Introduction TIC

1. IntroductionTIC Evolution of Counseling/Therapy Model • Psychodynamic – Freud and beyond • Cognitive-behavioral (60’s, 70’s, 80’s) • Systems approaches • Outcome-oriented brief therapy approaches- managed care models- these approaches have an ecological perspective.

2. Ecological Model • Person can not be fully understood unless influences of larger systems taken in to account. • Culture, race, religion, sexual orientation, class, race, ethnicity...(see Okun, Figure1.1,page 2 and Table 1.1, page 7- Ecological Intake Sheet)

3. Client/Therapist Woes Can you name some of stressors clients are facing in the 21st Century culture? Can you name some of stressors therapists are facing in servicing clients in the 21st Century culture?

4. Ecology, Managed Care and DSM-IV • Managed Care companies define “medical necessity” in terms of “global level of functioning”— Is the individual able to function in social and work environments (Axis V). • MC is also concerned with the psychosocial stressors faced by client (Axis IV). • MC will ask on treatment request forms whether you are utilizing community resources, whether you have contacted PCP, medications client is taking… (biopsychosocial perspective) • MC company is concerned about interrelationship of client and environment

5. Some of the Ways Counselors Help? • Diagnose/assess and refer, if necessary • Offer symptom relief • Engage in psychoeducation • Restructure faulty, self-defeating beliefs • Help develop realistic goals • Teach communications skills • Increase tolerance of differences… In other words, we are professional helpers

6. Success as a Professional Helper- • Helper w/ graduate level training. • What makes helper successful? Okun mentions these three factors I. Empathy II. Awareness of Personal Values III. Comfort in Applying Techniques

7. What’s More Important-Strategies or Relationship • To a degree, the answer is dependent on the approach. Why? • Okun makes an interesting point (page 21)

8. Reciprocal Model of Relationship Vs. Strategies- Pedoto • Personal view- I agree that a robust relationship creates a tolerance for the failure of certain strategies. • However, expert use of strategies also enhances the relationship (i.e. successful use of strategies gives the client a sense that I care about his/her well-being and am working hard to assist them).

9. Okun’s Three Dimensional Model of Helping Process • Model provides a broad conceptual perspective of three integrated dimensions which essentially describe what constitutes effective helping (pages 23-25). Dimensions I. Relationship/Strategies/Strategies II. Communications Skills III. Values Clarification/ethical matters

10. Beck and Ellis • Beck developed s/term tx for depression in 1960’s (CBT). Beck is a psychiatrist. Expanded tx model to encompass many other mental disorders. • Ellis started RT in the mid-50’s. Was disenchanted w/ Psychoanalysis. Ellis was a sex therapist early on. Obtained Ph.D. and went to Karen Horney Institute in NYC.

11. Cognitive TherapiesMajor Principles of Helping Theory REBT • Clients need to take responsibility for their own upset and own fates. • People are influenced by biological and environmental conditions, not controlled by them. • Thought/beliefs processes mediate emotions- problems caused by irrational beliefs not events. • People are inborn with tendency toward both rational and irrational thinking.

12. REBT • People are susceptible to social conditioning and they learn to re-indoctrinate or teach themselves to become more and more irrational. They refuse to accept reality, and insist on having things their way-the way things should be. Philosophical change is needed. • Active-directive form of therapy is needed to uproot irrationalities (disputing, in-vivo behavioral work…other homework) • Ellis Postulates A B C Theory • Employs cognitive, emotive and behavioral techniques.

13. CBT Helping Theory • Therapist needs to focus on systematic errors in reasoning and restructure (information processing model). • Negative automatic thoughts disrupt one’s mood. Leads to spiraling down… • Distorted reasoning based on systematic logical errors. • Therapy is an active process (eliciting self-talk/interpretations, gathering evidence against interpretation, setting up experiments-homework)

14. CBT • Therapist enters “collaborative” relationship w/ client. • The therapy is very structured following an agenda typically starting w/ review of HW and ending w/ summary

15. Case Exerpt • Read Case Excerpt- p.3-4, Beck book

16. CBT-General Principles 1)Formulate problem in cognitive terms: What aspects of client’s current thinking acts to maintain problematic emotions and behaviors? *Therapist might also be concerned w/ precipitating factors (context)- what environmental events might have influenced perceptions

17. CBT-Principles *CBT and other cognitive therapist would also be interested in developing hypotheses about key developmental events and enduring patterns of interpreting these events. Example: early childhood loss of father and tendency to deal poorly with later loss. partner.

18. CBT Principles 2) Therapy requires a sound alliance Warmth, caring, genuine regard… How is this shown… • Listening closely • Empathizing • Accurately summarize thoughts and emotions

19. CBT Principles 3) Collaboration and active participation- *Encourage client to view therapy as teamwork *Assign work between sessions *Over time, give client more responsibility to direct session.

20. CBT Principles 4) Cognitive Therapy is goal-oriented and problem-focused • Client encouraged in initial session to develop a problem list • Set specific goals of a behavioral nature-lonely- develop new friendships-develop plan, set HW • Identify thoughts interfering w/goal(s)

21. Principles-CBT 5) Present focused- here-and-now emphasis at first…want to reduce symptom stress. Attention shifts to past when a) client expresses strong desire, b) work on present problems produces little change in cognitions, emotions, behaviors, c) important dysfunctional ideas developed in the past (If I always do well, I am ok…if I don’t do well I am a turd)

22. Principles-CBT 6) Cognitive therapists aim to educate the person so that they can be their own therapist (self-help) using the techniques learned in therapy. 7) Therapy is intended to be time-limited (4-14 sessions) however this is not always possible. 8) CBT and cognitive therapy is structured.

23. CBT-Principles 9) Cognitive therapy teaches clients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs • The most basic question is to ask, “What was going through your mind when ____.” In other words, “What were you telling yourself.” • Then evaluate the validity of the thought via Socratic Questioning…where is it written that what you told yourself is true…and even if it were true, is it really as bad as you tell yourself (REBT). • CBTer’s use collaborative empiricism- helping determine accuracy and utility of an idea…REBT uses disputing

24. CBT-Principles • Cognitive therapists use a variety of change techniques to help people *cognitive- Socratic Questioning, Downward Arrow Technique, Thought Records *emotive- rational-emotive imagery, empty chair *behavioral experiments, in-vivo HW

25. CBT Principles 10) Cognitive Therapists vary their techniques to meet the needs of the individual client (see Beck pages 9-10).