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Counseling

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formal and structured interpersonal relatonship with someone who is actively seeking help with personal issues that interfere with or detract from a satisfactory life and leads to change in: behavior, beliefs, abilility to cope, decision-making knowledged and skill, level of emotional stress

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Crisis

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an acute emotional upset arising from situational, developmental, or social sources and results in a temporary inability to cope by means of one's usual problem solving strategies

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opening phase

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after initial interview, client is introducted to the structure of the analytic situation, role of the counselor, and role of the client

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development of transference

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counselor becomes a significant figure in the clients life and the feelings the client develops for the counselor are used to demonstrate how the client perceives, interprets, and responds to the present in the same way he/she responded to significant others in the past

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working through transference

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involves clarifying and understanding the unconscious transferences and the significant events associated with the transference

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the resolution of transference

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terminationation helps the client resolve any neurotic or dependent attachments the client has developed toward the counselor

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therapeutic approaches

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psychodynamic, cognitive behavioral,existential-humanistic

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free associations

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process of reporting to the counselor, without bias or critisim, whatever enters the clients mind

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interpretation

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the counselor interprets free associations, dreams, transference, and resistance to explain and teach the client the meaning of present behavior

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dream analysis

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used to uncover unconscious material and give patients insight into some area of unresolved problems

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Psychoanalysis techniques

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free associations, interpretation, dream analysis

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CBT (cognitive behavioral therapy)

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based on the formulation that howone thinks largely determines how one feels and behaves

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cognitive therapy

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collaborative process of empirical investigation, experimentation, reality testing, and collaberative problem solving

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CBT

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emotional and behavioral responses people exhibit are largely determined by how they perceive, interpret, and ascribe meaning to situations and events

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catastrophizing

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exaggerating the importance of negative aspects and playing down the importance of positive things

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overgeneralization

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making a general rule from one instance

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all or nothing thinking

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things are black or white,good or bad, there is no middle ground

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CBT Process

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1. identify and correct automatic thoughts 2. develop hypothesis underlying automatic thoughts and distorted congnitions 3. successively practice new cognitive and behavioral patterns until new self enhancing thoughts and performance approximate the levels desired by the client

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Collaborative empiricism

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the client and counselor become co investiagtors to scientifcically examine he evidence to support or reject the clients distorted cognitions

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guided discovery

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enables the client to reasssess and modify maladaptive beliefs and assupmtions.

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systematic desensitization

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systematically using clients internal mental processes to help them control their own adverse responses to adverse stimuli and inhibit undesirable behaviors

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thought stopping

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the process of interrupting unproductive, debilitating, and self defeating thoughts and images through both sudden and progressively systematic elimination of maladaptive thoughts and emotions.

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restructuring

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the process of replacing negative debilitating cognitions with positive, self enhancing thoughts and actions.

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reframing

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the process of modifying or restructuring a client's view or perception of a problem or behavior with a more adaptive, understandable, acceptable, or solvable perception

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person centered therapy

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concerned with helping people reach their full potential (self accualizaion)

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experiences

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the central focus of person centered therapy is experiencing feelings

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self concept

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developed from experiences, values, meanings, and beliefs that maintain and enhance the person and from which he or she drives a sense of "I" or "me"

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conditions of worth

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a persons worth or value, is conditional when his self esteem is based on significant others valuation of experience

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positive regard

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the perception of the self experience of another person that leads the individual to feel warmth, liking, and respect for the acceptance of that other person

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positive self regard

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a positive attitude toward the self that is not dependent on the perceptions of signifcant others

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unconditional self regard

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the perception of the self in such a way that no self experience can be discriminated as being more or less worthy of positive regard than an other self experience

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congruence

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the person is congruent when his/her acting, thinking, and feeling states are wholly integrated into the self concept

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person centered therapy

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can be best understood by its outcomes, which include: the client recongizes and expresses previously denied feelings and moves towards a more open, honest mode of communication with the counselor and others

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genuineness

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the act of being transparent

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freedom of roles

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the counselor is genuine in life, as well as in the therapeutic relationship

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spontaneity

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communicating freely with tact and without constantly weighing what to say

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non defensiveness

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knowing ones strengths and weaknessess and being open to negative client expression

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consistency

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genuine counselors have few discrepancies between what they think, feel, and say and remain in their values

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sharing of self

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the genuine counselor self discloses when appropriatate

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unconditional positive regard

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the term used to describe the counselor's professional and personal respect for the client.

