Counselling Notes

Lecture 2: Counselling methods

● Finding the problem, identifying symptoms, and then working to reduce them
● Benefit of treatment plan: Other clinical professionals can also understand what you are
trying to do
● They are also important for legal reasons - the file could get subpoena’d - the first thing
they would ask to see is treatment plan
● Insurance - You have to justify to insurance company that further treatment is REALLY
needed
● The treatment plan is also a way to show as the counsellor how you are accountable for
what you do. Can be used to hold someone accountable if something is not going
according to plan
● Treatment plan is how the colleges track that therapist actually does their job
● Symptom plan vs clinical plan
● When counselling is mandated by court the client does not get a choice in intervention
and treatment plan
● If employer sends to counselling, employer has a say in what the counselling entails
● Counselling tasks = Activities the counsellor does to work towards goals
● What actually happens in the session is always confidential unless the 3 exceptions
happen
● Parents can request child’s file

Counselling tasks:

● Initial phase - establish counselling relationship, assess individual, family, and social
dynamics
● Working phase - Monitor the relationship to ensure maintenance of that professional
relationship, make sure the kinds of interventions you’re using do make sense to the
client as well. Sometimes the counselling approach you use the client will not fit in well
with.
● Closing phase - It is unprofessional to keep seeing someone when the treatment is
completed. In this phase you say goodbye to the client.
● For counselling tasks, diversity factors are important to be considered
● This will also influence the power imbalance that is already there
● Therepeutic letters - Therapists writes a letter after session to client and has some
thoughts to think about and reflect on until the next session
 ● There should be goals set for every phase
● Relate intervention to your client **** important to the client **** show how this
intervention in particular will help client move forward
● Show how you justify what you do
● As you go along you would be adding multiple goals in the working phase

Case study
● Mary is encouraging avoidance
● Diversity note can be that they are a counsellor too or they’re older
● Simon’s goal: Reduced anxiety to healthy levels
● Keeping in routine of his social activities

Case Study 2

Lecture 3: Psychdynamic approaches

● The main idea of this approach is that humans are driven by an unconscious drives/forces
● So in therapy you would try to make conciouss of the unconcious
● Assumption: Humans are ambivalent about changing
● The therapeutic relationship is very important to psychoanalysis
● How come there are things that people will do that aren’t conscious? - Freud wanted to
make a scientific method to study this idea
● Freud founded it, others built on it
● Ego Psychology - Focuses on how the ego manages the internal mechanisms to manage
drives
● Object Relations Theory - Warm counselling relationship; provide a setting where the
unconcious will not resist; idea is to focus on the kind of relationship that the client
establishes; focus of therapy is to repair object and relationship of patterns
● Interpersonal analyisis - To work on relationships that are already there
● Self psychology - THe idea is to work with the inner world of the client; how the client
sees themselves; the focus is very much on self esteem; help view themselves in a more
positive light
● Relational and Intersubjectivity theories - More collaborative between patient and
client; goal is to make unconciouss concious but a lot more collaborative
● Jungian Analysis - FOcuses on the collective unconscious and how that presents in
certain archetypes
● It is important to remember how psychoanalysis evolved from what it was into these
different divisions
● Freud would say we are all neurotic because unconscious processes happen often in our
lives
● Defense mechanisms - operate on unconscious level and tend to deny or distort reality to
help ego maintain sanity
○ However, if these become an overarching issue it would become a problem and a
person would have to go to therapy
● Goal of classical psychoanalysis = make unconscious conscious and strengthen ego so
behaviour is based on reality
● People would lay on the couch with eyes closed to minimize the chance of defense
mechanisms to start coming out
● A lot of emphasis in maintaining an analytical framework - Lots of structure and
importance on where the person is sitting, consistency of meetings, etc.
● In psychodynamic therapy the changes are expected fast
○ People would go maybe once a week and it would last for no longer than a year
● It is not necessary to do a major turnover - more a small intervention that is not too
intense
● The idea is that people would get better and stop coming to therapy
● The therapist is very active in the sessions
● Interpratations are very careful, timely, and very client focused
● Transference - Client’s unconscious shifting to the analyst of feelings, attitudes, and
fantasies that are reactions to significant others in the client’s past
○ Transference needs to be worked through in therapy
● Counter transference - A therapists unconscious emotional responses to a client based
on the therapists own past
● Things that are included in psychodynamic therapy
○ Free Association - Asking client to decipher what they associate with their given
issue
○ Interpretation - Help client understand and talk about how they are feeling
○ Transference
●
Social interest is a central concept in the Adlerian approach. What value
do you view this concept having? Give an example of how it may apply
to someone attending counselling in the current times.

