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Gestault Therapy:
Franz & Laura Perls
Experiential in approach/stresses awareness of behaviors and living in the present
Main Belief: Self Regulation
Will happen on its own and is not controlled.
Uses experimental control by client ot identify key issues:
Explaination of resistance, contact and awareness. Experiments based on the here and now.
Principals of Gestault Therapy
1) Holism
2) Field Theory
3) Figure Formation Process
4) Organismic Self-Regulation
Holism:
Interested in the whole person: throught, feelings, behaviors, body and dreams.
Field Therory:
Client must be observed in his/her own environment for proper observation.
Figure Formation Process
How a person organizes his/her environment from moment to moment.
Orgasmic Self-Regulation:
Organizms will eventually regulate themselves, given their individual capabilities & resources in their environment.
Other Key Concepts:
1) The Now
2) Unfinished Business
3) Contact & Resistance to Contact
The Now:
Questions are asked "What" and "Why" questions. Gestault therapists believe that focusing on the past is due to avoidance of the future.
Unfinished Business:
Focus is on bodily experience based on unexpressed feelings which result in undesirable physical symptoms, even blockages in the family. This can manifest with preoccupation, compulisve behavior, opression and other self-defeated behaviors.
Contact & Resistance:
1) Introjection
2) Projection
3) Retroflection
4) Deflection
5) Confluence
Introjection:
Passively accepting others' beliefs, or standards without analizing or restructuring them to make them our own.
Projection:
The opposite of introjection. One disowns the personal attributes that may be inconsistant with his/her self image and puts them on to other people in order to avoid taking responsibility for his/her feelings.
Retroflection:
The art of turning aggression inward. This could be wished aggression toward someone else/make abstract generalizations or ask many questions to avoid making a direct statement.
Confluence:
Blur between self and the environment and between internal experience and outer reality. These persons prefer to blend in & avoid conflict if at all possible. High need for personal acceptance.
Energy and Blocks to Therapy:
Blocked energy is another form of resistance can manifest through body tension, closed body, shallow/improper breathing, avoiding eye contact and numbing feelings. Client often not aware of their energy or experience it in a negative manner.
The Therapeutic Process and Goals:
1) to gain awarenss in order to attain greater choice.
2) knowing one's environment, oneself, acceptance of self.
Other goals include:
1) increased self awareness
2) Assume ownership of their experience.
3) Develope skills and values that satisfy personal needs without violating the rights of others.
4) Gain increased awareness of all senses.
5) Begin accepting responsiblity for his/her actions including consequences.
6) Move from accepting outside supportive resources toward using their own internal support
7) Learn to ask for and get help, while also learning to be helpful.
The Gestault Therapist Role and Function
1)The basic work is done by the client. Therapist's job is to pay attention to body language, such as client saying angry words while smiling.
2) Clients may say "it" instead of "I" as in "It" talk.
3) "you" talk- client generalized "you" in place of "I".
Other client behaviors for therapist to look for:
1) Questions: client hiding behind questions in order to feel safe. Therapist may have to turn those questions into statements.
2) Language that denys power: Clients may add disclaimers or qualifiers such as "maybe", "sort of" or "I guess".
3) Listening to clients metaphors- by tuning in to metaphors therapis can tune into client's deeper feelings.
4) Listening for language that uncovers a story: Clients will reveal a small segment of a larger part of a situation, so therapist needs to look for these pieces to picture the "whole picture".
Client's Experience in Therapy:
1)Clients must be confronted about acting irresponsiblity.
2) Clients must be active participants
Three Stage Sequence that Characterizes Growth:
Stage One: Discovery
Stage Two: Accomodation
Stage Three: Assimilation
Stage One: Discovery
Clients acquire a new realization or view of themselves or a situation.
Stage Two: Accomodation
Clients realize that they finally have a choice.
Stage Three: Assimilation
Client learns how to influence their environments.
Relationship Between Client and Therapist
1. Therapists' are responsible for having a vast self knowledge of both theirselves and their client.
2) Therapist must provide welcoming and and open for their client yet avoid getting "pulled in" or "lost".
3) Therapist shouldn't get "technique bound" and needs to apply their own self and life experiences that are appropriate to the situation. (ONE CHARACTERISTIC THAT HAS BEEN REVISED SINCE PERL'S DEATH)
APPLICATION: THERAPEUTIC TECHNIQUES AND PROCEEDURES
1) Experiment in Gestault Therapy
2) Preparing Clients for Gestault Experiments
Experiment in Gestault Therapy
1) Role of therapist is as a creative agent, inventor and compassionate person.
2) Therapist will use e"exercises" at times in or to makes something happen or to achieve a desired goal.
3) Experiments may be used in kind to bring out internal conflict or encourage spontaneity and inventiveness.
Preparing Clients for Gestault Experiments
1) Therapist must first use the Gestault experiments before using them with clients.
2) Therapist must avoid suggesting these to clients in a commanding way.
