Counseling Theories NCMHCE and Addiction Exam Review

Counseling Theories NCMHCE and Addiction Exam Review


Welcome to the Addiction Counselor Exam
Review. This presentation is part of the Addiction Counselor certification
training. Go to http://www.ALLCEUs.com/certificate-tracks to learn more about
our specialty certificates starting at 149 dollars. Hi everybody and welcome to your review
of Counseling Theories. In this presentation we’re going to be focusing
on counseling theories that we typically use with individuals not families family
counseling is a different video in this one we’re going to review the most
common counseling theories used with individuals and potentially groups and
related interventions we’re going to start with my favorite cognitive
behavioral the premises of cognitive behavioral are that people respond to
their representation of events rather than the events themselves so for
example rollercoasters I hate rollercoasters I’m terrified of
them some people love rollercoasters now the event riding a roller coaster is the
same for them and for me we’re doing the same exact thing they happen to find it
thrilling I have happen to find it terrifying so
I’m responding to how I perceive the event learning is cognitively mediated
so everything we learn is influenced by everything we’ve learned up until then
if a dog comes charging up the fence at you you know me I’ve been raised around
dogs you know I’m gonna think oh my gosh he’s protecting his property isn’t that
sweet I’m probably gonna talk to him and baby talk and we’re gonna become best
friends or not but that’s the way it’s gonna go somebody else who has had a bad
experience with the dog may perceive that as threatening and become terrified
so every experience you encounter your brain goes ok have I done anything like
that before and is it safe unsafe good bad you know what am I supposed to do
here so you got to remember that everybody’s experiences are going to
affect how they experience things in the future thoughts impact emotional and
behavioral reactions if you take the the roller coaster for example if I think
that riding a roller coaster is you know dangerous that’s my thought it’s going
to make me feel scared and my behavioral reaction is to say oh no way in the
world am I going right that if you have positive thoughts
and you say oh my gosh that is so much fun that is totally safe and it is a
really fun way to you know get your adrenaline going then that person is
going to be happy about getting on a roller coaster maybe even downright
excited and they’re going to be eager to get on there they’re going to be moving
towards the roller coaster some types of thoughts can be monitored and modified
if you have a fear of spiders for example you spiders are everywhere just
that’s the way it is and if that makes your skin crawl those types of thoughts
that spiders are dangerous and spiders are gonna crawl on me and spiders are
going to bite me those things can be addressed and modified so we want to
look at the thoughts that can be addressed other types of thoughts that
can be modified are what we call irrational or I call them unhelpful
thoughts like everybody is always against me it’s probably not true I
don’t have never met a person yet I have not met a person yet
where everybody was always against them so they were catastrophizing so we want
to change those thoughts and say you know a lot of the people in my family
don’t seem to support me for example now that’s more specific okay well where are
the people that do support you so cognitive-behavioral helps people look
at a range of cognitive distortions or unhelpful thoughts and you can google
those or you can watch our video on cognitive behavioral techniques to learn
more about those but they address those in order to help people improve their
mood feel more empowered and behaviorally act differently act more
assertively and less less fearfully and less depressed modifying thoughts can
help modify emotions and behavioral responses if you modify your thought
about something you’re angry about for example then you can de-escalate your
anger and it’ll to fight whatever your behavioral urges
are maybe you want to put your fist through the wall well if you’re not
angry anymore then you’re not gonna want to put your foot fist through the wall
well isn’t that awesome both behavioral and cognitive techniques are useful and
can be and probably should be integrated so the goal is to identify and correct
unhelpful cognitions or cognitive distortions by clarifying and
challenging unhelpful or inaccurate cognitive schema which is cognitive
schema or the way we think about things our memories if you will and increase
the clients problem-solving abilities so when you encounter a situation like this
that makes you angry what can you do to deescalate your anger which will also
remove the likelihood that you’re gonna do something behaviorally that you’ll
regret a cognitive behavioral assessment these I’m a cognitive behavioral
therapist so I tend to think these are the easiest to do clinical interviews
can clarify antecedents and consequences to emotions and behaviors and strategies
that have and have not been helpful in the past what does that mean it means we
want to look at when something has happened that has made you angry you
know I want to look at what caused you to get angry and then you got angry and
what was the result what are the consequences what was the result of you
getting angry you know if you got angry and threw a temper tantrum and got your
way well then you’re likely to get angry and throw your temper tantrum again if
you were angry and threw a temper tantrum and got fired then you might be
less likely to do that in the future maybe not but we want to look at the
antecedents what causes it and the consequences of emotions and behaviors
and then we also want to look at strategies that the person’s used before
that’s been hot that have been helpful because that’s where we’re going to
start we’re not going to reinvent the wheel they know what’s worked for them
at least a little bit and we’ll build off of that but we also want to know
what they’ve done that hasn’t worked at all because there is no sense continuing
to do something that they don’t think is going to
our inventories and questionnaires are helpful in identifying cognitive
distortions so giving people handouts that say you know I believe that all
people are against man examples of cognitive distortions for example people
can go through and check those and you can either use a Likert scale so they
don’t believe it at all they believe it a little bit they believe it a fair
amount or they believe it a whole bunch so 1 2 3 & 4 or a simple yes/no however
