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The Author's Perspective
- No single model can explain all the facets of human experience.
- -Eleven appraoches to counseling and psychotherapy are discussed
The Teacher's Perspecitve
Models of understanding the human condition are found in the scripture
The Book Assumes:
- Students can begin to acquire a counseling style tailored to their own personality.
- - The process will take years
- - Different theories are not "right" or "wrong"
Corey is strongly influence by the existential approach and so believes
- Clients can excercise freedom to choose their future
- The quailty of the client/therapist relationships is key
Theory Chapters in Five Divisions:
- Psychodynamic Approaches- psychoanaltyic and Adlerian
- Experiential and Relationship oriented- existential, person-centered, and gestalt
- Action Therapies- Reality, Behavior, RET, Cognitive
- Systems Perspective- Feminist and family
- Post Modern Approaches- Social constructionism, solution-focused, and narrative
Corey likes to use a variety of techniques in an integrated approach:
Role Playing and various techniques from cognitive and behavioral therapy approaches.
- "... counseling entails far more than becoming a skilled technician"
- -Who you are as a therapist is critical
- - Students should experience being a "Client" and feel anxiety over self disclosure, and learn to model courage and growth
- It is not "sufficient to be merely a good person with good intentions"
- -Also essential are a knowledge of counseling theory and techniques, theories of perosnality, and supervised experiences.
Suggestions for Using the Book
- Relate readings to your own experience
- -Reflect on your own needes, motivations, values, and life experiences.
- Apply key concepts and techniques to your own personal growth
- Develop a personalized style of counseling that reflects your personality
The Therapeutic Realtionship
- It is an important component of effective counseling.
- The therapist as a person is a key part of the effectiveness of therapeutic treatments
- Research shows that both the therpay relationship and the therapy used contribute to treatment outcome.
The Effective Counselor
- The most important instrument you have is YOU
- -Your living example of who you are and how you struggle to live up to your potential is powerful
- -Be authentic
- -The stereotyped, professinoal role can be shed
- -If you hide behind your role the client will also hide
- Be a therapeutic person and be clear about who you are
- -Be willing to grow, to risk, to care, and to be involved.
- Have an identity
- Self respect
- Open to change
- Make changes that are life oriented
- Authentic, sincere, and honest
- Have a sense of humor
- Makes mistakes and is willing to admit them
- Appreciate the influence of culture
- Lives in the present
- Sincere interest in the welfare of others
- Have effective interpsonal skills
- Become deeply involved in their work and derive meaning from it
- Maintain healthy boundaries
Counseling for the Counselor
- Corey believes that "... therapist cannot hope to open doors for clients that they have not opened for themselves."
- Why do you think many avoid it?
Counseling for the Counselor: In your experience of being a client you can
- Consider your motivation for wanting to be a counselor
- Find support as you struggle to be a professional
- Have help in dealing with personal issues that are opend through your interactions with clients
- Be assisted in managing your countertransferences
Research shows that many therapists who seek personal counseling find it:
- Personally beneficial
- Important for their professional development
The Counselor's Values
- Be Aware of value imposition
- -How your values influence your interventions
- -How your values may influence your client's experience in therapy
- Recognize that you are not value-neutral
- You job is to assist clients in finding answers that are most congruent with their own values
- Find ways to manage value conflicts between you and your clients
- Begin therapy by exploring the client's goals
- Become aware of your biases and values
- Become aware of your own cultural norms and expectations
- Attempt to understand the world form your client's vantage point
- Gain knowledge of the dynamics of oppression, racism, discrimination, and stereotyping
- Study the historical background, traditions, and values of your client
- Be open to learning from your client
- Challenge yourself to expand your vantage point to explore your client's ways of life that are different from your own
- Develop an awareness of acculturation strategies
Issues Faced by Beginning Therapists
- Achieving a sense of balance and well-being
- Questioning competency as you learn new techniques or begin to practice on your own without supervision
- Accepting your limitation while simultaneously acknowledging your strengths
- Managing difficult and unsatisfying relationships with clients
- Struggling with commitment and personal growth
- Developing healthy helping relationships with clients
- Developing healthy personal boundaries in your professional life
Staying Alive-- It's a Prerequisite
- Take care of your single most important instrument--YOU.
