Application: Therapeutic Techniques and Procedures 211 Gestalt Therapy from a Multicultural Perspective 221 Gestalt Therapy Applied to Stan's Case 222 Summary and Evaluation 224. Application: Therapeutic Techniques and Procedures 241 Behavior Therapy from a Multicultural Perspective 259 Behavior Therapy Applied to Stan's Case 261 Summary and Evaluation 262.
AUTHOR INDEX 503 SUBJECT INDEX 507
There is a new section on evidence-based practice and the trend toward accountability in counseling practice.
The newly revised and expanded Case Approach to Counseling and Psychotherapy (Seventh Edition) features 26 experts working on Ruth's case from each of 11 therapeutic approaches. This book also complements The Art of Integrative Counseling (Second Edition), which expands on the material in Chapter 15 of the textbook.
Acknowledgments
Michael Russell from California State University, Fullerton • Chapter 7 (Person-Centered Therapy): Natalie Rogers, Person-Centered Therapy. Dattilio, Harvard Medical School and University of Pennsylvania School of Medicine; and Albert Ellis, founder of REBT • Chapter 11 (Reality Therapy): Robert Wubbolding, Center for Reality.
I encourage you to keep an open mind and seriously consider both the unique contributions and the particular limitations of each therapeutic system presented in Part 2. By studying the models presented in this book, you will gain a better sense of how to integrate concepts and techniques from different approaches as you define your own personal synthesis and framework for counseling.
Stand
On the contrary, it is a philosophy of counseling that emphasizes different methods of understanding the subjective world of a person. The online program (also available in DVD format) demonstrates one or two techniques from each of the theories.
Intake Interview and Stan’s Autobiography
I still remember my father asking me, “Why can't you be like your sister and brother. I do know that I want to be free of my self-destructive tendencies and learn how to trust people more.
Overview of Some Key Themes in Stan’s Life
In my opinion, this human dimension is one of the most powerful influences in the therapeutic process. What research reveals about the role of the counselor as a person and the therapeutic relationship in psychotherapy outcome.
Personal Characteristics of Effective Counselors
They are aware of the ways in which their own culture affects them, and they respect the diversity of values espoused by other cultures. But they can become aware of the signs of these reactions and can deal with these feelings in their own therapy and supervision sessions.
The Role of Values in Counseling
My experience in teaching and supervising counseling students shows me how important it is for students to be aware of their values, of where and how they have acquired them, and of how their values influence their interventions with clients. It is critical that you become aware of the nature of your values and how your beliefs and standards operate on the interventions you use in your professional work.
The Role of Values in Developing Therapeutic Goals
Counseling students often hold values—such as making their own choices, expressing what they feel, being open and self-disclosing, and striving for independence—that differ from the values of clients from different cultural backgrounds. It is essential that counselors become aware of how clients from different cultures may view them as therapists, as well as how clients may perceive the value of formal help.
Acquiring Competencies in Multicultural Counseling
The greater their depth and breadth of knowledge about culturally diverse groups, the more likely they are to be effective practitioners. They are willing to seek educational, consulting, and training experiences to enhance their ability to work with a culturally diverse client population.
Incorporating Culture in Counseling Practice
They understand their clients' worldviews and learn about their clients' cultural backgrounds. It is unrealistic to expect a counselor to know everything about a client's cultural background, but some insight into the client's cultural and ethnic background is essential.
Dealing With Our Anxieties
Learn to pay attention to the common ground that exists between people from different backgrounds. Here are some helpful guidelines for your reflection on meeting the challenge of becoming an effective counselor.
Being Ourselves and Disclosing Our Experience
SOME ADDITIONAL PRACTICE GUIDELINES If the counseling process is to be effective, it is critical that cultural concerns are addressed with all clients. It is this level of authenticity and presence that enables us to connect with our clients and establish an effective therapeutic relationship with them.
Avoiding Perfectionism
At the other end are therapists who strive too hard to prove they are human. If we are able to be ourselves in our therapeutic work and appropriately reveal our experience in counseling sessions, we increase the chances of being authentic and present.
