Psychotherapy and Counseling Essentials: An Introduction

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Psychotherapy and Counseling Essentials An
Introduction

• Chapter One

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• This class is about the mysteries of human
  distress, human growth, why people change, and
  how we can help them.
• Well be doing an overview of 9 counseling and
  psychotherapy theories and applicationswith a
  special emphasis on historical context and
  practical contemporary applications.

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Background and Overview

• Psychotherapy theories can explain and predict
  ways we treat each other, including how we define
  mental health and mental illness, our ideas about
  helping , rehabilitation, and personal
  responsibility.

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Background and Overview

• They help us answer the questions like
• What motivates people to do what they do?
• What disturbs thinking processes, triggers
  unmanageable anger, lowers individual
  productivity, and destroys relationships?
• What makes or breaks an individual?
• What makes some people resilience after facing
  traumatic event, while others are weakened or
  deeply damaged?

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Background and Overview

• Theres no single answer to these questions. Its
  common for mental health professionals to
  strongly disagree with each other on just about
  every topic.

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Human Suffering and Hope

• Psychotherapy is an imperfect science, because
  every human is unique with his/her idiosyncratic
  ways of being. There is much we dont know about
  human behavior, the brain, emotions and
  interpersonal relationships.
• Determining why people suffer, how they change,
  and how to help them live more satisfying and
  gratifying lives is a huge and important task.

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Historical Context

• Every human behavior or set of beliefs has its
  own particular historical context. This is
  related to psychotherapy and its close relatives
  counseling, therapy, mental health consultation
  and clinical social work.

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Historical Context

• Contemporary psychology originated in Europe and
  the United States in the late 1800s. During that
  time, women and other minorities were excluded
  from higher education. Much of psychotherapys
  history is written from the perspective of white
  man advocating a particular theory.

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Historical Context

• Who is the father of psychotherapy?
• Who is the mother of psychotherapy?
• What is meant by the following statement?
• In psychology, even the rats are white and male.

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Who is the father of psychotherapy?

• Sigmund Freud.
• This claim is truth. But its impossible to give
  a single individual the credit or blame for an
  enterprise as huge as psychotherapy.

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Alternative Historical-Cultural Realities

• Early treatments for human distress and
  disturbance consisted of a combination of these
  four perspectives
• The biomedical perspective (then trephining
  now serotonin hypothesis)
• The religious/spiritual perspective (then evil
  spirits now ??)
• The social-psychological-biomedical perspective
  (then ?? now ??)
• Feminist and multicultural perspectives emphasize
  relationship and community over individuality.
  (How do people with these perspectives define
  pathology and approach the counseling process?)

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The Biomedical Perspective

• Trephining and lobotomies Early archaeological
  findings provide evidence of a treatment
  procedure, now called trephining. This hole
  opening was a treatment by a shaman or healer to
  release and evil spirit from the brain. This is
  biomedical perspective. About a half million
  years later, a similar physical intervention ,
  prefrontal lobotomy emerged as a popular
  treatment for mental patients in the USA.

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The Religious/Spiritual Perspective

• Human looked for clergy, shamans, mystics, monks
  and other religious leaders for advice and
  counsel over the ages.
• For many Native American tribes, spiritual
  authorities are still important for healing. Many
  Asian and African cultures also believe spiritual
  practices.

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• Modern pyschosocial interventions include
  elements of spirituality. Dialectical Behavior
  Therapy (DBT) and Acceptance and Commitment
  Therapy (ACT) use Buddhist approaches to
  facilitate emotional regulation.
• Most clinicians know the emotional healing
  potential of spiritual practices and beliefs.
  Spiritual leaders have great wisdom and insight
  into the human condition.

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The social-psychological-biomedical perspective

• During the trephining period, about 500,000 years
  ago, human have probably understood that verbal
  interactions and relationship alterations can
  change thinking patterns, mood and behavior. Wise
  healers from different cultures and traditions
  use psychological and relational techniques.
  Siddhartha Gautama (Buddha) and Epictetus are
  forebears to modern cognitive theory and therapy.
  Avicenna seems to have been an early strategic
  or constructive theorist.

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Feminist And Multicultural Perspectives

• Traditional historical voices have generally
  been white and male, but mental health
  professionals must be aware of minority voices.
  Feminist mind set differs from traditional male
  mind. Last 40 years, feminist approaches have
  been integrated into psychotherapy approaches.
  Cultural sensitivity is important to positive
  therapy outcomes with diverse client populations.
  

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• Feminist and multi-cultural perspectives
  emphasize relationship and community over
  individuality. These are human values. The mental
  health professionals are beginning to recognise
  these values as different ways of being and not
  as pathological.

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Definitions of Counseling and Psychotherapy

• Should I get a PhD in psychology, a masters
  degree in counseling or a masters in social
  work? This disscusion leads to the confusing
  topic of the differences between counseling and
  psychotherapy.

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Definitions of Counseling and Psychotherapy

• What is psychotherapy?
• What is counseling?
• What are the differences between counseling and
  psychotherapy?

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Counseling versus Psychotherapy I

• The Histories
• Psychotherapy Freud Recovery from serious
  personal problems
• Counseling Out of guidance movement, which
  was/is about helping people with choosing or
  decision making

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What Is Psychotherapy?

• Anna O., Breuers patient, called to the
  treatment she received as the talking cure.
  Talking, expressing, verbalizing or sharing ones
  pain is potentially healing.
• How should psychotherapy be practiced? This
  question is relevent to how psychotherapy is
  defined.

