activities and rates them for pleasure and Mastery. Can be used in several different ways, the activity monitoring form allows the therapist and patient to: Assess how pt is spending time. Measure a sense of accomplishment and/or pleasure received by certain activities. Evaluate automatic thoughts or emotional shifts. Fill in specific times with planned activities such as pleasant activities for depressed pts or activities that must be accomplished for procrastinating pts. Compare predicted ratings of accomplishment and pleasure with actual ratings.

Examples of Cognitive Interventions in CT. Eliciting automatic thoughts through Dysfunctional Thought Records. Identifying whether thoughts represent distortions in information processing. Using Socratic questions to evaluate thought process. Generating alternatives in terms of how to think or how to behave differently. More Details about a Specific Cognitive Technique. Basic Question: What just went through your mind? Ask when an emotional shift is noted in session. Create an emotional shift by having the pt describe or visualize a recent situation when they felt intense emotions and then answer the question. If pt still cannot answer the question try asking. Do you think you were thinking of _____________? If someone else was in the situation what do you think they might have been thinking? Where you thinking _____________? (insert something paradoxical).

More Details about a Specific Cognitive Technique. Using Socratic Questioning to have pt examine and refute their dysfunctional thoughts. What evidence do you have to support the belief? What evidence do you have to refute it? What would your spouse, best friend sibling (or anyone whom you admire greatly) say in this situation? What would you say to your spouse, friend, or sibling if they were thinking the same thing you are thinking. How could you look at this situation so you would feel less depressed? Is this view as reasonable as your first choice?

Downward Arrow Technique. Use the downward arrow technique to obtain less accessible beliefs. If that were true what would it mean to you (about you)? And, then what? What then?

Principles for Setting Effective Homework. Make sure rationale is clear. When feasible, have client choose task. Personalize task to therapy goals. Begin where client is, not where client thinks he/she should be. Be specific and concrete: where, when, with whom, etc. Formalize the task e.g., write on paper. Plan ahead for potential obstacles and "trouble shoot". Practice the task in session. Review homework at the beginning of each session.

Other CT Techniques De-catastrophizing Asking a patient to ponder "what if" scenarios about feared consequences is known as De-catastrophizing. Reattribution Alternative explanations systematically explained.

Redefining Help client define the problem differently e.g., "Nobody ever talks to me" becomes "I need to try to initiate conversations so other people become interested in me." Decentering Used with social anxiety to shift focus: Client is taught to see that thoughts are just thoughts and not "them" or "reality". Modifying Core Beliefs creates the most significant change in a dysfunctional mode for a client.
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Chapter 7 - Behavior Therapy (Updated 2/23/06)


Chapter 7 - Behavior Therapy (Updated 2/23/06) Current Psychotherapies Chapter 7 Behavior Therapy G. Terrence Wilson Instructor: Jeff Garrett Ph.D

Four Major Figures that have Influenced Behavior Therapy Ivan Pavlov (1849-1936) B.F. Skinner (1904-1990) Joseph Wolpe (1915-1997) Alert Bandura

The first figure in the United States directly linked with the development of behaviorism in the early 1900s was J. B. Watson In its early stages, behavior therapy was most closely linked with modern learning theory Wolpe made important contributions to behavioral therapy e.g., systematic desensitization Eysenck - One of the only behavior theorists to use a trait theory of personality was Eysenck Albert Bandura is usually associated with the development of the social cognitive theory

Basic Concepts Behavior Therapy (often termed CBT) integrates behavioral techniques derived from principles of learning and cognitive restructuring techniques based on cognitive theories.

Basic Characteristics of all BT Practical: Symptoms seen as problems in living empirically derived Requires client collaboration Acknowledges underlying precursors of symptoms, but focuses on present Sees behavior (normal and abnormal) as learned Treatment driven by functional analysis of behavior

Continuum of BT (Power Point slide in lecture)

Basic Concepts Applied Behavior Analysis Extension of Skinners radical behaviorism; Cognition is ignored Focus is on overt behavior To alter behavior one attempts to alter the relationship between behavior and consequences (When a behavioral therapist focuses only on altering the antecedents and consequences associated with a behavior. The approach is the therapist utilizing is applied behavior analysis)

Basic Concepts Neobehavioristic Mediational Stimulus-Response (S-R) Model Recognizes that covert processes may mediate the stimulus response relationship Cognition is believed to follow the same principles of learning as behavior Imagery is often utilized

Basic Concepts Social-Cognitive Theory Initially espoused by Albert Bandura

Recognizes the interconnection between stimulus, reinforcement and cognition Sees the critical role of vicarious learning, cognitions, self regulations and expectations Person is seen as the agent for change; Self efficacy seen as a critical variable (The social-cognitive theory suggests that one of the best ways to predict a person's future behavior is to assess associated stimuli, reinforcers and cognitions) (According to social learning theory, a person would be predicted to act consistently across situations if similar behavior leads to similar consequences)

Comparison of BT with Other Systems (Power Point slide in lecture)

In contrast to psychoanalysts, behavior therapists are more directive

Comparison of BT with Other Systems Little Hans - In the classic case of Little Hans, Freud attributed the phobia of horses to castration anxiety whereas a behavior therapist would see it as classically conditioned response Comparison of BT with Other Systems

Other Key Contrasts Can include family systems when appropriate Empirical studies generally show it to be more effective than verbal therapies Treatment of choice for phobias, OCD, sexual dysfunction and many childhood disorders Treatment outcome studies comparing other forms of psychotherapy with behavior therapy have shown behavior therapy is likely more effective than psychoanalytic approaches

Ways BT Meets the Needs of Children and Adolescents Practical, here and now, experimental emphasis Techniques can be adapted to meet developmental level Action oriented which matches the fact that children learn by doing

Incorporates rewards which helps engage the child or adolescent

History Ivan Pavlovs research Rise of behaviorism by Watson E.L. Thorndikes research on animal learning (rewarding and punishing) Joseph Wolpes systematic desensitization (Systematic desensitization primarily involves incrementally exposing a client to anxiety producing stimuli) Eysencks description of BT as applied science Skinners operant conditioning paradigms Banduras social learning theories

Four Aspects of Behavior Therapy Classical Conditioning Operant Conditioning Social Learning Approach Cognitive Behavior Therapy

1. Classical Conditioning A neutral stimulus is repeated paired with a stimulus that naturally elicits a particular response. The result is that eventually the neutral stimulus alone elicits the response. e.g., Pavlovs dogs

2. Operant Conditioning *B.F. Skinner is associated with this behavioral approach (i.e., Operant Conditioning) *Skinner's view of controlling behavior is based on the principles of Operant Conditioning Focuses on actions that operate on the environment to produce consequences If the environmental change brought about by the behavior is reinforcing, the chances are strengthened that the behavior will occur again. If the environmental changes produce no reinforcement, the chances are lessened that the behavior will recur

e.g., *positive and negative reinforcement, punishment, and extinction techniques.

3. Social Learning Approach Behavior is influenced by triadic reciprocal interaction among - environment - personal factors (beliefs, preferences, etc) - individual behavior

Capable of self-directed behavior change Self-efficacy refers to the individuals belief that they can change.

4. Cognitive Behavior Therapy *Is now established as a part of mainstream behavior therapy. Emphasizes cognitive processes and private events (such as clients self-talk) as mediators of behavior change

View of Human Nature Current view does not rest on a deterministic assumption that humans are a mere product of their sociocultural conditioning. Current view the person is the producer and the product of his or her environment

View of Human Nature Increase individual freedom and increase peoples skills Action-oriented approach Stimulus events are mediated by cognitive processes The role of responsibility for ones behavior

Basic Characteristics and Assumptions 1. Based on the principles and procedures of the scientific method. 2. Deals with current problems and factors influencing them

3. Active behavior change (not mere talk-therapy) 4. Teaching clients skills to use in everyday life (outside of therapy). 5. Focus is on assessing behavior directly, identifying the problem, and evaluating change. 6. Emphasizes self-management strategies. 7. Treatment individually tailored to specific problems 8. Collaborative partnership 9. Practical applications to daily life in order to decrease maladaptive behaviors 10. Develop culturalspecific procedures and obtain clients cooperation.

Personality Behaviorists generally reject theories of personality but do incorporate ideas such as Mischel's person variables. Behaviorists view abnormal behavior as problems of living Behaviorists generally see behavior as situation specific and reject trait theories of personality

Eysencks classification (mild impact) Introversion vs. extroversion Neuroticism vs. emotional stability

Mischels person variables Competency to construct behaviors Expectancies Self-regulatory systems and plans Categorization of events and people Subjective values.

Basic Principles of Learning Learning - A relatively permanent change in behavior, not due to fatigue, drugs, or maturation Basic Principles of Learning

Classical Conditioning - Pavlovs study: Food is presented to the dog and the dog salivates. No learning involved. A neutral stimulus is presented to the dog (a tone). The dog does not salivate.

UCS ----------------------------------UCR Unconditional Stimulus Unconditional Response (sight of food) (salivation)

CS ------------------------------------CR Conditioned Stimulus Conditioned Response (tone) (salivation)

Classical conditioning is now viewed as the pairing of conditioned stimuli with unconditioned stimuli and the process of learning correlational or contingent relationships are present

A positive reinforcer should affect behavior by generally strengthening it Avoidance of an event that produces anxiety is negatively reinforcing The occurrence of a behavior in a situation other than where it was acquired is known as generalization The acquisition of new knowledge and behavior by observing other people and events is called vicarious learning

A variable ratio schedule of reinforcement yields the highest rate of response and the greatest resistance to extinction

If a cell phone is taken away from a teenager in order to get her to clean her room, the parents would be using negative reinforcement

In order to help a patient quit smoking, a therapist asks the patient to record what they were doing before smoking and how they feel afterwards. This is an example of using a self-monitoring technique

The form of behavior therapy which evaluates and treats only overt behavior is termed applied behavior analysis

Token Economy is a BT technique which backup reinforcers are given for completion of target behaviors

Ayllon and Azrin studied token economies with hospitalized schizophrenic patients and found earned tokens directly increased desired behavior

Personality The UCS and CS are repeatedly paired together until the UCR is elicited by the CS. In other words, the CS elicits the same behavior which is now termed CR. If Stimulus Generalization occurs the dog might respond to related stimuli with the same or similar response. If Stimulus Discrimination occurs the dog might not respond.

Personality Extinction - After learning has occurred, removing the UCS ultimately results in a decreased probability that the CR will be made. This is because the dog learns that the bell no longer means food will follow.

Spontaneous Recovery - After a time delay, if the stimulus is represented the CR will reoccur. This behavior will extinguish rapidly if the UCS does not follow quickly.

Operant or Instrumental Conditioning (B.F. Skinner) A response is emitted, perhaps randomly at first, and this results in consequences. Hence, the probability of the responses future occurrence is changed.

Continuous Reinforcement - Every response is followed by reinforcement, resulting in fast learning (acquisition) but also resulting in fast extinction

Personality Intermittent (or partial) Reinforcement Not every response is reinforced Yields a stronger response ultimately

Fixed ratio schedule Delivers reinforcement after a fixed number of responses and produces high response rate Example: Commission Work

Fixed interval schedule Reinforces the next response which occurs after a fixed period of time elapses. Example: Scheduled exams

Variable interval schedules Delivers reinforcement after unpredictable time periods Example: Pop Quizzes

Variable ratio schedule Yields the highest rates of response and greatest resistance to extinction. Example: Gambling Personality Schedule Effect ______________________________________________ Fixed Ratio (Relatively fast rate of response) ______________________________________________ Fixed Interval (Response rate drops to almost zero after reward; Picks up rapidly before next reward) _______________________________________________ Variable Interval (Slow steady response)

_______________________________________________ Variable Ratio (Constant high rate of response; May be difficult to break)

Personality Secondary Reinforcement A symbol or a token gains reinforcement value due to its association with a real reinforcer (e.g., dollar bill). Personality Vicarious Learning (Modeling) Learning which occurs through observation Vicarious learning is particularly relevant to children, but applies to all ages. By observing a model one grasps entire behaviors as well as component parts Vicarious learning may remain dormant until a situation warrants expression of the learned behavior A belief in one's ability to successfully complete a behavior is referred to as self efficacy A behavior therapist would not typically ask what? When? Where? (but not why?)

