Exam 3 Review

Chapter 10- Cognitive Therapy

Developed by Aaron Beck Beck compared his observation of automatic thoughts to Freud’s concept of the

“preconscious” Active approach to therapy- uses specific and direct dialogues with clients to bring about

change Stresses the importance of belief systems and thinking in determining behavior and

feelings Attention is paid to thoughts individuals may be unaware of and to important belief

systems Focus is on understanding distorted beliefs and using techniques to change maladaptive

thinking

Theory of Personality

Psychological disorders caused by a combination of biological, environmental, and social factors

Psychological disturbances are understood through use of a cognitive model of development that includes the impact of early childhood experiences on the development of cognitive schemas and automatic thoughts

Beliefs and schemas are subject to cognitive distortions

Development of Schemas (see diagram page 339)

Beliefs and assumptions about people, events, and ourselves form a cognitive schema Two basic types of cognitive schemas: positive (adaptive) and negative (maladaptive) Automatic thoughts are derived from beliefs (that an individual may not be aware of) A shift from adaptive beliefs to dysfunctional beliefs is referred to as a cognitive shift

Schema Terms/Concepts: Automatic thoughts; Schemas/cognitive schemas; Early maladaptive schemas; Active schemas; Inactive schemas; cognitive shift; negative cognitive shift; affective shift; hot cognitions

Cognitive distortion: systematic errors in reasoning, often stemming from early childhood errors in reasoning; an indication of inaccurate or ineffective information processing

Types of cognitive distortions: all-or-nothing thinking; selective abstraction; mind reading; negative prediction; catastrophizing; over-generalization; labeling and mislabeling; magnification; minimization; personalization

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Therapist works with clients to examine and change patterns of thinking, as well as behaviors, that interfere with client’s goals

Establishment of a collaborative and caring therapeutic relationship is essential

Goals of Therapy

Basic goal is to remove biases or distortions in thinking so that clients may function more effectively

Cognitive distortions are challenged, tested, and discussed to bring about more positive feelings, behaviors, and thinking

Therapists attend to automatic thoughts and the schemas that they represent Changing cognitive schemas is an important goal Changing schemas can be done at 3 different levels (1) schema reinterpretation (2)

schema modification (3) schema restructuring When establishing goals therapists focus on being specific, prioritizing goals, and

working collaboratively with clients The clearer and more concrete the goals – the easier it is for therapists to select

methods to use in helping clients change cognitive schemas

Assessment (see diagram page 345)

Interviews; self-monitoring; thought sampling; scales and questionnaires

Therapeutic process: guided discovery; three-question technique; specifying automatic thoughts; homework; session format; termination

Therapeutic techniques: understanding idiosyncratic meaning; challenging absolutes; reattribution; labeling of distortions; decatastrophizing; challenging all-or-nothing thinking; scaling; listing advantages and disadvantages; cognitive rehearsal

Chapter 9 – Rational Emotive Behavior Therapy (Albert Ellis)

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REBT Philosophical Viewpoints: hedonism; humanism; unconditional self-acceptance (USA); rationality

Factors Basic to REBT Theory of Personality

Being vulnerable to emotional disturbance for both social and biological reasons is a core view of Ellis.

Ellis believes that individuals have a biological tendency to severely disturb themselves and to prolong their emotional dysfunction

Social factors refer to the effect of interpersonal relationships on beliefs about self

A-B-C Theory

A = activating event B = belief system C = consequences Ellis believes that it is not the activating event (A) that causes positive/negative

emotional and behavioral consequences (C) – it is the individual’s belief system (B) that helps cause the consequences

When activating events are unpleasant – irrational beliefs may develop Ellis believes that individuals turn irrational beliefs into new activating events which

cause new irrational beliefs – he refers to this as disturbances about disturbances

REBT Terms/Concepts: irrational belief; musterbation; low frustration tolerance; discomfort anxiety; ego anxiety

Three categories of Irrational beliefs: (1) demands about self (2) demands about others (3) demands about the world and/or life conditions

Theory of Psychotherapy

The A-B-C theory of personality affects the way REBT therapists determine goals for their clients and select therapeutic techniques

Disputing irrational beliefs is a most important therapeutic intervention

Ellis has used a variety of cognitive, affective, and behavioral methods to help clients

Goals of REBT:

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Minimize emotional disturbances