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empathic understanding

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perceiving the world from the clients point of view and communicating these perceptions to theclient. Major counseling strategies: attending, refecting, paraphrasing, non verbal communications, use of silence

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Overgeneralizations

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making assumptions or conslusions through a one time experience and apply it to most every life event

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personalization

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applying personal meaning to external events

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dichotomolus thinking

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everything is either all good or all bad; black or white

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catastrophizing

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always thinking of the worst possible outcomes

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mind reading

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the individual believes they know what others are thinking of them or about them

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magnification/minimization

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exacerbating or making light of the importance of events

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perfectionism

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everything must be accomplished perfectly or the individual feels incompetent

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rational emotive therapy process

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A - activating event B - Beliefs C - Consequences D - Dispute the irrational beliefs E - Effect

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Albert Ellis

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Most noted rational emotive therapist. he combined humanistic and behavior therapies in RET/REBT

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rational emotive therapy concepts

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the clients thoughts are often based upon misguided or erroneous befliefs, attitudes, and assumptions

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reality therapy

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practical method of helping people take better control of their lives. roots based on choice theory. focus is on current behaviors and issues and on what the client can do to change or face the issues

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Transactional Analysis Concept

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Eric Berne, 3 ego states - parent, adult, child -- distinguished from one by another by distinct behaviors, words, tones, gestures, attitudes, and expressions, "Games People Play"

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Gestalt Therapy

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Frederick Perls, initial goal is to have the client gain awareness of what they are experiencing and doingin there here and now, helps rebuild thinking, feeling, and acting into connected wholes

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Gestalt therapy

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experiments allow clients to observe his/her own behaviors, thoughts, and feelings more objectively, encourage the client to become aware of emotions by observing nonverbal cues such a posture, voice, and eye or hand movements, encourage client to focus on awareness of bodily sensations, feelings, perceptions, and other immediate reactions

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TA practice

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based on mutual contracting between the counselor and client for change

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strategic family therapy

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improve family relationships that arepresumed to be directly related to youth behavior problems, improve relationships between the family and other important systms that influence the youth, couselor examines family dynamics focusing on hierarchy, boundaries, and interactions

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system approach

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family is a system with interdependent and interrelated parts

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process versus content

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focusing on patterns of interaction is a "process" focus content focus = what dad said when he yelled at the children process focus = who was involved in the conflict when it occurred, who responded to whom, what preceded and followed the incident

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behavior therapy

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helps clients alter behavior by using the relationship between the enviornment and their responses, based on perspective that maladaptive behavior patterns result in a person receiving little positive feedback or rejection from society

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Behavior

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motor and verbal activity as well as "covert" behaviors such as thoughts and feelings

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behavior analysis

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an in depth review of maladaptive behavioral responses that have caused problems for the client

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reinforcement

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an outcome that increases the probability that a behavior will reoccur - strenghts behavior pattern

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punishment

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an outcome that decreases the probability that a behavior will reoccur - weakens

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extinction

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failing to reinforce a behavior leading it to disappear

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operant conditioning

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skinner, maniupulating reinforcements and punishments to increase/decrease behavior

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classical conditioning

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pavlov, changing conditoned responses to stimuli, treating phobias and anxious responses

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motivational interviewing

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a patient centered, directive counseling method for enhancing a person's internal motivation to change by identifying, exploring, and resolving ambivalence

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express empathy

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aceeptance of the patient facilitates change

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identify the discrepancy

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ask the patient about the pros and cons of changing

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roll with resistance

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avoid arguing about change

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support self efficancy

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belief in the possibility of change and hope in the future are important motivatiors

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confrontation

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counseling intervention that describes a client's discrepancies, contradictions, and omissions

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confrontation

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one of the more controversial counseling techniques, because the everyday use of the word implies conflict or attack

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common incongruent behavior

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discrepancies between verbal messages and nonverbal behavior

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Confrontation risks

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confronting client defneses is the most risky kind of confrontation. Defenses may be a lifelong way of coping with stress and pain, may be reluctant about changing behavior. Task of counselor is to work with the client's resistances rather than attacking them