Therapeutic Goals General goals: Increase personal choice and create new conditions for learning To eliminate maladaptive behaviors and learn more adaptive behaviors Client and therapist collaboratively decide the concrete, measurable, and objective treatment goals

Therapists function and Role *Be active and directive *Be a consultant * Be a problem solver Conduct a thorough functional assessment, formulate initial treatment goals, use strategies for behavior change, evaluate the success of the change, and conduct a follow-up assessment Role modeling (observing others behavior)

Clients Experience in Therapy To be taught concrete skills To be motivated to change To enlarge the options for adaptive behaviors To continue implementing new behaviors

Relationship Between Therapist and Client *A good working relationship a necessary, but not sufficient, condition for behavior change to occur. Common factors (warm, empathy, acceptance et al.) are necessary but not sufficient for behavior change to occur. Believes the progress is due to specific behavioral techniques instead of therapeutic relationship

Therapeutic techniques and procedures Operant conditioning techniques Positive reinforcement (e.g., praise, money) Negative reinforcement (e.g., alarm) Extinction (e.g., tantrum = no attention) Positive punishment (e.g., reprimanding) Negative punishment (e.g., deducting money)

Therapeutic techniques and procedures The functional assessment model Gather data about the antecedents and consequences of problematic behaviors Use indirect methods (questionnaires) and direct methods (observation) Develop hypothesis Devise functional treatments Use negative punishment procedures only after functional approaches have been tried. Develop strategies to maintain behavior changes.

Therapeutic techniques and procedures Relaxation training---to cope with stress progressive muscular relaxation Soft and pleasant voice Create relaxing imagery through visualization Relax various parts of the body

Therapeutic techniques and procedures *Systematic Desensitization aimed at anxiety and avoidance reactions *Systematic desensitization typically includes the use of relaxation procedures such as progressive muscular relaxation Anxiety hierarchy Desensitization from visualizations to real life exposures. The client moves up the hierarchy from least to greatest anxiety arousing scene (then REPEATED EXPOSURE)

Therapeutic techniques and procedures *Modeling a model who is similar to the observer with respect to age, sex, race, and attitudes is more likely to be imitated than a model who is unlike the observer *Modeling methods have been used in treating people with snake phobias and in teaching new behaviors to socially disturbed children

Therapeutic techniques and procedures Exposure therapies In Vivo Desensitization (in real life situations) Brief and graduated exposure to an actual fear situation or event *In Vivo Flooding *Prolonged & intensive in vivo or imaginal exposure to highly anxiety-evoking stimuli without the opportunity to avoid them

Therapeutic techniques and procedures *Eye Movement Desensitization and Reprocessing (EMDR)

*EMDR is used to help clients restructure their cognitions or to reprocess information. An exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients

Therapeutic techniques and procedures Assertion Training Good for people who have Difficulty expressing anger Difficulty saying "No" Overly polite Difficulty expressing affection Social phobias

Therapeutic techniques and procedures *Self-management strategies 1. Selecting goals measurable 2. Targeting behaviors 3. Self-monitoring client observes their own behavior 4. Working out the plan maintain gains 5. Evaluate ongoing

Psychotherapy Identify goals for change Operationalize the behavior/thoughts separate traits from behaviors Distinguish overt from covert behaviors Obtain a baseline Complete a functional analysis Establish target behaviors to change: Behaviors to increase and to decrease Behaviors should be small, discrete, and chosen based on severity, immediacy, centrality, and potential for success. Develop a behavioral contract with goals and rewards Problem solve about possible obstacles; periodically reevaluate

In behavioral therapy the goals are primarily set by the client

Psychotherapy Assessment Direct behavioral observation (Assessment technique) Behavioral therapists view assessment as a continuous process throughout therapy Treatment A manual based treatment approach refers to treatment that provides a set of techniques to be implemented in a sequential fashion Empirically supported, manual based treatments are consistent with actuarial approaches (actuarial refers to statisticians who compute insurance risks and premiums)

Psychotherapy Techniques (Non-relaxation based) Role Play Physiological monitoring Self monitoring Behavioral Observation Guided imagery Cognitive restructuring (discussed in ch8) Assertiveness training Social skills training Self control techniques Systematic desensitization To treat a client with a phobia, a therapist helps the patient develop a hierarchy of anxiety producing situations and then helps the patient face those situations.

Psychotherapy Behavioral therapists most readily incorporate concepts consistent with the theory of Beck Psychotherapy

Application Anxiety disorders Phobias, Panic Disorders, OCD Sexual Disorders Depression Marital problems Behavioral Medicine Childhood Disorders Behavioral Problems (ADHD, ODD) Eating Disorders

Outcome Studies Behaviorists recommend that treatment outcome be assessed through multiple, objective and subjective measures Research has shown that behavior therapy is highly effective with the eating disorder of bulimia nervosa and may also be effective with the eating disorder termed binge eating disorder Studies assessing the treatment efficacy of cognitive-behavioral therapy (CBT) and imipramine for panic disorder suggested CBT effects were maintained long term.
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Chapter 14 - Experiential Psychotherapy


My Lecture Notes.

Current Psychotherapies. Chapter 14. Experiential Psychotherapy. Author:Alvin R. Mahrer. Instructor: Jeff Garrett Ph.D.

History. Experiential psychotherapy was developed by Alin R. Mahrer. Alvin Mahrer is Professor Emeritus School of Psychology, Universty of Ottawa. Author of 12 books and more than 200 other publications.

Basic Concepts. "The experiential conceptual system is a model that is useful, rather than a theory that is true." Alvin Mahrer. No structured theory of personality. The conceptual system utilized in experiential psychotherapy can generally be thought of as a model of usefulness. No discussion of personality traits, needs, drives, psychodynamics, impulses, psychic defenses, cognitions or core schemas only potentials. Experiential psychotherapy focuses on "potentials". The experiential model of a person is relatively simple, made up of potentials for experiencing. The experiential model views humans as made up of potentials for experiencing. Each person has a unique set of potentials.

Operating Potentials for Experiencing.

In experiential psychotherapy, the concept of a constructed personal world refers to the fact. that the client engages in creating and organizing the meaning of the world. Account for the way an individual behaves, reacts, perceives and constructs their world. These potentials for experiencing are closer to the surface compared to other potentials which are deeper.

Deeper Potentials for Experiencing. Far from the surface. The foundation under operating potentials. Their nature and content are individualized. There are no universal deeper potentials for experiencing, no shared commonality.

Potentials. There are relationships between and among potentials. Potentials may interact effectively. Potentials may also be at odds with one another.

Experiential Psychotherapy. Focus is on ways that people build and construct their external world. The external world presents itself to the person, and the person receives it, applies meaning to it. The external world is available as a resource to chose from and utilize in a manner relevant to the person. The person and the external world can work together to create and build what is important for the person. The person can actively create the kind of external world it is important for the person to experience. Humans build their own personal world to enable their own experiencing. People are building and organizing the external world. This organization represents externalizations of the persons own deeper potentials. Allows the person to experience what is important for the person to experience. Existence consists of providing a safe degree of experiencing of potentials (not too little or too much) and maintaining the present state of integrative-good or disintegrative-bad relationships between potential for experiencing.

How Change Occurs. In experiential therapy, the target of change is the client themselves. When an individual is able to make a qualitative change in the relationships between potentials for experiencing, this is referred to as integration.

When an individual is able to make their deeper potentials become operating potentials for experiencing, this shift is called actualization. An experiential psychotherapist is likely to focus on painful scenes of strong feeling. Movement toward an optimal state requires radical, transformational shifts into becoming a qualitative new person. Experientialists believe a person will remain essentially the same throughout life unless the person is ready, willing and able to undergo a qualitative, radical, transformational shift. Undergoing this shift allows a person to become closer to the optimal person the person is capable of becoming. Core of therapy is a four-step sequence followed in each session. "Each session is a gateway into a whole new state, a radical transformational shift into being what the person can be." Alvin Mahrer.

Methods of Psychotherapy. During an experiential session, the client sits eyes closed and discusses whatever is "out there." During an experiential psychotherapy session, the therapist sits side-by-side with the client both faced forward.

Goals for Each Experiential Session. For a person to become transformed through a radical shift leading to becoming what the person is capable of becoming. For the qualitatively new person to be rid of previous painful scene-situations.

The Sequence of Steps in an Experiential Session. Each session follows the same sequence.

Step 1 Discover the Deeper Potential for Experiencing. Get into a state of readiness for change. Find a scene of strong feeling. Fully live and be in the scene of strong feeling. Discover the moment of peak feeling in this scene. Discover the deeper potential for experiencing in the moment of peak feeling. The Sequence of Steps in an Experiential SessionEach session follows the same sequence.

Step 2 Welcome and Accept Deeper Potential for Experience. Name and describe the deeper potential. React positively and negatively to the deeper potential for experiencing.

Use other methods of welcoming and accepting the deeper potential. The Sequence of Steps in an Experiential SessionEach session follows the same sequence.

Step 3 Being the Deeper Potential for Experiencing Past Scenes. Find recent, earlier, and remote life scenes. Be the deeper potential for experiencing in past scenes. The Sequence of Steps in an Experiential SessionEach session follows the same sequence.

Step 4 Being the Qualitatively New Person in the New World. Find unrealistic new post-session scenes. Be the qualitatively new person in these unrealistic scenes. Find realistic new post-session scenes. Be the qualitatively new person in these realistic scenes. Rehearse being the qualitatively whole new person in these scenes (modify as needed). Be the qualitatively new person in the rehearsed scenes.

Termination. In experiential psychotherapy, the number of sessions the patient has is determined by whether sessions are successfully proceeding through a four-step process.

Ten Things You Need to Know About Experiential Psychotherapy. 1. Experiential psychotherapy was developed by Alvin Mahrer. 2. The conceptual system utilized in experiential psychotherapy can generally be thought of as a model of usefulness. 3. The experiential model of a person is relatively simple, made up of potentials for experiencing. 4. The foundation for operating potentials for experiencing is deeper potentials for experiencing. 5. When an individual is able to make their deeper potentials become operating potentials for experiencing, this shift is called actualization. 6. Welcoming and accepting deeper potentials of experiencing occurs in the existential psychotherapy step two. 7. In the final step of experiential psychotherapy the client becomes a qualitatively new person. 8. During an experiential psychotherapy session, the therapist sits side-by-side with the client both faced forward. 9. Step 1 of an experiential session is to discover the deeper potential for experiencing. 10. Step 2 of an experiential session encourages the individual to welcome and accept deeper potential for experiencing.

(#6, #7, #9, and #10 are sample questions. You know all four steps. I will ask similar types of questions on the exam so that you can demonstrate your knowledge of the sequence of steps in an Experiential Session.)
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2 COMMENTS:

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psychotherapist nyc OCTOBER 5, 2012 AT 1:11 AM

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Chapter 13 - Psychodrama
My Lecture Notes. Current Psychotherapies. Chapter 13. Psychodrama. Author: Adam Blatner. Instructor: Jeff Garrett Ph.D. Basic Concepts. A form of psychotherapy in which clients enact the relevant events in their lives instead of discussing them. In psychodrama clients enact various dimensions of real or imagined life experiences. In contrast to role-playing, psychodrama typically involves more in-depth exploration of emotions. In psychodrama, a patient will enact the events of their lives rather than talk about them. Clients are encouraged to express themselves through dramatization, role playing, and dramatic self-presentation. Verbal and nonverbal techniques are incorporated. History. Pioneered by J.L. Moreno, who got his ideas from watching children playing in the park in Vienna The inspiration for psychodrama originally came from the natural play of children. In psychodrama, action sociometry techniques are often used and this is similar to the sand tray techniques, which are used in play therapy. Psychodrama developed out of Moreno's ideas about social arrangements and how they enhance social interactions, which he termed sociometry. Dramatic enactments have been used to express feelings/ideas and to heal throughout history. Moreno integrated his interests in storytelling, dramatics, medicine and applied sociology. Initial concepts for psychodrama resulted from Morenos vision of social arrangements which enhanced social interactions (sociometry).