Decrease self-defeating behaviors

Think rationally

Have fewer irrational beliefs

REBT teaches individuals how to deal with negative feelings such as sorrow, regret, frustration, depression, and anxiety

Virtually all client problems are viewed from the perspective of the contribution of their irrational beliefs

Ellis believes that if people can think rationally and have fewer irrational beliefs they will live happier lives

Assessment

REBT therapist try to assess which thoughts and behaviors create problems for their clients

They may listen for themes that repeat themselves and conceptualize these themes by using the A-B-C theory of personality

Identifying the A-B-C’s is most basic form of assessment

Ellis believes that the best way to develop a therapeutic relationship is to help solve the client’s immediate problem

A-B-C-D-E Therapeutic Approach

A (Activating Event): often divided into two parts – what happened and what the client perceives happened.

B (Beliefs): irrational and self-defeating rather than rational or self helping beliefs are the focus of therapy

C (Consequences): Sometimes difficult to distinguish between consequences and beliefs. Consequences tend to be feelings such as “I feel stressed out.”

D (Disputing): Often done in three parts. (1)Detecting-the client and therapist detect the irrational beliefs that underlie activating events. (2) Discriminating – the therapist

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and client discriminate irrational from rational beliefs. (3) Debating – the therapist uses several different strategies to debate the client’s irrational beliefs.

E (Effect): developing an effective philosophy in which irrational beliefs have been replaced by rational beliefs is the product of successful REBT

Other Cognitive Approaches: coping self-statements; cost-benefit analysis; psycho-educational methods; teaching others; problem solving

Emotive Techniques: imagery; role-playing; shame-attacking exercises; forceful self-statements; forceful self-dialogue

Behavioral Methods: activity homework; reinforcements and penalties; skill training

Insight (3 types)

1. Acknowledging that disturbances largely come from irrational beliefs not from the past.

2. Learning how one has re-indoctrinated oneself with irrational beliefs from the past

3. Accepting 1 and 2, knowing that insight does not automatically change people, and working hard to effect change

Chapter 11 – Reality Therapy (William Glasser)

Reality theory developed from Glasser’s work with difficult and hard to reach populations (female adolescent delinquents)

Choice Theory: assumes that people are responsible for their lives and for what they do, feel, and think

Individuals’ perceptions of reality determine behavior (actions, thoughts, feelings) Perceptions of our world are used to satisfy needs Individuals make choices to meet their needs

Pictures of reality

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The perceptions and images that individuals have of the world around them influences how individuals’ needs are met

We cannot know reality itself but only our perceptions which we then can compare to others’ perceptions of reality

Five basic psychological needs: survival; belonging; power; freedom; fun

Needs often conflict with each other Fun is not as strong as survival, power, freedom, or belonging needs but it is still

important

Choice

Often choices are made without awareness that we are choosing

According to Glasser, we choose to be depressed. He prefers to say a person is not depressed but chooses to depress or is in the act of depressing.

Glasser believes that individuals can control their choices to depress, to anger, or to be anxious

Behavior: Total behavior; doing; thinking; feelings; physiology

For Glasser, the KEY to changing behavior is in changing our DOING, in particular, and also our THINKING. These will bring about emotional and physiological change

The Reality Therapy Car (see page 378)

Engine- basic needs (survival, belonging, power, freedom, fun) Steered by wants Rear wheels are feelings and physiology (less control over rear wheels) Front wheels are doing and thinking

Choosing Behavior (why would someone choose to depress, be anxious, or otherwise miserable?)

By choosing to depress or anxietize, individuals can keep angering under control(more power and control gained by depressing than angering)

People may choose to depress or anxietize to get others to help them (helps meet the need for belonging and sometimes power)

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Choosing pain and misery can excuse an individual’s unwillingness to do something more effective (example: easier to choose to depress over job loss than to make effort to find new job)

Choosing to depress or anxietize can help individuals gain power or control over others (example: when a person chooses to depress others must do things for that person – offer comfort, encouragement, etc)

Theory of Reality Therapy

Puts the responsibility of choosing goals and following through with them on clients A good relationship with clients ensures that clients see that therapists are there to help

them make changes which will make positive improvements in their lives Techniques are directed toward changing behaviors and focusing on strengths and

accomplishments

Goals of Reality Therapy

Basic goal is to help individuals meet their psychological needs for belonging, power, freedom, and fun in responsible and satisfying ways

