Theory and Practice of Counseling and Psychotherapy by Gerald Corey

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Theory and Practice of Counseling and Psychotherapy


by Gerald Corey

Brooks/Cole, a division of Cengage Learning



Theory Students: The following is an outline form of powerpoints produced by Gerald Corey, the textbook author, designed to accompany the textbook. Please note that the author is Gerald Corey and this work is produced by Cengage Learning, a division of Brooks/Cole Publishing Company. This work is copyrighted and can be reproduced and used only with the permission of the textbook company.

The Therapeutic Relationship

  • The therapeutic relationship is an important component of effective counseling

  • The therapist as a person is a key part of the effectiveness of therapeutic treatments

  • Research shows that both the therapy relationship and the therapy used contribute to treatment outcome

Theories of Counseling

  • Gerald Corey’s Perspective of Theories of Counseling:

  • No single model can explain all the facets of human experience

    • Eleven approaches to counseling and psychotherapy are discussed

  • Your textbook book assumes:

    • Students can begin to acquire a counseling style tailored to their own personality

      • The process will take years

      • Different theories are not “right” or “wrong”



The Effective Counselor from the perspective of Gerald Corey

  • The most important instrument you have is YOU

  • Your living example of who you are and how you struggle to live up to your potential is powerful

  • Be authentic
  • The stereotyped, professional role can be shed


  • If you hide behind your role the client will also hide

  • Be a therapeutic person and be clear about who you are

  • Be willing to grow, to risk, to care, and to be involved


Counseling for the Counselor

  • In your experience of being a client you can:

  • Consider your motivation for wanting to be a counselor

  • Find support as you struggle to be a professional

  • Have help in dealing with personal issues that are opened through your interactions with clients

  • Be assisted in managing your countertransferences

  • Corey believes that“...therapists cannot hope to open doors for clients that they have not opened for themselves.”

  • Research shows that many therapists who seek personal counseling find it:

  • Personally beneficial

  • Important for their professional development



The Counselor’s Values

  • Be aware of value imposition

    • How your values influence your interventions

    • How your values may influence your client’s experiences in therapy

  • Recognize that you are not value-neutral

  • Your job is to assist clients in finding answers that are most congruent with their own values

  • Find ways to manage value conflicts between you and your clients

  • Begin therapy by exploring the client’s goals

Multicultural Counseling

  • Become aware of your biases and values
  • Become aware of your own cultural norms and expectations


  • Attempt to understand the world from your client’s vantage point

  • Gain a knowledge of the dynamics of oppression, racism, discrimination, and stereotyping

  • Study the historical background, traditions, and values of
    your client

  • Be open to learning from your client

  • Challenge yourself to expand your vantage point to explore your client’s ways of life that are different from your own

  • Develop an awareness of acculturation strategies



Issues Faced by Beginning Therapists

  • Achieving a sense of balance and well-being

  • Questioning competency as you learn new techniques or begin to practice on your own without supervision

  • Accepting your limitations while simultaneously acknowledging your strengths

  • Managing difficult and unsatisfying relationships with clients

  • Struggling with commitment and personal growth

  • Developing healthy helping relationships with clients

  • Developing healthy personal boundaries in your professional life


Staying Alive – It’s a Prerequisite

  • Take care of your single most important instrument – YOU

  • Develop self-care strategies and a plan for renewal

  • Know what causes burnout

  • Know how to recognize and remedy burnout

  • Know how to prevent burnout through self-care

Professional Ethics

  • Ethics codes are a fundamental component of effective counseling:

    • Guidelines that outline professional standards of behavior and practice
    • Codes do not make decisions for counselors


    • Counselors must interpret and apply ethical codes to their decision-making

Types of ethics to consider:

  • Mandatory Ethics

  • Aspirational Ethics


Ethical Decision Making

  • The principles that underlie our professional codes

  • Benefit others, do no harm, respect other’s autonomy, be just, fair and faithful

