Counselling Lectures

Lecture 1: What is Counselling? Introduction Counselling based on idea it is good to talk and to be listened to. Counselling is subtle and powerful form of helping. Ways of defining counselling practice o o o o Counselling = way of helping people to help themselves. Counselling = working alliance of two or more where resources of one person used to explore, clarify, identify, activate and express available resources of another. Counselling = process where one person helps another via purposeful conversation to understand them . Seeks to establish helping relationship where client can express thoughts + feelings to clarify own situation, come to term with new experiences, see difÏculty objectively and face problem with less anxiety + tension. Assists individual to make own decision from choices made available. People engage in counselling when counsellor offers/agrees to offer time + attention + respect to client. Task of counsellor to give client opportunity to explore, discover + clarify ways of living resourcefully and toward greater wellbeing. What is a human being? Rollo May proposes basic nature of human being = “psyche” or “soul” or “personality”, which is characterised by freedom, individuality, social integration and spiritual tension. May formulates 4 principles of personality as guide for counselling: 1) 2) 3) It is the function of counsellor to lead client to acceptance of responsibility for conduct and outcome of their life. It is the function of counsellor to assist client to find their true self and then help them have courage to be this self. It is the counsellor’s function to assist client to cheerful acceptance of social responsibility, to give courage which releases client from compulsion of feeling inferior, guiding them to strive towards socially constructive ends. 4) It is the counsellor’s function while helping client to free themselves from guilt feeling, to assist client to accept + afÏrm spiritual tension inherent in human nature. Models of helping Egan’s model (1986) – 3-step model: identification, goal setÝng and action Heron’s six categories (1990) – Authoritative (prescriptive, information, confronting), Facilitative (cathartic, catalytic, supportive) Hopson’s model of Ways of Helping (1981) Direct action – acting to provide another’s immediate needs, acting on their behalf (e.g., providing a meal, lending money) Giving advice – offering someone opinion of best course of action based on view of situation (e.g., “if I was you…”) Giving information – giving person information they need (e.g., legal rights, address of an agency, available help) Providing instruction – enabling someone to acquire knowledge and skill (e.g., teaching, training, demonstration) Systems change – influencing + altering systems and context surrounding person’s problem (e.g., family therapy, working with groups) Counselling – helping person explore problem, clarify issues, re-evaluate experiences, explore choices (i.e., helping people to help themselves) Role of Counsellor o o o o o o To listen Empathise Be non-judgemental Open to experience Strive towards authentic relationship Generate opportunities for growth Client’s perceptions of counselling (Berzon) Increased awareness, recognition of similarity, core conditions, self/other perception, expressiveness, communication, warmth, ventilation. The client’s needs o o o o o To “speak” their mind To tell their “story” To avoid betrayal of personal meaning To experience themselves as “whole” To an authentic relationship with “another” Counsellor qualities and training Qualities of person who becomes counsellor, qualities counsellor draws in their work. Lecture 2: The Structure of Counselling Hough (2006) proposes counselling = requires coherent framework/structure that can serve as map in counselling. Counselling skills o Listening o Non-verbal communication o Gestures and touch o Silence (so clients can gather thoughts otherwise seen as intrusive + insensitive) o Dress and appearance Verbal communication skills o Paraphrasing + summarising o Asking questions + challenging o Immediacy (what is happening now in counselling situation) o Counsellor self-disclosure e.g., “I know that feeling… but when I…” o Giving information to the client o Identifying patterns and themes Action phase o Goal setÝng (helps client plan changes, tend to react positively to goal chosen themselves) o Choosing programmes o Creative thinking (idea storming, visualisation, imagery) o Giving encouragement o Evaluating goals + progression Active listening Franklands & Sanders (1995) = active listening is skill emphasised by all counselling methods. They propose active listening has two phases: 1) 2) Discrimination = observation part, what is beneath words i.e., body language, feelings, meanings, what is not being said Communication = responding part, includes responding back to person so they are heard and accurately understood i.e., non-verbal gestures, eye-contact, reflection, clarifying, para-phrasing Rogers’ “Core Conditions” of how counsellor should be when helping another: Empathy Unconditional positive regard Congruence o o o