Psychotherapy Fundamentals and Theories

1
Psychotherapy Fundamentals and Theories

• PSY 340 Section 2

2
Course Section 2 Goals

• Knowledge of basic counseling fundamentals
• Overview of the major psychological theories
• Main theorists, therapeutic goals, strategies,
  and beliefs of psychopathology
• Gain an appreciation of the variety and overlap
  of theories
• Begin to discover and formulate your own ideas
  about your theorectical orientation

3
Counseling Fundamentals

• Characteristics of counselors
• Therapeutic relationship
• 3 stage model of therapy
• Basic techniques and skills

4
Characteristics of Counselors

• Friend vs. Counselor
• Alliance with focus on the client
• Power issues
• Qualities of a counselor (Burger Youkeles,
  2000)
• Good listener
• Effective communicator
• Empathic
• Open
• Supportive
• Accepting

5
Characteristics of Counselors (cont)

• Counselors need to
• Be aware of self and impact on others
• Be open-minded and culturally sensitive
• Have a sense of ethics and professional
  responsibility
• Set good personal and professional boundaries
• Self-care and seek help when needed

6
Therapeutic Relationship

• Consider therapist and client characteristics
• Self as a tool
• Bring to counseling values, experiences, beliefs,
  personality
• Client characteristics
• Readiness for change
• Expectations
• Self-awareness
• Cultural background and experiences

7
3 aspects of the therapeutic relationship (Gelso
Carter, 1994)

• Working Alliance
• Collaboration towards goals
• Transference Configuration
• Clients and therapists repetition of past
  conflicts/relationships with significant others
• Real Relationship
• Genuine, realistic part of the relationship

8
Three-Stage Model (Hill OBrien, 1999)

• Exploration, Insight, and Action
• Exploration
• Clients explore thoughts, feelings, and actions
• Establish rapport, clients share and explore
  feelings, learn clients perspective
• Skills/ techniques used
• Listen/ awareness of verbal and non-verbal
• Restate and reflect content to demonstrate
  understanding
• Ask questions to facilitate exploration

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Three-Stage Model (cont)

• Insight
• Understanding thoughts, feelings, and actions
  see things in a new light
• Create new insight and understanding of clients
  role in their thoughts, feelings, and actions
• Use the therapeutic relationship as tool
• Additional Skills/ Techniques
• Challenge clients perspective
• Construct/ reframe experience
• Provide feedback, including in-session experience

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Three-Stage Model (cont)

• Action
• Facilitate action/choices on the basis of the
  exploration and insight stages
• Explore new behaviors, decide actions, facilitate
  needed skills, provide feedback, process feelings
  about change
• Additional Skills/ Techniques
• Assess current behaviors
• Teach new behaviors
• Reinforce changes
• Set and modify action plans

11
Progression of therapy

• Relationship building
• Information sharing and assessment of presenting
  concerns
• Narrow focus and set goals
• Explorefacilitate insight implement changes
• Evaluate progress and consolidate skills to
  future application
• Termination and maintenance

12
Relationship Building

• Be yourself!!
• Be aware of client and respond
• Expectations, concerns, uncertainties
• Provide core conditions
• Empathic understanding
• Unconditional positive regard
• Genuineness
• Congruence with thought/feelings and behaviors
• Never underestimate the power of listening and
  respect!

13
Techniques and Interventions

• With each intervention consider
• Therapeutic goals and conceptualization
• Your intent
• Specific action
• Anticipated response
• Evaluation
• Client conceptualization
• Treat each intervention as a hypothesis test

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Techniques and Interventions

• Active listening
• Verbal and nonverbal behavior
• Hearing vs. Listening
• Minimal Encouragers
• Small phrases, repetition single word
• Uh-hmm scared
• Silence
• Allows reflection
• Encourages client taking direction

15
Techniques and Interventions

• Open vs. Closed questions
• How do you feel? open
• Requires elaboration
• Do you feel sad? closed
• Can be answered yes or no
• Paraphrase
• Repeating what is said in different words
• Reflection of feelings
• Attention given to affect
• Highlighting the feeling underlying what is said
  or renaming the feeling

16
Techniques and Interventions

• Interpretation
• Giving insight or new view of event
• Confrontation
• Attending to discrepancies in clients thoughts,
  feeling, and/or behaviors
• Self-disclosure
• Providing relevant personal information

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Fundamentals Wrap Up!