Social interest plays into a person’s inherent desire to contribute to their community in
the Adlerian approach. This concept also looks at how people orient themselves for being their
‘best self’. I find this concept very important to evaluate for everyone as people who exhibit
genuine involvement in their community and enjoy contributing to it regardless of getting
something back from it tend to live happier lives. This is of course an anecdotal observation but
it is nonetheless worth a try for people who feel socially disconnected. Adler makes a great point
with this concept; humans are inherently social beings. Often a sense of community can get
clouded with competitiveness or feelings of failure (Low social interest), and it could be very
effective for people exhibiting these thoughts to work around highlighting their sense of unity.
For instance, in the modern day someone may come to counseling with their presenting problem
being depressed mood and feelings of loneliness. Perhaps they’re of older age and/or lost
numerous family members. Tying back to the notion of humans being social creatures, a therapist
practicing the Adlerian approach may ask this patient if they have any community functions that
they are a part of. An intervention might be volunteering at a local recreation center, or joining a
food drive. This way the client contributes to a group even though they do not get a monetary
return, but they feel greater unity. There are lots of methods to strengthen someone’s social
interest and involvement but the feeling of generosity is what sets this approach apart from the
others and provides interesting ideas on helping the client feel more uplifted.

Lecture 4: Adlerian Theories

● Adler is contemporary of Freud and Jung

○ Much more positive outlook compared to Freud to adult behavior
● Adler brought in the social factor
○ How social factors influence individual’s personality
● Adler looked at the experience of the individual
● Adler viewed the individual as guided by and trying to stay connected to the community
○ The willingness to give more to the community than recieving in return
● Strong attention to subjective reality
○ They work with what the people MAKE of their experience and not what that
experience should be like
● The lifestyle is a frame of reference from which an individual will interpret and go with
life
○ This emerges in the first 6 years of life
○ Sort of like a template through which events are interpreted by the person
● Inferiority influences the person’s social life
○ Not necessarily a bad thing
○ Bio inferiority is the idea that babies need someone to take care of them to survive
○ Cosmic inferiority is understanding death and limitations of human existance.
Forces us to take life in the present moment
○ Personal inferiority is feeling less powerful and able compared to others
● Recognition of inferiority feelings and striving for perfection are two sides of the same
coin
● Counsellors role is to promote social interest
● Basic mistakes - Self defeating aspects of individual’s lifestyle
○ Overgeneralization - “Everyone should like me”
○ False or impossible goals of security - “I’ll never succeed”
○ Misperceptions of life and lfies demands - Life is too hard
○ Denial of ones worth - I am stupid
○ Faulty values - Take advantage of others before they take advantage of you
● Early recollections technique
○ Refer to persons earliest clear memories of an event or situation
○ How the person made sense of events in the past and how do they recount it
○ What is the persons interpretation of that event
● Adler would say that earlier experiences are hints of the lifestyle framework
● Spitting in the soup
○ Deconstructing reasons for why someone may feel inferior
● Conveying encouragement
○ Looking for things the person does well
○ Foster social interest
○ Do things that make sense to you
○ Helping the client become more adaptable
○ Increase client’s self awareness
● Adlerian therapy DO use the DSM diagnosis
● In stage 3 we focus on understanding and insight
○ Therapist offers interpretations to help client gain insight as positive motivation to
take action
■ This helps turn unconscious thoughts into conscious ones
● Stage 4 is reorientation and re-education
○ The person can now put those new insights to work
○ Clients encouraged to act as if they were the person they wanted to be
 Lecture 5: Existential

● Existential therapy is a philosophical approach

● I-Thou encounter - Relating to the other person AS another person, really being in the
moment with them and understanding how they are
○ Behaviorists were super focused on results
● Not very many techniques
● Helps people live more meaningful lives
● Not a lot of interventions compared to other approaches
● The idea is for the person to facilitate a process where they will come up with their own
answers
● I-It encounter - The other as an object, a mental representation of another
● I - Thou can happen with a mentor for example; does not have to be someone super close
to you
● In therapy, the counselor would try their best to create an I-Thou
● The purpose of therapy is to help clients take responsibility for their choices
○ This approach is not action oriented, it is making sense of choices
● Therapeutic goals
○ Helping clients accept their freedom and responsibility
○ Assisting people in coming to terms with the crises in their lives
○ Encouraging clients to recognize the ways in which they are not living fully
authentic lives
○ Inviting clients to become more honest with themselves
● The counseling relationship
○ I/Thou relationship
○ Here and now presence
○ Promoting responsibility and independence
■ Counselor avoids being overly reassuring or over helpful; client feels
stronger
● When the deepest sense of the therapist meets the deepest sense of the client that is when
counseling goal is achieved
● Case conceptualization
○ No formal methods for existential counseling
○ They explore the existential anxiety and guilt of client
○ Each person conciously chooses sources of meaning/purpose
○ Person chooses to interpret and respond to life circumstances
○ Someone could get to a point where they can show symptoms because they do not
want to be aware that part of being a human being is being aware of our own
death
 ■ This isnt about thinking of death itself; this is more approaching situations
where you have to change who you are because of something that happens