Goals are met in such a way that they do not infringe on the needs of others The focus is on responsible choices

For Glasser, the more severe the symptom, the more the client has been unable to fulfill his/her needs

Therapist ascertains how realistic the wants of clients are and whether their behavior (doing, thinking, feeling, physiology) is helping them realize their wants

CLIENTS, not therapists, determine what they want. Therapists may help clients assess their Total Behaviors and needs and develop ways to meet them

Assessment

Ask clients what they want, what they “really want”

Assessment of how needs (belonging, power, freedom, fun) are being met and of total behavior (doing, thinking, feeling, physiology) are done throughout therapy

Listening for choices and control that are implicit in clients’ statements Do not often use objective or projective instruments Basic Needs Self Assessment and Contextual Needs assessment were developed to

measure the strength of basic needs

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Process of Reality Therapy (Wubbolding’s model)

W = wants D = direction and doing E = evaluation P = planning

4 basic phases:

1. Establish friendly environment

2. Client’s wants, needs, and perceptions are explored (W=wants)

3. Client’s total behavior , especially doing, is explored (D= direction and doing) (E= evaluation)

4. Plans are made to improve the behavior (P= planning). A commitment to plans is obtained

Process of Reality Therapy: friendly involvement; exploring total behavior; evaluating behavior; making plans to do better; commitment plans

Therapist Attitudes: don’t accept excuses; no punishment or criticism; don’t give up

Excuses should be ignored. Discussing why the client did not make the change he/she wanted to make will take the focus away from the client’s control over their own lives

Strategies: questioning; being positive; metaphors; humor; confrontation; paradoxical techniques

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Chapter 5 – Existential Therapy

Martin Heidegger had most direct impact on the development of Existential Therapy Existential Therapy is an ATTITUDINAL APPROACH to issues of living Viktor Frankl -experience in concentration camps – issues of mortality and guilt-

important concepts deal with the individual’s freedom and responsibility for oneself and others. Developed Logotherapy - a concept based on the idea that the most fundamental drive for individuals is to understand the meaning of their existence. He made use of specific techniques – but emphasis was not on techniques- but on dealing with existential or spiritual questions that focus on the realization of values, the meaning of life, and the meaning of time for the individual.

Rollo May: best known contemporary writer on existential psychotherapy. In his books he deals with important issues such as anxiety, dealing with power, accepting freedom and responsibility, and developing individual identity.

Irvin Yalom: his text provides the most thorough and comprehensive explanation of existential psychotherapy. In-depth approach deals with the themes of death, freedom, isolation, and meaninglessness.

Existentialism: a philosophical view that emphasizes the importance of existence, including one’s responsibility for one’s own psychological existence

Themes: living and dying; freedom; responsibility to self and others; finding meaningfulness in life; authenticity

Existential Personality Theory

Existence and themes related to existence form the core of existential personality theory

Most central concept is being-in-the-world which refers to examining oneself, others, and one’s relationship with the world, thus attaining higher levels of consciousness. (Derived from the German word Dasein)

Emphasizes the importance of time- past and the future – but particularly the PRESENT – in understanding oneself and one’s world

Existing in the world can bring about both normal and neurotic anxiety Anxiety occurs as individuals deal with important life themes such as living and dying;

freedom, responsibility, and choice; isolation and loving; and meaning and meaningless. Anxiety results from having to make choices in a world that may often be perceived as

hostile or uncaring In dealing with themes individuals strive for authenticity and self-transcendence

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How honestly and authentically individuals deal with themes affects their existential and psychological well-being

Being-in-the-world: Umwelt (‘thrown world”); Mitwelt (“with-world”); Uberwelt; Eigenwelt (“own world”)

Terms/Concepts: kairos; thrown condition; existential anxiety; neurotic anxiety; boundary situation; I-sharing; self-transcendence; authenticity

Normal Anxiety: 3 features that differentiate it from neurotic anxiety (1) it is appropriate to the situation that the individual deals with in life (2) normal anxiety is not usually repressed (3) normal anxiety can provide an opportunity to confront existential dilemmas, such as dying, responsibility, and choices.