you want to do it but that can help instead of having to sit there and go
through these different questions which takes a long time in the assessment that
can give you an idea about their cognitive style and their thinking style
and this distortions that may be contributing to their dysphoria
self-monitoring can help identify the frequency antecedents and consequences
of unhelpful thoughts and/or reactions so once you’ve identified some of those
unhelpful thoughts and educated them about cognitive distortions then give
them a sheet so they can monitor themselves each day and keep a log you
know they can just have a hash mark next to each time they use a particular
cognitive distortion and then they can start looking at how often are these
happening what triggers these types of unhelpful thoughts and what are the
consequences and generally the consequences are it causes them to get
anxious angry or depressed which is why they’re in your office so self
monitoring helps people get an idea of how often it’s occurring what causes it
so they can intervene there and if they can’t intervene there then they can
figure out a different way of responding so they don’t have the negative
consequence data from the assessment helps identify clients problem-solving
abilities when things happen do you emotionally disregulated you can’t
problem-solve or when these things happen what do you do how do you handle
it and again what are the consequences if you handle it and it has perfectly
good consequences it de-escalates the situation it’s a win-win everybody’s
happy that’s great but likely the person chooses a
problem-solving technique that isn’t wholly effective and it ends up having
negative consequences so then you’re going to look at how can you modify that
problem solving strategy in order to help them have more success in
problem-solving you’re going to look at their attributional style attributions
are where you assign responsibilities and so to speak
it can be global or specific so if somebody’s walking down the street and
they trip over and they trip a global assessment or attribution would be that
person is so clumsy a specific attribution would be that person did
something right there that was really clumsy you know maybe if you watched ah Miss Congeniality there were some
really good examples in there of where she was very prim and proper and then
all of a sudden she would just like fall down somewhere so you want to look as
global or stable when we’re looking at attributions global attributions such as
I’m stupid I’m useless are going to contribute to people’s misery as opposed
to specific attributions such as I am not any good at woodworking or at math
those are specific things that I know are not my strengths and you know I’m
okay with that because globally I’m a good person and I’m smart but there are
some things that not my strengths stable or changeable you know this thing that
you’ve got going on if you you know don’t like it is it stable is it can it
be changed at all if it can great if you’re clumsy you that’s generally
considered a stable trait if you had your shoelace is untied
that’s changeable so when you’re you know walking like when my son was little
we started getting in the little velcro shoes because his shoes would always
come untied and then he’d trip and you know but that was changeable there was
something I could do to change it it wasn’t about him it was about his
equipment and it was fixable and then the final attribution is it
internal or external so going back to the tripping an internal attribution
would be saying that person is clumsy so it’s something about them that made them
trip an external attribution would be to say there must have been a crack in the
sidewalk that they tripped over as putting the blame somewhere else now to
internal or to external can be bad because some things are due to you and
some things are due to external forces but looking at attributions and
challenging those and seeing are there negative things that are changeable
external or specific that you’re looking at is global stable and internal and it
gives you information the assessment that is
about their underlying belief systems and the cognitive distortions they use
such as everybody’s always against me and I never succeed at anything I do all
of those statements help you start seeing what maybe maintaining this
person’s unhappiness so what can you do about it daily mood and activity
monitoring is the place to start because we’re gonna keep track of it increased
rewarding behaviors and establish a daily routine so do things that make
yourself happy each day you know you need to rest relax sharpen the saw
whatever you want to call it and a daily routine helps keep your circadian rhythm
set so you’re getting more quality sleep so your energy levels are more
predictable and you have a sense of mastery over you know when you’re going
to be sleepy when you’re going to be awake when you’re going to be doing
whatever encourage the person to develop an understanding between the
relationship of the relationship between their feelings thoughts and behaviors so
start with you know when you’re depressed how does it affect the way you
think about things that day and how does it affect the things that you do okay so
let’s move it and instead of being a feeling let’s go to thoughts if you are
just being a negative Nelly you are in a negative mood that day how does it
affect your mood you know if your thoughts are negative how does it affect
your mood and it probably tends to make you more angry and irritable so you’re
negative you’re angry and irritable how does it affect what you do and then
finally move it around to behaviors and say all right you know so you wake up in
the morning and you decide you know what I’m just not going to get out of bed
today I don’t have it in me and you stay there all day long in the dark watching
a Netflix marathon how does that affect your mood you know it’s probably going
to make you feel tired more depressed you know a little bit more helpless and
hopeless you know there are things that it can contribute to and how does it
affect the way you think you know does your attitude change throughout the day
generally if you have time to sit there and dwell on things
your attitude is going to get a little bit more negative so you know helping
people see that if you inner being anywhere on the three pillars you’re
going to improve the situation use graded tasks to help clients start
approaching and addressing seemingly overwhelming problems maybe they have
social anxiety okay you know a lot of people do I have a little bit you know I
really hate mixers and I just don’t introduce myself to people well but so