• Know yourself and be aware of your impact
• You are a tool
• The relationship is central base to build on
• Even natural skills take time and practice
• Everything is process, learning occurs for all
  involved at all stages
• All interactions are purposeful and provide
  knowledge

18
Fundamentals In relationship to theories

• Basic skills are applied in all theories
• Building blocks of therapy
• Specific techniques or focuses are unique to some
  theories
• Theories may change the look of some basic
  skills depending on the emphasis of the theory

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Overview of Theories

• Psychodynamic
• Person-Centered
• Gestalt
• Behavioral Approaches
• Cognitive Approaches

20
Overview of Psychodynamic Theories

• Psychoanalysis
• Sigmund Freud
• Neo-Freudians
• Alfred Adler, individual psychology
• Carl Jung,
• Others (Horney, Sullivan)
• Object Relations
• Mahler Separation and Individuation
• Self-Psychology
• Kohut

21
Sigmund Freud Theory of Personality

• Emphasized internal drives/ energy
• Sexual and aggression
• Dynamic interaction of 3 personality aspects (Id,
  Ego, Superego)
• Importance of unconscious, hidden meanings
• Developmental stages and conflicts
• Role of defense mechanisms

22
Three components of personality

• Id
• I want, primitive impulses
• Self-focused without considering others
• No sense of reality
• All Id at birth
• Ego
• Mediates ID Superego controls/regulates
  impulses
• Concept of reality
• Superego
• Conscience (introjected parental values)
• Perfectionist standards of good person

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Stages of Personality Development

• Oral (birth 1.5/2 yrs)
• Mouth primary erogenous zone
• Ego begins to develop
• Anal (1.5/2 3 yrs)
• Anus primary erogenous zone
• Gratification controlling bowels, defecation
• Issue of socialization
• Anal retentive personality

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Stages of Personality Development (cont)

• Phallic (4 6 yrs)
• Genitals primary erogenous zone
• Oedipal complex
• Superego develops
• Latency (6 adolescence)
• Regulating represses impulses from Oedipal
  complex
• Preoccupation with rules and establishing order
• Genital (adolescence beyond)
• Redirected energy towards peers

25
Defense Mechanisms

• Denial
• Refusal to recognize real nature of ones
  behavior
• Rationalization
• Giving acceptable reason for behavior to hide
  real motive
• Projection
• Attributing ones unacceptable wishes, aims, and
  motives on other people

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Defense Mechanisms (cont)

• Displacement
• Deflect feelings onto a less threatening target
• Reaction Formation
• Acting in a way that is opposite to how you want
  to act
• Intellectualization
• To avoid them, repressed impulses are allowed
  into conciousness in an intellectual way
• Compensation
• Dealing with frustration in one area by investing
  in another area

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Beliefs about Psychopathology Anxiety

• Psychopathology is seen when defense mechanisms
  break down
• Event intensifies unconscious conflicts
• Symptoms have hidden meaning
• Emotional conflict
• Repression
• Events excluded because painful
• Symptoms alleviated with awareness

28
Therapeutic Tools and Techniques

• Free Association
• Say what ever comes to mind unrestricted
• Therapist sits behind and acts a blank screen
• psychic determinism- nothing happens by chance
• Interpretations and insight
• Major therapeutic tool
• Goal to increase insight
• Importance of timing
• Related affect needs to be present

