BEHAVIORAL AND SYSTEMIC APPROACHES discussion

After watching the documentary, Burnt Pages, and reviewing the power points on Behavioral, CBT and Systemic Approaches, please choose an individual from the video and discuss how you would apply one of the approaches/techniques with him/her in counseling.

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Theories of Counseling:
Behavioral Approaches

PowerPoint produced by Melinda Haley, M.S., New Mexico State University.

“This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

any public performance or display, including transmission of an image over a network;
preparation of any derivative work, including the extraction, in whole or part, of any images;
any rental, lease, or lending of the program.”

Behavioral Approaches

Development of Behavioral Approaches

John Locke: Blank Slate

John Watson: Learned Neuroses
B. F. Skinner: Operant Conditioning
Ivan Pavlov: Classical Conditioning

Behavioral Approaches

Basic Principles

Reinforcement: Rewards and Punishments.
Shaping: Working with small, incremental changes.
Measurement: Objective, measurable outcomes.
Action: Dwells more on behaviors than thoughts.

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

Theoretical Constructs and Techniques

Focuses on dysfunctional, irrational, unrealistic and distorted thoughts.
Feelings and behavior are also addressed.
Unconditional acceptance is important.
Ellis also believed in authenticity.
Clients are encouraged to think rationally.

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

Philosophy and Beliefs

Understanding belief systems is important.
Belief systems are organized ways of thinking about reality.
Belief systems affect one’s self-view.
The language a client uses, will speak to their philosophy and belief system.

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

Philosophy and Beliefs (continued)

Clients create their own emotional disturbances by believing in absolute and irrational beliefs.
Clients can choose their belief system.
Counselors can help clients by identifying irrational beliefs and helping the client find meaning in their lives.

Beliefs

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

Identifying Irrational Thinking

Helpless thinking is the result of irrational thinking.
It usually includes “all or nothing” statements.
It usually includes the words should, ought, never and must.

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

Identifying Irrational Thinking (continued)

Five common irrational or dysfunctional ideas:

“Life isn’t fair.”
“It’s awful.”
“I can’t stand it.”
“I must get what I want.”
“I’m incompetent.”

Behavioral Approaches

Albert Ellis/Rational-Emotive Behavior Therapy (REBT)

A-B-C-D-E-F

A = The activating event.

B = The irrational belief about the event.

C = The emotional consequence.

D = Disputing the irrational beliefs.

E = The emotional effect of disputing the belief.

F = New feelings and behavior.

Behavioral Approaches

Rational-Emotive Behavior Therapy and Multiculturalism

The therapy fails to address contextual-situational factors that adversely impact client’s lives.
REBT uses the ethnocentric approach to mental health care.
Does not focus on the phenomenological experience of the client.
Does not address the different ways irrational beliefs are manifested by the culturally different.

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

The Basics

Instead of seeking to change behavior, Reality Therapy works on changing awareness of responsibility.
Once responsibility is acknowledged by the client, it is then possible to work on behavior change.
The locus of the decision is placed on the client.

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

The Basics

The Reality therapist might borrow skills, techniques or ideas from other theories if it benefits the client.
The Reality therapist will be himself or herself, use humor, sarcasm and confrontation in personal ways to assist the client in greater understanding.
Role-playing, systematic planning, and teaching intentional living are all important in Reality Therapy.

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

The Basics

The client has control over his or her life, choices and personhood.
There is no need to explore a client’s past because the past is over and the client’s problems occur in the present.
Reality therapy puts the power into the client’s hands and shows the client how he or she can help himself or herself.

Power

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

The Basics

The client and counselor explores the client’s wants and needs.
It focuses on conscious, planned behavior.
The therapy focuses on responsibility and choice.
Trust and the relationship between client and counselor are critical.

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

The Basics

Since it is often used in institutions, the counselor’s communication of trust, warmth, respect and caring is especially important.
Reality therapy helps clients look at the consequences of their own actions.
This therapy is often used in settings other than the counseling office (e.g. playground or detention center) and is practiced by those other than counselors (e.g. teacher and prison guard).