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Denial

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client does not want to acknowledge or agree to the counselor's message

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confusion

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the client may indicate confusion or uncertainty about the meaning of the confrontation

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false acceptance

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occurs when the client verbally agrees with the counselor only to get the counselor to leave well enough alone

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genuine acceptance

answer

what we strive to obtain as counselors. occurs only when the client responds with a sincere desire to examine his/her behavior

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Preparation Steps for a Counseling session

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review intake information, review other available data, highlight information that may need to be clarified

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elements of counseling enviornment

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prepare physical setting: neat and professional, ensure no privacy act info is out and visible, hang a "do not disturb" sign

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self awareness and understanding

answer

awareness of your needs, motivation for helping, feelings, personal strenghts, limitations, and coping skills

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good psychological health

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counselors will be more effective when they are psychologically intact and not distracted by their own overwhelming problems

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sensitivty to and understanding of racial, ethnic, and cultural factors

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clients and counselors are representative of the ethnic and cultural diversity, awareness of your own ethnic and cultural heritage, seek understanding of the client's worldview based on ethnic and cultural factors an effective counseling relationship that is based on trust, genuineness, and acceptance

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open mindedness

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require BHT to be free from fixed or preconceived notions and ideas, allows counselors to aceept and respect client feelings, attitutdes, and behaviors that may be different than our own , prequisit for honest communication

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objectivity

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refers to the ability to be involved with a client, and at the same time, accuratley see what is happening with the client and within the counseling relationship

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competence

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refers to whether the BHT has the requisite information, knowledge, and skills to be of help

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trustworthiness

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reliability, responsiblity, ethical behavior, predictability, can be difficult to establish and can be destroyed by a single action

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interpersonal attractiveness

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related to how similar or compatible the client perveive the BHT is to him-/herself, clients often make this assessment intuitively, but it is highly predictive of positive outcome

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Stage 1: Rapport and relationship building

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all inclusive and continuous stage throughout the counseling process, refers to the psychological climate that emerges from the interpersonal contact between you and the client

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Stage 2: Assess and define the problem

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counselors theoretical/philospphical orientation, conditions present in the client's situation and the counselor's understanding of the conditon, cultural frame of reference and the conditions that the frame of reference imposes on the client's worldview

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needs

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something is missing and its absence is disturbing the client

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stressors

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something unpleasant or unexpected has occured in the client's life, which is distressing or distracting

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life conditions

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conditions outside the client's control are limiting potential happiness and sucess

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misinterpretations

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the way a client thinks about his/her life situation limits his/her alternative and decision making

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dysfunctional social patterns

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the client's social interactions are a source of distress

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Stage 3:Goal setting

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one of the most important processes in the counseling relationship, process of this is mutually defined by the client and counselor

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Stage 4: Initiating interventions

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dervied from the counselor's theoretical orientation, assessment of the presenting problem, personal view of human nature, and change processes, strategies the BHT and the client develop tohelp the client achieve stated goals

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Stage 5: Termination

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sucessful ... with the client is the ultimate criterion of sucessful counseling. Very important, can be anxiety producing event for clients and counselors

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therapeutic relationship

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creates an atmosphere of trust and safety for the client, provide a medium for intense affective expression, offers the client an opportunity to experience a healthy interpersonal relationship, serves a motivational function for the client to continue the change process

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core conditions: therapeutic relationship/rapport

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empathy, geuineness, positive regard, identify the client's strenghts and resources

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Empathy

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described as the ability to understand people from their frame of reference, rather than your own, helps build rapport and elicit information from the client by showing understanding and conveying that both counselor and client are working "from the same side."