29
Therapeutic Tools and Techniques (cont)

• Transference
• People transfer feelings from past onto present
  situations/ people
• Therapists acts as blank screen
• Use transference therapeutically, here and now
• Counter-transference
• Therapists feelings toward client
• Clues used therapeutically
• Process here and now

30
Goals of Psychoanalysis

• Uncover repressed emotions
• Awareness alleviates problems
• Gain insight of hidden meanings of behavior
• Overcome resistance to therapy

31
Research and Evaluation

• Research
• No evidence that longterm is better
• Difficulty to research repression
• Controversy of repressed memories of abuse
• No empirical evidence supporting Oedipal Complex
• Personality is not fixed

32
Research and Evaluation (cont)

• Criticisms of Psychoanalysis
• Difficulty is studying concepts
• Sexual and aggression drives to narrow
• Led to Jungs break away from Freud
• Sexist
• Focused on Hysterical women
• Time frame of treatment outlined to long
• Focus on psychopathology

33
Contributions of Psychoanalysis

• Major theory of personality and of treatment
• Emphasis on early childhood events
• Unconscious component of problems
• Importance of awareness and working with affect
  in session
• Therapeutic use of the relationship
• Transference, countertransference

34
Neo-Freudians

• Alfred Adler, Carl Jung, Karen Horney, Henry
  Stack Sullivan
• Disagreed with emphasis on sexual aggression
  drives
• Focused more on relationships
• Set the stage for modern perspectives
• Object Relations
• Self-Psychology

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Alfred Alder (1929-1964)

• Rejected emphasis on sexual and aggression
  drives
• Personality as unified
• Focused on conscious personality aspects
• Striving for superiority motivating force
• Inferiority Complex
• Created a personality typology

36
Carl Jung (1933-1956)

• Analytic psychology
• More emphasis on dreams
• Unconscious 2 parts
• Personal
• Collective unconscious (archetypes)
• Personality Typology
• Extraversion-Introversion
• Thinking, feeling, sensing, intuiting

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Object Relations

• Developed in response to disagreement with Freud
  s emphasis on drives
• Central emphasis on relationships, connectedness
• object person
• Internal representations of people, early
  relationships
• Theorists
• Mahler Separation-Individuation, splitting

38
Self-Psychology

• Concerned with development of the self
• Self-object person who serves a function to
  developing self
• Core sense of self at 2-years
• Needs of children
• Fulfilled by caretaker
• Support, empathy, and appreciation
• All-powerful parental figures to protect and
  provide strength
• Children need to learn to take care of self, self
  soothe

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Summary of Psychoanalytic Approaches

• Physic determinism behaviors/ reactions caused
  intrapsychic factors
• Emphasis/ importance early childhood
• Unconscious processes, defenses,
  repetition/transference
• Importance of therapy relationship
• Insight is key in behavior changes

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Overview of Theories

• Psychodynamic
• Person-Centered
• Gestalt / Existential
• Behavioral Approaches
• Cognitive Approaches

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Humanistic Approaches

• Person-Centered, Gestalt, Existential
• Reaction to Freud
• People can make choices and effect change
• Person in control of their life
• Create own meaning, identity, and life
• Positive, holistic view of the person
• Worth and dignity each person
• Right own opinions, individual choice
• Natural tendency towards growth/ actualization
• Person always changing, river metaphor

42
Person-Centered Therapy

• Carl Rogers originated it in 1940s
• Book Counseling and Psychotherapy
• Detailed non-directive therapy
• Need for empathy and safe environment
• Client knows best, client autonomy
• Emphasis on affect
• Helped to merge counseling and psychotherapy
• Change from Client to Person-Centered
• Applied to all settings

43
Overview of Person-Centered Theories

• Respect and facilitate natural growth process
• Many possible realities, subjective
• Positive growth results from respecting ones
  reality and providing basic trust
• No advice giving or judgments
• No labels or treatment plans