Moreno organizes Theater of Spontaneity which played out daily news events. In 1925 Moreno immigrated to US. In 1931 Moreno coins the term "group psychotherapy" during an APA presentation. In the 1930s Morenos ideas began to be tested clinically. Moreno published several of his own journals (Sociometry, Sociatry, Group Psychotherapy, International Journal of Sociometry and Sociatry). From the 1940s to the 1970s J.L. Moreno and Zerka Moreno traveled widely to disseminate the approach. American Society of Group Psychotherapy and Psychodrama (ASGPP). Founded in 1942 by J.L. Moreno. The pioneer membership organization in group psychotherapy. Organization focuses on ongoing developments in group psychotherapy and psychodrama. Current Status. Zerka Moreno continues to disseminate information about psychodrama. American Society of Group Psychotherapy and Psychodrama (ASGPP) can be accessed at http://www.asgpp.org/ . Journal of Group Psychotherapy, Psychodrama & Sociometry continues as main publication. The approach continues to be refined although proponents of psychodrama believe the therapy does not receive the attention is should in textbooks on therapy. Psychodramas Theory. Can be applied to an individual (psychodrama) or a group (sociodrama). Goals are to facilitate insight, personal growth, and integration on cognitive, affective, and behavioral levels. Role dynamics are crucial to psychodrama. Role refers to any function in a complex system. Focus is on the practical application of social role theory. An advantage of role theory over other theories is its framework for exploring interpersonal events. Moreno's definition of "encounter" included an honest, direct dialogue and willingness to appreciate another's viewpoint. Moreno believed that by becoming more aware of the roles we played we could play the roles more creatively. Role Theory offers a common language which psychodrama made more user friendly. Role dynamics offers a theoretical framework. Moreno's definition of catharsis involves abreaction followed by integration. Various roles or parts played. Meta-role, the role beyond the roles, which defines how the roles are played. Key Concepts. Spontaneity.

Playfulness. Self-expression. Drama. Dimension. Sociometry. Warming up. Physical action. The group. Social. Rapport. Psychopathology. Role dynamics attend to past, present, and future. Psychological disturbance seen as resulting from conflicts but also from individuals not having mastered role components or skills. Theory also recognizes that an individual might be healthy but disturbed because they are enmeshed in dysfunctional systems. Also focuses on idea that some roles are overdeveloped and others are underdeveloped. Psychopathology. Psychological disturbance seen as resulting from conflicts but also from individuals not having mastered role components or skills. Theory also recognizes that an individual might be healthy but disturbed because they are enmeshed in dysfunctional systems. Also focuses on idea that some roles are overdeveloped and others are underdeveloped. Other roles are invalidated or neglected by a family, a culture or society. Psychotherapy. The "heart" of psychodrama is role reversal. If a protagonist is asked to step out of a scene and then the auxiliary replays how the protagonist was behaving the director is using the mirror technique. Role reversal develops the capacity of empathy. Moreno's definition of "encounter" included an honest, direct dialogue and willingness to appreciate another's viewpoint. Restorative drama focuses on creating corrective emotional experiences. Moreno called the human tendency to avoid engagement and rely on what has already been created a cultural conserve. Psychotherapy. Roles of Group Members. Protagonist person(s) selected to "represent the theme" of group. The psychodrama participant who is the focus of the current psychological exploration is the protagonist. Auxiliary Group members who assume the roles of significant others in the drama. In psychodrama, the auxiliary refers to the

individuals playing supporting roles. Using an auxiliary during psychodrama affects transference by directing it toward original sources. Audience Group members who witness the drama and represent the world at large. The Stage The physical space in which the drama is conducted. Director The psychodramatist who guides participants throughout the psychodrama. Three Distinct Phases. There are 3 distinct phases in a psychodrama, which include warm-up, action, and sharing. 1. Warm-up Group theme is identified and protagonist is selected. Prior to a psychodrama the group participates in activities to increase involvement. This phase is known as warming up. 2. Action Problem is dramatized and protagonist explores new methods of resolving problem. 3. Sharing Group members are invited to express their connection with the protagonists work. Multiple factors are used in psychodrama. Engaging a creative attitude. Warming-up. Catharsis. Insight. Empathy. Cognitive orientation. Corrective experience. Psychotherapy. Multiple factors are used in psychodrama. Transference. Simulation. Spirituality. Role reversal. Mirroring. Doubling. Concretizng. Maximizing. Application. Methods are applicable to almost all types of problems. Can be used as an adjunct to individual psychotherapy and group therapy. Family sculpting can add to family therapy.

Supports a comprehensive recovery process for addiction. Trauma and grief. Cross cultural dynamics. Day to day group interactions (business, schools, religious, self help). Complex psychodramas should not be used with the following types of problems (acute psychosis, high anxiety, early withdrawal from alcohol or drugs, individuals with limited cognitive capacity).

Ten Things You Need to Know About Psychodrama 1. Psychodrama was pioneered by J.L. Moreno. 2. In psychodrama clients enact various dimensions of real or imagined life experiences. 3. In psychodrama, the auxiliary refers to the individuals playing supporting roles. 4. The psychodrama participant who is the focus of the current psychological exploration is the protagonist. 5. The "heart" of psychodrama is role reversal. 6. Prior to a psychodrama the group participates in activities to increase involvement. This phase is known as warming up. 7. In a psychodrama, protagonist is the individual selected to represent the theme of the group. 8. The three distinct phases of psychodrama are warm-up, action, and sharing. 9. J. L. Moreno is credited with coining the term group psychotherapy. 10. Psychodrama, a patient will enact the events of their lives rather than talk about them.
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Chapter 12 - Family Therapy - Update 11/8/07


Current Psychotherapies Chapter 12 Family Therapy Authors:Irene & Hebert Goldenberg Intructor: Jeff Garrett Ph.D.

Major Family Therapy Approaches Object Relations. (Framo and Scharff). Experiential. (Satir and Whitaker). Transgenerational. (Bowen). Structural. (Minuchin). Strategic. (Haley). Cognitive-Behavioral. (Beck and Ellis). Social Constructionist. (deShazer and Anderson). Narrative. (Michael White).

1. Object Relations. (Framo and Scharff). Satisfying relationship with some object (e.g., parent) is a fundamental need. Help client gain insight into early relationships (objects from past) and how it affects current relationships enabling individual development and fullfilling relationships.

2. Experiential. (Satir and Whitaker).

Troubled families need a growth experience derived from an intimate interpersonal experience (therapy). By being real (authentic) and disclosing families learn to be more honest, more expressive, and better able to achieve personal and interpersonal growth. For Satir, building self-esteem and learning to communicate openly are essential goals. Whitaker helping family members probe their own world of symbolic meanings frees them to activate innate growth processes. Example of this approach is: Emotionally-Focused Couple Therapy

3. Transgenerational. (Bowen). Thinking, feeling, and behaving are tied to the family system. The individuals problems arise and are maintain by relationship connections. Problems are passed from one generation to the next Fusion most vulnerable Differentiation of self least vulnerable

4. Structural. (Minuchin). Focused on how families are organized and what rules govern their transactions. Pays attention to rules, roles, alignments, coalitions and boundaries. Challenges rigid, repetitive transactions within a family, helping to unfreeze them and allow family reorganization.

5. Strategic. (Haley). Assigns tasks to get family to change aspects of the system that maintain problematic behavior. Paradoxical interventions are employed to force clients to abandon symptoms. NOT interested in providing insight.

6. Cognitive-Behavioral. (Beck and Ellis). Maladaptive behaviors can be extinguished as the contingencies of reinforcement are altered Communication skills Parent training skills Cognitive restructuring

7. Social Constructionist. (deShazer and Anderson). Each of our perceptions is not an exact duplication of the world, rather, a point of view seen through the limiting lens of our assumptions about people.

Jointly construct new options that change past accounts and allow new alternatives.

8. Narrative. (Michael White). Our sense of reality is organized and maintained through stories. Families present with negative, dead-end stories. The goal is to explore alternative stories, make new assumptions, and open up new possibilities by re-authoring stories.

Variety of Concepts.

Cybernetic Epistemology. lCybernetic Epistemology. A study of communication and control processes. lCybernetic is a word that describes a regulatory system that operates by means of a feedback loop. Example Thermostat (dynamic equilibrium) Family homeostasis. Circular (not linear) causality.

Two Types of Systems. 1. Open systems.Allow new information in.Preferable to closed ones.Allow situations to be seen from different perspectives. 2. Closed Systems.Have varying degrees of inner circles.Those outside the system are viewed as having nothing to contribute (e.g., they wouldnt understand the way we do things).

Concepts. Family structure. Invisible set of functional demands that organize the ways in which family members interact.Operates through transactional patterns.

Transactional patterns. Repeated transactions establish patterns of how, when, and to who to relate. Boundaries.Rules defining in a system who participates, how and when.Determines the systems sub-systems (i.e., each family structure). Continuum ranges from diffuse (enmeshment) to rigid (disengagement).

Sub-system. Individuals belong to different subsystems, with different levels of power and skills.

Dysfunction. A deviation from the healthy and normal.Dysfunction occurs when one of the following occurs. Rigid, diffuse or unclear boundaries coalitions formed against third party.Coalitions cross generational boundaries.Denied or concealed coalition.

Adaptation. Developmental changes within a family requiring alteration of boundaries.When adaptation does not occur it results in dysfunction.

Basic Family Therapy Concepts across All Schools of Thought.

Gender sensitive outlook. Stresses importance of not reinforcing stereotypical sexist or patriarchal attitudes.

Culturally sensitive therapy. Requires cultural competence.Therapist must remain aware of their own cultural filters and respect the cultural filters of the family being treated.

Differences between Family Therapy and Other Approaches.

Individual and family approaches have blended together considerably. Main difference remains the degree of focus on the family unit.

History.

Background. Early approaches focused on the individual (personality, internal, subjective). Treatment therefore focused on neurotic conflicts and destructive interactions in the family of origin. Individuals were treated separately from the families. Family therapist hypothesized psychological problems were developed and maintained in the family context. Personality was viewed as related to reciprocal interactions with others. Psychological dysfunction explained in terms or circular, recursive interpersonal events.Most instrumental events.

Research on family dynamics and the etiology of schizophrenia.

Studies of small group dynamics. Developments within social work. Child guidance movement. Marriage therapy practices. Elements of group dynamics relevant to family therapy.

Kurt Lewins research speculating that a group is more than the sum of its parts. Interdependence among group members seen as a stabilizing factor for maladaptive behaviors. Distinction between the process (how ideas are communicated) and content (what is said) of group. Discussions acting out familial conflicts with the group instead of discussing them. Instructing group members to imagine that the group is their family of origin to allow. unresolved family issues to be known.

Impact of the child guidance movement. Child guidance clinics were established on the premise that psychological problems began in childhood. View focused on early intervention. John Bowlby theorized childrens symptoms were often the result of family distress. Began conjoint interviews. Impact of the field of social work. Social workers often make home visits. Training centered around interviewing each individual family member to gain a comprehensive picture. Many social workers became family therapist.

Current Status.

Eight major current approaches listed in the Basic Concepts section above.

Variety of Major Approaches.

Family Therapy Approaches do not subscribe to a theory of personality per se.

Virginia Satir. Described family roles that serve to stabilize expected characteristic behavior patterns in a family. Examples: If one child is the bad child, a sibling may take on the role of the good child to alleviate family stress. Role reciprocity underscores why family dynamics are resistant to change.

Salvador Minuchin. Society acts as if all family violence is instrumental, and the response therefore is to increase control. But it is clear to us as family therapists that most cases of family violence are the products of generations of powerlessness. When we try to intervene by controlling the parents or with concern for the child alone, we can only produce a continuation of the pattern.

Salvador Minuchin. Founder of Structural Family Therapy (described in the Basic Concepts section). Author of the classic Families and Family Therapy (1974).

Jay Haley. Trained under the supervision of hypnotherapist Milton Erickson. Developed a brief therapy model which focused on the context and possible function of the clients symptoms. Utilized directives to instruct clients to act in ways that were counterproductive to their maladaptive behavior. Focus on clients actively doing something about their problems rather than understanding why they had problems. Haley was instrumental in bridging gap between strategic and structural approaches to family therapy. Explored concepts related to triangular and intergenerational relationships. Clients symptoms seen as the result of incongruence between manifest and covert levels of communication. Symptoms gave client a sense of control in their interpersonal relationships. Therapy should focus on client taking responsibility for their actions and to take a stand (i.e., therapeutic paradox).

Family Therapy. Assumes an individual is understood best in the context of the family. Families have a structure (how it is organized) and functions (how it meets members needs). Healthy families have a clear, flexible power structure with the most competent members having the most power. Dysfunctional families and often disengaged (isolated from one another) or enmeshed (overly involved with one another). Families which are cohesive and adaptable best serve the functions of members. Family systems attempt to achieve homeostasis (e.g., if mom and dad are in conflict a child may develop a problem to shift the focus). Multigenerational transmission of both strengths and problems are common (i.e., grandmother, mother, daughter, all have been sexually abused).