- -Develop self-care strategies and plan for renewal
- Know what causes burnout
- Know how to recognize and remedy burnout
- Know how to prevent burnout through self-care
Professional Ethics: Ethics codes are fundamental component of effective counseling:
- Guidelines that outline professional standards of behavior and practice
- Codes do not make decisions for counselors
- Counselors must interpret and apply ethical codes to their decision-making
Types of Ethics to Consider:
- Mandatory Ethics
- -minimum level of professional practice
- Aspirational Ethics
- -higher level that considers the best interest of the client
- Positive Ethics
- -Want to do best for client, not simply stay out of trouble
Ethical Decision Making: The Principles that Underlie Our Professional Codes
Benefit others, do no harm, respect other's autonomy, be just fair and faithful
The Role of Ethical Codes- They:
Educate us about responsbilities, are a basis for accountability, protect clients, are a basis for improving professional practice
Making Ethical Decisions
- Identify the problem, review relevant codes, seek consultation, brainstorm, list consequences, decides and document the reasons for your actions.
- To the degree it is possible, include the client in your decision making process.
- Clients need enough information about the counseling process to be able to make informed choices
- Educate clients about their rights and responsibilities
- Provide informed consent
Provide Informed Consent
- Therapy Procedures
- Risks/Benefits and Alternatives
- Right to withdraw from treatment
- Costs of treatment
- Privileged communication
- Limits of Confidentiality
Limits of Confidentality
Is essential but not absolute
Expectives to Limits of Confidentiality
- Duty to Warn (Tarasoff Case)
- The client pose a danger to self or others
- A client under the age of 16 is the victim of abuse
- A dependant adult or older adult is the victim of abuse
- The client needs to be hospitalized
- The infomration is made an issue in a court action
- The client requests a release of record
Multicultural Issues: Biases are reflected when we:
- Neglect soial and community factors to focus on unduly on individualism
- Assess clients with instruments that have not been normed on the population they represent
- Judge as psychopathological- behaviors, beliefs, or experiences that are normal for the client's culture
- Strictly adhere to Western counseling theories without considering its applicability to the client's diverse cultural background
- An ongoing process designed to help the counselor evaluate key elements of a clien'ts psychological functioning
- -Assessment practices are influenced by the therapist's theoretical orientation
- -Requires cultural sensitivity
- -Can be helpful in treatment planning
- The process of identifying pattern of symptoms which fit the criteria for a specific mental disorder defined in the DSM-IV-TR
- -Requires cultural sensitivity
- -Counselors debate its utility in understanding the client's subjective world
- -Can be helpful in treatment planning
Evidence-Based Practices: Strengths
- Counselors use treatment that have been validated by empirical research
- Treaments are usually brief and are standardized
- Are prefrerred by many insurance companies
- Calls for accountability among mental health professionals to provide effective treatments
Evidence-Based Practices: Criticisms
- Some counselors believe this approach is mechanistic and does not allow for individual differences in clients
- Is not well-suited for helping clinets with existential concerns
- It is difficult to measure both relational and technical aspects of a psychological treatment
- Has potential for misuse as a method of cost containment for insurance companies instead of a method of efficacious treatment for clients
- Are not deemed inherently unethical in the ethics codes of the APA or AC.
- Multiple relationships must be managed in an ethical way to eliminate non-professional interactions and protect client well-being
- Some helpful questions:
- -Will my dual relationship keep me from confronting and challenging the client?
- - Will my needs for the relationship become more important than the therapeutic activities?
- - Can my client manage the dual relationship?
- - Whose needs are being met-- my client's or my own?
- - Can I recognize and manage professionally my attraction to my client?