44
Beliefs about Psychopathology

• Occurs when not genuine and unable to listen to
  the self, needs, and experiences
• Lose ability to trust self, organismic valuing
  process
• Results in inability to grow and change
• When personal constructs are rigid
• Move away from shoulds that block natural
  knowing of needs
• Treat personal constructs as hypotheses
• Remember wouldnt call it psychopathology!!
• Doesnt label or diagnose

45
Therapeutic Tools and Techniques

• Unconditional positive regard
• Environment of non-judgment, acceptance,
  understanding
• Care for client regardless of choices/ actions
• Accept autonomy and clients desires
• Genuineness
• Honest and authentic with feelings and responses
• Self-disclosure

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Therapeutic Tools and Techniques (cont)

• Empathy
• See clients worldview, reality, and convey
  understanding
• Acceptance
• Acceptance of feelings, persons reality
• Different from agreement
• Other skills used
• Silence, restatement, reflection
• Encourage self exploration
• Avoid challenges and interpretations

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Goals of Person-Centered Therapies

• Adapt non-judgmental, self-accepting attitude
  toward self
• Increase ability to listen to experience and
  personal needs
• Empowerment of the client

48
Role of the therapist

• Provide non-judgmental environment to facilitate
  natural growth
• natural process of client self-regulation and
  evolution
• Two elements of therapy
• Client listen and accept experience, leading to
  more flexibility
• Focus on own resources to empower the client
  currently and in the future

49
Research and Evaluation

• Most widely researched of the Humanistic
  approaches
• Smith,Glass, Miller (1980)
• As effective as other approaches
• Generated considerable research on core
  conditions, therapeutic relationship
• Support for the core conditions
• Mixed findings if sufficient

50
Contributions of Person-Centered Therapies

• Importance of core therapeutic conditions
• Aspects often cited as fundamental skills
• Emphasis on empathy
• Focus on the client, client direction
• Self-healing potential
• Clear description of helping relationship
• Generated research

51
Overview of Theories

• Psychodynamic
• Person-Centered
• Gestalt / Existential
• Behavioral Approaches
• Cognitive Approaches

52
Overview of Gestalt Theory

• Fritz Perls, founder
• Client experience, choice, responsibility
• Gestalt - German
• whole, shape, or form
• Whole is greater than sum of parts
• People function as a whole
• Emotion can be expressed as physiological
• Field theory- look at all aspects
• Field, or background gives meaning
• Meaning from experiences

53
Overview of Gestalt Theory (cont)

• Hunger drives vs. sex /aggression
• Hunger to take in experiences, grow, awareness
  of needs
• Growth (need-satisfaction) Process
• Awareness - internal/ external experience
• Excitement - reaction, involvement with situation
• Action - tendency towards contact
• Contact - w/ all aspects of present situation
• attention not fixed or blocked on one aspect
• Results in need satisfaction

54
Beliefs about Psychopathology

• Strive for balance, growth, awareness of needs
• Whole disrupted when imbalanced
• Neurosis results from interruption of growth
  (need-satisfaction) process
• Defenses
• Split between should vs. wants
• In sum
• Pathology occurs when awareness of needs and
  feelings are blocked

55
Therapeutic Tools and Techniques

• Focus on
• Feelings, body awareness
• Here and now - direct experience
• Active experiments/ awareness exercises- to get
  in touch with feelings
• Role playing
• Two-chair
• I take responsibility

56
Goals of Gestalt Therapies

• Client to discover truth through inner
  experience, foster growth
• Maintain full, open contact
• Awareness of self as growing/ changing
• Identify/discriminate feelings and needs
• Awareness of polarities and work towards
  unification
• Empowerment to make decisions
• Self-sufficiency / independence

57
Role of the therapist

• No interpretation, client must discover
• Heighten awareness, intensify experience
• Recognizes defenses
• Awareness of needs and feelings
• Works towards creating balance between
  polarities, encourage growth
• Move toward authentic behavior/ balance
• More directive, leads and follows
• Use of experiments
• Attending to inner experience, non-verbals
• Use of confrontation to point out discrepancies