graded tasks would be having people do things that don’t make them so nervous
like when I go to the grocery store I talked to the cashier when I’m in other
situations I try to get out of side of my comfort zone and talk to people I
don’t know so I get more comfortable doing that the next step would be going
to for example presenting and that’s weird because I really love presenting
but I would do that so I’m in front of you know 150 people but I don’t know and
then I might go do something else that elicits a little bit more anxiety you
know as I master each level and realize that hey I can do this it’s not so bad
let me try something a little bit more difficult not too much more difficult
just a little bit and sometimes there has to be a an envisioning step in
between there so before I go to a Chamber of Commerce mixer I need to
rehearse it in my mind several times or maybe more than that and get to the
point where I’m comfortable doing it in my mind I know how I’m going to act I
know what I’m gonna do you know I feel confident in my mental rehearsal and
then I can actually go do it in person so there are great when they say graded
tasks does not like great at ABC but it’s gradually increasing movement
towards those things that are stressful and teach new skills and have clients
practice them between sessions I have clients learn a new skill each week like
the ABC worksheet cognitive processing worksheet and we’ll try different things
and I’ll say well Dusit we’ll try it in in session we’ll
work through a few examples and then I’ll say well why don’t you try this
during the week and see if it helps obviously I choose interventions based
off of what they have told me their strengths are so we’re building on what
they are what already works for them another thing that we do in cognitive
behavioral is address automatic thoughts so the first thing is to teach the
concept what are automatic thoughts and then you want to elicit the clients
thoughts so help them figure out you know when somebody cut you off in
traffic and then you got angry you had a bunch of automatic thoughts in there
that led to you having that stress reaction so what were your thoughts it
was dangerous I could have been killed that person was so rude yadda yadda help
them start eliciting and figuring out all those things that they’re telling
themselves in a millisecond label any distortions that you hear or see if you
can have them write write it down it’s even better I’ll generally write it on a
whiteboard as we’re talking and then we’ll label each cognitive distortion
with all-or-nothing thinking magnification personalization you know
you know your distortions and identify and challenge and modify maladaptive
schemas so you could have died well that’s kind of catastrophic how likely
is it that you would have died it was unsafe that’s true so we’re changing the
the thought we’re changing the schema we’re kind of changing the memory of
that event to something that was catastrophic and life-threatening to
something that was potentially hazardous and unsafe in order to help reduce the
anxiety about the situation and then when the person encounters future
situations they’re gonna have a lower level of anxiety because we’ve modified
that schema and we’re going to develop helpful alternatives when this happens
how can you handle it and how can you prevent it happening in the first place
a B C D and E are you know the basics of cognitive behavioral and rational
emotive behavioral therapy the activating event getting cut off in
traffic the consequences your emotional behavioral reactions but between those
is like a little millisecond automatic beliefs that your brain kind of floods
you with to tell you whether you’re safe or whether there’s a threat then you use
D and you go back in your dispute those automatic beliefs looking for cognitive
distortions and inaccurate schema or inaccurate representations or memories
of how dangerous it was or what happened and the final step is to evaluate your
reaction and the consequences for helpfulness so if you got cut off in
traffic and you decided that you were gonna speed up next to the person you
were gonna scream at them and flip them off did that do any good was that going
to keep them from cutting you off was that really a smart thing to do and the
answer is no in both cases so you want to evaluate the use of your energy was
getting upset over this a good use of my energy was screaming at somebody over
this a good use of my energy what would a bet of better use of my energy you
know if the person is driving like an idiot maybe calling local law
enforcement to you know come check and see if their DUI that could be but most
of the time it’s just not even worth your energy and you need to let it go
cognitive processing is another technique where when you have a belief
such as you know I am going to be alone the rest of my life you want to ask the
person to evaluate whether they’re using fact or emotional reasoning do they have
the facts that are telling them no doubt objectively you’re gonna be alone the
rest of your life or are you using emotions because you feel unlovable and
abandoned and lonely right now you fear that you’re gonna be alone for the rest
of your life there’s a difference once fact once
purely in emotion the next step is to identify all of those facts for and
against your thought so what are the facts that you will be alone for the
rest of your life you know what’s let’s look at those you know let’s look at
statistics let’s look at data you know let’s look at it and what are the
facts that support the notion that you won’t be alone for the rest of your life
because there’s going to be facts on both sides help the person figure out if
they’re looking at the big picture or they’re looking at tunnel vision
sometimes we think that we should have been more responsible or if you know
stay with this metaphor of being alone for the for your whole life you know you
break up with from one relationship and you say you know what I’m gonna be alone
the rest of my life but the big picture is you’ve dated 30 people and you know
27 of them you’re the one who’s broken up with them because you got bored or
whatever you know it’s not necessarily that you’re going to be alone for the
rest of your life you’ve got tunnel vision right now because you hurt and
you’re focusing on the hurt the other aspect to look at here is hindsight you
know hindsight is 20/20 so when you’re looking back at a relationship you know
you might have been able to see the warning signs that it was a bad
relationship for something and when you’re looking backwards at it but when
you’re in it you know you’re there’s other things going on and other factors