3) May be more difficult for clients who have a long history of containing their emotions for social or cultural reasons and require patience from the therapist.
Main Goals of Experiments
1) Assist client in "trying out" and "trying on" new behaviors.
2) Awareness is heightened which leads to greater understanding.
Guidelines To Follow In Preparing Clients in Gestault Experimentation
1) Therapist must be extremely sensitive to clients feelings.
2) Therapist must introduce experiments at the correct time and appropriately.
3) Nature of experiment must be appropriate to client's individual situation and life experiences.
4) Expeiments must require client's active role.
Guidelines To Follow In Preparing Clients in Gestault Experimentation Continued:
5) Therapist must respect client's cultural background.
6) If therapist hesitates, they need to stop and think why and what it would mean to the client.
7) Therapist must be flexible
8) Therapist should scale down tasks in order to help the client succeed.
9) Therapist must be aware of which experiments should be performed inside the seesion and which need to be perfomed outside.
The Role of Confrontation:
1. Gestault can sometimes be seen as confrontational as was Perl's way of dealing with avoidance- but has now evolved into what is sometimes called "relational Gestault therapy", which includes more empathy and compassion.
2. Has three therapy styles: imposing, competing and confrontational.
Therapy Style One:
1. Imposing: Therapist is more concerned with meeting his or own agenda than respecting or understanding client's needs.
Therapy Style Two:
2. Competing: There is some negotiation and give and take but in a contfrontational atmosphere.
Therapy Style Three
3. The client's whole being is the focus, along with his or her entire needs and experiences.
Some confrotnation is used in modern Gestault Therapy but not in a harsh, attacking manner. Clients can be invited to examine themselves more fully.
Gestault Therapy Interventions: Founded by Levitsky and Perl
1. The Internal Dialogue Exercise
2) The Empty-Chair Technique
3) Making the Rounds
4) The Reversal Exercise
5) The Rehersal Exercise
6) The Exaggeration Exercise
7) Staying with the Feeling
8) The Gestault Approach to Dreamwork
Gestault Therapy Intervention One
The Internal Dialogue Exercise:
1. Goal is to bring out the parts of one's personality that have been disowned or denied and to pay close attention to splits in personality function.
2) Often times division between the demanding, bossy, authoritarian "top dog" and the "underdog" who manipulates by playing the role of the victim by being defensive, apologetic and helpless.
3) Constant stuggle for control which is based in the mechanism of introjection.
Gestalt Therapy Intervention Two
The Empty Chair Technique
1. Client will sit in a chair and be the "top dog" and then move to the other chair to become the "underdog".
2) Client can continue the dialogue and hopefully accept and integrate both sides in order to resolve the conflict.
Gestault Therapy Intervention Three
Making the Rounds:
1. Group therapy exercise in which one member of group is asked to speak or do something with every other group member.
2. The purpose is to confront and risk and in turn, grow and change.
Gestault Therapy Intervention Four
The Reversal Exercise:
1. Use in group therapy too, members are asked to act out the reverse of the behavior that most disturbs them.
2. This techique assists clients in accepting attributes they have tried to deny.
Gestault Therapy Intervention Five
The Rehersal Exercise:
1. Some people constantly rehearse silently as a means of social acceptance.
2. When clients share these rehearsals aloud with therapist they become aware of as to what degrees and legnths they will go to gain social acceptance. They can then start working toward self-acceptance.
Gestault Therapy Intervention Six
The Exaggeration Exercise:
1. Therapist pays attention to body language and make client aware of the signals they send.
2. Clients may be asked to exaggerate movements or gestures, like shaking hands, clenched fists or crossing arms etc.
Gestault Therapy Intervention Seven
Staying with the Feeling:
1. facing or confronting feelings and use to facilitate new levels of growth.
Gestalt Therapy Intervention Eight
The Gestault Approach to Dreamwork:
1. Have client relive the dream as though it were actually happening in the present tense.
2. The dream is acted out by the client becoming each part.
Gestalt Therapy From A Multicultural Perspective
1. Can be used successfully if the therapist is creative since this threapy can be tailored to client needs.
2. Do no use experiments too soon, especially with culturally reserved clients.
Contributions of Gestalt Therapy
1. Can be used for clients with personality disorders, psychosomatic problems, substance addictions.
2. Shown equal or greater than other therapies for various disorders.
3. Cleinte tend to be stable 1-3 years after follow up, and termination of treatment.
Limitations and Criticisms of Gestalt
1. Confrontational techniques with clients may be outdated and were the personal style of Perls.
2. Focuses more on theoretical instruction, exposition and cognitive factors.
3. More emphasis is placed on facilitating or assisting clients with their own self-discovery.
Some Cautions:
1. Some therapist rooted in Gestault may be too rooted in the technique may have the potential to abuse their power.
2. If the therapist lacks sensitivity, timing, empathy and respect can boomerang back on to the therapist.
3. Need to be specifically trained to perform this type of therapy.
Gestalt Therapy- Other comments on column study sheet:
1. Can help overcome language barrier with bilingual clients, by focusing on bodily expressions.
2. Importance given to the I/Thou relationship
3. Can be used for marital counseling.
4. Formal diagnosis and testing are not a requirement for therapy.
5. Person strives for wholeness and integration of thinking.
6. Grounded in the here and now, emphasizing personal choice and responsibility.
7. What and how are asked of client to accept aspects of themselves.
8. Expands capacity to make choices.
BEHAVIOR THERAPY
Behavior Theapy and behavior modification are used interchangable but do have slightly different meanings.