58
Research and Evaluation

• Gestalt therapy is as effective as other
  therapies (Smith, Glass, Miller, 1980)
• Empty chair technique effective with anger and
  conflicting feelings
• To much focus on individual needs and
  independence
• Now softer approach, more interdependent

59
Contributions of Gestalt Therapies

• Balance between client and therapist action
• Client in charge, but therapist more active
• Formation of experiential techniques
• Help client understand self better
• Focus on the total being
• all experiences
• Importance of background
• Emphasis on creation of meaning

60
Similarities to Person-Centered Therapy

• Both
• Positive view of humans
• Natural movement towards actualization
• Problems arise when growth is blocked
• Gestalt
• Therapist more active
• More focus on needs and independence

61
Existential Theories

• Victor Frankl, Rollo May, Yalom
• More of a point of view on therapy
• Emphasis on choices
• People create own meaning and identity
• Choices led to anxiety, people avoid
• Reality of finality, death
• Limits as restricting freedom vs. giving meaning
  to choice

62
Existential Theories (cont)

• ultimate concerns
• Death
• Freedom
• Isolation
• Meaninglessness
• Defense mechanisms - block authentic choices
• Repression
• Distortion
• Avoidance

63
Awareness of ultimate concerns Anxiety
Acceptance Defenses (repression, distortion,
avoidance) Authenticity
64
Goals Existential Therapy

• Awareness of goals in life and making authentic
  choices
• Confront self, and face what avoiding
• Awareness and acceptance of anxiety
• Expand awareness
• Aware of denied potential
• Means of denial
• Reality of choice
• Resulting Anxiety

65
Summary of Humanistic Theories

• Person Centered, Gestalt, Existential
• Phenomenological approach- client is expert of
  own experience
• Actualizing tendency towards growth
• Emphasis on self-determination and choice
• Importance of the relationship

66
Overview of Theories

• Psychodynamic
• Person-Centered
• Gestalt / Existential
• Behavioral Approaches
• Cognitive Approaches

67
Overview of Behavioral Approaches

• Not one person credited with behavioral theory
• Based on learning theory
• Pavlov - Classical Conditioning
• B. F. Skinner - Operant Conditioning
• Social learning theory, modeling

68
Overview (cont)

• Behavior is learned
• Change behavior by new learning
• Personality is the product of accumulated
  learning
• Function of heredity and environment
• Behavior function of what learned from
  environment
• Focus on learning theory, not personality

69
Beliefs about Psychopathology

• Learned behaviors that can be understood when
  look at learning history
• abnormal behavior is thus normal for that
  learning history
• Normal and abnormal behaviors maintained by
  similar processes

70
Role of the therapist and therapy structure

• Therapist is coach
• Tailors technique to the client
• Eliminate unwanted behaviors, teach new skills
• Steps in counseling
• Problem identification and assessment
• Inform/ educate client on the process
• Set behaviorally specific goals
• Develop and commit to action
• Evaluate treatment

71
Therapist and Structure (cont)

• Emphasis on clearly defining goals
• Able to assess if accomplished
• Ways to document change
• Therapy methods tied to verified learning
  principles
• Research and assessment are central
• Concrete methods allow testing
• Generates research
• Empirically supported treatments (ESTs

72
Therapeutic Tools and Techniques

• Operant Conditioning
• Most commonly used
• Desensitization
• Cant be relaxed and anxious at same time
• Create anxiety hierarchy learn relaxation
• Apply learning to increasing levels of anxiety
• Implosive therapy
• Extinguish all at once without grading

73
Tools and Techniques (cont)

• Aversion therapy
• Pair aversive stimulus with behavior to remove it
• Social Skills (assertion) Training
• Behavior Modification
• Reward wanted behaviors, remove rewards for
  unwanted behaviors
• Timeout, token economies, contracting,
  self-management