contributing to your decision-making so you’re going to have a different
perspective after the fact than you do in the midst of it so you
know cut yourself some slack basically learn from it but cut yourself some
slack another thing to ask them is are you confusing high probability with low
probability is there a high probability you’re going to be alone the rest of
your life and you know how how long have you gone without being in a relationship
you know how many people have you dated looking at that versus low probability
you know maybe you’re gonna be alone for six months or a year maybe even two
years but how likely is it that you’re gonna be alone
the rest of your life and look for cognitive distortions when people are
talking about their thought that you know I’m going to be alone for the rest
of my life you know that’s kind of an extreme statement you know you don’t
know what’s going to happen six months from now or six years from now so let’s
focus on the present and then start addressing some of the unhelpful
thoughts that might be making them feel unlovable or abandoned another technique
is called the downward arrow let’s follow it through you know you broke up
with your boyfriend so you’re alone right now
all right now what you know are you gonna start dating again okay if you
start dating again then what happens you meet somebody and it doesn’t work out
you know you decide you don’t like them okay then what happens you keep dating
okay then what happens and you work through it and and follow the behavior
all the way through to the end until you figure out what happens at the very end
of the story you can question the evidence you know and that’s kind of
what we did in cognitive processing dee catastrophize you know when somebody
says I’m never gonna get another job or I’m never gonna find somebody to love me
again you know we want to take the catastrophe out of that take the never
out of it and look at how likely is it that that will happen
cognitive rehearsal is something else you can do and I talked about that a
little bit earlier and that’s imagining you know if you’re getting ready to do
something scary or getting ready to have a tense conversation with somebody you
might want to rehearse how it’s gonna go in your head a few times
before you do it so you know what you’re gonna say you know how you’re gonna
react you’re planned it’s kind of like when
football teams practice you know they’re not doing it cognitively they’re
actually on the practice field but a lot of athletes will actually rehearse in
their own mind you know a quarterback may rehearse the perfect pass
you know they rehearse what it’s going to look like so they’re prepared and it
also helps prepare your mind and body problem-solving skills training always
helpful because there’s multiple ways to solve any problem thoughts stopping is
just what it sounds like and that’s helping people figure out how to quiet
that annoying voice in their head that is saying that the sky is going to fall
or telling them that there good enough how can they stop that
thought you know getting themself distracted telling themself they’re not
gonna think about it singing the ABC’s what are what can they do and behavioral
you can narrow things sometimes things become associated with too much like
eating you know people when I was growing up yeah we ate all the time we
ate when we were watching TV we ate when we were on the way home from the grocery
store we ate at dinnertime we ate when we were bored we ate when we went to the
movies we ate we ate we ate and that didn’t develop really good eating habits
so narrowing would be reducing the number of situations when it is quote
okay to eat when you choose to allow yourself to eat so for example instead
of allowing yourself to eat while you’re watching TV sitting on the couch say you
know the only time I’m gonna eat is when I’m sitting at the table so then that
means you’re not eating in the car you’re not eating when you’re sitting on
the couch and you’re not eating in bed so that narrows the number of stimuli
that tell your brain hey it’s time to eat cue strengthening for positive
behaviors you know we want to trigger the positive reactions we want to
trigger people to exercise to eat healthy so you can put apples and
oranges and healthy foods healthy fruits and stuff in a basket on the counter
that’s it cue people see it they’re like Oh sounds like looks like something good
to eat and they may eat that instead of foraging for chocolate or something less
healthy you can put your gym bag by the front door to remind you to go to the
gym you know there are a lot of different things you can do to prompt
yourself to do helpful healthy behaviors and finally self reinforcement and
Punishment you know telling yourself if I you know do this whatever it is for
the entire week then at the end of the week I will reward myself by doing
whatever we do that with our kids when they’re little you know if you get stars
so many stars on your star chart this week the
on Saturday you can pick what movie we watch or whatever it is but there’s a
reinforcement concept to their indications for cognitive-behavioral
pretty much anything mood disorders especially depression anxiety and
phobias fears of failure rejection and abandonment eating disorders and to a
certain extent personality disorders now sometimes personality disorders are
ego-syntonic so the person doesn’t see the problem with the behaviors so it can
be sort of an uphill battle here but it has been used the only time you wouldn’t
use CBT is if somebody has significant cognitive dysfunction you know they have
a brain injury or something psychosis or mania they need to be able to think
things through and see consequences you’re probably not going to use a lot
of cognitive behavioral with young children either you know really young
children your elementary and middle school they can make connections you
just have to adjust what you use to meet their cognitive development level
behavioral models the premise of behavioral models is that current
behaviors are what we focus on current behaviors are under stimulus control
that means things that are rewarded happen more frequently things that are
punished happen less frequently bada-bing there’s no thought there’s no
feeling it’s you know stimulus reaction it rejects the idea that maladaptive
behaviors reflect underlying pathology an elimination of the behavior is the
primary goal of treatment so if you’re working with somebody who self-injure
z– you know the primary goal of a behaviorist for a behaviorist will be to
eliminate self injurious behavior not to address any underlying intrapsychic
conflicts those don’t exist so we’re going to remove the the behavior