Counselor values influence what
all aspects of the therapeutic process (assessment strategies, therapy goals, identifiying what client problems will be the focus of treatment, choice of techniques, and evaluations of therapeutic outcomes).
The challenege of providing informed consent consisits of
finding a balance between giving clients too much info and giving them too little.
- An ethical concept, and in most states the legal duty of therapists to not disclose information about a client.
- Central to developing a trusting and productive client-therapist relationship.
- Counselors have an ethical and legal responsiblity to discuss the nature and purpose.
- Clients have the right to know that their therapist may be discussing certain details of the relationship with a supervisor or colleague.
- It cannot be considered an absolute
When to Break Confidentiality
- Therapist must consider the requirements of the law, the institution in which they work, and the clientele they serve.
- Child Abuse
- Abuse of the elderly
- Abuse of dependent adults
- Danger to self or others
- When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some other crime.
- When the therapist determines that the client needs hospitalization
- When information is made an issue in a court action
- When clients request that their records be released to them or to a third party
- Excerise professional judgement, when it is cloudy
Have an Identity
They know who they are, what they are capable of becoming, what they want out of life, and what is essential
Respect and Appreciate Themselves
They can give and receive help and love out of their own sense of self-worth and strength. They feel adequate with others and allow others to feel powerful with them.
Open to Change
They exhibit a willingness and courage to leave the security of the known if they are not satisfied with the way they are. They make decisions about how they would like to change, and they work toward becoming the person they want to become.
Make Choices that are LIfe Oriented
They are aware of early decisions they made about themselves, others, and the world. They are not the victims of these early decisions, and they are willing to revise them if necessary. They are committed to living a fully rather than settling for mere existence.
Authentic, Sincere, and Honest
They do not hide behind maks, defenses, sterile roles, or facades.
Have a Sense of Humor
They are able to put the events of life in perspective. They have not forgotten how to laugh, especially at their own foibles, and contradictions.
Make Mistakes and are Willing to Admit Them
They do not dismiss their errors lightly, yet they do not choose to dwell on misery.
Generally Live in the Present
They are not riveted to the past, nor are they fixated on the future. They are able to experience and be present with others in the "now."
Appreciate the Influence of Culture
They are aware of the ways in which their own culture affects them, and they respect the diversity of values espoused by other cultures. They are also sensitive to the uniqe difference arising out of social class, race, sexual orientation, and gender.
Sincere Interest in the Welfare of Others
This concern is based on respect, care, trust, and a real valuing of others.
Possess Effective Interpersonal Skills
They are capable of entering the world of others without getting lost in this world, and they strive to create collabroative relationships with others. They do not present themselves as polished salespersons, yet they have the capacity to take another person's position and work together toward consensual goals.
Become Deeply Involved in their Work and Derive Meaning from It
They can accept the rewards flowing for their work, yet they are not slaves to their work.
They have the courage to pursue their passions, and they are passionate about life and their work.
Maintain Healthy Boundaries
Although they strive to be fully present for their clients, they don't carrry the problems of their clients around with them during leisure hours. They know how to say no, which enables them to maintain balance in their lives.
Reasons for Students Receiving Therapy
- Increased level of self-awareness
- Offers a model of therapeutic practice in which the trainee experiences the work of a more experienced therapist and learns experientially what is helpful or not helpful.
- Can further enhance a therapist's interpersonal skills that are essential to skillfully practicing therapy.
- Contribute to a therapist's ability to deal with the ongoing stresses associated with clincial work.
What are the essential skills of an effective culturally competent cousnselor?
- Beliefs and attitudes
A theory of personality development, a philosophy of human nature, and a method of psychotherapy that focuses on unconscious factors that motivate behavior. Attention is given to the events of the first 6 years of life as determinants of the later development of personality.
This is a growth model that stresses assuming responsibilty, creating one's own destiny, and finding meaning and goals to create a purposeful life. Key concepts are used inmost other current therapies.