Being Honest About Our Limitations
On the one hand are counselors who lose themselves in their assigned role and hide behind a professional facade.
Understanding Silence
The client may wait for the therapist to take the lead and decide what to say next, or the therapist may wait for the client to do so. Either the client or the therapist may be confused or preoccupied, or neither may have anything to say at the moment.
Dealing With Demands from Clients
Dealing With Clients Who Lack Commitment
Tolerating Ambiguity
Avoiding Losing Ourselves in Our Clients
Developing a Sense of Humor
Sharing Responsibility With the Client
Declining to Give Advice
Defi ning Your Role as a Counselor
Learning to Use Techniques Appropriately
Developing Your Own Counseling Style
Staying Vital as a Person and as a Professional
Topics covered include balancing clients' needs against your own, ways to make sound ethical decisions, educating clients about their rights, parameters of confidentiality, ethical concerns in counseling diverse client populations, ethical issues involving diagnosis, evidence-based practice and treatment. with dual and multiple relationships. An ethical problem exists when we meet our own needs, in overt or subtle ways, at the expense of our clients' needs.
The Role of Ethics Codes as a Catalyst for Improving Practice
While these needs are not necessarily unhealthy, it is essential that our needs are met outside of our work as therapists if we are to help others find fulfillment in their lives. The key is not to satisfy our needs at the expense of our customers.
Some Steps in Making Ethical Decisions
As much as possible, involve the client in all stages of the ethical decision-making process. Regardless of your theoretical framework, informed consent is an ethical and legal requirement that is an integral part of the therapeutic process.
Are Current Theories Adequate in Working With Culturally Diverse Populations?
In determining when to breach confidentiality, therapists must consider the requirements of the law, the institution in which they work, and the clients they serve. There is a legal requirement to break confidentiality in cases involving child abuse, elder abuse, dependent adult abuse and danger to self or others.
Is Counseling Culture-Bound?
Focusing on Both Individual and Environmental Factors
An appropriate theory of counseling deals with the social and cultural factors of an individual's problems. Both clinical and ethical issues are associated with the use of assessment and diagnostic procedures.
The Role of Assessment and Diagnosis in Counseling
The reason is that specific therapy goals cannot be formulated until a clear picture of the client's past and present functioning emerges. However, they add that the client actually accounts for more of the treatment outcome than the relationship or method used.
Perspectives on Dual and Multiple Relationships
You may be required to manage multiple roles regardless of the environment you work in or the client population you serve. This is one of the most useful books on therapeutic self-care and burnout prevention.
Case Approach to Counseling and Psychotherapy (Corey, 2009b) provides case applications of how each of the theories presented in this book work in practice. Indeed, most of the theories of counseling and psychotherapy discussed in this book have been influenced by psychoanalytic principles and techniques.
View of Human Nature
Structure of Personality
While the id knows only subjective reality, the ego distinguishes between mental images and things in the external world. It functions to inhibit the id impulses, to induce the ego to substitute moralistic goals for realistic ones, and to strive for perfection.
Consciousness and the Unconscious
Ruled by the reality principle, the ego does realistic and logical thinking and formulates plans of action to satisfy needs. The ego, as the seat of intelligence and rationality, checks and controls the blind impulses of the id.
Anxiety
Ego-Defense Mechanisms
Development of Personality
To a large extent, our lives are the result of the choices we make at each of these stages. A comparison of Freud's psychosexual view and Erikson's psychosocial view of the stages of development is presented in Table 4.2.
Therapeutic Goals
What are the sociocultural factors that influence development that must be understood if therapy is to be comprehensive. Psychosocial theory gives special weight to childhood and adolescent factors that are significant in later stages of development, while recognizing that the later stages also have their significant crises.
Therapist’s Function and Role
Organizing these therapeutic processes in the context of an understanding of personality structure and psychodynamics enables the analyst to shape the nature of the client's problems. One of the central functions of the analyst is to teach clients about the importance of these processes (through interpretation) so that they can gain insight into their problems, increase awareness of ways to change, and thus gain greater control over their lives.