assessment takes the form of a functional analysis that means they look
at the behavior so we’ll stick with self-injury at this point and we say
what are the antecedents what happens that triggers somebody to
want to self-injure what are the consequences of self-injury does the
person get a lot of attention when they’re doing it does it give them a
sense of personal control does it release endorphins so they get a little
bit of a rush because they’re feeling depressed you know what are the
consequences and what are the discriminative stimuli that means what
are the things in the environment that kind of make it possible for this to
happen in order to do the functional analysis you can do it through
naturalistic observation and that can be observing in a classroom of going to
somebody’s house and observing or even observing a videotape that the parent
brings in for example self monitoring you know obviously the person can
identify and we do this a lot in dialectical behavior therapy
role-playing so if there’s a particular type of situation that triggers
behaviors when my son was little I wanted to play with him and he didn’t
want to play with me and you know I couldn’t figure out why you know I was
trying really hard and you’ll find out in a few minutes what happened but I
talked to his preschool teacher and I’m like Jessica you know he plays with you
guys so well and he just doesn’t seem to be interested in playing with me what am
I doing wrong so she came to the house and she said okay you know let’s sit
down and show me what you do and so I started showing her what I do and all my
playing was more educational playing it wasn’t fantasy cars and stuff and after
about you know three minutes she’s like okay you can stop right there I’m like
you got what you needed she’s like yeah you’re boring
and I said oh okay well then but she had no way of knowing that until she saw how
I interacted Sean got bored which isn’t a term the behaviorist would use Sean
was interacting with me was not being rewarded would be what a behaviorist
would say so I needed to alter the way I interacted with him in order to make it
more rewarding when it was rewarding for him to interact with me he was more
willing to hang out with mom so role-playing is you know something
you can do in the office you know if I would have had that a family come in
with a similar situation I would have said sit down and show me or if the
parent would have come in I would say okay let me be jr. and I’ll sit down
here and I’ll pretend to be jr. and you show me what you do so I can get an idea
if I can’t observe the situation itself let’s reenact it
and then finally rating scales rating scales are great for helping people get
a sense of the frequency intensity and duration of things such as you know
temper tantrums or crying episodes or you know anything that is observable and
measurable behaviorist use principles operant conditioning classical
conditioning and observational learning we’re going to focus mainly on operant
conditioning which means behaviors are increased or decreased through
punishment and reinforcement and you can reinforce things by adding something
positive like giving somebody a token or a hug or taking away something
unpleasant so you can say if you eat your main course then you don’t have to
eat your green beans you know that would be rewarding for some for some kids so
reinforcement is either adding something positive or taking away something
unpleasant punishment is just the opposite
punishment is either adding something unpleasant like having to go out we
would make my son go out and pick up sticks in the yard
that had fallen down if he had misbehaved and he hated to go out in the
Florida Sun so that was punishing for him or punishment can mean removing
something positive like taking away somebody’s iPhone so there are basically
you either punishment means you make it unpleasant some way reinforcement means
you make it Pleasant in some way observational learning means that people
can also experience reinforcement and punishment for actions
by seeing it happen to others so if they see somebody
you know throw a chair at in school and then get sent to the principal’s office
you know that’s a negative consequence so they’re like well probably not going
to do that but if they see somebody smoking in the bathroom and getting a
lot of positive attention for it from their peers
then they’re gonna go oh well maybe if I try that
I’ll get positive attention so we learn vicariously by seeing reinforcement and
punishment of behaviors in other people as well as experiencing it directly our
self behavioral therapies goal is to identify the stimuli that prompt the
behavior the reinforcers things that are maintaining the behavior and punishments
in the environment what can we do to make this behavior less pleasurable in
order to figure out how to change it we want to remove the reinforcement and
cues for their target behavior so with alcohol for example if people drink take
antabuse when they drink they don’t get the sensation of getting buzzed or
whatever so the reinforcement is gone and the punishment comes in pretty
quickly when they get violently ill so that thought of drinking starts to
become less and less pleasurable and less and less frequent and we want to
increase reinforcement and cues for a new behavior because you don’t want to
just eliminate stuff you want to add stuff so let’s look at why were you
drinking and you know if you were drinking because you were stressed what
else could you do to deal with stress besides drinking if you were drinking
because you liked the taste of it what else can you do to stimulate your taste
buds besides drinking the assessment emphasizes observable measurable
behaviors and patterns we’re not going with thoughts or feelings we’re looking
at what happened what rewarded it what would punish it the client and
therapists agree on the definition of the problem behavior so what is exactly
that we’re looking at and baseline data is required so if you’re looking at
temper tantrums the parent or the person is going to go home and keep track of
how many temper tantrums had that week how long they lasted and
maybe what triggered them so that’ll bring a lot of information back to the
therapist interventions that can be used includes systematic desensitization
which starts with relaxation training you’ve got to learn how to relax and
then you work through that anger or anxiety hierarchy so you first think
about something that makes you you know your heart start beating really really
fast that’s measurable and then you know if you’ve got a heart rate monitor you
practice relaxation until you can think about that situation and your heart rate