Empathy is openness to feeling in another. Ability to perceive accurately the feelings of another person and ability to communicate understanding. Empathy = an atÝtude + activity. Being empathic is effort to see, feel and understand world from other’s POV. Pity and sympathy lack objectivity, they encourage over-identification and lead to inappropriate rescue fantasies. Basch (1988) gives 5 steps for empathic understanding: 1) Awakened affect reaction in the counsellor 2) Viewing the affective reaction objectively 3) Identifying client’s affective state 4) Discerning meaning/significance of client’s message 5) Communication/response Empathy depends on human intersubjectivity + focuses on client’s inner experience. Counsellor mustn’t take client’s words at face value but looks for deep meanings of what is/not said and un/conscious communication. Heron (1990) stresses discerning process and classifies empathy as a catalytic intervention  client says something with implicit feeling, thought or intention between lines not fully expressed. Egan (1986) distinguishes basic empathy which reflects back relevant surface feelings and meanings, and advanced accurate empathy which goes beyond expressed to partially expressed and implied to buried feeling and meanings. Suggests 5 ways to communicate this to client: 1) 2) 3) 4) 5) Expressing only what is implied Identifying themes Connecting islands Helping clients draw conclusions from premises From less to the more Tolan (2003) suggests at its most basic, empathy is reinstatement of someone’s words to show they are heard + understood. Frankland & Sanders (1995) propose essential skill element of empathising are (i) imagination rather than identification , (ii) perception + thought of world of other and (iii) resonance of feeling. Unconditional positive regard is openness to individuality of another . Involves respect/acceptance for client, avoiding judgement + possessiveness. Involves recognising worth of client not for status, achievements, material success but themselves and courage. Acceptance expressed through active warmth to client. Frankland & Sanders (1995) propose 3 elements involved: (i) acceptance of humanity of people in helping relationship, (ii) acceptance it is made of light and shade and (iii) acceptance of (counsellors) self which helps adopt non-judgemental approach when helping. Congruence is openness of “self”. Counselling involved overlap of 2 frames of reference, the client’s “felt self” and counsellors “felt self”. Congruence = outcome of tension between 2 references. Congruence involves maintaining basic honesty + authenticity . Involves counsellor being true to themselves. Can involve skills of confrontation, being frank of issue, challenging client. Tolan (2003) describes counselling to create distortion-free zone. Congruence helps client learn to trust counsellor’s experience. Developing a framework for counselling practice Counselling practice seen to rest on these perspectives: o o o o o Importance of active listening Establishing a therapeutic alliance (working relationship) Recognising human existential givens Exploring individual qualities of the client Identifying client’s resources, capacities and skills Lecture 3: Psychodynam ic Approaches o Facing challenge of growth and change Focuses on givens of human experience, what we bring to the world, how personality develops in relation to its interaction with outside world. Psychodynamic perspective in counselling o o o Circumstances – focus on unconscious component of our experience + consequent unconscious conflicts . Unconscious memories from past/early life experiences contribute to our lived experience like present circumstances we find ourselves. Support/Growth – emphasis on support than growth or, on insight arising from interminable self-exploration. In post-Freudian psychodynamic approaches more emphasis placed on personal growth and transformation. Self – notion of self has little contribution to traditional Freudian approach, but it does feature in later developments. Freud’s model of psyche is fragmentary “self”, with id-ego-superego in conflict with each other. But, notion of self = central to Carl Jung’s psychodynamic approach where goal of development is fulfilment + wellbeing rather than resolution of conflict. Freud’s contribution: Psychodynamic counselling Freud offered new language for mental event discussions + clinical work seriously took anxieties + disturbances client’s experienced. He observed how people experience phenomena as happening to them rather than under conscious control including dreams, free associations, slips of tongue, mistakes, re-emergent feelings of anger, fear + despair, neurotic symptoms + changes in bodily states. Key concepts include preconscious and unconscious, Oedipus complex, trauma theory, libido, pleasure principle, Thanatos, dreams, free association, transference, resistance, defences. Object relations (OR) Concerned with development of interpersonal relationships from early infancy to maturity, with emphasis on child-mother relationship. Object designates the thing (usually person/part-person) through