Family Therapy and Psychosis. Lidz studied families where a parent and child formed a relationship to the exclusion of the other parent which blurred boundaries. Hypothesized this type of relationship was a precursor to schizophrenia. Lidz referred to 2 schizogenic families.

Lidz Two schizogenic families

1. Marital schism. Family in a constant state of disequilibrium through repeated threats of parental separation.o Communication masks conflicts.o Parents disqualify each other and join with children excluding the partner.

2. Marital skew. a. Distorted parental relationship. b. Relationship is not under threat, due to one excessively powerful and dominant person.

Pseudo-mutuality and Pseudo-hostility Wynne described family communication patterns which lead to perceptual and thought disorders as they denied reality of feelings. Disjointed or fragmented communication leads to disrupted interactions. Pressure is put on the child to maintain the faade to avoid meaningless of family relationships. Pseudo-mutuality - A faade of togetherness. Absorbed with fitting together at the expense of developing separate identities. Pseudo-hostility quarreling that is merely a superfical tactic for avoiding deeper and more genuine feelings. A way of maintaining connection without becoming either deeply affectionate or deeply hostile to one another.

Double-bind relationship Bateson described the Double-bind relationship. Communication which leads to mixed messages. Repetitiveness leads to a unique learning experience in which the messages recipient cannot escape and cannot comment. Leads the individual to lose their capacity to discriminate between the different levels of communication provoking psychosis.

Mystification. Process that occurs when on or more family members fail to understand the meaning or the purpose of communication from another member. The communication received is often deliberately vague. The vague communication places the mystified persons in an inferior position.

Triangulation. Occurs when a third person is brought into a dyadic relationship to de-intensify a disput between two people (generally parents). Communication occurs through the third person. The third person often hears negative comments about the individuals involved in the dispute. When triangulation occurs, two people need to be communicating directly, but enmesh a third person so as to avoid any direct communication.

The Elephant in the Room. The problem that no one wants (or dares) to talk about. Problem is clearly visible to all involved. Fear of retaliation or negative

consequences and shame often keep individuals from discussing the problem. Self blame is common. Enablers continue to allow the problem to exist and not be discussed.

Lack of Differentiation. Autonomy is important for all individuals. Autonomy represents the degree of independence that an individual needs to function apart from others in a system. Fusion is the absence of differentiation. Lack of differentiation leads to enmeshment with others.

Scapegoating. Families often scapegoat on individual for all the familys problems. The person scapegoated may have difficulties but is unduly blamed as they are often displaying the symptoms of an unhealthy family environment or have a bona fide illness. Lesser forms of scapegoating occur when every failure or conflict is pinned on an individual. Scapegoating rarely takes into consideration any other factors. e.g, Drinking is a conflict area where the couple can complain about each other endlessly with no demand for change Through the years of Lars drinking has become the cause of all family problems. This fixing of causality on the behavior of one person blurs the nature of the other family transactions. Salvador Minuchin.

Lack of Boundaries. All individuals need boundaries. The absence of boundaries produces unclear limits. Without boundaries abuse can easily occur. Families often have no boundaries in some areas and very rigid boundaries in other areas. Without boundaries humans are unable to emotionally relate to others or set reasonable limits on others.

Techniques.

Examples of Structural Family Therapy Techniques. Goal is to restructure the family system to create clear and flexible boundaries. Joining therapist utilizes familys language/styles of communication to form a nonjudgmental partnership.

Focusing Exploring specific areas.

Enactment Therapist has family enact an interaction to enable the family to try different ways of interacting. Intensification Therapist increases emotional aspects of interactions transaction by a variety of means. Unbalancing Conscious attempt to form coalition with one member against another or supporting one member at the expense of another to throw the family system off balance.

Examples of Milan Systemic Family Therapy Concepts and Techniques.

Neutrality - Therapist is an observer and remains neutral. Hypothesizing educated guess about symptoms in context. Circular questioning - designed to elicit differences. What is the symptom the client presents? What is it there for? What function does it serve? What is the context of the symptom i.e., what is happening when the symptom occurs? Why then? Why this symptom? Who can make it better? Who makes it worse? Who is affected by the symptom? How does the symptom affect the family and how does the family affect the symptom? Paradoxical Prescription Symptoms of the client and family are positively connoted. Therapist prescribes the symptom (more of the same) to create a paradoxical effect.

Family Therapy Psychoeducation Approaches. Focus is on manageable tasks and strengths. Therapist empathizes with family and normalizes events when feasible. Educating families about illness. Communication training. Problem-solving. Formulating a detailed plan. Operant-conditioning strategies. Family education regarding diagnosis, symptoms, causes, treatment, and prognosis of illness as well as impact on family.

Application. Marital conflict. Parent-child conflict. Child abuse. Family problems with co-occurring mental disorders such as depression, anxiety, substance abuse.

Twenty Things You need to Know about Family Therapy

1. Nathan Ackerman wrote The Psychodynamics of Family Life. It is viewed by many as the first text defining the field of family therapy.

2. The individual identified with strategic family therapy is Jay Haley

3. The founder of structural family therapy is Salvador Minuchin

4. A family therapist will typically ask the entire family to attend the initial session.

5. A family therapist interacts in a manner that is active, empathic and balanced

6. Family therapists shift the locus of pathology from individuals to family systems

7. Viewing interactions as reciprocal suggests causality is circular

8. Family systems which allow new information in and individuals within the family to see things from different perspectives are called open systems.

9. The manner in which a family arranges, organizes, and maintains itself is known as its: Structure

10 A genogram is a family tree diagram of generational behavior patterns

11. When a third person is brought into a dyadic relationship to deal with a conflict, this is termed Triangulation

12. A family therapist asks each member of a family sequentially to pose the other family members in physical space as a representation of their view of the family. This technique is known as family sculpting

13. An example of Double-bind communication would be: A parent tells a child "I love spending time with you" while nonverbally appearing annoyed.

14. Designing interventions that are paradoxical in nature is known as therapeutic double-binds

15. Family therapists would often say that the identified patient in a family has been scape-goated by the family as the family blames them for the family's problem.

16. In family therapy the term "identified patient" conveys that a symptomatic family member expresses family dysfunction

17. Assuming a child's tantrum occurs because parents reinforced the behavior would be consistent with a Behavioral theoretical orientation

18. When parents are overly involved in the life of their and the boundaries within the family are diffuse. This family would be described as enmeshed

19. Rigid boundaries that permit limited emotional contact between members characterize families that are disengaged

20 In systems terms, family boundaries yield systems that exist along an open/closed continuum.
POSTED BY JGARRETT43MU AT 9:51 AM

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family therapy massachusetts JANUARY 20, 2013 AT 7:18 PM

Jackie Champion said... Hello! I'm glad to stop by your site and know more about family therapy. This is a good read. Keep it up! I will be looking forward to visit your page again and for your other posts as well. Thank you for sharing your thoughts about family therapy in your area. Family therapy journals include Family Process. A couple or family concurrently experience a traumatic event.

family therapy massachusetts JANUARY 21, 2013 AT 7:56 AM

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Chapter 6 - REBT

My Lecture Notes Current Psychotherapies Chapter 6 Rational Emotive Behavior Therapy Albert Ellis Instructor: Jeff Garrett Ph.D.

Basic Concepts of REBT Practical and symptom focus Philosophically based but techniques have empirical support Requires collaboration with client Clients change through identification of irrational thoughts Clients behavior and thought processes are evaluated Stresses thinking, judging, deciding, analyzing, and doing Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship Is highly didactic, very directive, and concerned as much with thinking as with feeling Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

Basic Propositions of REBT People have the potential to be rational, self preserving, creative, functional and to use metathought OR to be irrational, selfdestructive, short-range hedonists Culture and family can perpetuate irrational thinking Humans perceive, think, emote and behave simultaneously All psychotherapies are not equally effective Ellis implies that highly cognitive, directive therapies requiring tasks and discipline are likely to be effective in a shorter time period with less sessions required A warm therapeutic relationship may be desirable but it is not necessary or sufficient condition for change REBT Therapists use a variety of techniques - the focus is not symptom removal but cognitive and behavioral change Neurotic thinking is the result of unrealistic, illogical thinking The causes of an individuals problems are not the events that have happened but how the individual perceives them There is an element between stimulus and response; it is thought

S -> thoughts -> R REBT holds that beliefs mediate events and emotions REBT provides clients with methods for changing irrational beliefs

Comparing REBT with Psychoanalysis REBT does not focus on free association, complex history taking, dream analysis or sexual conflicts Transference is seen in REBT as resulting from irrational thoughts REBT employs persuasive and directive techniques If transference occurs a REBT therapist is likely to relate it to the client's irrational beliefs In REBT the unconscious is viewed as virtually meaningless as most elements can be brought into conscious

Comparing REBT with Adlers Theory The most salient similarity between REBT and Adlerian psychotherapy is the emphasis on basic mistakes Departs from Adler regarding emphasis on past memories, social interest REBT is more future oriented and behavioral

Comparing REBT to Jungian Therapy Both types of therapy are holistic REBT views the Jungs focus on dreams, fantasies, symbols or archetypes as a "waste of time"

Comparing Cognitive Therapy with REBT In CT thoughts are labeled dysfunctional In REBT thoughts are labeled irrational CT therapists are more collaborative REBT therapists are more confrontational CT less aggressive REBT more aggressive The most significant difference between REBT and Cognitive therapy (CT) therapist's forcefulness in disputing beliefs Both CT and REBT use psychoeducation

Comparing REBT and Behavior Therapy REBT focuses more on cognitive aspects REBT is more similar to CT and Multimodal Therapy than BT

History REBT developed by Alfred Ellis After two decades of practicing psychoanalysis he became increasingly disillusioned by the limited progress clients were making 1957 published How to live with a Neurotic 1975 published A New Guide to Rational Living which continues to be one of his most popular books 1977 published Handbook of Rational-Emotive Therapy

Current Status Albert Ellis institute established in 1959 teaches principles of healthy living Journal of Rational-Emotive Therapy and Cognitive Behavior Therapy reports latest findings. Research Supports Several REBT Principles Thoughts and feelings are not two disparate processes Beliefs are more important than events Metathought occurs (often captured in images) Changing thoughts, behaviors, or emotions changes other modalities

Personality Basic tenet of REBT is that emotional upsets, as distinguished from feelings of sorrow, regret, annoyance, and frustration, largely stem from irrational beliefs Problematic beliefs center around words/concepts like should, ought, awful, must, I want, I need This is the basic personality theory of REBT Humans largely create their own distress

Ellis agrees with Freud that the pleasure principle drives behavior Ellis agrees with Horney and Fromm that cultural and family influences impact peoples irrational thinking Ellis agrees with Adler that fictitious goals order peoples lives Ellis agrees with Pavlov that cognitive conditioning occurs Ellis agrees with Piaget that active learning is more effective than passive Ellis agrees with Anna Freud that people refuse to acknowledge mistakes and resort to defenses Ellis agrees with Maslow and Rogers that humans have great untapped recourses

Personality View of Human Nature We are born with a potential for both rational and irrational thinking

Ellis suggests humans have an innate nature to want, need and condemn when needs aren't met If an individual's needs aren't met they display a tendency to childishly condemn themselves, others and the world Ellis contends that we are self-talking, self-evaluating, and self-sustaining. We have an inborn tendency toward growth and actualization We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk We have the capacity to change our cognitive, emotive, and behavioral processes

View of Emotional Disturbance REBT views emotional disturbances as the result of irrational thinking and behaving. We learn irrational belief from significant other during childhood REBT therapist teach clients to feel "undepressed" even when they are unaccepted and unloved by significant others. Blame is at the core of most emotional disturbances Irrational idea (e.g., I must be loved by everyone) internalize self-defeating We have a tendency to make ourselves emotionally disturbed by internalizing self-defeating beliefs REBT hypothesizes that we keep ourselves emotionally disturbed by the process of self-indoctrination REBT holds that neurotic problems directly stem from magical, "unvalidated" thinking

The solution for dealing with an individual's demandingness most strongly supported by REBT is decreasing demandingness

The ABCs (and D) of Emotion REBT refers to the ABCD. ABCD stands for, activating events, beliefs, consequences (or consequent emotion), and dispute In challenging an individual's thought processes, REBT would use persuasion and directive The A-B-C Theory of Personality

A does not equal C

A+B=C

D = Dispute

Is this statement/idea/belief true?