hardly goes up at all and then you move to the next step you
know let’s take spiders so you’re looking at an aquarium full of spiders
you’re not touching them you’re completely safe from them but you’re
looking at the aquarium your heart rate goes up you practice relaxation and you
get to the point where you can be in the same room with the aquarium and your
heart rate doesn’t really go up at all and the next step is taking the lid off
the aquarium so there’s a chance that the spider could crawl out you see where
we’re going with this assertiveness training can be used to combat anxiety
because the belief is assertive behaviors are completely counter to
anxious behaviors anxious behaviors make you make people tend to run tend to you
know get nervous tend to flee assertive behaviors are the opposite behavioral
rehearsal so practice doing things you know if you’ve got to go give a speech
go to wherever it is that you’re going to give the speech and practice giving
the speech their aversion therapy make it unpleasant just like taking antabuse
for example makes drinking unpleasant flooding and this flooding needs to be
used with great caution it is the treatment of choice for agoraphobia but
you know you need to know what you’re doing
it is in vivo exposure with response prevention which basically means you
take somebody and put them in the situation that freaks them out
and don’t let them leave it there stuck there so they’ve either got spiders
crawling all over them or with agoraphobia you make somebody go out
into public and you don’t let them retreat back into their home and help
them deal with the the feelings and the thoughts that they’re having
during that extremely stressful period you can increase behaviors through
reinforcement so if you want your kids to do more chores or you know your your
child to get his homework done before six o’clock at night you can add
reinforcement so if you do that then you get an additional hour of TV time or you
can stay up an hour later so you can increase behaviors by adding rewards
shaping means rewarding what we call successive approximations so if I want
my son to keep his room clean that’s you know a big step so the first thing I’m
going to say is you know in order for your room to pass inspection you can’t
have laundry on the floor you know we got it let’s start by working on getting
the laundry off the floor once he’s doing that regularly I can say all right
now you’ve got the whole getting the laundry up down really well now I want
you to start making your bed – okay he gets that down so shaping is
rewarding a behavior until it’s consistent and then saying okay you
don’t get the reward anymore until you do that plus something else or until you
do that a little bit better the Premack principle is one of my favorite it pairs
high frequency or high likelihood activities with low likelihood
activities or pleasurable activities with less pleasurable activities so for
example I fold laundry while I watch TV I love watching TV so you know it makes
it less yucky when I used to do my my calculus homework I always used to save
my M&Ms for the day until I did my calculus homework and that’s when I
could eat my mmm so it made it a little bit more tolerable not necessarily the
healthiest but so paring things that somebody doesn’t really want to do
something that’s so bad a lot of people like to listen to
podcasts or watch their favorite television show while they’re at the gym
so getting an iPad so they can watch it while they’re on the treadmill or
whatever that’s the Premack principle response cost is having to give away
something each time the target behavior occurs
so speeding is the perfect example you get caught speeding you have to pay a
fine you have to give away money and most of us don’t like to do that but you
can use it with other things like nail biting each time you bite your nails you
have to put a quarter in the nail biting jar each time you say a swear word you
have to put a quarter in the in the swear jar whatever it is and timeout
we all know what timeout is but we have to use it correctly if the function of
whatever the person’s doing is to get quiet time because they’re over
stimulated then timeout is probably just going to reward that behavior because
they’re like hey if I do this I get to go where it’s quiet so we want to
determine the function of the behavior if it’s to get attention then putting
somebody in timeout is punishing because they’re not getting attention anymore
and they’re like well this is no fun if they’re doing something out of boredom
then putting them in timeout which is still boring boring probably isn’t going
to have much of an effect so you want to figure out what the reinforcer is and
give them time out from the reinforcer so timeouts are not all the same behavior therapy contracts contingency
contracts have an explicit definition of the behavior such as Johnny will go to
bed by 10:00 p.m. the behaviors can be monitored they have to be observable and
measurable so I can look in his room and say you’re asleep or you’re in bed or
you’re not in bed sanctions for failure so there has to be a punishment if
you’re not in bed by 10:00 what happens and there has to be record-keeping with
contingency contracts I also like to put reinforcers in there so if you do go to
bed by 10 o’clock each day this week then on Saturday you can choose whatever
from this list possible rewards which takes us to our
token economy you want to define the target behaviors when I ran the
adolescent treatment center we used a token economy and the youth had things
they had to do every day from making their bed to participating in their
schoolwork participating in treatment doing their chores bathing you know
there was a list of about 10 things and the counselors would monitor and mark
those off and for each level of completion we had a 70% level an 80%
level in 90 % level and 100 percent level they would get a different number
of points so at the end of the week that we would tally their points and they
could cache those points in in the store and that’s where they could buy tokens
for video time or snacks or there are a variety of things they could get to
reward their behavior but the token was were the points so we were giving them
these tokens and they were able to cash them in at the end of a week you want to
be able to select the reinforcers that are gonna work for that person
video games wouldn’t work for me you know there are a bunch of other
reinforcers that might so select appropriate reinforcers monitored the
behaviors then eventually you’re going to have to fade out reinforcers where
the person’s just doing it because it’s what they do not because they’re hoping