which instinctual drive is able to achieve its aim. OR = system of psychological explanation based on premise that mind is comprised on elements taken in from outside. This occurs in process of internalisation (of objects). In OR theory psyche seen as object-seeking instead of pleasure seeking. For infants, first object is part object e.g., breast. Infant doesn’t respond to mother as whole but as supplier of its needs. Ego strengthened by finding of good objects. Internalisation (introjection + identification) important for development of psychic structure + mental functioning. The psyche through projection attributes/places feelings onto objects + through splitÝng, can distinguish between pleasurable and non-pleasurable aspects of same object. Psychodynamic: The basics Major contribution = understanding subtlety of working alliance between client + counsellor. Greatest insight = past is implicated in our livedexperience of present but we are not aware of this. Everything we experience = simultaneous product of what is in front of us and unconscious projections of minds generated by earlier experiences. Transference = projection of past meanings/experiences onto the person of the counsellor who can recognise in transference, unconscious mind is exposed. Psychoanalytical work includes: Techniques used include working with transference, working with dreams, free association, exploring defences + resistance. Projection involves unconsciously attributing one’s own traits, atÝtudes or subjective feelings to others ; ascribing one’s own unacknowledged desires + faults as a defence against guilt; or perceiving objective stimuli in line with personal interests, desires, fears or expectations. Boundaries between self + other become blurred by projections. Transference describes process whereby a client shifts affects/feelings applicable to another person onto counsellor. Client enacts their unconscious in the present moment, leading to insight + self-realisation. Counter-transference concerns arousal of counsellor’s repressed feelings by therapeutic situation. Now viewed as important site of unconscious communication. With right self-awareness the counsellor can gain insight from counter-transference that will help the client. Unconscious resistance involves opposition to any attempt to lay bare content of unconscious material. This takes form of ego defence mechanisms like denial, humour, repression, regression, rationalisation, displacement, sublimation, splitÝng that enable person to avoid awareness of anything arousing anxiety. With skill of confrontation, counsellor can challenge resistance and explore clients’ defences. Supervision raises issue of who counsels counsellors? Regular supervision, respecting confidentiality is requirement of professional counselling practice. Counsellors can carry burden of unconscious projections from clients or fail to recognise signs of “burn out” without enough supervision. Jung said it’s important to train therapists. Symptoms as signs – it’s our capacity to use signs + symbols that make us human. This capacity mediates human ability to think and communicate, to represent things to ourselves, including representing ourselves to ourselves. Signs + symbols enable transcendence of here + now so human thought not bound by time + space, they enable us to think in terms of possibilities and in turn, enables human consciousness. Through symbols we contact what lies beyond us. Objects become symbols by their ability to reflect back as a feedback mechanism that feelings originally made them the objects of our attention. Symptoms viewed as pointers to next stage of personal growth. Positives include transference as enactment of unconscious processes in present situation, Freud’s model of unconscious primary + secondary thinking, new language to understand mental processes, primary of early experience, observation, attention to detail, idea of symptoms as encoding truths that clients avoid, id-ego-superego, conflict model of neurosis, role of irrational in complex psychodynamic basis of experience Lecture 4a: Humanistic Approaches Negatives include theory seen as clumsy, over-deterministic, dogmatic, drawing on limited narrative, infantile sexuality over-stressed, skills of therapist emphasised at expense of client’s experience, intrapersonal emphasised at expense of interpersonal. Freud’s concept of unconscious limited compared to Jung’s, focus of psychopathology is on neurosis at expense of psychosis. o o o Circumstances – focus on “here and now”, upon conscious awareness, present lived experience + relationships. Emphasis on phenomenological approach (“pure” contents of our experience). Existential perspective stresses “givens” of human life. Support/Growth – personal growth = core humanistic theme. Rogers tried to identify basic conditions that optimise human growth + he stresses as humans; we are in continuous process of “becoming”. Client is supported through crisis with aim of helping them to take responsibility for self. Maslow stresses need to study goals of human growth, self-actualisation + personal transformation. Self – notion of self