Behavior Modification:
1. An approach to an assessment, evaluation, or behavior change that focuses on development of adaptive and pro-social behaviors (decreasing maladaptive behavior in daily life).
2. This therapy aims to eliminate maladaptive behaviors and learn more effective behavior
3. Abnormal behavior is the result of faulty learning and normal behavior is learned through reinforcement and imitation.
Behavior Therapy:
1. Clinical approach to treat a variety of disorders in various settings and populations.
2. Emerged with great force in the 1970's.
3. Therapy is based on the principals of learning theory.
Four Areas of Development:
1. Classical Conditioning
2. Operant Conditioning
3. Social Learning Theory
4. Cognitve Behavioral Therapy
Classical Conditioning:
1. Refers to what happens prior to learning what causes a response through pairing.
Operant Conditioning:
1. Involves a type of learning in which behaviors are influenced by the consequences that follow them.
Social Learning Theory:
1. Influenced by stimulus events, external reinforcement and by cognitive mediational processes.
2. People are capable of self-directed behavior change.
Cognitive Behavioral Therapy:
1. Emphasizes cognitive processes that involve private events such as the client's self talk.
Basic Characteristics and Assumptions of Behavior Therapy
1. Based on principals and proceedures of the scientific method.
2. Deals with clients current problems.
3. Those involved are expected to take an active role by engaging in certain actions to deal with their problems.
4. Emphasizes teaching clients skills of self-management expecting they will be responsible for transferring what they learn with therapist to every day life.
Continued Basic Characteristics and Assumptions of Behavior Therapy
5. Focus on exerting overt and covert behavior directly and identifying problems and evaluating change.
6. Emphasizes a self-control approach in which clients learn self management strategies.
7. Individually tailored to specific problems experienced by clients.
Continued Basic Characteristics and Assumptions of Behavior Therapy
8. A collaborative partnership between the client and therapist.
9. Every attempt is made to inform client about the nature and course of treatment.
10. Emphasis is on practical applications.
11. Therapists strive to develop culture-specific proceedures and obtain their clients adherence and cooperation.
Therapeutic Goals :
1. General goals are made to increase personal choice and to create new conditions for learning.
2. Therapist helps client define goals.
3. Continued assemssment in therapy seesions determines the degree to which goals are being met.
4. Important to devise a way to measure progress.
Therapist Function and Roles
1. Use approaches such as summarizing, reflecting, clarification and opend ended questions.
2. Conducts a throurough functional assessment.
3. Formulates initial treatment goals and designes and implements a treatment plan to accomplish these goals.
4. Uses strategies to promote generalization and maintainance of behavior change.
Therapist Function and Roles
Continued:
5. Evaluate success of the change plan.
6. Conduct follow up assessments.
7. Therapist must model positive behaviors to client.
Client's Experience in Therapy
1. Requires the client to participate and be involved.
2. Client encouraged to experiment.
Relationship between Therapist and Client
1. A good therapeutic relationships is important for the client to be receptive in therapy.
Operant Conditioning Techniques
1. Positive reinforcement
2. Negative reinforcement
3. Extinction
4. Positive Punishment
5. Negative Punishment
Positive Reinforcement
Involves addition of something of value to the individual.
Negative Reinforcement
Involves the escape from or avoidance of average or unpleasant stimuli.
Extinction
Witholding reinforcement from a previously reinforced response.
Positive Punishment
An adverse stimulus is added after the behavior to decrease the frequency of the behavior.
Negative Punishment
A reinforcing stimulus is removed following the behavior to decrease the frequency of a target behavior.
The Functional Assessment Model
How to deal with problem behaviors through a step by step functional assessment and treatment program.
Functional Assessment Steps
1. Conduct a functional assessment to gather data.
2. Conduct assessment by using both direct and indirect methods (interviews and observations)
3. Therapist will then develop a hypothesis based on the assessment.
Functional Assessment Steps Cont.
4. Once problem behaviors are identified, functional treatments are devised.
5. Negative punishments proceedures may be used to decrease problem behaviors (only after functional approaches have been tried).
6. Develop strategies to promote the generalization and maintainance of behavioral changes.
Relaxation Training and Related Methods
1. Method used to teach people to cope with everyday living.
2. It is aimed at achieving muscle and mental relaxation that is easily learned.
3. Relaxation training involves several components that usually require 4 to 8 hours of instruction.
Systematic Desensitization
1. Clients imagine successively more anxiety arounding situations at the same time they engage in a behavior that promotes anxiety.