  • The role of ethical codes--they:

  • Educate us about responsibilities, are a basis for accountability, protect clients, are a basis for improving professional practice



Making ethical decisions

  • Identify the problem, review relevant codes, seek consultation, brainstorm, list consequences, decide and document the reasons for your actions

  • To the degree it is possible, include the client in your decision making process


Informed Consent

  • Clients need enough information about the counseling process to be able to make informed choices

  • Educate clients about their rights and responsibilities

  • Provide Informed Consent

  • Therapy Procedures

  • Risks/Benefits and Alternatives

  • Right to withdraw from treatment

  • Costs of treatment

  • Supervision

  • Privileged communication

  • Limits of Confidentiality


Limits of Confidentiality

Confidentiality is essential but not absolute

Exceptions to Confidentiality:
  • Duty to Warn (Tarasoff Case)


  • The client poses a danger to self or others

  • A client under the age of 16 is the victim of abuse

  • A dependant adult or older adult is the victim of abuse

  • The client needs to be hospitalized

  • The information is made an issue in a court action

  • The client requests a release of record


Multicultural Issues

  • Biases are reflected when we:

  • Neglect social and community factors to focus unduly on individualism

  • Assess clients with instruments that have not been normed on the population they represent

  • Judge as psychopathological – behaviors, beliefs, or experiences that are normal for the client’s culture

  • Strictly adhere to Western counseling theories without considering its applicability to the client’s diverse cultural background


Assessment and Diagnosis

  • Assessment is an ongoing process designed to help the counselor evaluate key elements of a client’s psychological functioning

  • Assessment practices are influenced by the therapist's theoretical orientation

  • Requires cultural sensitivity

  • Can be helpful in treatment planning




  • Diagnosis is the process of identifying pattern of symptoms which fit the criteria for a specific mental disorder defined in the DSM-IV-TR

  • Requires cultural sensitivity

  • Counselors debate its utility in understanding the client’s subjective world

  • Can be helpful in treatment planning


Evidence-Based Practices
  • Strengths


    • Counselors use treatments that have been validated by empirical research

    • Treatments are usually brief and are standardized

    • Are preferred by many insurance companies

    • Calls for accountability among mental health professionals to provide effective treatments

  • Criticisms

  • Some counselors believe this approach is mechanistic and does not allow for individual differences in clients

  • Is not well-suited for helping clients with existential concerns

  • It is difficult to measure both relational and technical aspects of a psychological treatment

  • Has potential for misuse as a method of cost containment for insurance companies instead of a method of efficacious treatment for clients

Dual Relationships

  • Are not deemed inherently unethical in the ethics codes of the APA or ACA.

  • Multiple relationships must be managed in an ethical way to eliminate non-professional interactions and protect client well-being.




  • Some helpful questions:

    • Will my dual relationship keep me from confronting and challenging the client?

    • Will my needs for the relationship become more important than therapeutic activities?

    • Can my client manage the dual relationship?

    • Whose needs are being met--my client’s or my own?

    • Can I recognize and manage professionally my attraction to my client?


Psychoanalytic Therapy

Structure of Personality
  • THE ID—The Demanding Child


    • Ruled by the pleasure principle

  • THE EGO—The Traffic Cop

    • Ruled by the reality principle

  • THE SUPEREGO—The Judge

    • Ruled by the moral principle



Conscious and Unconscious

The Unconscious

Clinical evidence for postulating the unconscious:

  • Dreams

  • Slips of the tongue

  • The Unconscious

  • Posthypnotic suggestions

  • Material derived from free-association

  • Material derived from projective techniques

  • Symbolic content of psychotic symptoms

    • NOTE: consciousness is only a thin slice of the total mind


Anxiety

  • Feeling of dread resulting from repressed feelings, memories and desires

  • Develops out of conflict among the id, ego and superego to control psychic energy