Inauthentic persons are more likely to experience psychopathology and maladaptive means of dealing with crises

Goals of Existential Psychotherapy

Authenticity is the basic goal Finding a purpose or meaning in life Understand beliefs and values Make choices based on them Help people fully experience their existence

Assessment

Therapist evaluates client’s authenticity (how aware client is of his/her problems and responsibility for them)

Therapists listen for existential themes (responsibility; mortality; isolation; meaninglessness)

Therapeutic Relationship: Yalom’s “Therapeutic Love”; resistance; transference; therapists are fully present

Yalom’s “Therapeutic Love” is non-reciprocal

Mortality

Death anxiety (two ways individuals choose to deny or avoid): (1) belief in own specialness (2) belief in ultimate rescuer

Grief – confronting own mortality

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Methods: guided fantasies (imagery); talking with terminally ill; writing own obituary

Yalom says death anxiety is inversely proportional to life satisfaction. When an individual is living authentically – anxiety and fear of death decrease.

Responsibility

Acceptance of responsibility for problems

versus blame

therapist assumes that clients have created their own distress

Clients identify their own role in their problems

Responsibility and freedom for decision and choices made

Isolation

Explore feelings of loneliness and isolation

Use the therapeutic alliance to address intimacy problems

Risk of dependency (client may develop intimacy with therapist but not others)

Meaning and Meaninglessness

Meaning emerges as one lives and becomes concerned for others

Transcend themselves – look toward events/people in which the client finds meaning Put their problems in perspective

Logotherapy (Frankl)

A type of existential therapy that focuses on challenging clients to search for meaning in their lives

Associated with techniques of : attitude modulation; dereflection; paradoxical intention; Socratic dialogue (also called guided discovery)

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Chapter 13 – Feminist Therapy: A Multicultural Approach

More than other theories of psychotherapy, feminist therapy examines not only psychological factors that lead to individuals’ problems but also sociological influences, such as the impact of gender roles and multicultural background on individual development

Feminist therapists recognize the importance of the different ways that men and women develop throughout the lifespan, including differences in social and sexual adolescent development, child raising practices, and work roles

An issue of importance is developing a social and cultural explanation for women’s overrepresentation in certain psychological disorders, such as depression and eating problems

Emphasis on social action and empowering clients reflect a view summarized as “the person is political” – which recognizes the effect of social and political institutions on individuals

More than other psychotherapy theorists, feminist therapists address the issue of ethnic and racial background

History

Chesler’s criticism of the relationship between the female patient and the male therapist

Criticism of gender bias in psychoanalysis

Concerns about social and political rights of women

Consciousness-raising groups

Encouragement of therapist involvement in social action groups

No single leader of feminist therapy

Concerns about social and political rights of culturally diverse populations

Basic Concepts: Intersection of multiple identities; consciousness raising groups (CR); alpha bias; beta bias

Gender Schema Theory (Bem)

Cultural schema: beliefs about one’s own culture as it relates to other cultures.

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Gender Schema: a set of mental associations in which individuals are seen from the point of view of their gender, as opposed to other characteristics

Bem believes that gender is one of the strongest schemas or ways of looking at society- she is concerned that a strong gender schema is a very limiting way to view oneself and others

Gilligan’s Ethic of Care

Based on Lawrence Kohlberg’s model of moral development

Gilligan’s morality of care deals with being responsible to self and others

Emphasis on compassion and the relationship or interdependence between self and others

In Kohlberg’s model, a high level of morality of justice is determined by the individual’s ability to understand rules and the need to obey them as they relate to a need for social order

Gilligan’s major contribution- to show that making moral judgments is not only based on rational judgments but also in valuing and caring and relationships when men and women make moral decisions

Relational Cultural Model

Emphasizes the importance for women of finding a sense of identity through the context of relationships

Rather than see the need for relatedness as a weakness, the relational model sees this as a strength that should be valued and appreciated

Developed by Jean Baker Miller and other writers at the Stone Center at Wellesley college-name changed from self-in-relation theory to relational theory and now – relational cultural theory

Jean Baker Miller saw women as subordinate group in society who developed characteristics (exp: passivity, dependency, lack of initiative, inability to act) that helped them cope with this subordination

Growing emphasis on applying this theory to women of different cultures Central focus of relational cultural theory is being responsive to and being responded to

when dealing with others A major concern is disconnectedness that occurs in relationships with others Disconnections usually represent failures in being understood by others Power contributes to disconnections in relationships

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Miller and her colleagues believe that women (as well as minorities and poor people) have been subordinate to dominant groups (generally white males)

As a subordinate group, they have had to please the dominant group and thus improve their relationships with both men and women by attending to the emotional and physical needs of others

Mutual Empowerment: zest; action; knowledge; a sense of worth; desire

Relational resilience: refers to growing in a relationship and being able to move forward despite setbacks. Resilience also concerns recognizing when relationships are not mutual and moving on from them.