Person Centered Therapy

● Developed by Carl Rogers
● Subjective experience of person is the most important thing
● We are all different, and we will be different in terms of how we express, interpret, and
make meaning
● Much more positive outlook about human life and mental health problems
○ Provides the type of setting where person grows AS a person
○ This is very different from Freud’s view in the sense that his focuses more on how
an experience shapes us
● This therapy has the strongest importance of the therapeutic relationship
○ Counselor must respect, and be present in this therapy
○ Unconditional positive regard
● In this therapy the therapist facilitates, people dont nessesarily learn from them
○ The relationship is a lot more equal rather than the expert
○ No advice or persuasion
○ Clients CAN understand and resolve their own issues without direct help
○ People over problems
● The goal of these therapists is
○ To assist in achieving greater independence for clients
○ Therapist is instrument for change
● Understand Therapeutic Core Conditions
● What therapists DONT do
○ Saying “Its going to be ok”
○ Giving advice
○ Agreeing with client
○ Disagreeing with client
○ Giving approval
○ Expression disapproval
● Limitations
○ Some people want techniques
○ If a client is very challenging or they are in a bad space and they need to be
confronted, this approach does not use confrontation
 Lecture 6: CBT
Relies heavily on psychoeducation

· How do we think and how do we get stuck in these thinking processes

· CBT does not focus on the experience, it focuses on the behaviour

· The idea is to make sense of human behaviour by studying what is observable

· A lot more focus on how the cognitive process influences behaviour

· REBT – Rational Emotive Behavioural Therapy

o Albert Ellis

o People would contribute to their problems because of extremely rigid beliefs

o Focusing on the way that people think to change the events effect on behaviour

o Very didactic and very directive

· A lot of confrontation in this approach

· ABC theory

o Activating Event, Belief, Behavioural/emotional consequence

o Therapy hits belief (disrupting intervention/challenging irrational beliefs),

effective philosophy, new feeling

· REBT uses cognitive homework

Aaron Beck = CBT

Cognitive triad

● Cognitive Triad
○ Self criticism
○ Ff
○ F
● Automatic thoughts - Automatic reactions to distressing situations
● Intermediate beliefs - Extreme or absolute rules that are more general (Good students get
good grades all the time)
● Core beliefs - (I am stupid)
● Schemas - Cognitive frameworks of the mind
● The diff between rebt and cbt
○ REBT is very directive and confrontational
○ CBT is thought as much more of a collaborative process
■ Therapist and client will both analyze ways for client to change thoughts
○ REBT sees thoughts as irrational and they have to be replaced
○ CBT sees these more like errors, and that you can do something about them
○ CBT places emphasis on noticing and doing something different with these
thoughts
● Thought record
○ Deconstructs situation that has been problematic
● Exposure therapies
○ Used to deal with very particular specific fears
○ There is a gradual exposure technique - Desensitization
○ The opposite is called Flooding, being put into an intense situation
● Mindfulness and acceptance
○ Accepting where you are at and taking a moment to decide how you are going to
proceed next
○ DBT and ACT are the main ones
● DBT
○ Used commonly with grounding people in the present
● Contributions of CBT