Client’s Experience in Therapy
The analyst listens for gaps and inconsistencies in the client's story, infers meaning from reported dreams and free associations, and remains sensitive to clues about the client's feelings toward the analyst. If the therapist pushes the client too quickly or gives poorly timed interpretations, the therapy will not be effective.
Relationship Between Therapist and Client
Hayes (2004) refers to countertransference as the therapist's responses to clients based on his or her unresolved conflicts. Ainslie (2007) also agrees that the therapist's countertransference responses can provide rich information about both the client and the therapist.
Maintaining the Analytic Framework
Free Association
Interpretation
In making an appropriate interpretation, the therapist should be guided by the client's sense of willingness to consider it (Saretsky, 1978). Another general rule is that interpretation should always start at the surface and go only as deep as the client can go.
Dream Analysis
It is important that interpretations are timely; the client will reject those that are inappropriately defined. In other words, the analyst must interpret material that the client has not yet seen for himself, but is able to tolerate and incorporate.
Analysis and Interpretation of Resistance
During free association or dream association, the client may demonstrate a reluctance to relate certain thoughts, feelings, and experiences. When handled properly, resistance can be one of the most valuable tools for understanding the client.
Analysis and Interpretation of Transference
As a defense against anxiety, resistance specifically works in psychoanalytic therapy to prevent clients and therapists from succeeding in their joint effort to gain insights into the dynamics of the unconscious. The therapists' interpretation is aimed at helping clients to become aware of the reasons for the resistance so that they can deal with it.
Application to Group Counseling
They compensate for the overdevelopment of an aspect of the individual's personality (Schultz & Schultz, 2005). Mahler conceives of the development of the self somewhat differently from the traditional Freudian psychosexual stages.
Strengths From a Diversity Perspective
This is accomplished by using the client-therapist relationship as a means of understanding how the person interacts in the world. Levenson maintains that “the first and foremost goal in performing TLDP is for the client to have a new relationship experience.
Shortcomings From a Diversity Perspective
As you'll see, one of Stan's goals is to learn how to be less intimidated around women and more himself around them. If the therapist operates from a contemporary psychoanalytic orientation, her focus may well be on Stan's developmental sequences.
Contributions of the Psychoanalytic Approach
Self-psychology focuses on the nature of the therapeutic relationship, using empathy as the main tool. Therapists who work from a developmental perspective can see continuity in life and see certain directions their clients have taken.
Contributions of Modern Psychoanalytic Theorists
This perspective gives a bigger picture of the individual's struggle and clients can discover some important connections between different life stages.
Limitations and Criticisms of the Psychoanalytic Approach
He heard the doctor tell his father "Alfred is lost." Adler associated this time with his decision to become a doctor. Along with Freud and Jung, Alfred Adler was a major contributor to the initial development of the psychodynamic approach to therapy.
Subjective Perception of Reality
We are driven to overcome our sense of inferiority and strive for ever higher levels of development (Schultz & Schultz, 2005). Adlerians recognize that biological and ecological conditions limit our ability to choose and create.
Unity and Patterns of Human Personality
Applied to human motivation, a guiding self-ideal might be expressed this way: “Only if I am perfect can I be safe” or “Only if I am important can I be accepted.” The guiding self-ideal represents the image of a individual of a goal of perfection, which he or she strives for in a given situation. By pursuing goals that have meaning for us, we develop a unique lifestyle (Ansbacher, 1974).
Social Interest and Community Feeling
More often than not, when people seek therapy, it is because they are having difficulty successfully completing one or more of these life tasks. The goal of therapy is to help clients adjust their lifestyle so that they can more effectively manage one of these tasks (Carlson & Englar-Carlson, 2008).
Birth Order and Sibling Relationships
- Establish the proper therapeutic relationship
- Explore the psychological dynamics operating in the client (an assessment)
- Encourage the development of self-understanding (insight into purpose)
- Help the client make new choices (reorientation and reeducation)
- Establish the Relationship
- Explore the Individual’s Psychological Dynamics
- Encourage Self-Understanding and Insight
- Reorientation and Reeducation
This is followed by a re-education of the client to the useful side of life. After summarizing and interpreting these early memories, the therapist identifies some of the major successes and mistakes in the client's life.
