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Clinical Models. Week 14. Agenda. Clinical models that turn worry into action Clinical models that strengthen self-evaluation Clinical models that nurture self-respect. Clinical models that strengthen self-evaluation. Cognitive Behavioral Therapy (Arnold A. Lazarus)
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Clinical Models Week 14
Agenda • Clinical models that turn worry into action • Clinical models that strengthen self-evaluation • Clinical models that nurture self-respect
Clinical models that strengthen self-evaluation • Cognitive Behavioral Therapy (Arnold A. Lazarus) • Dialectical Behavior Therapy (Marsha M. Linehan) • Transactional Analysis (Eric Berne)
Clinical models that nurture self-respect • Client Centered Therapy (Carl Rogers) • Narrative theory (Michael White)
Cognitive Behavioral Therapy (CBT) • Modern adaptation by Arnold Lazarus
Cognitive Behavioral Therapy • Draws from • cognitive therapies (Albert Ellis’ Rational Emotive Therapy, Aaron Beck’s Cognitive Therapy) and • behavioral therapies (Pavlov, Wolpe, Skinner, Eysenk) • Here-and-now orientation • Briefer and time-limited (efficacy within <16 sessions) • highly instructive nature and the fact that it makes use of homework assignments. • the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. • Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. • The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change.
CBT Techniques • Techniques include: • Validity testing. • Cognitive rehearsal. • Guided discovery. • Writing in a journal. • Homework. • Modeling. • Systematic positive reinforcement. • Aversive conditioning.
CBT Techniques (cont’d) • Slow-talk/slow walk/slowing down • Stopping automatic negative thinking (ANTs) • The acceptance paradox: how we keep the fires burning and how to put them out • Rational and helpful self-statements that can become permanent and "automatic”
CBT Techniques (cont’d) • Continuing to move our self-statements up • Whose voice are you listening to, anyhow? Do we have to listen and believe all those old lies? • The determination factor: becoming more focused and gently determined • Focusing: What are you paying attention to? • Later, it’s important we address: • perfectionism, anger, frustration, setbacks, and our view of the world
Dialectical Behavior Therapy (DBT) • Marsha Linehan • Most noted for work with clients with borderline personality disorder
Dialectical Behavior Therapy • DBT combines • standard cognitive-behavioral techniques for emotion regulation and reality-testing • with concepts of • mindful awareness, • distress tolerance, and • acceptance largely derived from Buddhist meditative practice.
Teaching Interpersonal Effectiveness within DBT • The interpersonal effectiveness module focuses on • situations where the objective is to change something (e.g., requesting that someone do something) or • to resist changes someone else is trying to make (e.g., saying no). • The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
Teaching Emotion Regulation within DBT • Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile. • They can be • angry, • intensely frustrated, • depressed, or • anxious. • This suggests that these clients might benefit from help in learning to regulate their emotions
Teaching Distress Tolerance within DBT • Distress tolerance skills constitute a natural development from mindfulness skills. • The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them.
Transactional Analysis • People are OK; thus each person has validity, importance, equality of respect • Most everyone has the capacity to think • People decide their story and destiny, and these decisions can be changed • Freedom from historical maladaptations embedded in the childhood script is required • The aim of change under TA is to move toward autonomy (freedom from childhood script), spontaneity, intimacy, problem solving
Client Centered Therapy • Carl Rogers • This technique uses a non-directive approach. • This aids patients in finding their own solutions to their problems.
Client Centered Therapy • Rogers stated that there are six necessary and sufficient conditions required for therapeutic change: • Therapist-Client Psychological Contact • Client incongruence, or Vulnerability • Therapist Congruence, or Genuineness • Therapist Unconditional Positive Regard • Therapist Empathic understanding • Client Perception
Narrative Therapy • Michael White • From the post-modern branch of counseling • Narrative therapy holds that our identities are shaped by the accounts of our lives found in our stories or narratives
Concepts ofNarrative Therapy • The narrative therapist is a collaborator with the client in the process of discovering richer ("thicker" or "richer") narratives • “The person is not the problem, the problem is the problem.” • Operationally, narrative therapy involves a process of deconstruction and "meaning making”
Common Elements in Narrative Therapy • The assumption that narratives or stories shape a person's identity • An appreciation for the creation and use of documents • An "externalizing" emphasis • A focus on "unique outcomes" or exceptions to the problem • A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles • Responding to personal failure conversations