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genuineness

answer

means being oneself without being phony orplay a role, contributes to an effective counseling relationship by reducing the emotional distance between the client and counselor and by helping the client to identify with the counselor, to perceive the counselor as another person similar to oneself

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verbal/nonverbal

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empathy is conveyed to the client by the counselor through ... and ... messages

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genuineness is communicated this way

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supportive nonverbal behavior, role behavior, congruent behavior, spontaneity, self disclosure

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supportive nonverbal behavior

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nonverbal behaviors that convey genuineness include eye contact, smiling, and leaning towards the chlient while sitting

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role behavior

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counselors who do not overemphasize their role,authority, or status are likely to be perceived as more genuine by clients

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congruent behavior

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the counselor's words, actions,and feelings match -- they are consistent

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spontaneity

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expressing oneself naturally without contrived or artificial behavior, being tactful w/o deliberating about everything you say or do

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self disclosure

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any information counselors convey about themselves to their clients

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positive regard

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"respect," the ability to prize or value the client as a person with worth and dignity, number of functions in establishing and maintaining the counseling relationship, including the communication of willingness to work with the client, interest in the client as a person, and acceptance of the client

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Positive regard: 4 components

answer

commitment, understanding, nonjudgemental attitude, warmth

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Adaption skills

answer

Assessed through the OILPS (occupational, interpersonal, leisure, physical, somatic changes)

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Purpose of the MSE

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describe the patient's appearance, speech, actions, and thoughts at the time of the interview, serve as the basis for future comparison to track the progress of the patient over time

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broad categories of the MSE

answer

general description, mood and affect, speech, perceptual disturbances, thought content/process, sensorium and cognition,impulse control, judgement and sight

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general descripiton-appearance

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description of the patient's overall appearance and the overall physical impression conveyed to the interviewer

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documentation

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address patient's clothing, address any unusual physical characteristics, appearance in relationship to age, posture, eye contact, general body movements

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general description - behavior and psychomotor activity

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refers to both the qualitative and quantitative aspects of the patients motor behavior

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general description - attitude/behavior towards examiner

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described as cooperative, friendly, attentive, interested, frank, seductive, defensive, contemptuous, perplexed, apathetic, hostile, playful, ingratiating, evasive, or guarded

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mood and affect - mood

answer

the pervasive and sustained emotion that colors a person's perception of the world. it is a self - report of the prevailing emotional state and reflects the patient's life situation

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mood and affect - affect

answer

the patient's outwardly expressed emotions in a behavioral sense (tone of voice, facial expression, use of hands, body movements) the patient's present emotional responsiveness, affect is inferred from the patient's facial expression, including amount and range of expressive behavior

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mood and affect - appropriateness

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... of the patient's emotional responses can be considered in the context of the subject matter the patient is discussing. Inconrguent - not appropriate

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speech

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can be described in terms of quantity, quality, and rate of production

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perceptual disturbances

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usually experienced in reference to the patient's self or their enviornment (hallucinations, illusions)

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hallucinations

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false sensory impressions or experiences

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illusions

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mistaken perception of reality

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command hallucination

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those that tell the patient to do something, such as kill oneself, harm another, or join someone in afterlife

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depersonalization

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detachment from one's self

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derealization

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detachment from one's environment

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formication

answer

the feeling that bugs are crawling on or under the skin, found in alcohol withdrawal

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thought process

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the way a person puts together ideas and associations, the "form of thinking."

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Sensorium & Cognition - alertness and level of consciousness

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determine and document whether the patient is alert, dazed, sleepy, comatose

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Sensorium & Cognition - orientation

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patient's orientation to person, place, time and situation, orientation also includes whether a patient behaves as though they know where they are and the role of people around them in relation to themselves

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sensorium and cognition - memory

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remote memory - distant past. recent past memory - past weeks to months. recent memory - minutes to days. immediate retention and recall - retention and recall of immediate events

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sensorium and cognition - concentration and attention

answer

the interviewer needs to attend to the patient's ability to focus on an activity, conversation, or thought without being distracted by unrelated stimuli or thoughts

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Sensorium and cognition-visuospatial ability

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the ability to understand visual representations and their spatial relationships

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abstract thinking

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ability to deal with concepts

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judgment

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involves making decisions that are constructive and adaptive

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insight

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patient's degree of awareness and understanding that they are ill

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self concept

answer

assesed by identifying the client's thoughts perception and beliefs, about the problem

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physical state

answer

assessed by asking questions about the client's eating and sleeping and somatic pain

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social function

answer

OILPS

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potential for treatment/rehab

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assessed by asking clients for attempts to resolve

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urgency

answer

if it is suspected that the patient is psychotic, suicidal, homicidal, or the situation is life threatening, seek immediate supervision

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high risk behaviors

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assessed as potential for violence and gathered during risk assessment