Is it healthy? Is it helpful? Is it realistic? Is it logical? Is it rational?

Case Discussion 1 Tom, a college sophomore, want to overcomes his shyness around women. He does not date and even does his best to keep away from women because he is afraid they will reject him. But he want to change this pattern. Using the ABCs of Emotion analyze and help Tom

Case Discussion 2 Mary would like to take a course in creative writing, but she fears that she has no talent. She is afraid of failing, afraid of being told that she is dumb, and afraid of follow through with taking the course. Using ABCs of Emotion to analyze and help Mary

Case discussion 3 Brent feels that he must win everyones approval. He has become a "super nice guy" who goes out of his way to please everyone. Rarely does he assert himself, for fear that he might displease someone who then would not like him. What are the possible irrational beliefs? How do you help Brent? If Brent is Asian American, what cultural components you might take into account?

Irrational Ideas Irrational ideas lead to self-defeating behavior Some examples: "I must have love or approval from all the significant people in my life." "I must perform important tasks competently and perfectly." "If I dont get what I want, its terrible, and I cant stand it."

Ten Common Irrational Ideas I should be loved and approved by significant others and live up to their expectations.

I must be highly competent, adequate, intelligent and achieving before I can me happy. When people act unfairly I should blame them and view them as bad people. It is a terrible catastrophe when I am rejected, treated unfairly, and things arent as I would like them. Since my feelings are caused by external factors, I have little or no ability to control or change them. I should be greatly concerned about dangerous and fearful things and must center my attention on them until the danger has past. I can handle difficulties and responsibilities better by avoiding them than by facing them. People and things SHOULD turn out better than they do, and when they dont I should see them as awful, terrible, etc. My past remains all-important, and must influence my feelings and behavior now because it once did. I can achieve maximum happiness by inaction or by passively enjoying myself.

The Therapeutic Process Therapy is seen as an educational process Clients learn To identify and dispute irrational beliefs To replace ineffective ways of thinking with effective and rational cognitions To stop absolutistic thinking, blaming, and repeating false beliefs

Therapeutic Goals A basic goal is to teach clients how to change their dysfunctional emotions and behaviors via cognitive and behavioral methods into healthy ones. Two main goals of REBT are to assist clients to achieving unconditional self-acceptance and unconditional other acceptance. As clients become more able to accept themselves, they are more likely to unconditionally accept others.

Therapists function and Role 1. Encouraging clients to discover their irrational beliefs and ideas 2. Making connection of how these irrational beliefs lead to emotional disturbances 3. Challenging clients to modify or abandon their irrational beliefs. 4. Dispute the irrational beliefs and substitute rational beliefs and behaviors. 5. Displaying warmth toward clients may be desirable but it is not necessary.

Clients Experience in Therapy Client is a student and learner--- the client learns how to apply logical thoughts, experiential exercises, and behavioral homework to problem solving and emotional change. Focus on here-and-now experiences Does not spend much time to exploring clients early history and connecting present and past Expect to actively work outside the therapy sessions.

Relationship Between Therapist and Client The role of the client in rational emotive behavior therapy is like that of a student and a learner Relationship Between Therapist and Client Intensive therapeutic relationship is not required. But, REBT therapist unconditionally accept all clients and teach them to unconditionally accept others and themselves. (therapists accepts them as persons but confront their faulty thinking and selfdestructive behaviors) Ellis believes that too much warmth and understanding can be counter-productive, fostering dependence for approval.

Relationship Between Therapist and Client Therapists shows great faith in their clients ability to change themselves. Open and direct in disclosing their own beliefs and values Transference is not encouraged, when it occur, the therapist is likely to confront it (e.g., clients believe that they must be liked and loved by their therapists.) Therapeutic techniques and procedures

Cognitive methods Disputing irrational beliefs If I dont get what I want, it is not at the end of the world Doing cognitive homework Applying ABC theory in daily lifes problems Put themselves in risk-taking situations to challenge their self-limiting beliefs. Replace negative self-statement to positive message

Changing ones language It would be absolutely awful.. It would be inconvenient Using humor

Emotive Techniques Rational-emotional imagery Imagine the worst things that could happen to them Role playing Shame-attacking exercises Take a risk to do something that they are afraid to do because of what others might thinkuntil they realize that their feeli ngs of shame are self-created. Use of force and vigor From intellectual to emotional insight Reverse role playing

Behavioral Therapy Use most of the standard behavioral therapy approaches. PersonalityWays Individuals Alleviate Pain Distraction Shame Attacking Exercises

Demandingness

Leads to less demands of others Individual becomes less anxious Palliative (soothing) Satisfying Demands If demands are catered to, the individual feels better but does not get better Therapist can give love and approval; provide pleasurable sensations Ultimate impact is demandingness is reinforced. Magic and Mysticism

Magical solutions are often offered to children and even to adolescents and adults Generally magical solutions only temporarily placate the individual

Main Goals of REBT The primary goal of REBT is the alteration of basic values and beliefs REBTs goal is to achieve minimal demandingness and maximal tolerance Although temporary, palliative techniques may be used in REBT but the main goal is for more permanent solutions Goal is minimization of musturbation, perfectionism, grandiosity, and low frustration tolerance In therapy, REBT teaches patients to differentiate between those items they want or desire and musts REBT assist client in seeing how giving up perfectionism improves their lives REBT aims at changing habits as well as cognition through cognitive and behavior techniques

Psychotherapy REBT helps clients acquire a more realistic, tolerant philosophy of life REBT practitioners often employ a rapid-fire active-directive-persuasive-philosophical methodology The solution for dealing with an individual's demandingness most strongly supported by REBT is decreasing demandingness

Psychotherapy REBT Therapist Stress only hard work and practice will correct irrational beliefs self defeating behavior is past related but maintained by present beliefs current distress results from self continuation of irrational beliefs

Mechanisms of Psychotherapy The focus is on the clients irrational beliefs REBT therapists do not hesitate to contradict the clients beliefs and is often one step ahead while showing acceptance REBT therapist teaches the client to think and act differently - sometimes therapist may do more talking than the client Therapists do not merely tell clients that their thoughts are irrational but attempts to encourage clients to see this for themselves

Application of REBT Depression Anxiety Psychosis Bipolar Autistic Anger management Stress managment Children Problems with love, sex, and marriage Couples and marriage and family counseling Prevention Research from CT supports the basic premise of REBT
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Chapter 5 - Person-Centered Therapy.


Lecture Notes. Current Psychotherapies. Person-Centered Therapy. Chapter 5. Nathaniel J. Raskin &Carl R. Rogers. Instructor: Jeff Garrett Ph.D.

Key Points and Terms. Developed by Carl Rogers. Also termed Client-Centered. Humanistic, or Phenomenological Therapy . The person is viewed as creative, responsible, developing individual. By providing a therapeutic atmosphere which is real, caring, and non-judgmental the person can develop their full potential.

Challenges: The assumption that "the counselor knows best". The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation. The belief that clients cannot understand and resolve their own problems without direct help. The focus on problems over persons.

Emphasizes: Therapy as a journey shared by two people. The persons innate striving for self-actualization. The personal characteristics of the therapist and the quality of the therapeutic relationship. The counselors creation of a permissive, "growth promoting" climate. People are capable of self-directed growth if involved in a therapeutic relationship. Person-Centered Therapy is a form of humanistic therapy.

Rogers Basic Assumptions. Rogers believed in an actualizing tendency in all human beings. Represented movement towards the realization of the individuals full potential. Viewed as part of a formative tendency. Formative tendency represents movement toward order, complexity and interrelatedness. Seen across aspects of nature including the stars, crystals, microorganisms and humans.

Basic Requirements for the Therapeutic Environment (Therapist). Genuineness/Congruence. Correspondence between the therapists thoughts and their behavior. Unconditional Positive Regard. Therapists regard/attitude remains unaltered regardless of the patients choice. Empathy. Profound interest and car for the patients perceptions and feelings.

Basic Requirements for the Therapeutic Environment (Client). Self-concept. At therapy onset, self regard/self-esteem often low. Improvement correlated with success in therapy.

Locus-of-Evaluation. At therapy onset, focus on what others think. Progress associated with internal locus-of-evaluation. Experiencing. At therapy onset, rigid; Success related to flexibility.

Six Basic Premises of Humanistic Psychology. Hereditary, environment and creative power are crucial forces. Anthropomorphic model preferred. Purpose is the decisive dynamic. Holistic approach most adequate. Human subjectivity critically important. Psychotherapy is based on good relationship.

Distinctive Components of Person-Centered Therapy. Therapists attitude can be necessary and sufficient conditions for change. Therapist needs to be immediately present and accessible to clients. Intensive, continuous focus on patients phenomenological world. Process marked by clients ability to live fully in the moment. Focus on personality change, not structure of personality.

Comparing Person-Centered Therapy with Other Approaches. Language Common Sense (PC). Esoteric (Psychoanalysis). How to Understand. The individual Subjective Interpersonal (PC). Objective intrapersonal (Psychoanalysis). Emphasis Purpose (PC). Causality (Psychoanalysis). Characterization. Of the individual Holistic (PC). Reductionistic (Psychoanalysis).

View of Human. Nature People can be good or bad (PC). People are bad (Psychoanalysis).

Role of Therapist Facilitate self discovery (PC). Interpretation for the client(Psychoanalysis).

View of Transference Not central to the clients ability to change (PC). Fundamental to the change process (Psychoanalysis). Presentation Of Therapist A caring person who is willing to listen (PC). Authority, teacher (Psychoanalysis).

Differences between PC and REBT. PC places greater value on relationship. PC is more client directed. PC is more accepting of clients perceptions. PC therapist typically relates to clients on a feeling level.

Difference between PC Therapist and Behavior Therapist. PC would argue that behavioral changes occur through internal factors whereas behavioral therapy sees behavior changing through external factors.

Similarities between PC and REBT. Great optimism in the ability of people to change. Perception that individuals are often overly self critical. Willingness to put forth great effort to help people. Respect for science and research.

History of PC Therapy. Carl Rogers was born 1902, Oak Park Illinois.

Family emphasized strong work ethic, responsibility and the fundamentals of religion. Graduated 1924 from University of Wisconsin. Started at the Union Theological Seminary then transferred to Teachers College, Columbia University. Worked for 12 years at a Child-Guidance Center. In 1939 published Clinical Treatment of the Problem Child. Offered professorship at Ohio State University. 1940 Rogers presented Some Newer concepts in Psychotherapy at the University of Minnesota (viewed by most as the birth of Client-Centered Therapy). Published Counseling and Psychotherapy in 1942. During WWII served as Director of Counseling Services for the US Organizations. Served as head of University of Chicago Counseling Center (12 years). In 1957, Rogers published classic paper on "necessary and sufficient conditions" for therapy. Rogers died in 1987 .

Current Status of PC Therapy. Special interest of Rogers was application of his theory to international relationships. Since 1982 Biennial International Forums on PC approach. Workshops at Warm Springs. Person-Centered Review began to be published in 1986 (renamed The Person-Centered Journal).

Theory of Personality - 19 Propositions. 1. Individual is center of a continually changing world of experience. 2. Organism reacts based on their reality. 3. Organism reacts as an organized whole. 4. Organism has one basic tendency actualization. 5. Behavior is goal directed based on perception of reality. 6. Emotion accompanies and facilitates goal directed behavior. Theory of Personality19 Propositions. 7. Best point to understand behavior is from the individuals frame of reference. 8. Part of the perceptual field is differentiated as the self. 9. Self is formed through interaction. 10. Values come from experience and introjection from others. 11. Experiences are integrated, ignored, or denied.

12. Behavior is generally consistent with self concept. 13. Behaviors inconsistent with self concept can occur but are seen as "not owned". 14. Psychological maladjustment comes from denied experiences. Theory of Personality19 Propositions. 15. Psychological adjustment occurs when experiences are assimilated. 16. Inconsistent experiences are threats. 17. Under the right conditions inconsistent experiences can be examined/assimilated. 18. When the individual integrates in all of their experiences they are more understanding of others. 19. As experiences are integrated an internal locus-of-evaluation develops.