Consequences

Behavioral Approaches

William Glasser/Reality Therapy//Choice Theory

Cognitive Aspects of Reality Therapy

Reality therapy aids the client in examining the types of thoughts he or she has about himself or herself and the external world.
It helps clients exert control over their own actions, lives, choices and feelings.
Clients choose misery and symptoms. This becomes a way a client has of dealing with the world (e.g. depressing, headaching).

Thoughts

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

Cognitive Aspects of Reality Therapy

There are negative additions (e.g. drugs, stealing) and positive addictions (e.g. walking, meditation).
We choose our addictions and therefore our fate.
Reality therapy helps clients to: Explore their wants and how that relates to their needs; look at what they are doing to meet those needs; evaluate behaviors in relationship to those needs and helps the client plan to change behavior to more effectively meet needs.

Behavioral Approaches

William Glasser/Reality Therapy/Choice Theory

Cognitive Aspects of Reality Therapy

There are negative additions (e.g. drugs, stealing) and positive addictions (e.g. walking, meditation).
We choose our addictions and therefore our fate.
Reality therapy helps clients to: Explore their wants and how that relates to their needs; look at what they are doing to meet those needs; evaluate behaviors in relationship to those needs and helps the client plan to change behavior to more effectively meet needs.

Behavioral Approaches

Reality Therapy and Multiculturalism

Many of the tenets of Reality therapy fits well with other cultures.
Helping the client explore wants and needs keeps the focus on the client’s values and concerns within the client’s cultural context.
Reality therapy challenges the client to see the self in relationship to his or her context. This includes the client’s cultural context.

Behavioral Approaches

Donald Meichenbaum’s Ten Central Tenets of Cognitive Behavioral Therapy

Behavior is reciprocal between a client’s thoughts, feelings, psychological processes and resultant consequences.
Cognitions do not cause emotional difficulty.
Counselors help clients understand how they construct and construe reality.
CBT therapists dissuade from the rationalist or objectivist position.
There is an emphasis on collaboration with the client.

Behavioral Approaches

Donald Meichenbaum’s Ten Central Tenets of Cognitive Behavioral Therapy (continued)

Relapse prevention is central to cognitive behavioral therapy.
The client/therapist relationship is critical for change to occur.
Emotions play a critical role in cognitive-behavioral therapy.
CBT is used with couples and families.
CBT can be used in a variety of setting with a variety of issues.

Behavioral Approaches

Applied Behavioral Analysis: Central Constructs

Client-counselor relationship is imperative and counselors exhibit high levels of empathy, self-congruence and interpersonal contact. The relationship is collaborative and relationship variables differ according to client and culture.
Operationalization of Behavior: Focuses on the concreteness and specifics of behavior. Vagueness is transformed into objective, observable actions.
Functional Analysis: The ABC’s of behavior. An individual's behavior is directly related to events and stimuli in the environment.

Behavioral Approaches

Applied Behavioral Analysis: Central Constructs

Reinforcement: Behavior develops and maintains itself through a system of punishments and rewards.
Goals: These are designed to make specific behavioral changes. Goals are concrete, specific, observable and measurable.

Resources

Ivey, A. E., D’Andrea, M., Ivey, M. B. and Morgan, L. S. (2002). Theories of counseling

and psychotherapy: A multicultural perspective, 5th ed. Boston, MA.: Allyn &

Bacon.

James, R. K. & Gilliland, B. E. (2003). Theories and strategies in counseling and

psychotherapy, 5th ed. Boston, MA: Allyn & Bacon.

Kottler, J. A. (2002). Theories in counseling and therapy: An experiential approach.

Boston, MA: Allyn & Bacon.

Theories of Counseling:
Cognitive Behavior Therapy

PowerPoint produced by Melinda Haley, M.S., New Mexico State University.

“This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

any public performance or display, including transmission of an image over a network;
preparation of any derivative work, including the extraction, in whole or part, of any images;
any rental, lease, or lending of the program.”

Cognitive Behavior Therapy

Basic Tenets

The main theories are Cognitive Behavior Therapy, Rational Emotive Behavior Therapy and Cognitive Behavior Modification.
The way individuals structure and interpret experiences, determines their moods and behaviors.
Changing conceptualizations lies at the heart of cognitive behavioral therapy.
Combines both cognitive and behavioral approaches.