fundamental to humanistic-existential approach. Emphasis on whole person + human fulfilment. Rogers’ Psychology of Becoming Maslow focuses on goals of human growth. Roger focuses on process of becoming a person, a self and actualising tendency. Rogers developed a self-theory. These ideas based on Rogers’ person-centred approach. In Rogers’ theory, the phenomenal field organised like: o o o Self – conscious organised + consistent set of beliefs about one-self. Organism – sum of all experiences, unconscious feelings, perceptions, wishes. Congruence/genuineness – harmony of self + organism – flexible/realistic. Rogers argues process of becoming person requires conditions for psychological growth. Primary requirement is experience of unconditional positive regard, acceptance + consequent positive self-regard/acceptance of self. Argued psychological growth becomes blocked by imposition of conditions of self-worth from others. Conditions of self-worth lead to feelings of incongruence that are experienced as conflict between self + reality/self + ideal-self = low self-esteem, confusion, defensiveness, vulnerability. Basic ideas behind person-centred counselling approach involves: i) ii) iii) An atÝtude on the part of the counsellor A particular way of relating with client Optimistic view of human potential + growth Counsellor = trained to actively listen in empathic way + respond to client by reflecting back to client their thoughts/feelings. Approach is phenomenological i.e., client’s view of themselves + of world is validated. Approach is non-directive, resisting imposition of interpretation. Emphasis centred on relationship between client and therapist + healing dialogue that unfolds. Counselling focuses on what client is becoming. 1) Humanistic view of personality recognising uniqueness of individual together with accepting validity of individual’s lived experience + phenomenal field. Human personality seen as dynamic, responsive to changes in awareness + consciousness. Like Jung’s theory of individuation, human development is not limited to growth throughout childhood/adolescence but continues across lifespan. Through middle + old age, individual develops in response to life events + crises to actualise, unfolding transpersonally + spiritually. 3) Importance of personal meaning emphasised. While acknowledging historical basis of meanings that circulate + offer themselves + inevitable cultural embeddedness of human experience 4) Existential givens of freedom, choice + agency is honoured. We are all agents of life journey. 2) In later work, Rogers proposes qualities of person of tomorrow: 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) Openness – to inner + outer world, open to experience, new ways of seeing, being, new ideas and concepts. Desire for authenticity – valuing communication as means of telling it way it is, rejecting hypocrisy and deceit. Scepticism regarding science + tech – deep distrust of science + tech to conquer world of nature. Desire for wholeness – dislike of living in compartmentalised world of body + mind Wish for intimacy – seeing new forms of closeness, of intimacy, shared purpose, new forms of communication. Awareness of change – we are always in process of change and need to welcome risk-taking way of being/alive. Caring for others – eager to help others. AtÝtude to nature – closeness to + caring for ecological issues + elemental nature – ecologically minded. Anti-institutional – antipathy for highly structured inflexible institution, believe it should exist for people. Authority within – trusting own experience + distrust of authority, making own moral judgements, disobeying laws. Unimportance of material things – indifferent to material rewards + comforts. Yearning for spiritual – seeking meaning + purpose in life greater than individual, open to experiencing unity + harmony of universe. Lecture 4b: Existential Approaches “Existence” – Latin = to emerge, to proceed, carries sense of movement + stresses view of human existence as process of “being-in-the-world” + “becoming” where change is fundamental. Yalom describes existential approach emphasises conflict underlying human condition that flows from confrontation with existence i.e., ultimate concerns, intrinsic properties that are part of human existence. Yalom describes 4 givens: 1) 2) Death – we exist now but we won’t one day. Death will come and there is no excuse from it. Freedom – we think of freedom as positive concept. Yet freedom viewed from perspective of ultimate ground is riveted with dread. In its existential sense freedom refers to absence of external structure. 3) Isolation – not interpersonal isolation with its attendant loneliness or intrapersonal isolation, but a fundamental isolation. No matter how close we become to another, there is a final gap. We enter existence alone and depart alone. Existential conflict is tension between awareness of absolute isolation and wish for contact, protection, to be part of larger whole. 