Rogers Theory of Personality Summarized. Behavior is best understood through the individuals reality (perception of experiences). For social purposes, reality is defined as common perceptions across individuals. Personal growth occurs through decreased defensiveness. Self actualization is the organisms one, basic tendency (Rogers believed an organism has one basic tendency and striving which is to actualize, maintain and enhance the experiencing organism. Experiences inconsistent with self concept are threats leading to increased rigidity. Therapy allows the individual to accept and integrate all of their experiences. In Roger's personality theory, behavior is defined as a goal directed attempt to satisfy an organism's needs.

Other Concepts. Experience is the private world of the individual. Reality basically refers to the private perceptions of the individual; Social consists of perceptions that have a high degree of commonality among individuals. Self is the organized gestalt of "I" and "me". According to Rogers, the center of an individual's world of experience is the individual. The process by which an individual becomes aware of an experience is known as symbolization. In ambiguous situations individuals tend to symbolize experiences in a manner consistent with self concept. Carl Rogers would view neurosis as the result of incongruence between the real self and the ideal self. Carl Rogers believed all humans had a(n) actualizing tendency, which he saw as a part of the formative tendency of the world.

Rogerian View of Psychotherapy. Implied Therapeutic Conditions.

Client and therapist must be in psychological contact. Client must experience distress. Client must be willing to receive conditions offered by therapist.

Process of PC Therapy.

Therapy begins at first contact. In the first interview, a person centered therapist will go where the client goes. For Carl Rogers, empathy, unconditional positive regard, and congruence. (genuineness) were the 3 basic requirements to create a therapeutic environment. Respect shown immediately for client. In addition to the basic requirements of the therapeutic environment for the therapist, Rogers believed the client must focus on self-concept, locus-of-evaluation and experiencing. Therapys length is determined by client (In person centered therapy termination is decided by the client). Quick suggestions and reassurances are avoided.

Empathy - Understanding another individual by "living" in their internal frame of reference.

Person centered therapists believe that empathy, unconditional positive regard, and congruence are necessary and sufficient conditions for therapeutic change.

Congruence - a correspondence between the thoughts and the behavior of a therapist.

Client centered therapy focuses most heavily on the present. A successful person centered therapy outcome would be defined by the client's evaluation that therapy was beneficial.

Therapist Role and Function. Function: to be present and accessible to clients, to focus on immediate experience, to be real in the relationship with clients. Through the therapists attitude of genuine caring, respect, acceptance, and understanding, clients become less defensive and more open to their experience and facilitate the personal growth.

Therapist Role and Function. Role: Therapists attitude and belief in the inner resources of the client, not in techniques, facilitate personal change in the client.

Use of self as an instrument of change. Focuses on the quality of the therapeutic relationship. Serves as a model of a human being struggling toward greater realness. Is genuine, integrated, and authentic. Can openly express feelings and attitudes that are present in the relationship with the client.

Therapy Goals. helping a person become a fully functioning person. Clients have the capacity to define their goals. an openness to experience. A trust in themselves. An internal source of evaluation. A willingness to continue growing.

Clients Experience in Therapy. Incongruence: discrepancy between self-perception and experience in reality anxiety motivation to help. As clients feel understood and accepted, their defensiveness is less necessary and they become more open to their experiences. Therapeutic relationship activate clients self-healing capacities. Relationship between Therapist and Client. Emphasizes the attitudes and personal characteristics of the therapist and the quality of therapeutic relationship. Therapist listening in an accepting way to their clients, they learn how to listen acceptingly to themselves.

Relationship between Therapist and Client A central variable related to progress in person-centered therapy is the relationship between therapist and client. A person-centered therapist is a facilitator.

Therapeutic Techniques. It is not technique-oriented. A misunderstanding---this approach is simply to restate what the client just said or the technique of reflection of feelings (It is incorrect). The therapeutic relationship is the primary agent of growth in the client. Therapists presence: being completely engaged in the relationship with clients. The best source of knowledge about the client is the individual client.

Caring confrontations can be beneficial.

Application. individual counseling, group counseling, businesses, international relations, community development education, marriage and family A variety of problems: anxiety, crisis intervention, interpersonal difficulties, depression, personality disorder..

Contribution from a Multicultural Perspective. Contributions. Has reached more than 30 counties and has been translated to 12 languages. Reduction of racial and political tensions. Limitations. Some people need more structure, coping skills, directedness. Some may focus on family or societal expectations instead of internal evaluation. May be unfamiliar with people in different cultures.

Contribution of PC Therapy. Contributions. Active role of responsibility of client. Inner and subjective experience. Relationship-centered. Focus on therapists attitudes. Focus on empathy, being present, and respecting the clients values. Value multicultural context.

Summary and Evaluation. Limitations. Discount the significance of the past. Misunderstanding the basic concept: e.g., reflection feelings. People in crisis situations often need more directive intervention strategies. Client tend to expect a more structured approach.

Bozarths (1998) Summarization of Research on Psychotherapy.

According to Bozarth's summarization of research on psychotherapy, the most consistent variables affecting therapy are empathy, unconditional positive regard and congruence (genuineness).

Effective psychotherapy predicated on: Relationship between therapist and client. Type of therapy, technique, training and experience of therapists are largely irrelevant. Clients who receive psychotherapy improve more than those who do not. Little support that specific treatments are best for particular issues. Tost consistent variables related to effectiveness are empathy, genuineness, and unconditional positive regard.
POSTED BY JGARRETT43MU AT 11:37 PM 1 COMMENT:

TUE SD AY ,

SE P TE MBE R

1 1,

2007

Chapter 4 - Analytical Psychotherapy.

My Lecture Notes. Current Psychotherapies. Analytical Psychotherapy. Claire Douglas. COUN 603. Instructor: Jeff Garrett Ph.D.

Basic Concepts. Jung defined psyche as the inner realm of personality that balanced the outer reality. The psyche consist of spirit, soul, and idea. Jung defined psyche as the inner realm of personality that balanced outer reality. Jungs view of the mind was similar to Freuds except he believed the unconscious also included undeveloped parts, elements from the collective. unconscious, and material unimportant to the psyche.

Collective Unconscious. Vast, hidden psychic resource shared by humans. Jung found basic motif across individuals in their dreams, fantasies, etc. Jung defined the collective unconscious as the portion of the unconscious universal to all humans. Images from the collective unconscious are shared by all but modified by our own personal experiences.

Archetype. Organizing principle. System of readiness. Dynamic nucleus of energy. An archetype can be viewed as the pathway for communication between collective unconscious and conscious. Complex - An emotionally charged association of ideas and feelings that draws images, memories and ideas into its orbit. The relationship between collective unconscious and archetype corresponds to the relationship between personal unconscious and complex.

Types of Archetypes. Heroic Quest. Night Sea Journey. Inner Child. Divine Child. Maiden, Mother, and Goddess. Wise Old Man. Wild Man. Complexes are to personal unconscious as archetypes are to collective. Concept came from Word Associations Test. Defined as sensitive, energy-filled, duster of emotion.

Comparing Jung and Other Theories. Royal road to the unconscious - (Jung) complexes (Freud)- Dreams. Emphasis -(Jung) inclusive set of drives, search for meaning drives. (Freud) sexual and aggressive. Interaction with patient - (Jung) face to face (Freud) patient lying on couch. View of complexes - (Jung) Broad, rich, complexes both negative and positively charged, focused on preoedipal phase (Freud) Limited, negatively charged; focused on oedipal phase. View of the unconscious - (Jung) added ideas about colletive conscious (Freud) empahasis on persoal unconscious. While Freud believed that dreams represented the royal road to the unconscious, Jung believed it was complexes.

Jungs Theory Compared to Adlers. Jung's emphasis on early recollections, future goals and societal interest paralleled Adler. Stressed importance of similar theory of dreams.

Revealed what an individual didnt want to see about themselves (i.e., shadows). Showed our underlying ways of interacting with the world. Past memories; Social Interest. Future orientation (as well as review of the past).

Development Theorists Influenced by Jungian Theory. Erik Erikson and Lawrence Kohlberg. Their ideas of developmental stages reflect Jungs view of individuation over time. Harry Stack Sullivan. Good me = Jungs positive shadow. Bad me = Jungs negative shadow. Jungs Theory Compared with Asian Psychotherapies. Both emphasize value of being as well as doing. Role and religious and mystical ideas central. Jungs method of incubating fantasies represents a meditative process.

History of Analytical Psychotherapy Carl Jung. Born in 1875. Educated in Protestant theology and the classics. Theories of Kant and Nietsche strong influence. Jungs family of origin strongly influenced his theories. Experience mother as 2-sided; Daytime/Good vs Nighttime/Bad Mother. Unsatisfactory relationship with father. 1902-1909 worked in a psychiatric hospital where he developed his Word. Association Test. Jung appointed as president of the International Psychoanalytic Association. Jung and Freud part because of creative and personality differences. The break was solidified after Jung published The Psychology of the Unconscious in 1911 Revised in 1956 as Symbols of Transformation. Over the next decade Jung had a period of extreme introversion. 1921 Jung published Psychological Types.

Current Status of Analytical Therapy. In 2003, International Association for Analytical Psychology had 2,500 certified. members in 28 countries and 48 professional

societies. Jungian analysis remains a prerequisite for providing analysis. How to deal with multiculturalism created rifts. One group sought ways to address multicultural, gender, and aging issues. More traditional group rejected the idea of reinterpreting i.e., "watering down" Jungs words.

Personality. According to Jung our understanding of ourselves comes from encounters with social reality and what we deduce from our own observations. Two Aspects to the Psyche. Conscious Unconscious. Accessible Not accessible. Comprised of ones senses, intellect, Comprised of personal experience, emotions and desires forgotten or denied or collective. unconscious. If our self assessment matches others Can only be understood through we deem ourselves as normal dreams and analysis. Infant starts Fragmentation Personality. in a state of occurs reintegrates. wholeness with experience in the healthy person. Collective unconscious refers to a shared inherited human factor of psychic functioning. In Analytical psychology aspects of the ego denied development are labeled the shadow. The public image an individual maintains is known as his/her persona.

Other aspects of Personality. The ego is the most important fragment of self. The archetypal energy which orders and integrates the personality is known as the Self. The personal shadow balances the ego in the unconscious. The persona is the public face we show to others. Task of early life strengthens the ego. Task of later life is individuation, i.e., completeness. Requires assimilation of personal shadow material. Contrasexual element in the psyche (Anima Archetypal image of feminine and Animus Archetypal image of masculine).

Introduced the concept of Typology in 1921 in Psychological Types to describe individuals and groups of individuals (e.g., countries).

Introversion. Natural, basic, energy flows inward. Adapts outer reality to inner psychology. Needs solitude; few but deep relationships. e.g., Switzerland.

Extroversion. Connects with reality through external objects. Adapts self to external environment and others. Communicates well; a people person. e.g., United States.

Other aspects of Personality. Jung defined the primary task of the first part of life as strengthening the ego. Most people are born with four functional types [1) Thinking, 2) Feeling, 3) Sensation, 4) Intuition]. The most dominant function is used most and developed more fully. Jung stressed the importance of the least developed function. This underdeveloped function can bring distress, but also creativity when it comes into consciousness.

Compensation. Everything in the personality balances itself. Similar to the homeostatic balance achieved by the physical body.

Transcendent Functions. Form bridges between opposites allowing a new attitude to develop.

Mandala. Jung became intrigued with Mandala as a symbol of an archetype of wholeness and of the center of personality. A geometric figure in which a circle and square lie within each other, and each is further subdivided.

Any of various ritualistic geometric designs symbolic of the universe, used in Hinduism and Buddhism as an aid to meditation. Jung viewed the mandala as an artistic expression of the self.

Development of Conscious. take notes of model in class.

Personality. For Jung the most decisive stage of personality development was preoedipal. Psychopathology develops from conflicts in mother-child relationships. Made worse by stressors. Analytical therapists believe recurrent dreams are often linked with repressed traumas. Pathological symptoms occur because of frustrated thwart urges toward wholeness. Defense mechanisms are the psyches attempts to survive complexes (e.g., During group Jungian psychotherapy, group members often project unaccepted parts of their personality onto the group. The group member is projecting his/her shadow). Defense mechanisms can represent normal as well as destructive modes. Become pathological only if an individual becomes stuck in the defense.

Analytical Psychotherapy.