  • Reality Anxiety

  • Neurotic Anxiety

  • Moral Anxiety


Ego-Defense Mechanisms

  • Ego-defense mechanisms:

    • Are normal behaviors which operate on an unconscious level and tend to deny or distort reality

    • Help the individual cope with anxiety and prevent the ego from being overwhelmed

    • Have adaptive value if they do not become a style of life to avoid facing reality


The Development of Personality

  • ORAL STAGE First year

    • Related to later mistrust and rejection issues


  • ANAL STAGE Ages 1-3

    • Related to later personal power issues

  • PHALLIC STAGE Ages 3-6

    • Related to later sexual attitudes

  • LATENCY STAGE Ages 6-12

    • A time of socialization

  • GENITAL STAGE Ages 12-60

  • Sexual energies are invested in life


Transference and Countertransference

  • Transference

    • The client reacts to the therapist as he did to an earlier significant other

      • This allows the client to experience feelings that would otherwise be inaccessible

      • ANALYSIS OF TRANSFERENCE — allows the client to achieve insight into the influence of the past

  • Countertransference

    • The reaction of the therapist toward the client that may interfere with objectivity

      • Not always detrimental to therapeutic goals; can provide important means of understanding your client’s world

      • Countertransference reactions must be monitored so that they are used to promote understanding of the client and the therapeutic process.

Psychoanalytic Techniques

  • Free Association

    • Client reports immediately without censoring any feelings or thoughts

  • Interpretation

    • Therapist points out, explains, and teaches the meanings of whatever is revealed

  • Dream Analysis
    • Therapist uses the “royal road to the unconscious” to bring unconscious material to light


    • Latent content

    • Manifest content

Resistance

  • Resistance

    • Anything that works against the progress of therapy and prevents the production of unconscious material

  • Analysis of Resistance

    • Helps the client to see that canceling appointments, fleeing from therapy prematurely, etc., are ways of defending against anxiety

      • These acts interfere with the ability to accept changes which could lead to a more satisfying life

Application to Group Counseling

  • Group work provides a rich framework for working through transference feelings

    • Feelings resembling those that members have experienced toward significant people in their past may emerge

    • Group members may come to represent symbolic figures from a client’s past

  • Competition for attention of the leader provides opportunities to explore how members dealt with feelings of competition in the past and how this effects their current interactions with others.

  • Projections experienced in group provide valuable clues to a client’s unresolved conflicts


Limitations of Classical Analysis

  • This approach may not be appropriate for all cultures or socioeconomic groups

  • Deterministic focus does not emphasize current maladaptive behaviors

  • Minimizes role of the environment

  • Requires subjective interpretation

  • Relies heavily on client fantasy

  • Lengthy treatment may not be practical or affordable for many clients

Adlerian Therapy


Alfred Adler’s Individual Psychology


  • Based on the holistic concept

  • A phenomenological approach

  • Teleological explanation of human behavior

  • Social interest is stressed

  • Birth order and sibling relationships

  • Therapy as teaching, informing and encouraging

  • Basic mistakes in the client’s private logic

  • The therapeutic relationship—a collaborative partnership


The Phenomenological Approach

  • Adlerians attempt to view the world from the client’s subjective frame of reference

    • How life is in reality is less important than how the individual believes life to be

    • It is not the childhood experiences that are crucial –
      it is our present interpretation of these events

  • Unconscious instincts and our past do not determine our behavior


Social Interest

  • Adler’s most significant and distinctive concept

    • Refers to an individual’s attitude toward and awareness of being a part of the human community

    • Embodies a community feeling and emphasizes the client’s positive feelings toward others in the world

    • Mental health is measured by the degree to which we successfully share with others and are concerned with their welfare

    • Happiness and success are largely related to social connectedness

Lifestyle

  • A life movement that organizes the client’s reality, giving meaning to life

    • fictional finalism” or “guiding self ideal”

    • Psychiatric symptoms are “failed attempts” at achieving our lifestyle
    • Adlerian therapy helps clients to effectively navigate lifestyle tasks


  • Lifestyle is how we move toward our life goals

    • private logic”

    • Values, life plan, perceptions of self and others

    • Unifies all of our behaviors to provide consistency

    • Makes all our actions “fit together”


Inferiority and Superiority

  • Inferiority Feelings

    • Are normal

    • They are the wellspring of creativity.