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psychopathology interventions

answer

medication, combination of forms of therapy, meds use to increase or decrease activity of neurotransmitters in the brain

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antipsychotics

answer

used to reduce psychotic thinking and behavior. thorazine, mellaril, haldol, zyprexa

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antidepressants

answer

used to treat depression, panic attacks, OCD, bulimia, cocaine craving, and smoking cessation

question

sedatives and hyponotics

answer

used for treating severe sleep disturbances, highly addictive and rarely prescribed to active duty population. 2 classes: barbiturates and nonbarbiturates

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antianxiety meds/anxiolytics

answer

used to manage symptoms of anxiety. xanax, klonopin, valium

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purpose of assessment of client problems

answer

assessment is a systemiatic way to obstain information about the client's presenting problems and concerns. it not only involves all counselor actions to gather information but also includes the conclusions drawn about the client's concerns

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intake interview

answer

provides a wreath of information about the client's background, especially how it may relate to the current problem or complaint

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collateral sources

answer

could include info from command, police report, spouse, parent, must obtain client authorization to obtain data from collateral sources unless the client is a command referral

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adjunctive data

answer

refers to results of psychological testing, self ratings, and other valid and reliable measures

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SSRI

answer

selective serotonin reuptake inhibitors

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SNRIs

answer

seletive norepinephrine reuptake inhibitors

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problem definition using an assessment interview

answer

provides a structure method of collecting detailed information and prioritizing the client's problems

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sources of assessment data

answer

intake interview, collateral sources, and adjunctive data

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general assumptions in assessment of client problems

answer

most problem behavior is learned, causes of problems are multi-dimensional, problems must be viewed operationally, most problems occur in a social context and are functinoally related to internal and external antecedents and consequences

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cohesion

answer

the strenght of the members desire to work together toward common goals

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group

answer

a collection of people who have a relationship with one another, are interdependent, and may have common norms

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norms

answer

standards of behavior

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power

answer

the members abilitly to influence the group as a whole and its other members individually

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education groups

answer

leader is presenting some info, members are eager to learn, unless they are forced, leaders must pay attention to group dynamics and relate the material for all member's level of understanding

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discussion groups

answer

often led in conjunction with a workshop or class and are a one time experience that last 15 mins to an hour, leader should be upbeat, positive, leaders want to pay attention to how comfortable members are in sharing

question

support groups

answer

members share thoughts and feelings about a common issue, leader is often a person who has experienced the same issue, trust, commitment, and genuine caring are important dynamics, leader creates safe enviornment

question

counseling, therapy groups

answer

used to address more serious mental illnesses such as depression or personality disorders, can become intense very qucikly, much skill, knowledge,and courage are needed to lead this group

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self help group

answer

no formal leader or professional facilitator, usually ongoing, with new members coming and others leaving, most often memebers need individual therapy in addition to self help group

question

goals of counseling groups

answer

members decide for themselves the specific groups of the group experience, offers an opportunity to work with others on common tasks, or to share common expriences. experiences can be taken from group and generalized to other relationships or situations outside the group

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general goals: group therapy

answer

learn to trust oneself and others, increase self acceptance, find ways of dealing with things, become aware of one's choices, make specific plans for changing certain behaviors, confrontation, achieve self knowledge, more soical skills, become more sensitive

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Beginning stage

answer

used for intorductions, to set group rules, and to state the purpose of the group, group members tend to be caustious and reserved, facilitar is viewed as expert, feedback from members to each other tends to be superficial

question

conflict and controversy

answer

second stage usualy begins with an attack on the leader, members in this stage have not yet developed the ability to receive feedback and observations from the leader without feeling attacked themselves, conflict will emerge between group members and how the leader deals with it will determine if the group continues to grow

question

working and cohesion

answer

members focus more closely on the purpose of the group, hierarchy of the group emerges and roles are filled, members provide more honest and meaningful feedback, more willing to work through differences of opinion and misunderstandings in order to maintain the relationships in the group

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Termination

answer

a time for reflection of the group experience, allows members to publicially acknowledge how group therapy has been useful and how they intend to incorporate the info from experience into future decisions or lifestyles, begins the process of closure and prepares members to leave the group

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written screening

answer

potential group member fills out a form giving information pertinent for the leader to decide if they are appropriate for that particular group