2. Gradually or systematically clients become less sensitive to the anxiety arousing situation.
Systematic Desensitization Steps
1. Relaxation training
2. Development of the anxiety hierarchy.
3. Systematic desensitization proper
Criticism of Behavioral Therapy
1. Critics say that this therapy may change behavior, but not feelings and ignores the relational factors in therapy.
2. Does not provide insight but ignores historical causes of present behavior.
3. Involves control and manipulation by the therapist and is limited in its capacity to address certain aspects of the human condition.
Focus of Behavior Therapy
1. Behavior is a product of learning. We are both the product and the producer of the environment.
2. No set of unifying assumptions about behavior can incorporate all the existing proceedures in the behavior field.
3. Focus is on overt and present behavior.
Other Methods Used in Behavioral Therapy
1. Flooding
2. Eye movement and desensitization reprocessing.
3. modeling
4. assertion training
5. social skills training
6. Self management training
7. Using "What, How and When" questions but not 'why".
8. Homework
9. Reinforcement techniques
What Problems Can Behavior Therapy Be Used For?
1. Depression
2. Phobic Disorders
3. Sexual Disorders
4. Childrens Behavioral Disorders
5. Stuttering
6. Prevention of Cardiovascular Disease
Exposure Therapy (Behavioral)
1. In Vivo Desensitization
2. Flooding
Eye Movement Desensitization and Reprocessing
1. A form of exposure therapy that involves imaginal flooding, cognitive restructuring and use of rapid rhythmic eye movements and other bilateral stimulation to treat clients who have experiences in traumatic stress.
2. There are eight stages
Assertion Training
1. Used for people who have difficulty feeling that it is appropriate or right to assert themselves.
2. For people who lack social skills experiencing interpersonal difficulties at home, school, work and during leisure time.
3. Training helps give client the tools they need to make the choice of whether to behave assertively in certain situations.
4. Client is taught to express themselves in ways that reflect sensitivity to the feelings and rights of others.
Self Management Programs and Self Directed Behavior Steps:
1. Selecting goals
2. Translating goals into target behavior
3. Self-monitoring
4. Working out a plan for change
5. Evaluating an action plan
Multimodal Therapy: Clinical Behavior Therapy
Technical Eclecticism and the Basic ID
1. Behavior
2. Affect
3. Sensation
4. Imagery
5. Cognition
6. Interpersonal Relationships
7. Drugs/Biology
COGNITVE BEHAVIORAL THERAPY
1. Combines both cognitive behavioral principals and methods in a short term treatment model (approach has generated more empirical research than an other psycotherapy model.
2. More than 20 different therapies are labeled cognitive or cognitive behavioral.
Cognitive Behavior Attributes
1. collaborative relationship between client and therapist.
2. The premise is that psychological distress is largely a function of disturbances in cognitive processes.
3. A focus on changing cognitions to produce desired changes in affect and behavior.
4. Generally time limited and educational treatment focusing on specific and structured target problems.
Albert Ellis's Rational Emotive Therapy
1. REBT approach stresses thinking, judging, deciding, analyzing and doing.
2. People contribute to their own problems as well as specific symptoms by the way the interpret events and situations.
3. REBT is based on the assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal cause and effect relationship.
REBT Cont.
4. Became general school of psychotherapy aimed at providing clients with tools to restructure their philosophical and behavior styles.
5. The psychoanalytic approach is sometimes inefficient because people often seem to get worse before they get better.
6. Ellis credits the Greek Philosopher Epictetus saying "people are disturbed not by things, but by the view which they take of them".
REBT Cont.
7. REBT's basic hypothesis is "our emotions stem from our beliefs, evalustion, interpretations, and reactions to life situations."
8. Like the Adalarian approach, REBT emphasizes the importance of goals, purposes, values and meanings in human psychology.
REBT Focuses
1. Active Teaching
2. Use of persuasive methods
3. giving of live demonstrations before an audience.
4. Theapist is like an educational process.
5. Therapist functions as teacher
6. works with client on homework assignments.
7. Teaching strategies for straight thinking for everyday life.
Views of Human Nature
1. REBT: Humans are born with potential for both rational and straight thinking and irrational or "crooked" thinking.
2. Attempts to help people accept themselves as creatures who will continue to make mistakes yet at the same time, learn to live more peacefully with themselves.
3. Ellis assumes we are "self talking", "self evaluating", and "self sustaining".
4. Emotional and Behavioral difficulties come about when people mistake "simple preference" (desires for love, approval, success) for dire needs.
5. Inborn tendency toward growth and actualization. People sabatoge movement toward growthdue to learned self defeating patterns.
View of Emotional Disturbance
1. Irrational beliefs learned from significant others during childhood.
2. We create irrational dogmas and superstitions by ourselves.
3. By processes of auto suggestion and self-repetition and by behaving as if they are useful, we actively reinforce self-defeating behaviors.
