Counseling Theories for Individuals
Instructor: Dr. Dawn-Elise Snipes
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery & The Addiction Counselor Exam Review
Objectives
~ Review the most common counseling theories and related interventions

Cognitive Behavioral
~ Premise
~ People respond to their representation of events rather than the events themselves
~ Learning is cognitively mediated
~ Thoughts impact emotional and behavioral reactions
~ Some types of thoughts can be monitored and modified
~ Modifying thoughts can help modify emotions and behavioral responses
~ Both behavioral and cognitive techniques are useful and can be integrated
~ Goal:
~ To identify and correct unhelpful cognitions by clarifying and challenging unhelpful or inaccurate cognitive schema and increase the client’s problem-solving abilities
Cognitive Behavioral Assessment
~ Clinical interviews can clarify antecedents and consequences to emotions and behaviors and strategies that have and have not been helpful in the past
~ Inventories and questionnaires are helpful in identifying cognitive distortions
~ Self-monitoring can help identify the frequency, antecedents and consequences of unhelpful thoughts and/or reactions
~ Data from the assessment helps identify the client’s:
~ Problem solving ability
~ Attributional style (Global/Stable/Internal)
~ Underlying belief systems (Cognitive distortions)

Cognitive Behavioral Interventions
~ Daily mood and activity monitoring
~ Increase rewarding behaviors and establish a daily routine
~ Develop understanding of the relationship between feelings, thoughts and behaviors
~ Graded tasks to help clients start approaching and addressing seemingly overwhelming problems
~ Teach new skills and have client practice them between sessions
~ Address automatic thoughts
~ Teach the concept
~ Elicit the client’s thoughts
~ Label the distortion
~ Identify, challenge and modify maladaptive schemas
~ Develop helpful alternatives

Cognitive Behavioral Interventions
~ ABC-DE
~ Activating Event
~ Beliefs (Automatic)
~ Consequences (Emotional and behavioral reactions)
~ Dispute cognitive distortions and inaccurate schema
~ Evaluate the reaction/consequences for helpfulness
~ Cognitive Processing
~ Fact vs. emotional reasoning
~ Facts for and against
~ Big picture or tunnel vision (context/hindsight)
~ High vs. low probability
~ Cognitive distortions?

Cognitive Behavioral Interventions
~ Downward arrow (Follow it through)
~ If so, then what…
~ Questioning the evidence
~ Decatastrophizing
~ Cognitive rehearsal
~ Problem solving skills training
~ Thought stopping
~ Behavioral
~ Narrowing (unlinking)
~ Cue strengthening for positive behaviors
~ Self-reinforcement and punishment

Cognitive Behavioral Indicators
~ Indications
~ Mood disorders (depression, anxiety, phobias)
~ Fears of failure, rejection, abandonment
~ Eating disorders
~ Personality disorders
~ Counterindication
~ Significant cognitive dysfunction, psychosis or mania
Behavioral Models
~ Premise
~ Emphasis on current behaviors which are under stimulus control
~ Reject the idea that maladaptive behaviors reflect underlying pathology
~ Elimination of the behavior is the primary goal of treatment
~ Assessment takes the form of a functional analysis
~ Antecedents, consequences and discriminative stimuli
~ Naturalistic observation
~ Self monitoring
~ Role playing
~ Rating scales
Behaviorism Principles
~ Operant conditioning
~ Behaviors are increased or decreased through punishment and reinforcement
~ Observational learning
Behavioral Therapy
~ Goal: Identify stimuli, reinforcers and punishments in the environment which are maintaining the problem behavior
~ Remove reinforcement and cues for target behavior
~ Increase reinforcement and cues for new behavior
~ Assessment
~ Emphasizes observable, measurable behaviors and patterns
~ Client and therapist agree on the definition of the problem behavior
~ Baseline data is acquired