Family system theory

● We are born into relationships with others, the world, and ourselves
● Rather than looking at what happens inside a persons head, this therapy looks at the
interaction of the relationship itself
○ We do things and invite others to interactions
○ The focus is the inbetween
● Carries assumption that all behaviour is logical in context
● The types of interactions that individuals will engage in
● We are always engaged in these invitations and responses
● We really aren't thinking about how we engage in these interactions
● Systemic family thinking was born out of different disciplines that started to think about
these systems
● General systems
 ○ All systems will behave in a way that is given by how the parts of that system will
relate
○ The relationship of the parts is what makes the system
● Cybernetics
○ The idea is that systems have the capacity to self correct and they steer their own
course
○ They are self correcting through their equilibrium and this is particular for the
family
○ Feedback loops exist
■ Fridge example, how it returns to the temperature
○ Two ways a system can react
■ Positive and negative feedback
■ Negative feedback loop means that the system stays the same; keeps
homeostasis; nothing to do with feedback, this is about stability
■ Positive feedback loop is when a system starts to accelerate; we do
something different so the system has to adjust; an escalation
● Parts of interaction
○ The circularity implies a pattern that repeats itself over and over again and which
reflects a salient aspect of the overall relationship
○ Talking/listening, criticising/defending
■ The more you defend yourself the more you get criticised
■ This could be something that could escalate
■ This is example of interaction of suffering and where there could be an
escalation
● 4 phases of interaction
○ Normal - tension rises - symptom - tension subsides
○ Child has temper tantrum, the mother calms him down, the father says it isnt
working, the child calms down, then they return to normal
● First order change
○ When there is first order change the family returns to homeostasis
● Second order change
○ Requires the system to change the rules of how they are interacting
○ The kind of change we would look for in therapy
○ You are trying to help the families to interact in ways that are beneficial
● Another assumption is that one cannot not communicate
● Even if you do not talk you are still communicating
○ This is because it is always understood to the context
○ One of the most influential assumptions
● *** language is at the centre of each relationship ***
● No one orchestrates these interactions
● Its all about action and response
● Double binds
○ Request to do something but there was a second message that contradicts the first
○ Individual does not respond because any response could be bad for their
relationship
● 3 schools of thought within family therapy
○ Structural
○ Mri
○ Milan
■ (paradoxical)
● Milan
○ Families seen by team of therapists
○ They would observe them through one way mirrors
○ The therapist would then consult with team and talk about intervention
○ The therapist goes back to the family and deliver that intervention
● Strategic family therapy
○ Interest in changing behaviour not history
○ (Check slides)
● Structural family therapy
○ Based on same systemic concepts
○ Works with subsystems
■ Parental subsystem, sibling subsystem
● Family genogram
○ (Went over this in bio)
● The family and therapist become a therapeutic system
● The assumption that family knows what is good for them
○ Any changes made must be towards something they want to achieve
● 4 steps
○ Clearly define the problem
○ Identify prior attempted solutions
○ Develop clear description of preferred change
○ Develop a systemic treatment plan

Postmodern Therapies

● Postmodernism - emphasizes importance of pluralism and diversity along with the

dialogue
● Empiricism is existential, behaviourism is different
● Systemic therapies are also different; it goes under the post modern ideas
● What are post modern ideas?
● They emphasise dialogue and diversity
● It is not about being right, it is rather about what are the different parts
● It is impossible to know the world without language
● 4 way stop example - these unwritten rules are what shape society -Gerkinkel
● Social constructionism - through language use, social reality is generated and maintained
and change
○ Social artifacts - refers to a practice
■ Such as “selfie”
○ Language is socially performed
○ Different tone changes meaning
● Linguistic turn in therapy
○ This happened 1980-1990
● Social constructionist informed therapies
○ The client is the expert, not the therapist
○ Its not about what the therapist wants to change, what is it that the client wants to
change
○ Therapist collaborates with clients
○ Relationships are the focus
○ The shift is that everything starts with their relationship, it is not an add on
○ It is not about finding the correct way but its including that perspective and seeing
if it is hindering or aiding their opportunities
● Therapeutic goals
○ Client is expert in their own lives anad it is important for them to change what
needs to be changed but therapist has a say in how that is going to happen
○ Solution focused is very focused on the present and on the conversation; works
really micro in what happens in a person's life. Narrative therapy analyses history,
perspectives, influence, etc. SOLUTION IS MICRO, NARRATIVE IS MACRO
● SFBT
○ Wants to have a more positive outcome in their life
○ The focus on the present is very much that's a signature of SFBT
○ Very little emphasis on the history and the problem
○ What is something that the person tried already, even if it didnt work.
○ Rather then where did the problem start, we dont say that
○ Grounded approach
○ Really concerned with highlighting what are the things that are already working
that a aperson is doing
○ Look for exceptions to the problem
 ○ When you find the problem you find the exceptions to that problem - what are the
situations when that probem has not appeared
○ Clear orientation to solution focus
○ Not “how about this”
○ Finding ways of building from what is working for the person that the person is
not as aware
○ We tend to notice what is working vs what is not working
○ Theres a resource potential in what is already working, lets build on it
○ Small changes are something that is central
○ The best therapy involvs collaborative paartnerships
○ Small steps that leads to big changes ******
○ Open ended questions
○ You are trying to build towards the future and open their eyes to what they are not
aware of
● Questions of SFBT
○ One of the things that solution focus proposes
○ Customer type relationship - client and therapist jointly identify problem and
solution to work forward
○ Complainant relationship - a client describes a problem but is not able or willing
to take an active role in constructing a solution
○ Visitors - come to therapy because someone else thinks they have a problem
■ Such as court
○ SFBT has to be a specific and doable issue
● Miracle question - What would be different if the problem miraculously disappeared
○ You have to set it up that the person thinks about what would be different if the
problem wasn’t there
○ Ask them what about this what else would be different
○ This brings in hope
○ Ask how husband would know if the problem went away from you
○ You have to be focused and build on this miracle