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screening by referral

answer

when the leader accepts referrals from hospitals, teacher, or other therapists who have screened the members prior to making the referral based on the leader's critical for the group members

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personal interview

answer

although the best method it is also the most time consuming

question

3 ways members will be screened

answer

personal interview, written screening, screening by referral

question

group member guidelines

answer

purposes of group referrals to the group interviews with potential members

question

homogenous groups

answer

... will share preselected criteria (all memebers will be women who sufferered incest as children)

question

heterogeneous groups

answer

will include a mixture of people, such as a group for men and women who want to build their self esteem

question

"here and now'

answer

focusing on .... is popular for inpatient groups

question

beginner stage

answer

introduce group rules, allow member to introduce themselves, state purpose

question

working stage

answer

introduce the activity, encourage participation

question

utilize group leader skilsl

answer

active listening, reflection, clarification, summarizing, info giving, encourage and support, modeling and self disclosure, attending, maintaining control of the group

question

closing stage

answer

allow group members to commone on what they learned from the group, summarizing the group, close

question

leader

answer

models effective communication, understanding, flexibility, tolerance, encouragement, sensitivity, and caring. Responsibilites: observe, assess, and analyze the group while encourage interaction, exploring problems, focusing, and offering support to all members

question

task

answer

patterns of individual role performance. look at interactions as they relate to the work of the group who suggests, initiates, summarizes

question

power

answer

refers to the patterns of influence. look at who communicates to whom, who is listened to, and who makes decisions

question

communication

answer

who talks to whom, listens to whom, who responds to whom, and who does not participate

question

sociometric

answer

refers to preference and interpersonal intimacy. look at who refers to who in the group, who sits next to whom, observe physical proximity, facial expression, tone of voice, and eye contact

question

active listening

answer

entails listening to the content, voice, and body language of the person speaking

question

reflection

answer

to restate a comment, conveying that you understand the content, the feeling behind it, or both

question

clarification

answer

helps members clarify their statements

question

summarizing

answer

used because members are busy listening and sharing, they often do not pick up on or remember many of the details. very helpful

question

information giving

answer

provide information to enable people to learn from you and from the discussion that follow, provide new and intersting ideas, keep it shrot

question

encouragement and support

answer

helps members deal with the anxiety of being in a new situation and sharing their ideas or persoanl feelings with others, acknowledge that some discomfort is normal

question

tone setting

answer

setting the mood for the group

question

ways to build trust

answer

improve eye contact, increased listening skills, increased use of open ended questions, giving and recieving of feedback, self disclosure

question

modeling and self disclosure

answer

your style of communication, ability to listen, and your encouragement of others will serve as a model for members to emulate, --- can indicate that you are human and you have delt with similiar issue as thosein which they are exploring

question

attending

answer

showing the group and individual members that you are present, paying attention, and concerned with their progress, scan for nonverbal cues, eye contact

question

use of voice

answer

a leader conveys hwo the content of his or her words and the tone of his or her voice will lead a group

question

groud rules

answer

issues to address; profanity, discussion of religion or politics, confidentiality, acting out, food or drink rules

question

ending the session

answer

deal with the memebers feelings, examine the effects of the group on oneself, give and receive feedback

question

opening the group

answer

introduce yourself and the co facilitator, have group members introduce themselves, state the purpose of the group, develop ground rules

question

monopolist

answer

takes up a great deal of the groups time, with idle chatter

question

silient patient

answer

opposite of the monopolist, what is holding the patient back from talking may be the very thing that prompted them to seek help, fear of speaking in front of others, confrontation, display weakness, and break down in front of others

question

boring patient

answer

seldom takes risks, prefers to play it safe all the time and is frequently masochistric, putting themselves down before others can, add very little to the group and have difficulty benefitting from the group if left alone, often have a deeper issue of dependency, which is most likely the issue that brought them to the group, and want to feel accepted at all times

question

help rejecting patient

answer

ask for help but come up with reasons that the help offered will not work for them, assumes and verbalizes that his or her problem is much more significant than those of other group members and at times will belittle other patients for bringing up what they perceive to be petty problems in the face of their life or death problems, deep distrust of authority figures, issue of dependency and look to group and leader for help

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