    • Develop when we are young--characterized by early feelings of hopelessness

  • Superiority Feelings

    • Promote mastery

    • Enable us to overcome obstacles

  • Related Complexes

    • Inferiority Complex

    • Superiority Complex

Birth Order

  • A concept that assigns probability to having a certain set of experiences based on one’s position in the family

  • Adler’s five psychological positions:

    • Oldest child– receives more attention, spoiled,
      center of attention

    • Second of only two– behaves as if in a race, often opposite to first child

    • Middle– often feels squeezed out

    • Youngest– the baby

    • Only– does not learn to share or cooperate with other children, learns to deal with adults

Four Phases of Therapy

  • Phase 1: Establishing the Proper Therapeutic Relationship

    • Supportive, collaborative, educational, encouraging process

    • Person-to-person contact with the client precedes identification of the problem

    • Help client build awareness of his or her strengths
  • Phase 2: Exploring the Individual’s Psychological Dynamics


    • Lifestyle assessment

    • Subjective interview

    • Objective interview

    • Family constellation

    • Early recollections

    • Basic Mistakes

  • Phase 3: Encouraging Self-Understanding/Insight

    • Interpret the findings of the assessment

    • Hidden goals and purposes of behavior are made conscious

    • Therapist offers interpretations to help clients gain insight into their lifestyle

  • Phase 4: Reorientation and Re-education

    • Action-oriented

    • Useful vs. unhelpful


Encouragement

  • Encouragement instills self confidence by expecting clients to assume responsibility for their lives and embrace the fact that they can make changes

  • Encouragement is the most powerful method available for changing a person’s beliefs

    • Helps build self-confidence and stimulates courage

    • Discouragement is the basic condition that prevents people from functioning

    • Clients are encouraged to recognize that they have the power to choose and to act differently

Application to Group Counseling

  • Group provides a social context in which members can develop a sense of community and social-relatedness

  • Sharing of early recollections increases group cohesiveness

  • Action-oriented strategies for behavior change are implemented to help group members work together to challenge erroneous beliefs about self, life and others.

  • Employs a time-limited framework


Limitations of the Adlerian Approach
  • Adler spent most of his time teaching his theory as opposed to systematically documenting it


  • Hence, some consider Adlerian theory simplistic

  • Many of Adler’s theoretical constructs (i.e. lifestyle) are difficult to measure and require empirical testing

  • Research on treatment efficacy is limited

Existential Psychotherapy



  • Born from philosophy

    • A phenomenological philosophy of “humanness”

    • Humans are in a constant state of transition, evolving and becoming

    • Clients are searching for meaning in their subjective worlds

  • Common questions/sources of existential angst for clients

    • “Who am I?”

    • “I will die.”

    • “What does it all mean?”

    • “Will I die alone?”

    • “How am I going to get to where I want to be in my life?”

Existential Therapy
A Philosophical/Intellectual Approach to Therapy

  • BASIC DIMENSIONS OF THE HUMAN CONDITION

    • The capacity for self-awareness

    • The tension between freedom & responsibility

    • The creation of an identity & establishing meaningful relationships

    • The search for meaning

    • Accepting anxiety as a condition of living

    • The awareness of death and nonbeing

  • The Capacity for Self-Awareness

    • The greater our awareness, the greater our possibilities for freedom

  • Awareness is realizing that:

    • We are finite--time is limited

    • We have the potential and the choice, to act or not to act

    • Meaning is not automatic--we must seek it
    • We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation


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