for a token but that’s way down the line the humanistic perspective so we’re
switching gears now we did cognitive behavioral which focused on the
cognitive then we went to straight-up behavioral which only looked at
observable measurable external behaviors now we’re moving over to a whole
different school of thought called humanistic the premise is of humanistic
is to understand a person one must have understand his or her subjective
experience so remember I said we can go through the same thing and interpret it
differently like riding a roller coaster well to understand why somebody really
loves riding roller coasters I have to try to understand their experience
because my experience is different emphasis on the uniqueness and wholeness
of the individual because each person is unique and all of their characteristics
combined create who they are a belief in the person’s inherent ability for growth
and self-determination if they’re provided a good environment they will
grow and prosper therapy involves authentic collaborative interactions and
rejection of traditional assessment techniques and diagnostic labels the
self is a conceptual Gestalt composed of perceptions of I Who am I and the
relationship of Who I am with the world and values attached to those perceptions
so you know I know who I am and if I think I am adequate and lovable and I
think those values are important then I’m going to feel pretty darn good if I
think I am inadequate and incompetent or untrustworthy or whatever you know how I
for you myself then I’m going to look at you know is this a good thing or a bad
thing and I’m going to value whether I’m a good person or a bad person based on
that to grow the person must remain unified and organized disorganization
occurs when there’s in congruence between the self and the experience so
for example the person believes I’m lovable for Who I am you know they’re
going along great and then all of a sudden things change and the parents are
like no no you are only lovable if you make me proud those are the conditions
of work I don’t love you for who you are I love you for what you do and then that
kind of shakes the person’s world because they’re like no no I’m lovable
for who I am and the parents are sending the message no you’re lovable if you do
what I want you to do and it creates sort of a schism or a disorganization
therapeutic goals are to help the client achieve congruence between self and
experience by providing an authentic atmosphere with unconditional positive
regard so this atmosphere says you are an awesome person you are a
good person now sometimes you may make poor choices but you’re you are a good
person and that removes the blocks and empowers people to grow assessment is
pretty minimal in person-centered it examines the difference between the who
the client is and who the client perceives herself to be so if I am for
example really successful at what I do and whatever but I perceive myself to be
inadequate you know then that’s something we’re going to work on in
counseling is to fix that gap and it also believes that the client is the
expert on themselves so we’re not going to start offering a whole lot of
opinions techniques include unconditional positive regard accepting
the person for who they are as a good person providing accurate empathy you
know really connecting with the client being genuine and congruent you know
admitting how you feel you know if you feel frustrated saying you know what I’m
feeling frustrated right now I’m wondering how you’re feeling so being
you know transparent basically an avoiding interpretation manipulation
probing or advice-giving Gestalt therapy is another humanistic therapy and the
premise it’s based on are that people tend to seek closure and people’s
Gestalt reflect their current needs so things they’re doing reflect their
current needs behavior represents a whole that is greater than the sum of
its parts so behavior is you know just what we’re
seeing but it is a representation of something much greater there was one
video with Fritz Perls and I can’t remember the woman’s name I should I saw
it enough times but she was shaking her shaking her foot and pearl said tell me
what your foot is trying to communicate because that behavior was what was
observable but what was underneath it was anxiety and
frustration and fear that you know he wouldn’t be able to help her or whatever
so that behavior was just kind of the the tip of the iceberg behaviors have to
be understood in context so shaking your foot may mean that you’re nervous or
you’re frustrated or it couldn’t mean that you’re cold or a variety or your
foots asleep you know when your foots asleep you may shake it to try to get it
to wake up a focus on the here and now is needed to increase self-awareness and
help clients live in the now we can’t change the past we can’t forecast the
future so let’s look at what’s going on with
you now and improve the present moment it believes that the self is the
creative forward moving aspects of the person and the self image is the part
that imposes external demands so the self is who you are and this wonderful
forward moving person the self image is that idea you have of who you should be
and that can place external demands that say you are not good enough unless
historical information in Gestalt therapy is only relevant to the extent
that it’s impacting the present so we look at you know if you have unfinished
business with your in your family of origin and it impacts your current
ability to trust in relationships we’re going to look at it in terms of that but
we’re not going to start dealing with all that stuff in your past we’re
dealing with how your past experiences made you who you are right now and are
impacting your present problems are believed in gestalt therapy to arise
from abandonment of the self for the self image so instead of being true to
yourself and thinking I’m good gosh darn it saying I’m gonna be who everybody
else thinks I should be whose society says I need to be which creates a lack
of authenticity a lot of times problems stem from disruption of the boundary
between self and the external environment resulting and failure to
meet personal needs so when you’re doing what everybody else
wants you to do or what you think you should do sometimes you neglect what you
actually really need and that causes problems and emotional distress boundary
issues in Gestalt therapy are seen as reactions to problems or problems
introjection means that people accept things from the
environment without understanding or questioning
so I since I’m a female then I should get married I should have children I
should do this I should do that you know these cultural mores that are
kind of programmed into us introjection means I take those in I don’t question