4. Largely our own repetition of early indoctinated irrational thoughts, instead of a parent's repetition, that keeps dysfunctional attitudes alive and operative within us.
View of Emotional Disturbance Cont.
5. REBT attempts to help people find ways of overcoming unhealthy feelings of depression, anxiety, hurt, loss of self-worth and hatred.
6. Blame is at the core of most emotional disturbances.
7. To recover from a neurosis or a personality disorder, we had better stop blaming ourselves and others.
8. Here are some irrational ideas that we internalize and that inevitably lead to self defeat.
9. I "must" have love or approval from all of the significant people in my life.
10. I "must" perform important tasks competently and perfectly well.
View of Emotional Disturbance Cont.
10. I stongly desire that people treat me considerately and fairly. 11. If I don't get what I want its terrible and I can't stand it.
12. It's easier to void facing life's difficulties and responsibilities than to undertake more rewarding forms of self-discipline.
13. We have a strong tendency to make and keep ourselves emotionally disturbed by internalizing self-defeating behaviors such as the ones above.
ABC Theory of Personality
1. ABC theory of personality is central to REBT theory and practice.
2. A is the existance of a fact, an event, or the behavior or attitude of an individual.
3. B is the person's belief about A
4. C is the emotional and behavioral consequence or reaction of the individual which can either be a healthy or unhealthy reaction.
ABC Theory Cont.
1. Showing people how they can change irrational beliefs that directly cause disturbed emotional consequences is the heart of REBT.
2. Emotional disturbance is fostered by the self defeating sentences clients continually repeat to themselves such as "I am totally to blame for the divorce." or "I am a miserable failure, and everything I do is wrong." or "I am a worthless person."
3. You mainly feel the way you think.
4. Revised ABC's of REBT now define B as believing, emoting and behaving.
Solution Based Focus Therapy
1. Find out what clients want
2. Do not look for pathology, and do not attempt to reduce clients by giving them a diagnostic label.
3. If what clients are doing is not working, then encourage them to experiment with doing something different.
4. Keep therapy brief by approaching each session as if it were the last and only session.
Goals of SFBT
1. People have the ability to define meaningful personal goals and that they have the resources required to solve their problems.
2. Focus is on small, realistic, achievable changes that may lead to additional positive outcomes.
3. Therapist joins with the language of their clients, using similarwords, pacing and tone.
SFBT- Several Forms Goals
1. Changing the viewing of a situation or a frame of reference.
2. Tapping into client strengths and resources.
SFBT Main Goal
1. Involves helping clients adopt an attitudinal and a language shift talking about problems and solutions.
Roles and Functions of SFBT
1. Adopts a not-knowing position.
2. Client is the expert in their own lives.
3. Main task consists of helping client imagine how they would like things to be different and what it will take to bring about these changes.
SFBT Relationships- 3 Types
1. Customer- The client and therapist jointly and a solution to work toward.
2. Complainant: client describes problem but is not able or wiling to assume a role in constructing a solution.
3. Visitor: Client who comes to therapy because someone else thinks the client has a problem.
Techniques for Cognitive Behavioral Therapy
1. Use a variety of cognitive, emotive and behavioral techniques.
2. Time activated, directive, time limited, present centered, structured therapy.
3. Gather data on assumptions one has made and keep a record of activities.
4. Turn alternative interpretations, learning new coping skills, changing one's language and thinking patterns.
5. Use role playing, imagery and contronting faulty beliefs.
Treatment of CBT for Counseling
1. Depression
2. Anxiety
3. marital problems
4. Stress Management
5. Skills Training
6. Substance Abuse
7. Assertion Training
8. Eating Disorders
9. Panic Attacks
10. Performance Anxiety
11. Social Phobias
Cognitive Behavioral Therapy
1. Emphasis on comprehensive and eclectic therapy.
2. Best used for faulty thinking
3. Does not focus on the unconcious or underlying conflicts and sometimes does not give enough weight to clients past.
4. May be too structured for some clients,
NARRATIVE THERAPY
1. Individuals construct the meaning of life in interpretive stories, which are treated as "the truth".
Narrative Therapy Approach
1. Involves adopting a shift in focus from traditional therapy.
2. Therapist wants to establish a collaborative approach with a special interest in listening to client stories.
3. Search for times in client's lives when they were resourceful.
4. Question in a way to engage clients and facillitate their exploration.
5. Avoid diagnosing and labeling the client
Narrative Therapy Approach Cont.
1. Accepting a totalizing a description based on a problem.
2. Assisting clients mapping the influence a problem has in their life.
3. Assist clients in separating themselves from the dominant stories they have internalized so that space can be opened for the creation of alternative life stories.
4. These stories we live by grow out of conversations in a social and cultural context.
5. We live our lives by the stories we tell ourselves and that others tell about us.
Narrative Conversation
1. Attention is given to the totalizing language, which reduces the complexity of the person by assigning an enbracing, single description to the essence of the person.