Four Stages of Psychotherapy. Confession cathartic recounting of ones history e.g., secrets. Elucidation - the therapist attempts to connect the patient's transference to its origins in childhood. Education concerned with persona and ego tasks. The therapist encourages patient to develop an active and health-promoting role in everyday life (many patients stop after the first three stages but some seemed impelled to go further, especially people in the second half of life). Transformation period of self-actualization.

Analytical Psychotherapy. In analytical psychotherapy the ultimate goal is self actualization. Personality can heal itself and enlarge; Psyche is a self regulating system. Unconscious has a creative and compensatory component. Doctor-patient relationship facilitates self-awareness and healing. Personality growth takes place throughout life span.

Neurosis occurs when an individual avoids important life task.

Analytical Psychotherapy. Psychotherapist should look for underlying complexes. "Patients are only as sick as their secrets". Also deals with mental/moral conflicts of normal individuals. Psychotherapy represents dialogue between two people to facilitate growth. Therapist needs self analysis, self awareness, and to value the patient. Transference and counter-transference is paramount.

Applications. Jung described individuals as possessing habitual ways of responding to the world in his theory of typology. Myers-Briggs Type Indicator. A personality measure based on Jung's theory of typology. One of the most popular personality tests available. Developed by Katharine Briggs and her daughter Isabel Briggs Myer. Used Jungs concepts about type and function.

Typology. e.g., For an individual whose behavior is primarily dictated by hunches the dominant mental function would likely be intuition. Four Scales on Myers-Briggs Type Indicator. Extroversion Introversion (E-I). The most important; 75% of the population is extroverted. Sensing Intuitive (S-N). 75% of the population is sensing. Thinking Feeling (T-F). Distributed evenly through the population. But 2/3s of men are thinkers, while 2/3s of women are feelers Judging Perceiving (J-P). Not one of Jungs original dimensions.
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2007 (15) November (5) October (4) September (3) Chapter 6 - REBT Chapter 5 - Person-Centered Therapy. Chapter 4 - Analytical Psychotherapy. August (3)

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Chapter 5 - Person-Centered Therapy.


Lecture Notes. Current Psychotherapies. Person-Centered Therapy. Chapter 5. Nathaniel J. Raskin &Carl R. Rogers. Instructor: Jeff Garrett Ph.D.

Key Points and Terms. Developed by Carl Rogers. Also termed Client-Centered. Humanistic, or Phenomenological Therapy . The person is viewed as creative, responsible, developing individual. By providing a therapeutic atmosphere which is real, caring, and non-judgmental the person can develop their full potential.

Challenges: The assumption that "the counselor knows best". The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation.

The belief that clients cannot understand and resolve their own problems without direct help. The focus on problems over persons.

Emphasizes: Therapy as a journey shared by two people. The persons innate striving for self-actualization. The personal characteristics of the therapist and the quality of the therapeutic relationship. The counselors creation of a permissive, "growth promoting" climate. People are capable of self-directed growth if involved in a therapeutic relationship. Person-Centered Therapy is a form of humanistic therapy.

Rogers Basic Assumptions. Rogers believed in an actualizing tendency in all human beings. Represented movement towards the realization of the individuals full potential. Viewed as part of a formative tendency. Formative tendency represents movement toward order, complexity and interrelatedness. Seen across aspects of nature including the stars, crystals, microorganisms and humans.

Basic Requirements for the Therapeutic Environment (Therapist). Genuineness/Congruence. Correspondence between the therapists thoughts and their behavior. Unconditional Positive Regard. Therapists regard/attitude remains unaltered regardless of the patients choice. Empathy. Profound interest and car for the patients perceptions and feelings.

Basic Requirements for the Therapeutic Environment (Client). Self-concept. At therapy onset, self regard/self-esteem often low. Improvement correlated with success in therapy. Locus-of-Evaluation. At therapy onset, focus on what others think. Progress associated with internal locus-of-evaluation.

Experiencing. At therapy onset, rigid; Success related to flexibility.

Six Basic Premises of Humanistic Psychology. Hereditary, environment and creative power are crucial forces. Anthropomorphic model preferred. Purpose is the decisive dynamic. Holistic approach most adequate. Human subjectivity critically important. Psychotherapy is based on good relationship.

Distinctive Components of Person-Centered Therapy. Therapists attitude can be necessary and sufficient conditions for change. Therapist needs to be immediately present and accessible to clients. Intensive, continuous focus on patients phenomenological world. Process marked by clients ability to live fully in the moment. Focus on personality change, not structure of personality.

Comparing Person-Centered Therapy with Other Approaches. Language Common Sense (PC). Esoteric (Psychoanalysis). How to Understand. The individual Subjective Interpersonal (PC). Objective intrapersonal (Psychoanalysis). Emphasis Purpose (PC). Causality (Psychoanalysis). Characterization. Of the individual Holistic (PC). Reductionistic (Psychoanalysis). View of Human. Nature People can be good or bad (PC). People are bad (Psychoanalysis).

Role of Therapist Facilitate self discovery (PC). Interpretation for the client(Psychoanalysis).

View of Transference Not central to the clients ability to change (PC). Fundamental to the change process (Psychoanalysis). Presentation Of Therapist A caring person who is willing to listen (PC). Authority, teacher (Psychoanalysis).

Differences between PC and REBT. PC places greater value on relationship. PC is more client directed. PC is more accepting of clients perceptions. PC therapist typically relates to clients on a feeling level.

Difference between PC Therapist and Behavior Therapist. PC would argue that behavioral changes occur through internal factors whereas behavioral therapy sees behavior changing through external factors.

Similarities between PC and REBT. Great optimism in the ability of people to change. Perception that individuals are often overly self critical. Willingness to put forth great effort to help people. Respect for science and research.

History of PC Therapy. Carl Rogers was born 1902, Oak Park Illinois. Family emphasized strong work ethic, responsibility and the fundamentals of religion. Graduated 1924 from University of Wisconsin. Started at the Union Theological Seminary then transferred to Teachers College, Columbia University.

Worked for 12 years at a Child-Guidance Center. In 1939 published Clinical Treatment of the Problem Child. Offered professorship at Ohio State University. 1940 Rogers presented Some Newer concepts in Psychotherapy at the University of Minnesota (viewed by most as the birth of Client-Centered Therapy). Published Counseling and Psychotherapy in 1942. During WWII served as Director of Counseling Services for the US Organizations. Served as head of University of Chicago Counseling Center (12 years). In 1957, Rogers published classic paper on "necessary and sufficient conditions" for therapy. Rogers died in 1987 .

Current Status of PC Therapy. Special interest of Rogers was application of his theory to international relationships. Since 1982 Biennial International Forums on PC approach. Workshops at Warm Springs. Person-Centered Review began to be published in 1986 (renamed The Person-Centered Journal).

Theory of Personality - 19 Propositions. 1. Individual is center of a continually changing world of experience. 2. Organism reacts based on their reality. 3. Organism reacts as an organized whole. 4. Organism has one basic tendency actualization. 5. Behavior is goal directed based on perception of reality. 6. Emotion accompanies and facilitates goal directed behavior. Theory of Personality19 Propositions. 7. Best point to understand behavior is from the individuals frame of reference. 8. Part of the perceptual field is differentiated as the self. 9. Self is formed through interaction. 10. Values come from experience and introjection from others. 11. Experiences are integrated, ignored, or denied. 12. Behavior is generally consistent with self concept. 13. Behaviors inconsistent with self concept can occur but are seen as "not owned". 14. Psychological maladjustment comes from denied experiences.

Theory of Personality19 Propositions. 15. Psychological adjustment occurs when experiences are assimilated. 16. Inconsistent experiences are threats. 17. Under the right conditions inconsistent experiences can be examined/assimilated. 18. When the individual integrates in all of their experiences they are more understanding of others. 19. As experiences are integrated an internal locus-of-evaluation develops.

Rogers Theory of Personality Summarized. Behavior is best understood through the individuals reality (perception of experiences). For social purposes, reality is defined as common perceptions across individuals. Personal growth occurs through decreased defensiveness. Self actualization is the organisms one, basic tendency (Rogers believed an organism has one basic tendency and striving which is to actualize, maintain and enhance the experiencing organism. Experiences inconsistent with self concept are threats leading to increased rigidity. Therapy allows the individual to accept and integrate all of their experiences. In Roger's personality theory, behavior is defined as a goal directed attempt to satisfy an organism's needs.

Other Concepts. Experience is the private world of the individual. Reality basically refers to the private perceptions of the individual; Social consists of perceptions that have a high degree of commonality among individuals. Self is the organized gestalt of "I" and "me". According to Rogers, the center of an individual's world of experience is the individual. The process by which an individual becomes aware of an experience is known as symbolization. In ambiguous situations individuals tend to symbolize experiences in a manner consistent with self concept. Carl Rogers would view neurosis as the result of incongruence between the real self and the ideal self. Carl Rogers believed all humans had a(n) actualizing tendency, which he saw as a part of the formative tendency of the world.

Rogerian View of Psychotherapy. Implied Therapeutic Conditions. Client and therapist must be in psychological contact. Client must experience distress. Client must be willing to receive conditions offered by therapist.

Process of PC Therapy.

Therapy begins at first contact. In the first interview, a person centered therapist will go where the client goes. For Carl Rogers, empathy, unconditional positive regard, and congruence. (genuineness) were the 3 basic requirements to create a therapeutic environment. Respect shown immediately for client. In addition to the basic requirements of the therapeutic environment for the therapist, Rogers believed the client must focus on self-concept, locus-of-evaluation and experiencing. Therapys length is determined by client (In person centered therapy termination is decided by the client). Quick suggestions and reassurances are avoided.

Empathy - Understanding another individual by "living" in their internal frame of reference.

Person centered therapists believe that empathy, unconditional positive regard, and congruence are necessary and sufficient conditions for therapeutic change.

Congruence - a correspondence between the thoughts and the behavior of a therapist.

Client centered therapy focuses most heavily on the present. A successful person centered therapy outcome would be defined by the client's evaluation that therapy was beneficial.

Therapist Role and Function. Function: to be present and accessible to clients, to focus on immediate experience, to be real in the relationship with clients. Through the therapists attitude of genuine caring, respect, acceptance, and understanding, clients become less defensive and more open to their experience and facilitate the personal growth.

Therapist Role and Function. Role: Therapists attitude and belief in the inner resources of the client, not in techniques, facilitate personal change in the client. Use of self as an instrument of change. Focuses on the quality of the therapeutic relationship. Serves as a model of a human being struggling toward greater realness.

Is genuine, integrated, and authentic. Can openly express feelings and attitudes that are present in the relationship with the client.

Therapy Goals. helping a person become a fully functioning person. Clients have the capacity to define their goals. an openness to experience. A trust in themselves. An internal source of evaluation. A willingness to continue growing.

Clients Experience in Therapy. Incongruence: discrepancy between self-perception and experience in reality anxiety motivation to help. As clients feel understood and accepted, their defensiveness is less necessary and they become more open to their experiences. Therapeutic relationship activate clients self-healing capacities. Relationship between Therapist and Client. Emphasizes the attitudes and personal characteristics of the therapist and the quality of therapeutic relationship. Therapist listening in an accepting way to their clients, they learn how to listen acceptingly to themselves.

Relationship between Therapist and Client A central variable related to progress in person-centered therapy is the relationship between therapist and client. A person-centered therapist is a facilitator.

Therapeutic Techniques. It is not technique-oriented. A misunderstanding---this approach is simply to restate what the client just said or the technique of reflection of feelings (It is incorrect). The therapeutic relationship is the primary agent of growth in the client. Therapists presence: being completely engaged in the relationship with clients. The best source of knowledge about the client is the individual client. Caring confrontations can be beneficial.

Application.

individual counseling, group counseling, businesses, international relations, community development education, marriage and family A variety of problems: anxiety, crisis intervention, interpersonal difficulties, depression, personality disorder..

Contribution from a Multicultural Perspective. Contributions. Has reached more than 30 counties and has been translated to 12 languages. Reduction of racial and political tensions. Limitations. Some people need more structure, coping skills, directedness. Some may focus on family or societal expectations instead of internal evaluation. May be unfamiliar with people in different cultures.

Contribution of PC Therapy. Contributions. Active role of responsibility of client. Inner and subjective experience. Relationship-centered. Focus on therapists attitudes. Focus on empathy, being present, and respecting the clients values. Value multicultural context.

Summary and Evaluation. Limitations. Discount the significance of the past. Misunderstanding the basic concept: e.g., reflection feelings. People in crisis situations often need more directive intervention strategies. Client tend to expect a more structured approach.