4) Meaninglessness – if we must die, then what meaning does life have? Why do we live? How do we live? Yalom’s 4 givens lead to dynamic existential psychotherapy that retains Freud’s basic dynamic structure but radically alters the content. The old formula Drive  Anxiety  Defence Mechanisms Replaced by Awareness of ultimate concern  Anxiety  Defence Mechanisms Rollo May Existential psychotherapy placing emphasis on tragic aspects of life doesn’t imply it is pessimistic, confronting genuine tragedy is cathartic experience psychically. Tragedy is inseparably connected with human’s dignity + grandeur. ‘I need to see things as they are + not always look for hidden motives, influences + causes’. What is experienced is as important as why it is experienced. Existential thinking afÏrms human freedom and choice. While you find yourself in situations not chosen, you can choose relationships with the situations you find yourself in. Therapy offers the freedom for a fruitful engagement with circumstances you find yourself in. Question of choice introduces anxiety + guilt into experience. Being confronted with choice endangers existential anxiety different from neurotic anxiety of frustration to instinctive drives and avoiding choice results in a kind of existential guilt which is different from neurotic guilt produced by internalised authority. Laing’s view of Existential Therapy Idea of therapy springs from hope that authentic meeting between human beings still possible. Essence of therapy lies in therapist’s ability to achieve state of being that facilitates rapport, synchronisation + resonance between therapist + client. Therapists skill lies in acceptance + tolerance of otherness. For Laing therapy involves a partaking of sacrament of every present moment that is the healing factor. Review of other humanistic therapies Gestalt Therapy = Encourage someone to be aware of themselves with interpersonal context they find themselves in. Gestalt therapy sees person as a whole, paying attention to non-verbal cues + stresses personal responsibility, speaking in present tense, taking risks, choice + avoids gossip, questioning, interpretations/taking about the past. Techniques include empty chair, hot seat, making rounds, dream work. Transactional Analysis = is therapy developed by Berne, concerned with analysis of transactions . Berne proposes human personality can be divided in 3 ego states: parent, adult, child. When we communicate we use one of the ego states to communicate with particular ego state in another person. Communication between ego states = transactions which can be complementary, crossed, ulterior. Psychosynthesis = combines Eastern + Western ideas to emphasise importance of spiritual dimension in human experience, developing higher levels of consciousness + self-actualisation. Superconscious seen as source of inspiration, imagination + peak experiences which transcend individual’s sense of existing as a separate isolated being. Psyche seen as made of different parts = body, mind, feelings, roles in life, sense of selfhood. Aim is to synthesise within fully integrated self-conscious awareness or self, appropriately developed sense of will with ability to make choices and have sense of individuality. Includes imagery, creative expression i.e., drawing or painting. Encounter groups = following energy of the group, physical expression + exaggeration of emotions of feeling and honesty (Schutz). Rogers pioneered basic encounter involving hundreds of participants from different cultures, encouraging open/honest engagement in participants. Neuro-linguistic programming (NLP) = stresses paying attention to how person acts/looks if they rely on visual/auditory modality i.e., pupil size, breathing, gaze. Method uses mirroring, matching, reframing, pacing, anchoring. Personal construct therapy (PCT) = Kelly developed range of techniques for eliciting constructs + intervention in personal construct system. Body work = stress on interrelationship between mind + body between bodily tensions + feelings + need to release bioenergy. A person’s character is reflected in their body, posture, movements. Tensions in body reflects the psychological make-up of person + can be used to diagnose emotional conflicts. Primal therapy = heals pain from past abuse/neglect by physical expression of feelings by screaming, sobbing. Lecture 5: Development al Tasks Sand-play therapy = requires objects + artefacts i.e., sand, water, objects, stones. Offers non-verbal route to human psyche to promote healing, growth + development, involves active imagination where mental images transformed from invisible to tangible . Method facilitates diagnosis, tracking a growth, unfoldment + development and deep exploration and the integration of conflicts. Erikson’s psycho-social stages/crises o Maturity  ego-integrity VS despair (WISDOM) o Middle adulthood  generativity VS stagnation (CARE) o Young adulthood  intimacy VS isolation (LOVE) o Adolescence  identity VS identity confusion (FIDELITY) o School age  industry VS inferiority (COMPETENCE) o Play age  initiative VS guilt (PURPOSE) o Early childhood  autonomy VS shame, doubt (WILL) o Infancy  basic trust VS basic mistrust (HOPE) Stages of development according to Erikson Approximate age Birth to 1 year 1 to 2 years 3 to 6 years 6 to 12 years Adolescence Young adulthood Adulthood Maturity Developmental task/conflict to be resolved Trust vs. mistrust: babies learn to trust/mistrust others care for basic needs like nourishment, sucking, warmth. Autonomy vs. shame + doubt: children learn to be self-sufÏcient in toileting, feeding, walking, talking/doubt abilities. Initiative vs. guilt: children undertake adultlike activities, sometimes overstepping limits set by parents + feel guilty. Industry vs. inferiority: children learn to be competent and productive or feel inferior + unable to do anything well. Identity vs. identity-confusion: figure out “who I am?”