Behavioral Therapy Interventions
~ Systematic desensitization
~ Relaxation training
~ Anxiety/Anger hierarchy
~ Assertiveness training to combat anxiety
~ Behavioral rehearsal
~ Aversion therapy
~ Flooding (in vivo exposure with response prevention)—Agorophobia
~ Increasing behaviors through reinforcement
~ Shaping
Behavioral Therapy Interventions
~ Premack Principle
~ Response cost (having to give away something each time the target behavior occurs)
~ Smoking, speeding, nail biting, poor academic performance, aggression
~ Time out from reinforcement
~ Determine the function of the behavior (i.e. to get attention vs. because of boredom)
Behavior Therapy Contracts
~ Contingency contract
~ Explicit definition of behavior (go to bed by 10pm)
~ Behaviors that can be monitored (observable, measurable)
~ Sanctions for failure (punishment)
~ Record keeping to provide feedback (logs)
~ Token Economy
~ Define target behaviors
~ Select the reinforcers
~ Monitor the behaviors
~ Fade out reinforcers
Humanistic
~ Premise
~ To understand a person, one must understand her subjective experience
~ Emphasis on the uniqueness and wholeness of the individual
~ Belief in the persons inherent ability for growth and self-determination
~ Therapy involves authentic, collaborative interactions
~ Rejection of traditional assessment techniques and diagnostic labels
Person Centered
~ The self is a consistent conceptual gestalt composed of perceptions of “I” and the relationships of “I” with the world and the values attached to those perceptions
~ To grow the person must remain unified and organized.
~ Disorganization occurs when there is incongruence between the self and experience. (conditions of worth)
~ I am lovable for who I am vs. You are lovable if you make me proud.
~ Therapeutic goals are to help clients achieve congruence between self and experience (eliminate the shoulds) by providing an authentic atmosphere with unconditional positive regard.

Person Centered Assessment
~ Assessment
~ Examine the difference between who the client IS and who the client perceives herself to be.
~ Believes the client to be the expert on herself
~ Techniques
~ Unconditional positive regard
~ Accurate empathy
~ Genuineness and congruence
~ Avoid interpretation, manipulation, probing or advice giving
Gestalt Therapy
~ Premises
~ People seek closure
~ Peoples “gestalts” reflect current needs
~ Behavior represents a whole that is greater than the sum of it’s parts
~ Behavior must be understood in context
~ A focus on the here and now to increase self-awareness and help client’s live in the now
~ The self is the creative, forward moving aspect of self
~ The self-image is the part that imposes external demands
~ Historical information is only relevant to the extent that it is impacting the present “unfinished business”
Gestalt Therapy
~ Problems
~ Arise from abandonment of the self for the self-image
~ Stem from disruption of the boundary between self and external environment resulting in failure to meet personal needs
~ Boundary Issues
~ Introjection: Accepting things from the environment without understanding or questioning
~ Projection: Disowning aspects of the self and putting them on other people
~ Retroflection: Do to the self what you want to do to others
~ Confluence: Intolerance of differences between self and others (guilt and resentment)
Gestalt Techniques
~ Directed awareness
~ No questions (especially why) to prevent intellectualizing
~ Instead of “What is your foot trying to communicate” say, “Tell me about what your foot is communicating.”
~ Use I language
~ Assume responsibility
~ Empty chair
~ Role reversal
~ Role rehearsal
~ Dream work
Psychodynamic therapy
~ Premises
~ Internal conflicts, and their relation to the problem are central themes of treatment
~ Psychopathology develops especially from early childhood experiences
~ Internal representations of experiences are organized around interpersonal relations
~ Life issues and dynamics will re-emerge in the context of the client-therapist relationship as transference and counter-transference
~ Distress is masked by defense mechanisms
~ Behavior is influenced by unconscious thought, and once vulnerable or painful feelings are processed the defense mechanisms reduce or resolve
Psychodynamic therapy
~ Interventions
~ Use of free association as a major method for exploration of internal conflicts and problems
~ Focusing on interpretations of transference, defense mechanisms, and current symptoms and the working through of these present problems
~ Review emotions, thoughts, early-life experiences, and beliefs to gain insight into their lives and their present-day problems.
~ Encouraging clients to trust that insight about how their past is impacting their present is critically important for success in therapy
~ Interpretation of transference reactions
~ Examine
~ Acts of the self toward others
~ Expectations about others' reactions
~ Acts of others toward the self
~ Acts of the self toward the self (introjection)

Summary
~ Cognitive behavioral approaches address the connection between unhelpful thoughts, feelings and behaviors
~ The focus is often on changing thoughts and/or behaviors
~ Behavioral interventions focus only on observable, measurable behaviors, thoughts and feelings are irrelevant.
~ Humanistic therapist focus on helping people live as an authentic, integrated whole
~ Psychodynamic techniques focus on how the past is influencing current behaviors