Bozarths (1998) Summarization of Research on Psychotherapy. According to Bozarth's summarization of research on psychotherapy, the most consistent variables affecting therapy are empathy, unconditional positive regard and congruence (genuineness).

Effective psychotherapy predicated on: Relationship between therapist and client. Type of therapy, technique, training and experience of therapists are largely irrelevant. Clients who receive psychotherapy improve more than those who do not. Little support that specific treatments are best for particular issues. Tost consistent variables related to effectiveness are empathy, genuineness, and unconditional positive regard.
POSTED BY JGARRETT43MU AT 11:37 PM

1 COMMENT:

kesler said... Thanks a Million for post this on line. I use it at work to train my counselor! Stephanie Settle MARCH 2, 2011 AT 6:49 AM

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2007 (15) November (5) October (4) September (3) Chapter 6 - REBT Chapter 5 - Person-Centered Therapy. Chapter 4 - Analytical Psychotherapy. August (3)

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JGARRETT43MU

VIEW MY COMPLETE PROFILE

Chapter 5 - Person-Centered Therapy.


Lecture Notes. Current Psychotherapies. Person-Centered Therapy. Chapter 5. Nathaniel J. Raskin &Carl R. Rogers. Instructor: Jeff Garrett Ph.D.

Key Points and Terms. Developed by Carl Rogers. Also termed Client-Centered. Humanistic, or Phenomenological Therapy . The person is viewed as creative, responsible, developing individual. By providing a therapeutic atmosphere which is real, caring, and non-judgmental the person can develop their full potential.

Challenges: The assumption that "the counselor knows best". The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation. The belief that clients cannot understand and resolve their own problems without direct help. The focus on problems over persons.

Emphasizes: Therapy as a journey shared by two people. The persons innate striving for self-actualization. The personal characteristics of the therapist and the quality of the therapeutic relationship. The counselors creation of a permissive, "growth promoting" climate. People are capable of self-directed growth if involved in a therapeutic relationship. Person-Centered Therapy is a form of humanistic therapy.

Rogers Basic Assumptions. Rogers believed in an actualizing tendency in all human beings.

Represented movement towards the realization of the individuals full potential. Viewed as part of a formative tendency. Formative tendency represents movement toward order, complexity and interrelatedness. Seen across aspects of nature including the stars, crystals, microorganisms and humans.

Basic Requirements for the Therapeutic Environment (Therapist). Genuineness/Congruence. Correspondence between the therapists thoughts and their behavior. Unconditional Positive Regard. Therapists regard/attitude remains unaltered regardless of the patients choice. Empathy. Profound interest and car for the patients perceptions and feelings.

Basic Requirements for the Therapeutic Environment (Client). Self-concept. At therapy onset, self regard/self-esteem often low. Improvement correlated with success in therapy. Locus-of-Evaluation. At therapy onset, focus on what others think. Progress associated with internal locus-of-evaluation. Experiencing. At therapy onset, rigid; Success related to flexibility.

Six Basic Premises of Humanistic Psychology. Hereditary, environment and creative power are crucial forces. Anthropomorphic model preferred. Purpose is the decisive dynamic. Holistic approach most adequate. Human subjectivity critically important. Psychotherapy is based on good relationship.

Distinctive Components of Person-Centered Therapy. Therapists attitude can be necessary and sufficient conditions for change.

Therapist needs to be immediately present and accessible to clients. Intensive, continuous focus on patients phenomenological world. Process marked by clients ability to live fully in the moment. Focus on personality change, not structure of personality.

Comparing Person-Centered Therapy with Other Approaches. Language Common Sense (PC). Esoteric (Psychoanalysis). How to Understand. The individual Subjective Interpersonal (PC). Objective intrapersonal (Psychoanalysis). Emphasis Purpose (PC). Causality (Psychoanalysis). Characterization. Of the individual Holistic (PC). Reductionistic (Psychoanalysis). View of Human. Nature People can be good or bad (PC). People are bad (Psychoanalysis).

Role of Therapist Facilitate self discovery (PC). Interpretation for the client(Psychoanalysis).

View of Transference Not central to the clients ability to change (PC). Fundamental to the change process (Psychoanalysis). Presentation Of Therapist A caring person who is willing to listen (PC). Authority, teacher (Psychoanalysis).

Differences between PC and REBT.

PC places greater value on relationship. PC is more client directed. PC is more accepting of clients perceptions. PC therapist typically relates to clients on a feeling level.

Difference between PC Therapist and Behavior Therapist. PC would argue that behavioral changes occur through internal factors whereas behavioral therapy sees behavior changing through external factors.

Similarities between PC and REBT. Great optimism in the ability of people to change. Perception that individuals are often overly self critical. Willingness to put forth great effort to help people. Respect for science and research.

History of PC Therapy. Carl Rogers was born 1902, Oak Park Illinois. Family emphasized strong work ethic, responsibility and the fundamentals of religion. Graduated 1924 from University of Wisconsin. Started at the Union Theological Seminary then transferred to Teachers College, Columbia University. Worked for 12 years at a Child-Guidance Center. In 1939 published Clinical Treatment of the Problem Child. Offered professorship at Ohio State University. 1940 Rogers presented Some Newer concepts in Psychotherapy at the University of Minnesota (viewed by most as the birth of Client-Centered Therapy). Published Counseling and Psychotherapy in 1942. During WWII served as Director of Counseling Services for the US Organizations. Served as head of University of Chicago Counseling Center (12 years). In 1957, Rogers published classic paper on "necessary and sufficient conditions" for therapy. Rogers died in 1987 .

Current Status of PC Therapy. Special interest of Rogers was application of his theory to international relationships.

Since 1982 Biennial International Forums on PC approach. Workshops at Warm Springs. Person-Centered Review began to be published in 1986 (renamed The Person-Centered Journal).

Theory of Personality - 19 Propositions. 1. Individual is center of a continually changing world of experience. 2. Organism reacts based on their reality. 3. Organism reacts as an organized whole. 4. Organism has one basic tendency actualization. 5. Behavior is goal directed based on perception of reality. 6. Emotion accompanies and facilitates goal directed behavior. Theory of Personality19 Propositions. 7. Best point to understand behavior is from the individuals frame of reference. 8. Part of the perceptual field is differentiated as the self. 9. Self is formed through interaction. 10. Values come from experience and introjection from others. 11. Experiences are integrated, ignored, or denied. 12. Behavior is generally consistent with self concept. 13. Behaviors inconsistent with self concept can occur but are seen as "not owned". 14. Psychological maladjustment comes from denied experiences. Theory of Personality19 Propositions. 15. Psychological adjustment occurs when experiences are assimilated. 16. Inconsistent experiences are threats. 17. Under the right conditions inconsistent experiences can be examined/assimilated. 18. When the individual integrates in all of their experiences they are more understanding of others. 19. As experiences are integrated an internal locus-of-evaluation develops.

Rogers Theory of Personality Summarized. Behavior is best understood through the individuals reality (perception of experiences). For social purposes, reality is defined as common perceptions across individuals. Personal growth occurs through decreased defensiveness. Self actualization is the organisms one, basic tendency (Rogers believed an organism has one basic tendency and striving which is to actualize, maintain and enhance the experiencing organism.

Experiences inconsistent with self concept are threats leading to increased rigidity. Therapy allows the individual to accept and integrate all of their experiences. In Roger's personality theory, behavior is defined as a goal directed attempt to satisfy an organism's needs.

Other Concepts. Experience is the private world of the individual. Reality basically refers to the private perceptions of the individual; Social consists of perceptions that have a high degree of commonality among individuals. Self is the organized gestalt of "I" and "me". According to Rogers, the center of an individual's world of experience is the individual. The process by which an individual becomes aware of an experience is known as symbolization. In ambiguous situations individuals tend to symbolize experiences in a manner consistent with self concept. Carl Rogers would view neurosis as the result of incongruence between the real self and the ideal self. Carl Rogers believed all humans had a(n) actualizing tendency, which he saw as a part of the formative tendency of the world.

Rogerian View of Psychotherapy. Implied Therapeutic Conditions. Client and therapist must be in psychological contact. Client must experience distress. Client must be willing to receive conditions offered by therapist.

Process of PC Therapy.

Therapy begins at first contact. In the first interview, a person centered therapist will go where the client goes. For Carl Rogers, empathy, unconditional positive regard, and congruence. (genuineness) were the 3 basic requirements to create a therapeutic environment. Respect shown immediately for client. In addition to the basic requirements of the therapeutic environment for the therapist, Rogers believed the client must focus on self-concept, locus-of-evaluation and experiencing. Therapys length is determined by client (In person centered therapy termination is decided by the client). Quick suggestions and reassurances are avoided.

Empathy - Understanding another individual by "living" in their internal frame of reference.

Person centered therapists believe that empathy, unconditional positive regard, and congruence are necessary and sufficient conditions for therapeutic change.

Congruence - a correspondence between the thoughts and the behavior of a therapist.

Client centered therapy focuses most heavily on the present. A successful person centered therapy outcome would be defined by the client's evaluation that therapy was beneficial.

Therapist Role and Function. Function: to be present and accessible to clients, to focus on immediate experience, to be real in the relationship with clients. Through the therapists attitude of genuine caring, respect, acceptance, and understanding, clients become less defensive and more open to their experience and facilitate the personal growth.

Therapist Role and Function. Role: Therapists attitude and belief in the inner resources of the client, not in techniques, facilitate personal change in the client. Use of self as an instrument of change. Focuses on the quality of the therapeutic relationship. Serves as a model of a human being struggling toward greater realness. Is genuine, integrated, and authentic. Can openly express feelings and attitudes that are present in the relationship with the client.

Therapy Goals. helping a person become a fully functioning person. Clients have the capacity to define their goals. an openness to experience. A trust in themselves. An internal source of evaluation. A willingness to continue growing.

Clients Experience in Therapy. Incongruence: discrepancy between self-perception and experience in reality anxiety motivation to help.

As clients feel understood and accepted, their defensiveness is less necessary and they become more open to their experiences. Therapeutic relationship activate clients self-healing capacities. Relationship between Therapist and Client. Emphasizes the attitudes and personal characteristics of the therapist and the quality of therapeutic relationship. Therapist listening in an accepting way to their clients, they learn how to listen acceptingly to themselves.

Relationship between Therapist and Client A central variable related to progress in person-centered therapy is the relationship between therapist and client. A person-centered therapist is a facilitator.

Therapeutic Techniques. It is not technique-oriented. A misunderstanding---this approach is simply to restate what the client just said or the technique of reflection of feelings (It is incorrect). The therapeutic relationship is the primary agent of growth in the client. Therapists presence: being completely engaged in the relationship with clients. The best source of knowledge about the client is the individual client. Caring confrontations can be beneficial.

Application. individual counseling, group counseling, businesses, international relations, community development education, marriage and family A variety of problems: anxiety, crisis intervention, interpersonal difficulties, depression, personality disorder..

Contribution from a Multicultural Perspective. Contributions. Has reached more than 30 counties and has been translated to 12 languages. Reduction of racial and political tensions. Limitations. Some people need more structure, coping skills, directedness. Some may focus on family or societal expectations instead of internal evaluation. May be unfamiliar with people in different cultures.

Contribution of PC Therapy. Contributions. Active role of responsibility of client. Inner and subjective experience. Relationship-centered. Focus on therapists attitudes. Focus on empathy, being present, and respecting the clients values. Value multicultural context.

Summary and Evaluation. Limitations. Discount the significance of the past. Misunderstanding the basic concept: e.g., reflection feelings. People in crisis situations often need more directive intervention strategies. Client tend to expect a more structured approach.

Bozarths (1998) Summarization of Research on Psychotherapy. According to Bozarth's summarization of research on psychotherapy, the most consistent variables affecting therapy are empathy, unconditional positive regard and congruence (genuineness).

Effective psychotherapy predicated on: Relationship between therapist and client. Type of therapy, technique, training and experience of therapists are largely irrelevant. Clients who receive psychotherapy improve more than those who do not. Little support that specific treatments are best for particular issues. Tost consistent variables related to effectiveness are empathy, genuineness, and unconditional positive regard.
POSTED BY JGARRETT43MU AT 11:37 PM

1 COMMENT:

kesler said... Thanks a Million for post this on line. I use it at work to train my counselor! Stephanie Settle

MARCH 2, 2011 AT 6:49 AM

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