Cognitive Behavior Therapy

Basic Tenets

Cognitive therapy rests upon the belief that what one thinks determines how one feels.
The therapist is supportive and empathic and uses experiments and empirical processes along with a collaborative alliance with the client, to explore thinking and alternatives.
Cognitive therapy has been used with a variety of disorders and problems (e.g. anxiety, phobias, depression).

What do

I think

Cognitive Behavior Therapy

Theory of Personality

Personality includes both genetic endowment and social influence.
It reflects the individual’s cognitive organization and structure.
Emotions and behaviors are based on perceptions, interpretations, and assumptions.
Schemas have an important impact on how one operates cognitively.

Cognitive Behavior Therapy

Theory of Personality

Schemas: A person’s core beliefs and basic assumptions.
Schemas can either be functional or dysfunctional and more than one schema can compete with another.
Cognitive Vulnerability: When a person’s beliefs and assumptions predispose him or her to psychological distress.

Cognitive Behavior Therapy

Nature of Maladjustment.

Maladjustment stems from irrational beliefs and distorted cognitions.
Maladaptive cognitions come from:
Selective attention
Misperception
Maladaptive focusing
Maladaptive self-arousal
Repertory deficiencies

Cognitive Behavior Therapy

Nature of Maladjustment.

Maladaptive cognitions lead to maladaptive, self-defeating behaviors.
Adaptive, self-enhancing behaviors come from a client’s self-enhancing thoughts and this can be taught.
Clients can be taught to shift from self-defeating thoughts to self-enhancing thoughts.

Cognitive Behavior Therapy

The Counseling Process

Cognitive therapy and cognitive behavior modification uses a variety of techniques or procedures to assist clients in changing negative, self defeating responses.
The therapist might range from directive to unconditionally accepting, from scientific to empathic, from systemic to open or from suggestive to instructive.
It is highly eclectic and utilizes resources and techniques that fit with the client’s thought processes.

Cognitive Behavior Therapy

The Counseling Process

Both cognitive and behavioral strategies might be used.
Client and therapist work together:

to help the client gain cognitive and behavioral control over his or her problem.

to look at different ways of behaving.

to analyze thoughts and emotions.

to practice new cognitive and behavioral patterns.

Cognitive Behavior Therapy

Strategies for Helping Clients

Beck’s cognitive psychotherapy

The goals are to correct faulty information processing and help clients modify their assumptions that maintain their maladaptive behaviors and emotions.

Collaborative Empiricism: Therapist and client are co-investigators.

Guided Discovery: Guided by the therapist, the client engages in experiments that result in more adaptive ways of thinking.

Cognitive Behavior Therapy

Strategies for Helping Clients

Relaxation Training and Relaxation Therapy

A person cannot be in a state of complete physical relaxation while at the same time be emotionally anxious.

Works well for stress, anxiety, physiological problems, workplace pressures, and coping with modern lifestyles.

Cognitive Behavior Therapy

Strategies for Helping Clients

Mental and Emotive Imagery

Mental Imagery is a process through which a person focuses on vivid mental pictures of experiences or events—past, present or future.
Emotive Imagery: It is a procedure where the client imagines the emotional sensations and feelings of an actual situation or behavior.

Cognitive Behavior Therapy

Strategies for Helping Clients

Cognitive Modeling: Identification of what maladaptive or bad thoughts or emotions the client wishes to be rid of and then the therapist models with self-talk that the client will incorporate.
Covert Modeling: A client imagines engaging in the desired behaviors he or she wants to learn or adopt.
Thought Stopping: Interruption of unwanted thoughts when they occur by shouting “stop” whenever the unwanted thought pops into consciousness.

Cognitive Behavior Therapy

Strategies for Helping Clients

Cognitive Restructuring: Replacement of negative, maladaptive thoughts with positive, adaptive ones.
Reframing: To modify or restructure a person’s view or perception regarding a problem or behavior.
Stress Inoculation: A process of teaching clients both cognitive and physical skills for autonomously coping with future stressful and distressing situations.

Cognitive Behavior Therapy

Strategies for Helping Clients

Meditation and Relaxation: Helps the client concentrate on some internal or external stimulus that serves to focus the client’s attention away from aversive stimuli.
Biofeedback: Uses technology to communicate to a client what his or her own body is doing and then allows that person to use mental processes to control bodily functions.
Neurolinguistic programming: Using the client’s sensory language to fully experience the client’s inner world (e.g. I see that (visual); I feel that (kinesthetic) ; I hear that auditory).