them I’m just like this is what I do I don’t say is this what I want I’m
looking at the self-image at that point projection is disowning aspects of the
self and putting them on other people so if a person tends to be grumpy all the
time and they’re like they look at everybody else they’re like everybody is
so negative all the time they’re projecting that grumpiness onto other
people in 12-step recovery a lot of times we
say the things that you dislike most and other people are often a reflection of
what you dislike most in yourself ret reflection is doing to the self what you
want to do to others so if you want to abandon them you know your tire their
their stuff and you just want them to go away instead of abandoning them you may
abandon yourself if you get angry at them and you want to lash out
you may lash out internally at yourself and finally confluence is intolerance of
differences between self and others which leads to feelings of guilt and
resentment so you know all of these boundary issues can be issues that are
handled in Gestalt therapy techniques that are used include directed awareness
which is being aware of yourself in the here and now
kind of like mindfulness what are you doing and what does it mean no questions
are allowed which prevents intellectualizing so instead of pearls
saying what is your foot trying to communicate
he said tell me what your foot is communicating there was no question in
there it was a statement tell me what it is use I language so you’re owning stuff
and assumed responsibility saying I take responsibility for how I react in this
situation the empty chair technique can be really useful for dealing with issues
with other people or for behavioral rehearsal you know pretend your boss is
sitting in that chair and you’re gonna ask for a raise
tell me how it would go or you know you have a lot of stuff that you need you
feel like you need to say to your mother pretend she’s in that chair and and go
for it tell her what you need to tell her
role reversal is another technique where you take on the persona the client takes
on the persona of the other person so in the last example maybe you have a lot of
resentment towards your mother so role reversal you would take your
mother’s perspective and you would act as if you were your mother and try to
get into her head to understand her perspective a little bit role rehearsal
is just what it sounds like envisioning what you’re going to do and rehearsing
it and Gasol also works with dream work which we’re not going to get into a lot
here but you know it’s one of the few techniques that still does do a fair
amount of dream work and finally psychodynamic therapy is rest on the
premises that internal conflicts and their relation to the problem are
central themes of treatment so we want to look at you know you’re depressed or
whatever this is this is the problem what internal conflicts are causing that
psychopathology develops especially from early childhood experiences so
psychodynamic therapists believe things happened in childhood and they’re
continuing to negatively impact you today and that’s what’s causing problems
internal representations of experiences are organized around interpersonal
relations so psychodynamic is very interpersonally focused so when we look
back at experiences and we get current experiences we’re looking at
the relationships between people and maybe you know how does this person
remind you of your mother how have you recreated your family of origin life
issues and dynamics will re-emerge in the context of the therapeutic
relationship as transference and countertransference so we figure that
people have a relatively ingrained way of responding so they’re going to act in
therapy the way they act in the outside world so to speak so we can start
addressing some of those issues distress is often marked by defense mechanisms
and behavior is influenced by unconscious thought and once voll neural
or painful feelings are processed the defense mechanisms tend to reduce or
resolve so you know you have this distress which is why somebody’s coming
to treatment well a lot of that distress is caused by defense mechanisms because
you’re sitting there going I’m not going to deal with it I’m not going to deal
with it I don’t feel it and underneath you’re just like it’s like acid it’s
burning so once you deal with these underlying conflicts you don’t need the
defense mechanisms to avoid dealing with it because it’s not there anymore
there’s peace so to speak interventions in psychodynamic therapy
use of free association is a major method for exploration of internal
conflicts and problems so it’s a lot less directive there’s a focus on
interpretations of transference defense mechanisms current symptoms and the
working through of these present problems there’s a lot of interpretation
in psychodynamic therapy clients often review emotions thoughts early life
experiences and beliefs in order to gain insight into their lives and their
present-day problems they can see why they react this way to this situation
because of what happened back then and then they can choose how they’re gonna
react henceforth and ever forevermore but first they need to understand how
they got to this place psychodynamic therapy encourages clients to trust that
insight about how their past is impacting their present is critically
important for success in therapy so they have to be willing to buy into that
whole stuff from the past is impacting the present in psychodynamic therapy the
therapist will examine acts of the self towards others you know how do you
interact toward other people do you trust them do you let them in do you
have zero boundaries what are your expectations about others reactions in
the present and that will help me learn a little bit about what may have
happened in the past acts of others toward the person so how do you how do
people respond to you and acts of the self toward the self how do you act
toward yourself are you demeaning and hateful towards yourself or are do you
care for yourself so cognitive behavioral approaches address the
connection between unhelpful thoughts feelings and behaviors the focus is
often on changing thoughts or behaviors and the feelings tend to improve
behavioral interventions focus only on observable measurable behaviors thoughts
and feelings are irrelevant so behavioral is just what what can you see
humanistic therapists focus on helping people live as authentic integrated
whole organism and that includes person-centered as
well as Gestalt therapy and psychodynamic therapies focus on how the
past is influencing the person’s present behaviors

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