Relational competence: refers to being able to be empathic toward self and others. It also includes the ability to participate in and build a sense of strength in community.

Theories of Feminist Therapy

Feminist therapy is a theory that is combined with others rather than used strictly on its own

Goals of feminist therapy reflect how society’s institutions affect women

Assessment also reflects the therapist’s awareness of social and cultural background and events as they affect their clients

Techniques tend to reflect an awareness of women’s lack of power in society in general and our approaches to resolving problems in effective ways

Goals of Feminist Therapy

Goals listed in the text are not the only goals of feminist therapy – but they are the ones that put a focus on social change

Unlike other therapies, feminist therapies point out that the problem is often in the culture or society rather than in the client

Goals:

Therapy for change, not adjustment Self nurturance and self esteem Balancing instrumental and relational strengths Body image and sensuality Affirming diversity

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Empowerment and social action

Assessment

Feminist therapists have been critical of the major diagnostic system (DSM-IV-TR) because of its absence of consideration of social factors and its development by the dominant group (white men)

Feminist therapies criticize labeling because it is seen as encouraging adjustment to social norms that reinforce stereotypes rather than questioning social injustices

Techniques

Feminist therapists use many methods and techniques in their work

Gender-role analysis and intervention and power analysis and intervention are methods that reflect the need to help people deal with and overcome social inequalities

Culture analysis: problems individuals discuss in counseling should be seen in the context of culture (to what extent do the issues of the dominant culture that the client lives in affect the definition of the problem (EXP: U.S. is white, Western, heterosexual dominant-affects the way issues such as rape and spouse abuse are seen)

Gender role analysis: identify gender role messages; identify positive and negative consequences of gender related messages; identify self statements based on gender related messages; decide which messages you want to change; develop a plan to help client make changes in behavior

Power role analysis: have client choose a definition for power and apply it to different kinds of power; describe ways that client can become more powerful (exp. financial control, self defense classes); discuss with client different ways to bring about change in power; examine gender role messages that interfere with client becoming more powerful; decide how to be powerful in certain situations; plan behavioral changes with client

By increasing clients’ awareness of the differences between the power of men and women in society, therapists can then help them make changes where their lack of power has previously prevented change

Interventions

Many interventions and techniques in feminist therapy empower clients to deal with social and political inequities

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Therapists also seek to inform and educate clients about ways of dealing with environmental stresses and events – in doing this, they often seek to create equality between themselves and their clients

Cultural intervention: understanding the client’s culture and helping him or her to make use of interventions that may include the use of lawyers, social agencies, families, or taking action in some way

Gender role intervention: such interventions deal with reinforcing or helping clients’ interventions or helping them deal with gender role obstacles in their lives. Some interventions provide insight into social or political issues that serve as obstacles to clients.

Power intervention: empowering clients can occur in the course of therapeutic discussion. Often encouragement and reinforcement are ways to help clients become more powerful.

Assertiveness training: a technique to teach clients to effectively express positive and negative feelings to others so that they may achieve desired purposes (often helpful to practice by role playing)

Assertiveness-standing up for one’s rights without violating the rights of others –assertive behavior is a clear and direct statement or request

Aggressiveness refers to insisting on one’s rights while violating the rights of others

Passive or non-assertive behavior means giving up one’s rights and doing what others may want

Bibliotherapy: a therapeutic technique in which the therapist suggests readings for the client for purposes such as gaining insight into problems, learning new information, and increasing self esteem

Reframing: (changing the frame of reference) looking at an individual’s behavior from a different point of reference. This helps individuals understand how social pressures can affect their problems. In feminist therapy usually means a shift from blaming oneself to looking at society for an explanation. (EXP. If client is depressed and believes she is overweight - look at societal pressures in the media and social values that reinforce thinness as a goal for women)

Relabeling: attaching a new name to a problem so that therapeutic progress can be made. For example, saying that a client is overwhelmed by an issue rather than “depressed” may allow the client to develop methods to deal with the problem

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Self disclosure: the process in which therapists or counselors discuss aspects of their own lives in order to enhance therapeutic progress with clients

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