Cognitive Behavior Therapy

Strategies for Helping Clients

Eye Movement Desensitization Reprocessing (EMDR):

Used primarily to treat traumatic memories.

The client imagines the scene, is aware of the negative statement regarding that scene (along with noxious feelings), and then follows the therapist’s finger with his or her eyes.

Then the client erases the image from his or her mind.

This is continued over a series of steps until hopefully the painful image and noxious feelings and memories are removed.

Cognitive Behavior Therapy

Advantages of Cognitive Behavior Therapy

It has established human thought processes as data or events that can be studied.
It validated a number of relaxation techniques.
It has enhanced the rational therapies such as Rational Emotive Behavior Therapy.
Uses the systematic scientist-practitioner model.

Cognitive Behavior Therapy

Disadvantages of Cognitive Behavior Therapy

It has been harshly judged by feminists, multiculturalists and ecologists because it mirrors masculine and Euro-American worldviews and does not adequately take culture into consideration.
It requires a lot of training and skill.
The therapist needs to not only understand cognitive techniques but also have a vast understanding of behavioral and learning theories.
The therapist needs to have strong discipline and there is less tolerance for error.

Cognitive Behavior Therapy

Cognitive Behavior Therapy with Diverse Populations

It matches problems to treatments without regard for race or cultural considerations.
It can be used effectively if culture and the client’s worldview is take into consideration.
Therapy is a collaboration and depends upon trust between counselor and client and this can work well with culturally diverse clients.

Resources

Ivey, A. E., D’Andrea, M., Ivey, M. B. and Morgan, L. S. (2002). Theories of counseling

and psychotherapy: A multicultural perspective, 5th ed. Boston, MA.: Allyn &

Bacon.

James, R. K. & Gilliland, B. E. (2003). Theories and strategies in counseling and

psychotherapy, 5th ed. Boston, MA: Allyn & Bacon.

Kottler, J. A. (2002). Theories in counseling and therapy: An experiential approach.

Boston, MA: Allyn & Bacon.

Theories of Counseling:
Systemic Approaches

PowerPoint produced by Melinda Haley, M.S., New Mexico State University.

“This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

any public performance or display, including transmission of an image over a network;
preparation of any derivative work, including the extraction, in whole or part, of any images;
any rental, lease, or lending of the program.”

Systemic Approaches/Systems Therapy

Basic Tenets

Looks at circular or reciprocal influence rather than linear influence.
Systemic thinking has been influenced by natural science, mathematics, chaos theory, physics, systems theory, psychoanalysis, anthropology and evolutionary psychology.
Circular causality: Looks at the way conflict occurs in the context of others who are causing reciprocal grief.

Systemic Approaches/Systems Therapy

Basic Tenets (continued)

Rules of Relationships: Every family or system has explicit or subtle rules to guide behavior. Rules apply to:

Power structure: Who has the power?

History: What are the family legends, myths and history that have been inherited from previous generations?

Systemic Approaches/Systems Therapy

Basic Tenets (continued)

Coalitions: Who is aligned with whom?

Hierarchy: Who is in control? What is the pecking order?

Roles: Who is the rescuer? Distracter? Troublemaker?

Boundaries: Are the boundaries loose or ridged?

Enmeshment: Is there differentiation or are members too close to each other.

Systemic Approaches/Systems Therapy

Basic Tenets (continued)

Culture: What is the cultural identity of the family? (religion, socioeconomic status, ethnicity).

Communication: What are the communication patterns and metarules?

Life Cycle: What is the developmental stage of the family? (launching children, empty nest, married without children etc.)

Metaphors: What is the underlying symbolic interactions between family members?

Systemic Approaches/Systems Therapy

Types of Therapies

Psychoanalytic (Murray Bowen, Nathan Ackerman and James Framo): Looks at the way influences from the past shape the present family dynamics.
Humanistic/Existential (Carl Whitaker and Virginia Satir): Emphasizes relationships within family systems and the therapists use themselves as tools while being warm, engaging and receptive.