74
Goals of Behavioral Approaches

• Purpose of counseling to change self-destructive
  behavior
• Teach new skills and behaviors
• Doesnt focus on how problem developed
• Achieve specific goals
• Success needs to be observable
• Self-understanding not a goal

75
Research and Evaluation

• Emphasis on research, assessment, and empirical
  support of efficacy
• More easily validated/ supported
• Specific treatments
• Generated a lot of research
• Many ESTs contain cognitive/behavioral elements
• As effective as other therapies and more
  effective for some problems

76
Contributions of Behavioral Approaches

• Little emphasis on history
• Except for assessment of learning conditions
• Problem-focused
• Goal directed, focused
• More specific in era of managed care
• Works well in brief model
• Specific techniques
• Can be more easily evaluated
• How changes in behavior influence cognitions and
  other factors

77
Overview of Theories

• Psychodynamic
• Person-Centered
• Gestalt / Existential
• Behavioral Approaches
• Cognitive Approaches

78
Overview of Cognitive Approaches

• Key players
• Aaron Beck- Cognitive therapy for depression
• Albert Ellis- Rational-Emotive Behavioral Therapy
  (REBT)
• Donald Meichenbaum
• Belief that faulty cognitions, distorting
  thinking causes emotional upset, ineffective
  behavior
• Thoughts influence emotions and behaviors
• People have capacity for rational/ irrational
  thought

79
Becks Cognitive Therapy

• Most influential approach
• First w/ depression
• Now anxiety, personality disorders
• Depression results from cognitions (beliefs about
  the world)
• Focus on thought process,not so much actual
  thoughts
• Cognitive Triad - negative view of
• Self - I am an awful person
• Future Things will never get better, change
• Experiences Today was awful

80
Beliefs about Psychopathology

• Automatic irrational thoughts influence
  self-view, behavior, and emotion
• Extreme, unflexible cognitions
• Either-or thinking
• Rigid childhood thinking carried into adulthood
• Global, absolute, either-or
• Magnify negative, minimize positive

81
Becks problematic thought processes

• Selective abstraction
• Focus on limited info, ignore other info
• Dichotomous thinking
• Either-or
• Overgeneralization
• Applying information out of context to many other
  unrelated situations

82
Problematic thought processes (cont)

• Magnification
• Overestimating importance of event
• Arbitrary inference
• Conclude things are bad with no evidence
• Personalization
• Events, actions related to oneself when they are
  not

83
Role of the therapist and therapy structure

• Systematic, structure approach
• Each session has agenda
• Therapist more directive
• Relationship source of learning
• Core conditions important, but not sufficient
• Cognitive restructuring and the therapeutic
  process
• ID dysfunctional beliefs
• Relate to triggering feelings/ behaviors
• Learn to modify dysfunctional beliefs
• Practice

84
Therapeutic Tools and Techniques

• Behavioral techniques
• used first with severely depressed patients
• Daily Activity Sheet
• sense of mastery/ accomplishment
• Graded Task Assignments
• Slowly return to full functioning
• Cognitive Rehearsal
• Rehearsal task, create how-to to-do list
• Role Playing
• Play another person in similar situation

85
Therapeutic Tools and Techniques (cont)

• Cognitive techniques
• Make client aware of connection b/w thoughts and
  feeling
• Daily record automatic thoughts
• Record situation, thoughts, feelings, mood
• Create and practice alternate thoughts
• Question dysfunction thoughts
• Evidence? Alternate viewpoints? So what?
• Homework assignments
• Test dysfunction and new beliefs

86
Goals of Becks Cognitive Therapy

• Identify and modify dysfunctional beliefs
• Cognitive restructuring is core mechanism of
  change
• Treat thoughts as hypotheses
• Look for evidence
• More flexible thought processes