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• A conversation with a therapeutic purpose
  (Korchin, 1976)
• The purchase of friendship (Schofield, 1964)
• When one person with an emotional disorder gets
  help from another person who has a little less of
  an emotional disorder (J.Watkins, personal
  communication, October 13, 1983)

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What Is Counseling?

• Adler might claim that counseling has an
  inferiority complex with respect to its older
  sibling, psychotherapy. Or psychotherapy has a
  superiority complex with respect to its younger
  rival, counseling.
• Counseling is the artful application of
  scientifically derived psychological knowledge
  and techniques for the purpose of changing human
  behavior. (Burke, 1989)

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What are the differences between counseling and
psychotherapy?

• Patterson (1973) There are no essential
  differences between counseling and
  psychotherapy
• Counseling and psychotherapy are the same
  qualitatively they differ only quantitatively
  there is nothing that a psychotherapist does that
  a counselor does not do (Corsini Wedding, 2000,
  p. 2).

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• For Corsini and Weddings definiton, both of them
  engage in the same behaviors but may differ.

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Counseling versus Psychotherapy III

• What are the differences between psychotherapy
  and counseling?
• Goals?
• Shorter versus longer?
• Problem versus person?
• Guidance versus advice?
• A little more on the surface versus a little
  deeper?
• Cheaper versus more expensive?

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• Psychotherapist Less directive, go a little
  deeper, work a little longer, charge a higher
  fee.
• Counselor Slightly more directive, work more on
  developmentally normal issues, work more briefly,
  charge a bit less fee.

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The Goals of Counseling and Psychotherapy

• People come to therapy to alleviate their painful
  symptoms (e.g., anxiety, depression, guilt) and
  undesirable behaviors (e.g., compulsions,
  impulsivity, etc.).
• People come for assistance in decision making.
• People also come to therapy to grow or improve
  themselves.

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Counseling and Psychotherapy Defined

• A process that involves
• a trained professional who abides by
• accepted ethical guidelines and has
• skills and competencies for working with
• diverse individuals who are in distress or have
  life problems that have led them to
• seek help (possibly at the insistence of others)
  or the individuals may be

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CPDefined II

• choosing to seek personal growth, but either way,
  these parties
• establish an explicit agreement (informed
  consent) to
• work together (more or less collaboratively)
  toward
• mutually agreed upon or acceptable goals

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CPDefined III

• using theoretically based or evidence-based
  procedures that, in the broadest sense, have been
  shown to
• facilitate human learning or human development or
  effectively reduce disturbing symptoms.

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What Is a Theory?

• A coherent group of general propositions used as
  principles of explanation for a class of
  phenomena (Random House Dictionary, 1993, p.
  1967).
• In psychology, theories are used to generate
  hypotheses about human thinking, emotion and
  behavior.
• For counseling and psychotherapy, a theory needs
  to accurately describe, explain, and predict a
  wide range of therapist and client behaviors.

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What is a Theory? II

• A theory is not built on observation. In fact,
  the opposite is true. What we observe follows
  from our theory.
• Without a guiding theory . . . , clinicians
  would be vulnerable, directionless creatures.
  (Prochaska, 2003)
• But with a guiding theory, what sorts of things
  are likely to happen?

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The Scientific Context of Counseling and
Psychotherapy

• Major Historical Developments Eysencks (1952)
  Findings (24 studies)
• Analytic44
• Eclectic (Mishmash, hugger-mugger) 64
• Custodial72

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The Scientific Context of Counseling and
Psychotherapy II

• A Psychotherapy Research Boom
• Smith and Glass developed method of
  meta-analysis. Effect size is a statistic used to
  estimate how much change is produced by a
  particular intervention. Effect size represents
  the difference in efficacy between interventions
  and no treatment control groups.
• Smith, GlassMiller, 1977 Average person who
  gets counseling is better off than 75 of those
  untreated.
• What is the dodo bird effect?

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The Scientific Context of Counseling and
Psychotherapy III

• The Great Psychotherapy Debate
• Point Research has demonstrated the superiority
  of a few select psychotherapy techniques over
  other specific techniques.
• Counterpoint Research doesnt show that some
  specific techniques are better than others
  instead, research shows there are common
  therapeutic factors operating across different
  therapy techniques.

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• Weinbergers common therapeutic factors ???

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The Scientific Context of Counseling and
Psychotherapy IV

• Common Therapeutic FactorsLambert (1992)
• Extratherapeutic change (40) Client Factors
  (motivation, severity of disturbance, ego
  strengths, psychological mindedness.)
• Therapeutic relationship (30) (Rogers
  unconditional positive regard, empathy and
  congruence) (Freud therapeutic alliances)
• Expectancy (15) (hope)
• Techniques (15)

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• Salvador Minuchin Dont be too sure
• No theory holds the key to all problems. No
  theory entirely explains what it means to be
  human.
• When we get too sure about a theory, we close
  ourselves off to different perspectives.

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The Zeitgeist, the Ortgeist, and the Poltergeist

• Zeitgeist The spirit of the time
• Ortgeist The spirit of the place
• Poltergeist A mischievous spirit or ghosta
  mystery

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Poltergeist

• As a therapist, we should be ready for surprises.
  Sometimes your clients will say and do shocking
  things. Or well suddenly feel the urge to say or
  do something inappropriate. In the therapy room,
  sitting cheek by jowl with another person for
  long time can make unusual experiences.

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Five-Minute Discussion

• Groups of three or four.
• Up to now, according to your knowledge as a
  major, come up with three or four reasons why
  therapy can sometimes be harmful.

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Concluding Comments and Review

• Homework Start dating Freud this week.