2. Therapists begin to separate the person from the problem in their mind as they listen and respond.
3. Clients are the primary interpreters of their own experiences.
4. The process of change can be facilitated but not directed by the therapist.
Goal for Narrative Therapy
1. To invite people to describe their experiences in a fresh new language.
Function and Role- Narrative Therapy
1. Main task of therapist is to help the client construct a preferred story line.
2. The narrative therapist adopts a stance characterized by respectful curiosity and works with clients to explore both the impact of the problem on them and what they are doing to reduce the effects of the problem.
3. Ask questions of clients and based on the answers generate further questions.
Techniques used in Narrative therapy
1. Externalization
2. Deconstruction
Externalization
1. A process for deconstructing the power of a narrative and separating the person from identifying with the problem and sometimes giving it a name.
Deconstruction
1. Used to separate the person from the problem is referred to as externalizing conversations.
2. Particularly useful when people have diagnoses and labels that have not been validating or empowering the change process.
Contributions of Narrative Therapy
1. Hopefully a post-modern approach is competent and can be trusted in giving the clients resources to better empower themselves and build more life affirming stories.
2. Is found that clients are able to make significant moves toward building more satisfying lives in a relatively short period of time.
3. Future oriented questions that challenge clients to think about how they are likely to solve potential problems in the future.
Limitations of Narrative Therapy
1. Postmodern appoaches to therapy are that each use of narrative or SFBT will vary with each client and their story.
2. There is not a set formula or a recipe to follow.
3. It is essential that therapist be skilled in brief invention due to the fact practitioners must be able to assessments, assist in formulating specific goals and use appropriate interventions in a short time.
FAMILY SYSTEMS THERAPY Key Contributor
1. Alfred Adler was the first of a modern era to do family therapy using a systematic approach.
2. Set up more than 30 child guidance clinics in Vienna after WWI (Rudolf Dreikurs brought this concept to the U.S.)
3. Conducted family sessions in a open public forumto educate parents in greater numbers.
4. Believed the problems of any one family are common to all of the others.
Disputing
The application of methods to help clients challenge their irrational beliefs.
3 Components of Disputing Process
1. Detecting
2. Debating
3. Discriminating
Detecting
1. Clients learned to detect irrational beliefs, particularly their absolutist "shoulds" and "musts", their "awfulizing" and their "self-downing."
Debating
1. Clients debate their dysfunctional beliefs by learning how to logically and empirically question them and to vigorously argue themselves out of and act against believing.
Discriminating
1. Clients learn how to discriminate irrational (self-defeating) beliefs from rational self-helping) beliefs.
REBT in Family Systems Therapy
1. Stresses the this process of disputing both during therapy sessions and in everyday life.
Effective Pholosphy
1. Practical side consists of replacing unhealthy thoughts with healthy ones.
New Set of Feelings
1. Feel healtily sorry and disappointed in accord with a situation.
Philosophical Restructuring
1. Changes our dysfunctional personality by using steps.
Philosophical Restructuring
Steps
1. Fully acknowledge that we are largely responsible for creating our own emotional problems.
2. Accept the notion we have the ability to change these disturbances significantly.
3. Recognize that our emotional problems largely stem from irrational beliefs.
4. Clearly percieve these beliefs.
Philosophical Restructuring
Steps Cont.
5. See the value of disputing such self-defeating beliefs.
6. Accept the fact that if we expect to chage we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional
feelings and actions that follow.
7. Practice REBT methods of uprooting or changing disturbed consequences for the rest of our life.
The Therapeutic Process
1. Process rates behaviors and actions not only as 'good' or 'bad', 'worthy' or 'unworthy' but also to rate ourselves as a total person on the basis of our performances.
2. Ratings constitute one of the main sources of our emotional disturbances.
3. General goal of most cognitive behavior therapists, teaching clients how to separate the evaluation of their behaviors from the evaluation of themselves and how to accept themselves with their imperfections.
2 Main Goals of REBT
1. Assist clients in the process of achieving unconditional self-acceptance (USA) and unconditional other acceptance (UOA)
2. To see how the (USA) and (UOA) are related.
Therapist Function and Role
1. Show clients that they've incorporated many irrational "shoulds", "oughts" and "musts".
2. Demonstrate that clients are keeping their emotional disturbances active by continuing to think illogically and unrealistically.
3. Help clients modify their thinking.
4. Challenge clients to develop a rational philosophy in life so that tin the future they can avoid becoming the victim of other irrational beliefs.
5. Dispute the core of the irrational thinking and teach clients how to substitute rational beliefs and behaviors in place of irrational ones.
Clients Experience in Therapy
1. Clients role in REBT is that of a learner and a doer.
2. Psychotherapy viewed as a reeducative process whereby client learns to apply logical thought, experimental exercises and behavioral homework to problem solving and emotional change.
