NBCC, NAADAC, CAADAC, CBBS, Florida approved continuing education series in mental health, substance abuse and dual disorders counseling for nurses, counselors, therapists, social workers and addictions professionals.

1. Counseling Theories Dr. Dawn-Elise Snipes

2. Overview Counseling Theories Person-Centered Therapy (Carl Rogers) Rational-Emotive Behavior Therapy (Albert Ellis)/Cognitive-Behavioral Therapy Reality Therapy (William Glasser) Personality Theories Psychoanalysis (Sigmund Freud) Individual Psychology (Alfred Adler) Erik Erikson Learning Theories Classical Conditioning Operant Learning (Stimulus-Response Theory) Social Learning

3. Purpose By understanding the origins of distress, we are better able to deal with distress. Counseling Theories assert that problems stem from ineffective relationships or thoughts in adulthood. Personality Theories speculate that distress stems from more innate, long standing problems often starting in childhood Learning Theories emphasize the fact that distress and behavior is learned from exposure to rewards and punishments

4. Theories: Person Centered Humans are good and forward moving unless they are blocked Blockages often occur from a lack of unconditional positive regard which leads to low self esteem and low self efficacy By creating a nurturing, positive environment, people will naturally move in the right direction.

5. Theories: Person Centered 6 necessary conditions required for change: Therapist-Client Psychological Contact: a relationship between client and therapist in which each person's perception of the other is important must exist. Client incongruence, or Vulnerability:incongruence exists between the client's experience and awareness causing vulnerability/anxiety increasing motivation. Therapist Congruence, or Genuineness Therapist Unconditional Positive Regard (UPR) Therapist Empathic understanding Client Perception of the therapist's UPR and empathic understanding.

6. Theories: REBT/CBT Focuses on changing the current evaluations and/or reactions Distress is caused by a combination of the event and the person’s perception of the event By using the A-B-Cs, people can evaluate their beliefs and reactions (consequences) to events.

7. A-B-C A= Activating Event B= Beliefs/assumptions about/interpretations of an event C= Consequences D= Dispute irrational beliefs What is the evidence for my beliefs? What are other possible explanations for what happened? E= Evaluate reactions/consequences for effectiveness What are the implications of my believing this way, and do they make it worth holding on to my beliefs? How useful are my beliefs? Do I or others get any benefits from holding on to them, or would we benefit more if we held other beliefs?

8. CBT/REBT: Irrational Thoughts Irrational Idea 1 - It is a dire necessity to be loved or approved by almost everyone for virtually everything he or she does. Irrational Idea 2 - One should be thoroughly competent, adequate, and achieving in all possible respects. Irrational Idea 3 - Certain people are bad or wicked, and should be severely blamed and punished. Irrational Idea 4 - It is terrible, horrible, and catastrophic when things are not going the way one would like them to go. Irrational Idea 5 - Happiness is externally caused and people have little or no ability to control their emotions.

9. Irrational Thoughts cont… Irrational Idea 6 - If something is dangerous or fearsome, one should dwell on it Irrational Idea 7 - It is easier to avoid facing many life difficulties and self-responsibilities than to undertake more rewarding forms of self-discipline. Irrational Idea 8 - The past is all-important and because something once strongly affected one’s life, it should indefinitely do so. Irrational Idea 9 - People and things should be different, and it is catastrophic if things do not immediately change. Irrational Idea 10 -Maximum human happiness can be achieved by inertia and inaction or by passively "enjoying oneself."

10. CBT/REBT: Irrational Thoughts Emotional perfectionism: I should always feel happy, confident, and in control of my emotions. Performance perfectionism: I must never fail/make a mistake. Perceived perfectionism: People will not love and accept me as a flawed and vulnerable human being. Fear of disapproval or criticism: I need everybody’s approval Fear of rejection: If I’m not loved, then life is not worth living. Fear of being alone: If I’m alone, then I’m miserable Fear of failure: My worth depends on my achievements Conflict phobia: People who love each other shouldn’t fight. Emotophobia: I should not feel angry, anxious, jealous etc. Entitlement: People should always be how I expect

11. CBT/REBT: Irrational Thoughts all or nothing thinking overgeneralization mental filter – dwell on the bad and let it discolor everything discount the positives jumping to conclusions/overgeneralization magnification emotional reasoning –we FEEL bad so we believe we are shoulds labeling – we label ourselves negatively instead of trying to learn from the situation or thinking about the best way to overcome it blame – we hold other people responsible for our pain or blame ourselves entirely for every problem mind reading catastrophizing - we expect disaster. personalizing - we think that everything people do or say is some kind of reaction to us

12. CBT/REBT: Irrational Thoughts Control Fallacy - If you feel externally controlled, you see yourself as a totally helpless victim of fate. Conversely, it can hold you responsible for the pain and happiness of everyone around you. Fallacy of Fairness–Life is not fair. Fallacy of Change - You expect that other people will change to suit you if you just pressure or cajole them enough. Fallacy of Being Right - Being wrong is unthinkable, and you will go to any length to demonstrate your rightness. Heaven's Reward Fallacy - You expect all your sacrifice and self-denial to pay off, as if there were someone keeping score. You feel bitter when the reward does not come.

13. Theories: Reality Therapy Focus on the present Avoid discussing symptoms and complaints. These are the ineffective ways that counselees choose to deal with problems. Focus on what counselees can do directly-act and think. Spend less time on what they cannot do directly: changing their feelings and physiology. Avoid criticizing, blaming and/or complaining Remain non-judgmental, but encourage people to ask: Is what I am doing getting me closer to the people I need? Teach that excuses stand in the way of making needed connections.