Reacting against the tendency to view therapy as a system of well-defined techniques, this model stresses building therapy on the basic conditions of human existence, such as choice, the freedom and respsonbility to shape one's lif,e, and self-determination. It focuses on the quality of the person-to-person therapeutic realtionship.
This approach was developed during ht 1940s as a nondirective reaction against pscyhoanalysis. Based on subjective view of human experiencing, it places fiath in and give resposnbility to the client in dealing with problems and concerns.
An experiential therapy stressing awareness and integration, it grew was a reaction against analytic therapy. It integrates the functioning of body and mind.
This approch applies the principles of learning to the resolution of specific behavioral problems. Results are subject to continual experimentation. The methods of this approach are always in the process of refinement
Cognitive Behavior Therapy
Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy that stresses the role of thinking and belief system as the root of personal problems. Give primary role to thinking as it influences behavior.
This short-term approach is based on choice theory and focuses on the client assuming responsiblity in the present. Through the therapeutic process, the client is able to learn more effective ways of meeting his or her needs.
This approach grew out of the efforts of many women. A central concept is the concern for the psychological oppression of women. Focusing on the constraints imposed by the sociopolicial status to which women have been relegated, this approach explores women's identity development, self-concept, goals, and aspirations, and emotional well-being.
A number of key figures are associated with the development of these various approahces to therapy. Steve de Shazer and Insoo Kim Berg are the co-founders of solution-focused brief therapy. Michael White and David Epston are the major figures associated with narrative thearpy. Social construcitonism, solution focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.
Family Systems Therapy
A number of significant figures have been pioneers of the family system approach, including Alfred Adler, Murray Bowen, Virginia Satir, Carl Whitaker, Slavador Minuchin, Jay Haley, and Cloe Madanes. This systemic approach is based on the assumption that the key to changing the individual is understanding and working with the family.
Counselors who work with culturally diverse populations need to:
- have some understanding of the client's cultural and ethnic background
- suspend any proconceptions about clients' race/ethnicity and that of their family members
- Engage clients in conversations about race and ethnicity to avoid stereotyping and making faulty assuptions.
- Address how racial/ethnic differences between therapist and client might affect the therapy process
- Acknowledge that power, privilege, and racism can affect interactions with clients.
- Recognize that the more comfortable therapists are with conversations about race and ethnicity, the more easily they can respond appropriately to clients who may be uncomfortable with such discussions.
- Remain open to ongoing learning about the various dimensions of culture and how they may affect therapeutic work.
An approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble.
What is necessary to become an ethical practitioner?
- Knowing and following your profession's code of ethics
- Respect for clients
- Having their welfare as a central concern
- Practicing within the framework of professional codes
- Good judgement
When should a therapist consult with a colleague?
Culturally diverse clients, self-doubts, mistakes during a session, when to make a referral, making ethical decisions, different course of action, any questions.
An authentic counselor is best described as?
Being yourself, being able to appropriately disclose yourself during sessions
Issues Stan Struggles With:
- Making friends
- No sense of direction
- Wants to make a difference
- Afraid of failure
- Drinks to cover up his emotions
- Afraid of women
- Has terrible anxiety at night
- Feels guilty that he wasted his life; depression
- Never felt loved or wanted by his parents
- Self-destructive tendencies and learn to trust people more R
- Negative self-image
Role of the Counselor's Personal Value is:
To create a climate in which clients can examine their thoughts, feelings, and actions and eventaully arrive at solutions that are best for them.
How does the feminist and post modern therapist view diagnosis as it is traditionally done?
They are oppressive and that such pracitces are based on a White, male-centered, Western notion of mental health and mental illness. These diagnoses ignore societal contexts.
Role of Assessment
- Generally an ongoing part of the therapeutic process
- Should not precede or dictate intervention; rather, it is woven in and out of the therapeutic process as a pivotal componenet of therapy itself.
- Consists of evaluating the relevant factors in a client's life to identify themes for further exploration in the counseling process.