3. Therapeutic process focuses on client experiences in the present emphasizing the "here and now".
4. Work toward client's present ability to change the pattern of thinking and emoting they've constructed earlier.
5. Clients expected to actively work outside therapy. Homework is carefully designed and agreed upon to get client to carry out positive actions that induce emotional and attitudinal change.
Relationship Between Therapist and Client in REBT
1. Intense relationship between therapist and client is not required.
2. Practitioners unconditionally accept all clients and also teach them to unconditionally accept others and themselves.
3. Too much warmth and understanding can be counterproductive, fostering a sense of dependence for approval from the therapist.
4. Rational emotive behavioral therapists therapists are often open and direct in disclosing their own beliefs and values.
5. Transference is not encouraged.
Application of Therapeutic Techniques and Proceedures for the Practice of Rational Emotive Behavior Therapy
1. REBT generally starts with clients disturbed feelings and intensley explores these feelings in connection with thoughts and behaviors.
Cognitive Methods with REBT
1. REBT practitioners use forceful methodology.
2. Demonstrate to clients in a quick and direct manner what it is they are continuing to tell themselves.
3. Then teach clients how to deal with these self statements.
4. Encourage clients to develop a philosophy based reality.
REBT & Cognition relies on:
1. Thinking
2.Disputing
3. Debating
4. Challenging
5. Interpreting
6. Explaining
7. Teaching
Disputing Irrational Cognitive Thoughts
1. Most common method of REBT to challenge their own thoughts.
Doing Cognitive Homework
1. Clients are expected to make their own list of problems, look for absolute beliefs and dispute them.
2. Clients use the ABC Theory.
3. Changing one's language-replace distortions by using positive preferences.
4. Use humor-don't take self too seriously to where you lose sense of perspective and humor over events in life.
EMOTIVE TECHNIQUES
1. REBT employs acceptance, rational role playing, modeling, national emotive imagery and shame attacking excercises.
2. Clients are the value of unconditional acceptance.
Rational Emotive Imagery
1. A form of intense mental practice designed to esablish new emotional patterns. "clients imagine thinking, feeling and behaving exactely the way the would like to feel, think and behave in real life.
Role Playing
Emotional and behavioral components are involved. "The focus is on working through the underlying irrational beliefs that are related to unpleasant feelings."
Shame Attacking Exercises
1. Helps people to reduce shame over behaving in certain ways. The main point of these exercises is that clients work to feel unashamed when others clearly disapprove of their them.
2. Exercises are aimed at increasing self-acceptance and mature responsiblity.
3. Helps the client to see that much of what they think of as being shameful has to do with the way they define reality for themselves.
Use of Force and Vigor
1. A way to help clients go from intellectual to emotional insight.
2. Shows client how to conduct forceful dialogue with themselves in which they express their unsubstantial beliefs and then powerfully dispute them.
BEHAVIORAL TECHNIQUES
1. Operant Conditioning
2. Self Management Principals
3. Systematic Desensitization
4. Relaxation Techniques
5. Modeling
6. Skill Training
7. Homework
Research
1. REBT uses a combination of cognitive, emotive, and behavioral methods within a single seesion with a given client.
2. If one technique doesn't work use another which makes controlled research difficult.
REBT Treatment
1. Anxiety
2. Hostility
3. Character Disorders
4. Psychotic Disorders
5. Depression
6. Sexual Disorders
7. Love Problems
8. Marriage Problems
9. Social Skills Problems
REBT
1. Suitable to group therapy
2. Can be applied to couples and family counseling.
3. Brief form of therapy
COGNITVE THERAPY
1. Developed by Aaron Beck founded on his research of depression.
2. Observed that depressed individuals had more negative thinking of life events which contributes to their cognitive distortions.
3. Similar to REBT, both are active, directive, time limited, persent centered, collaborative, stuctured.
Cognitive Therapy Cont.
4. Insight focused-emphasizes recognizing and changing negative thoughts and maladaptive beliefs.
5. Based theoretical rationale that how people feel and behave is how their perceive and stucture the experience.
Basic Theory of Cognitive Therapy
1. To understand the nature of an emotional episode or disturbance.
2. It is essential to focus on cognitive content of an individual's reaction to an upsetting event or stream of thoughts.
Basic Principals of Cognitive Therapy
1. Automatic thoughts: personalized notions that are triggered by stimuli that lead to emotional responses.
2. People with emotional difficulties tend to commit "logical errors" that tilt objective reality in the direction of self deprication.
3. Psychological problems coming from commonplace processes such as faulty thinking and making incorrect inferences based on inadequate birthday or incorrect information and failing to distinguish fantasy from reality.
Cognitive Disorders
1. Systematic errors on reasoning that lead to faulty assumptions or distortions.
Cognitive Disorders
1. Arbitrary inferences: Making conclusions without supporting and relevant evidence. Includes catastrophizing or thinking the absolute worst scenario or outcomes for given situations.