14. Reality Therapy cont… Focus on specifics. Who are counselees are disconnected from Help them make specific, workable plans to reconnect with the people they need. Follow through on what was planned by helping them evaluate their progress. Be patient and supportive but keep focusing on the source of the problem, disconnectedness.

15. Personality Theories: Psychoanalysis The conscious mind is what you are aware of at any particular moment, your present perceptions, memories, thoughts, fantasies, feelings Working closely with the conscious mind is what Freud called the preconscious, what we might today call "available memory.“ The largest part by far is the unconscious. It includes all the things that are not easily available to awareness, including many things that have their origins there, such as our drives or instincts, and things that are put there because we can't bear to look at themthe unconscious is the source of our motivations

16. Psychoanalysis cont… The id, the ego, and the superego The id (instinct)works with the pleasure principleto take care of needs immediately The ego helps the person searches for objects to satisfy the id’s wishes as the ego struggles to keep the id happy, it meets with obstacles in the world. It keeps a record of consequences. This record of things to avoid and strategies to take becomes the superego. There are two aspects to the superego: conscience, which is an internalization of punishments and warnings. The other is called the ego ideal. It derives from rewards and positive models presented to the child.

17. Psychoanalysis cont… The defense mechanisms When the Id/superego conflict becomes overwhelming, the ego must defend itself. The techniques are called the ego defense mechanisms Denial Sublimation Displacement Humor Reaction Formation

18. Personality Theories: Adler Striving for perfection is a single "drive" or motivating force behind all our behavior and experience Since we are not perfect, our personalities are accounted for by the ways in which we do -- or don't -- compensate or overcome our failures Adler felt that there were three basic childhood situations that most contribute to a faulty lifestyle. Disabilities. If someone doesn't come along to draw their attention to others, they will remain focused on themselves. pampering. Many children are taught, by the actions of others, that they can take without giving. neglect. They learn inferiority because they are told and shown every day that they are of no value; They learn selfishness because they are taught to trust no one.

19. Personality Theories: Erickson We develop through a predetermined eight stages. Progress through each stage is determined by our success in all the previous stages. Each stage involves certain developmental tasks If a stage is managed well, we develop a certain virtue or strength

20. Erickson’s Stages hope - Basic Trust vs. Mistrust - Infant stage. Does the child believe its caregivers to be reliable? will - Autonomy vs. Shame and Doubt - Toddler stage. Child needs to learn it is safe to explore the world. purpose - Initiative vs. Guilt - Kindergarten - The child can do things on his own. If "guilty" about making choices, the child will not function well. competence - Industry vs. Inferiority - Around age 6 to puberty. Child comparing self worth to others. fidelity - Identity vs. Role Confusion - Teenager. Questioning of self. Who am I, how do I fit in? If the parents continually push him/her to conform to their views, the teen will face identity confusion.

21. love (in intimate relationships, work and family) - Intimacy vs. Isolation - Young adult. Who do I want to be with or date, what am I going to do with my life? Will I settle down? caring - Generativity vs. Stagnation - the Mid-life crisis. Measure accomplishments/failures. Am I satisfied or not? The need to assist the younger generation. Stagnation is the feeling of not having done anything to help the next generation. wisdom - Ego Integrity vs. Despair - old age. Some handle death well. They reflect on the past, and either conclude at satisfaction or despair

22. Learning Theories: Classical Conditioning Classical conditioning involves presentations of a neutral stimulus along with a stimulus of some significance (usually an unconditioned stimulus) Classical conditioning is most important in helping us understand why seemingly neutral stimuli evoke a response from a client

23. Learning Theories: Operant Conditioning Operant conditioning is the use of consequences to modify the occurrence and form of behavior (Treatment planning) Reinforcement is a consequence that increases a behavior. +/- Punishmentis a consequence that decreases a behavior. +/- Extinctionis the elimination of a behavior by removing the reward.

24. Learning Theories: Social Learning People learn from one another, through observational learning, imitation, and modeling. People can learn by observingbehavior and the outcomes of those behaviors. Learning can occur without a change in behavior. Cognition, awareness and expectations of future consequences can have a major effect on the behaviors that people exhibit. Reciprocal causation: The person, the behavior, and the environment can have an influence on each other.

25. Social Learning cont… 4conditions that are necessary before an individual can learn Attention: the person must first pay attention to the model/situation Retention: the observer must rememberthe behavior that has been observed. Rehearsal: the third condition is the ability to replicate the behavior. Motivation: Learners must want to demonstrate what they have learned.

26. Social Learning cont… Self Regulation Set goals and standards Self-observe Judge yourself React, revisit and reinforce

27. Implications of Social Learning Theory Students often learn a lot by observing others. Describing the consequences of behavior can effectively increase the appropriate behaviors and decrease inappropriate ones. Modeling can be used in conjunction with shaping Expose people to a variety of other models/behaviors/lifestyles People must believe that they are capable or have a sense of self-efficacy. Help students set realistic expectations Teach self-regulation techniques

28. Summary There are a multitude of theories Most boil down to clients lacking self confidence or motivation to do the correct behaviors By helping people identify obstacles to their behaviors or motivation, we can help them improve their quality of life.

29. Further Reading Personality Theories: http://webspace.ship.edu/cgboer/perscontents.html