Systemic Approaches/Systems Therapy

Types of Therapies (continued)

Structural (Salvador Minuchin): Looks at the underlying structure of families while looking to initiate adjustments.
Strategic (Jay Haley and Cloe Madanes): Concerned with inter-relational and communication styles and how these might be altered.
Multicultural approaches: Looks at the societal influences of marginalization, oppression and ethnic identity.

Systemic Approaches/Systems Therapy

Types of Therapies (continued)

Narrative Therapy (Michael White and David Epston): It is a phenomenological approach that looks at a family’s inner experience and personal meaning through the use of language.

Systemic Approaches/Systems Therapy

Interventions

Externalizing Conversations: Helps the client place the problem outside of himself or herself (e.g. When did this problem begin to start to take over your life?”)
Mapping the Influence: Helps the family to explore the effects and outcomes and makes it clear that everyone “owns” the problem.
Unique Outcome Questions: Looking for the exceptions to the problem.

Systemic Approaches/Systems Therapy

Interventions (continued)

Unique Possibilities: Helps the family visualize a time in the future when the problem is no longer affecting them.
Restorying: Helps families change their narratives about who they are and what got them to the place there are at right now.
The Problem Is The Problem: The problem is not the individual or the family, but the problem is the problem.

Systemic Approaches/Systems Therapy

Similarities Among the Therapies

Problems need to be understood within the context of the family system.
Changes in one part of the system will affect all others who are interconnected to that system.
It is expedient to involve all family members in treatment.
All therapy is family therapy.

Systemic Approaches/Systems Therapy

Similarities Among the Therapies (continued)

Families go through a family life cycle.
Experiences you had in your family of origin shapes the way your current family evolves.
Families as a system, organize themselves to maintain stability.
Family structures exist in a cultural context.

Systemic Approaches/Systems Therapy

Similarities Among the Therapies (continued)

Human behavior is often triangular, meaning conflicts between two people usually involve a third person.
Families get stuck in ruts or repetitive patterns that restrict their freedom and options.
Symptoms are often useful and functional and help maintain family equilibrium.

Systemic Approaches/Systems Therapy

Notes About Working With Families

You need to decide which members of the family with which you are going to work.
You have to join the family to effect change from within.
You have to be careful you don’t take sides and are perceived as fair and objective.
You need to maintain control over the session.

Systemic Approaches/Systems Therapy

Notes About Working With Families (continued)

You need to help the family reframe the problem so that the focus is not just on one family member.
You need to be highly active and directive in order to implement your interventions.
You need to consider individual behavior but also attend to family interactive patterns.

Systemic Approaches/Systems Therapy

Notes About Working With Families (continued)

You need to keep things moving and be active to keep the family members (especially children) engaged in the process.
You need to get more supervision than you would with individual cases because family therapy is infinitely more complex.

Systemic Approaches/Systems Therapy

Stages in the Process

First Contact: First impressions are important and you need to be perceived as accessible to every one, knowledgeable, confident and calm. It is important to note where each family member sits and how the family interacts.
Joining the Family: You need to try to build a connection with every family member without showing favoritism or bias toward one over another.

Systemic Approaches/Systems Therapy

Stages in the Process (continued)

Assessment: You need to check out coalitions, power hierarchies, channels of communication, dysfunctional behavior etc., all while looking at the strengths and weaknesses of each family member.
Reorientation: This is where you present your impression or interpretation of what is going on within the family.

Systemic Approaches/Systems Therapy

Stages in the Process (continued)

Structural Realignments: This means making changes in the way family members interact with each other.
Intervention: These are the therapeutic actions that are taken and these will vary depending upon the theory used.

Resources

Ivey, A. E., D’Andrea, M., Ivey, M. B. and Morgan, L. S. (2002). Theories of counseling

and psychotherapy: A multicultural perspective, 5th ed. Boston, MA.: Allyn &

Bacon.

James, R. K. & Gilliland, B. E. (2003). Theories and strategies in counseling and

psychotherapy, 5th ed. Boston, MA: Allyn & Bacon.

Kottler, J. A. (2002). Theories in counseling and therapy: An experiential approach.

Boston, MA: Allyn & Bacon.

BEHAVIORAL AND SYSTEMIC APPROACHES discussion

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