87
Elliss Rational-Emotive Behavioral Therapy
(REBT)

• Negative emotion and irrational behavior are a
  result of irrational thinking
• Musturbatory thinking
• Absolute standard for behavior and life
• Shoulds
• ABC theory
• A activating event
• B thoughts about the event
• If B is irrational, then C will be negative
• B is most important!!
• C emotion/ behavioral reaction

88
ABC Theory

• Most people believe an event causes a reaction
• A (event) C (reaction)
• Actually one reacts to their interpretation of
  the event! B is crucial!
• A B C
• Event Thoughts Reaction

89
Beliefs about Psychopathology

• Irrational beliefs
• Rigid
• Absolute
• Intolerable
• Demanding
• Musturbatory thoughts
• Turning preferences into needs
• Need to accept what just is
• Problems with self-evaluating

90
Beliefs about Psychopathology (cont)

• Pathology occurs when natural thoughts are held
  to the extreme, held rigidly
• 3 thought groups
• Need to be competent and win approval
• Deserve to be treated kindly, fairly, properly
• Must have all needs met and things I want

91
Therapeutic Tools and Techniques

• Disputing irrational thoughts
• Logically challenging irrational beliefs
• Steps
• Narrow to a few basic irrational thoughts
• Challenge client to validate
• Create and implement more rational thoughts
• Test irrational thoughts experientially
• Homework assignments

92
Role of the therapist

• More directive than person-centered Beck
• Unconditional acceptance of client
• Challenge irrational thoughts
• Attack is on the behavior thoughts,not the
  person
• Respect clients value system
• Doesnt attack values, but the rigid nature

93
Goals of Elliss Cognitive Therapy

• Dispute and modify irrational beliefs
• Awareness of how thoughts effect reaction
• Make reactions less automatic
• Challenge clients beliefs and request support for
  such
• Foster acceptance of what is
• Recognize true needs
• Focus away from shoulds, musts
• More flexible thinking, away from rigidity
• Emphasis away from self-evaluative behavior

94
Beck and Ellis Compared

• Beck
• Hypothesis testing
• Lets client determine which beliefs are
  irrational via testing
• Less directive
• BOTH
• Ask questions, have structure
• Assign homework
• Focus on cognitions

• Ellis
• Focus on clients beliefs
• More directive, confronting
• IDs irrational beliefs

95
Meichenbaums Cognitive Behavior Modification

• Self-guiding speech directs/ controls behavior
• Learned through internalization
• Becomes automatic
• Maladaptive self-speech
• Dysfunctional self-speech
• Absence of self-speech
• Goal to eliminate dysfunctional and increase
  functional/ adaptive self-speech
• Create flexible coping strategies

96
Social Cognitive Approaches

• More to it than operant learning
• Stimulus serves as a warning, it means something!
• Vicarious learning- learn by watching others
• Behavior is situational specific
• Self-efficacy
• beliefs in ones ability/competence in specific
  situation
• Cognitive belief affects actions, performance

97
Cognitive Approaches Research and Evaluation

• Research demonstrates effectiveness
• Smith, Glass, Miller (1980)
• As effective as other approaches
• Effective for depression, panic attacks,
  generalized anxiety disorder
• 12 cognitive-behavioral treatments on Division 17
  EVT list
• Manuals and ease of research

98
Research and Evaluation (cont)

• Mixed beliefs about relationship b/w thoughts and
  feelings
• Reciprocal? Which comes first? Strongest
  influence?
• Value judgment of rational vs. irrational
  thoughts

99
Contributions of Cognitive Approaches

• Systematic approaches
• Can be manualized for specific disorders
• Easily studied
• Simple language, techniques
• Explained easily to clients
• Cognitive language widely used
• Emphasis on cognitions, idea of schema

100
Remember the Goals?

• Knowledge of basic counseling fundamentals
• Overview of the major psychological theories
• Main theorists, therapeutic goals, strategies,
  and beliefs of psychopathology
• Gain an appreciation of the variety and overlap
  of theories
• Begin to discover and formulate your own ideas
  about your theorectical orientation