2. Selective abstraction: forming conclusions based on an isolated detail of an event. Other information is ignored and the significance of the total context is missed. Assumption is that the events that matter are those dealing with failure and deprivation.
3. Overgeneralization: Holding eextreme beliefs on the basis of a single incident them applying them inappropriately to dissimilar events or settings.
Cogntive Disorders Cont.
4. Magnification and minimization: percieving a case or situation in a greateror lesser light than it truly deserves.
5. Personalization: Tendency for individuals to relate to external events to themselves even when there is no basis for making this connection.
6. Labeling and Mislabeling: Portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity.
7. Polarized thinking: Thinking and interpreting in all or nothing thinking and categorizing experiences in either or extremes. Events are labeled in black or white terms- no latitude for being imperfect.
Becks take on Cognitive Therapy
1.Correcting all faulty thinking that cause psychological distress.
2. Most direct way to change dysfunctional emotions, thinking and behaviors is to modify inaccurate beliefs.
3. Cognitive therapy focuses on the present and is a time limited therapy.
4. Assist patients to resolve their most pressing problems and teach clients relapse prevention strategies.
Differences between Cognitive Theapy and REBT
1. REBT is highly directive, persuasive, confrontational and focuses on the teaching role of the therapist.
2. Collaborative empiricism: cognitve therapists attempt to collaborate with clients in testing the validity of their cognitions.
Dysfunctional beliefs are problematic because they interfere with normal cognitive processing, not because they're irrational.
Similarities of CB and REBT
1. Both are highly organized
Client/ Therapist relationship:
1. Eliis (REBT) views the therapist as the teacher and doesn't think a warm personal relationship with the client is neccesary.
2. Beck emphasizes the quality of the therepeutic relationship is basic to the application of CT.
3. CT encourages client to take an active role in the therapy process.
Client Relationship Cont.
4. Cognitive therapists are continuously active and deliberately interactive with clients; also strive to engage clients active participation and collaboration throughout all phases of therapy.
5. Cognitive Therapist aim to teach clients how to be their own therapist.
6. Homework and bibilotherapy are often used as part of therapy.
Application of Cognitive Therapy- Applying Congitive Therapy
1. Therapist mainly interested in applying proceedures that will assest individulas in making alternative interpretations of events in their daily life.
2. Apply CT prinicpals: become aware of distortions in thinking patterns by examining automatic thoughts; therapists ask client to look at inferences which may be faulty-then trace back to earlier experience in the client's life.
3. Therapist helps client to see how sometimes a conclusion is reached by magnification of the problem or minimization of thinking, or exaaggerating the meaning of an event.
4. Teach cleint not to disregard important aspects of a situation, nor to engage in overly simplifying and rigid thinking or generalize from a single instance of failure.
Treatment of Depression (Beck)
1. Cognitive Triad is a pattern that triggers depression.
2. The tendency to interpret events in a negative view of themselves.
3. Gloomy visions and projections about the future.
Beck Depression Inventory (BDI)
1. 21 symptoms and attitudes.
2. Sadness
3. Pessimism
4. Sense of failure
5. dissatisfaction
6. Guilt
7. Sense of punishment
8. Self dislike
Beck Depression Inventory Cont.
9. Suicidal ideation
10. Crying bouts
11. Irritability
12. Crying bouts
13. Indecision
Beck Depression Inventory Cont.
14. Social withdrawl
15. Distorted body image
16. Work inhibition
17. deep disturbance
18. tendency to become fatigued
Beck Depression Inventory Cont.
19. Loss of appetite
20. Weight loss
21. Somatic Preoccupation
22. Loss of libido
Application in Family Therapy
1. Focuses on family interaction pattern and family relationships, cognitions, emotions and behavior are viewed as exerting a mutual influence on one another.
2. Key aspect of the therapeutic process: restructuring distorted schemas (beliefs).
REALITY THERAPY (Glasser)
Based on choice therapy, makes underlying assumptions that problems of most clients are the same. They are either involved in a present unsatisfying relationship or lack of what can be called a relationship.
Client Problems
1. Issues caused by inability to connect, get close to others.
2. Inability to have a satisfying or successful relationship with at least one other significant person.
What Clients Need to Understand
1. Few clients have a clear understanding about what their problem is and how it leads to their behavior.
2. Many times they are forced into therapy because of their unacceptable behavior by school administration, court officials, a spouse, parent or the legal system.
Cautions of Glasser
1. Do not label clients if at all possible.
2. Labeling ineffective behavior as mental illness is not accurate.
Key Concepts of Reality Therapy
1. Choice theory says there is no such thing as a blank slate, but are motivated by the experiences that happen to us in the world around us.
People Born with Five Genetically Encoded Needs:
1. Survival
2. Love
3. Belonging
4. Power
5. Achieving
6. Freedom
7, Independence
8. Fun
Choice Theory
We all have a need for love and belongingness since we are social creatures- we need to recieve love, and some need more than others do.