Areas of Application
Many of the major teacher education models are based on principles of Adlerian psychology (see Albert, 1996). Instead, they are aware of the value of adapting their techniques to each client's situation.
Contributions of the Adlerian Approach
Another contribution of the Adlerian approach is that it is suitable for short-term, time-limited therapy. All these approaches are based on a similar concept of the person as purposeful, self-determining and striving for growth.
Limitations and Criticisms of the Adlerian Approach
It is clear that there are significant connections between Adler's theory and most theories today. If your thinking is aligned with the Adlerian approach, you may consider seeking training in individual psychology or becoming a member of the North American Society for Adlerian Psychology (NASAP).
He learned from experience that everything can be taken from a person except one thing: “the last of human freedoms – to choose one's attitude under any circumstances, to choose one's own path” (p. 104). He established his international reputation as the founder of what has been called “The Third School of Viennese Psychoanalysis”.
Historical Background in Philosophy and Existentialism
Becoming human is a project, and our task is not so much to discover who we are as to create ourselves. Heidegger's phenomenological existentialism reminds us that we exist "in the world" and should not try to think of ourselves as beings separate from the world into which we are thrown.
Key Figures in Contemporary Existential Psychotherapy
The current focus of the existential approach is on the individual's experience of being alone in the world and facing the anxiety of this isolation. His understanding of himself is based on two basic relationships: "I/she" and "I/Thou". I/she is the relation to time and space, which is a necessary starting place for the self.
Phases of Existential Counseling
These practitioners prefer describing, understanding, and exploring the client's subjective reality, as opposed to diagnosis, treatment, and prognosis (van Deurzen, 2002b). Van Deurzen (1997) identifies as a primary ground rule of existential work openness to the individual creativity of therapist and client.
Clients Appropriate for Existential Counseling
The goal of therapy is to enable clients to find ways to implement their explored and internalized values in a concrete way between sessions and after therapy ends. Clients typically discover their strengths and find ways to employ them in a purposeful existence.
Application to Brief Therapy
Members learn that it is not in others that they find the answers to questions about meaning and purpose in life. While it is true that some clients may not feel a sense of freedom, their freedom can be increased if they recognize the social boundaries they face.
Contributions of the Existential Approach
As clients become more aware of the ways in which they define themselves and their world, they can also see new possibilities for choice and action. Bugental and Bracke (1992) see the possibility of creatively connecting the conceptual propositions of existential therapy with many other therapeutic orientations.
Limitations and Criticisms of the Existential Approach
Members receive a regular newsletter and an annual copy of the Journal of the Society for Existential Analysis. My opinion is supported by a 2006 survey conducted by Psychotherapy Networker (“The Top who identified Carl Rogers as the single most influential psychotherapist of the past quarter century.
Four Periods of Development of the Approach
This period was characterized by a shift from clarifying feelings to a focus on the client's phenomenological world. In the early years of the approach, the client, not the therapist, was in charge.
Existentialism and Humanism
- Two persons are in psychological contact
- The fi rst, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious
- The second person, whom we term the therapist, is congruent (real or gen- uine) in the relationship
- The therapist experiences unconditional positive regard for the client
- The therapist experiences an empathic understanding of the client’s inter- nal frame of reference and endeavors to communicate this experience to
- The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved
It is the therapist's attitude and belief in the client's inner resources that create the therapeutic climate for growth (Bozarth et al., 2002). Communication with the client about the therapist's empathic understanding and unconditional positive regard is achieved to a minimal extent.
Early Emphasis on Refl ection of Feelings
Evolution of Person-Centered Methods
One of the most important ways in which person-centered therapy has developed is through diversity, innovation, and individualization in practice (Cain, 2002a). Tursi and Cochran (2006) propose the integration of certain cognitive behavioral techniques within a person-centered framework.
The Role of Assessment
Application of the Philosophy of the Person-Centered Approach
Application to Crisis Intervention
