deterioration in the quality of the relationship between patient and therapist
How to repair a rupture?
Own up to it and ask what you can do to help repair it, use feelings and emapthy when talking with the client about the rupture.
4 types of probes
Statements, requests, questions, words/phrases - in effect to questions or requests
When to summarize
beginning of session, during a session that is going no where, when a client gets stuck, when a client needs a new perspective
Give examples of non-verbal and verbal prompts
nonverbal - noding, leaning
Verbal - sounds of agreement, silence
Example of a distressing/alarming Label?
How could I be so stupid?
Example of an alarming/distressing Standard?
I must always be perfect.
Example of an alarming/distressing Prediction.
If I do this...this will happen.I will never like it there it's not fun.
Protects us from danger, however can cause stress anxiety when it takes all of our time and energy.
Our emergency-response system can be re-trained to respond differently to different stimuli. In anxiety disorders this response can work against the person to cause more stress.
How anxiety affects the body
Automatic Immediate response - Fight for our life or Flee
Heart Beats faster - blood to the muscles and oxygen to muscles
Lungs - Need more oxygen, breathe faster and more shallow.
Muscles - tighter more tense
Digestion - decreases, less energy devoted to it.
Sweating increases - too cool off while you are running or fighting
Adrenal Gland - increases adrenaline
Immune System - becomes suppressed
if you can increase your anxiety by exposing yourself to an anxious stimuli, the discomfort begins to lessen, and your system begins the slow but certain process of retraining.
Key Ingredients for Relaxation
Decreased Muscle Tone
allows the chest to remain relaxed, because downward movement of the diaphragm pulls air into the lungs.
Why does diaphragmatic braething help?
To increase your awareness of overbreathing and chest breathing, which tend to increase sensations of anxiety such as numbness, tingling, chest pressure, hot flashes, blurred vision, and sweating.
To lower baseline levels of arousal/tension.
To give you a method of taking calm, relaxing breaths in order to break the cycle of increasing arousal during anxious episodes.
Cue-controlled relaxation involves identifying a cue, or reminder, for ourselves, and practicing a simple “letting go” relaxation technique whenever and wherever we see or hear the cue.
brief paragraph (5-8 sentences) about a worrisome scene.
Worry exposure is one way of gaining control of cognitive (thinking) anxiety: it involves creating a mental picture of various worries, and maintaining that picture until anxiety begins to lessen
During the day they write every worry they have in their worry log. Give a time later at night, 7-8 tonight to worry about it.
Increases the likelihood for suicide, followed by OCD.Fight or flight response is extremely heightened. Will have a panic attack, lasts 10 mins, but will spend the next month worrying about having another panic attack, and most likely will not go out in public for fear of having another panic attack.
Not a failure, it's a slip and use as a cue to get back on the program.Educate them what to do when it happens. Give them the tools to deal with a relapse.
your brain is telling your body that there is a threat to your life and the pupils will dilate giving the brain more information.
Reasons for Reluctance
Fear of intesity
lack of trust
fear of disorganization
cost of change comfort vs work
Loss of hope
Resistance in clients
see no reason to go
resent third party referrers
fearful of the unknown
counseling = weakness
different from therapist
If a client comes to you and talks about worry
Look for anxiety
If a client describes instability
Look for borderline personality disorder
Client describes being depressed
Mood disorders or depressive disorders
a better way to confrontation
Reasons for challanging a client
Blind spots, client may be unaware, self-deception, choosing to stay in the dark, knowing but not caring.