Narrative and Collaborative Therapy

● The emphasis is bringing out the alternative story
● We understand the world through the stories that we tell and make about it
● What is it that we do in language
● Solution focused will from the start look for exceptions to the problem
 ○ Narrative therapy will first explore the problem saturated story and will highlight
unique outcomes, these are unique situations where someone was able to resist the
problem or make it go away.
○ The idea is to re edit this story.
○ Narrative therapy is similar because it works towards solutions
○ The therapist does not impose their own assumptions, rather it is a collaborative
process
○ The idea of the client being the expert is present in this therapy
● This therapy is super collaborative
○ Key idea: externalization - separating the person from their problem
● We are relational beings, we understand each other through language
○ If we want the alternative story to be the main one, we need to create it so that
when other people hear it they understand it
● Externalization - When you separate the problem from the person. Helps free them from
being identified to their problem
○ Assists clients in identifying time where they dealt with the problem successfully
○ It is a way of talking, but it has effect in how a person goes about dealing with the
problem
● Ex of externalization - a character named Mr. Worry was causing a child’s problem
● There is another method to the exercise
○ You could do the interview acting as the character that you are facing
● Collaborative approach = therapist is facilitator not expert
● Counsellor’s position is thought of as a conversational partnership
● There isnt one perspective to life
○ The sum of the parts is worth more than the system
○ It becomes a system because of the relationships of the parts
● Very transparent collaboration
● Conversational questions ask about your experience
● Appropriately unusual comments
○ A bit different but offers a new perspective
○ Offer more perspective to client

***** WOODS HOMES *******

jmcormick@mtroyal.ca
 Lecture feminist therapy
● The main criticism of family therapy was how gender roles were thought of and
performed in society
● This cultural uniqueness influences a lot of things in therapy
○ This does not mean it is only on women
○ It just centeres their lens to things that is connected to gender and how power
plays into societies
● Women's movement in the 1960’s laid the groundwork for this movement
● Socialist feminism focused on oppression
● Culture interpersonal feminism proposed that women’s experience is different then mens
● Radical feminism wanted social change
● Multicultural feminism - adresses the unique needs for ethnic non-dominant groups of
women in western society
● Postmodern feminism - looks at how gender is constructed and looks at women's
relationships and how they respond to societal discourses
● Problems are viewed in a sociopolitical and cultural context
● The psychological oppression that women and minorities have experience is
acknowledged
● The socialization of gender roles (traditional) and its acceptance is challenged
● Emphasis is on educating clients about the therapy process (process is transparent)
● The personal is political
○ Problems originated in political and social context
● The therapeutic relationship is egalitarian
○ Goals and therapeutic process negotiated between therapist and client
● Focus is on person’s strength
○ Not looking at deficit, but rather seeing they are part of a group that is oppressed
and the strengths they display in their lives
● For men, there is a focus on challenging ideas about masculinity
● Feminist therapy would comfront sexist behaviour in a client but it is also a requirement
that the therapist challenges their own ideas
○ It redefines the gender interactions to acknowledge and propose a much more
egalitarian relationship between genders
● Feminist therapy is very critical of the dsm system
● Reframing
○ Changes the frame of reference for looking at an individual’s behaviour
● Self-disclosure
○ To help equalize the therapeutic relationship and provide modelling for the client
○ Shows client this belongs to a larger issue
● Bibliotherapy
 ○ Using local knowledge to give them power to understand what they are going
through

Final Lecture: Psychotherapy Integration

● Multiplicity: 400+ approaches

● It is important to establish a good therapeutic relationship regardless of the approach you
use
● Integration -
● Common factors approach
○ The one that has the most empirical support
○ Focus is on the common factors of therapy
● Theoretical integration
○ Connects 2 or more theories into a single model
● Assimilative integration
○ Grounded in a particular school of psychotherapy
○ Base yourself somewhere and incorporate things that are related
● Technical eclecticism
○ Good for newer counsellors
○ Draws techniques from various theories
○ The key is not introducing techniques that could contradict themselves
● Systematic treatment selection
○ Organized template for integrative theories that incorporate evidence based
practice
● Syncretism and sloppy thinking
●