. Establish sexual, ethnic, career identities + future roles. Intimacy vs. isolation: seek companionship + love with another person or become isolated from others. Generativity vs. stagnation: productive, performing meaningful work + raising family/become stagnant + inactive. Integrity vs. despair: try make sense of lives, seeing life as whole/despairing at goals not reached + q’s unanswered. Psychosocial modalities (field of action) o o o o o o o o Infant  to get, to give in return Toddler  to hold on, to let go Preschooler  to go after, to play School-age  to compete, to make things together Adolescent  to be oneself, to share oneself Young adult  to lose + find oneself in another Middle adult  to make be, to take care of Old adult  to be through having been, to face not being Psychosocial strengths/virtues o o o o o o o o Infant  hope, faith Toddler  will, determination Preschooler  purpose, courage School-age  competence Adolescent  fidelity, loyalty Young adult  love Middle adult  care Old adult  wisdom Psychosocial Maladaptations o o o o o o o o Infant  sensory distortion/withdrawal Toddler  impulsivity/compulsion Preschooler  ruthlessness/inhibition School-age  narrow virtuosity/inertia Adolescent  fanaticism/repudiation Young adult  promiscuity/exclusivity Middle adult  over-extension/rejectivity Old adult  presumption/despair Counselling considerations o o o o o Psychosocial stages & Freud’s psycho-sexual stages Infant  oral Toddler  anal Preschooler  phallic (oedipal) School-age  latency Adolescent  puberty Young adult  genitality Middle adult Old adult Stages/crises Tasks/issues Healthy personality Significant relationship Unresolved stages/regression o o Qualities/meanings Maladaptations introduction Lecture 6: Counselling & Responses to Loss attachment + loss = universal human experiences, constitute 2 givens of human existence. Losses not trivial, range from bereavement to dealing with traumatic event, to relationship break-up, job loss, status, pet, possessions, disruption, change. Human experience made of “necessary” + “unnecessary” losses. Human life cycle = pattern of growth + loss. Loss induces stress. Grief = in-built human response to loss. Process happens in stages that need to Loss, stress & human life cycle 1) Between families: unattached young adult be worked through. Experience of loss provides opportunities for personal 2) Joining families through marriage: new couple transition + change. 3) Family with young children 4) Between years: family with school-age children Grieving + loss 5) Family with adolescents Grieving processes focus lots of bereavement, but model can serve how we 6) Launching children + moving on deal with losses in general. Would be abnormal if following not experienced: 7) Family in later life o FEELINGS = sadness, anger, guilt + self-reproach, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, numbness, despair, depression. o PHYSICAL SENSATIONS = hollowness in stomach, chest tightening, tight throat, oversensitive nose, breathlessness, weak muscles, lack of energy, dry mouth. o COGNITIONS = disbelief, confusion, pre-occupation, sense of presence, hallucinations. o BEHAVIOUR = sleep disturbances, appetite disturbances, absent-mindedness, social withdrawal, disturbing dreams, searching + calling out, sighing, restless over-activity, crying/inability to cry. Crisis = opportunity for personal growth Useful to regard loss as transition. Transition = discontinuity in person’s life, can be +ve/-ve & accumulative. Transitions = stressful if unpredicted, involuntary, unfamiliar, involve high change + high rate of change. Incidence of physical illness = +vely correlated with amount of life change. Transitions represent crisis + opportunity (for personal growth + development). Work of counsellor is to provide support + monitor client’s “movements” through different transition phases, reviewing factors that facilitate, interrupt/complicate grieving process. Working through loss prepares client to deal with future loss + provides opportunity for re-integrating past losses not fully worked through. Psychological phases in response to loss = Parkes (1998) 4 stages: 1) The phase of shock 2) The phase of denial + optimism 3) The phase of anxiety + depression 4) The phase of resignation + adjustment Kubler-Ross proposed model of 5 stages of grief: 1) Denial: “It can’t be happening to me.” 2) Anger: “Why me? It’s not fair.” 3) Bargaining: “Just let me live to see children graduate.” 4) Depression: “I’m so sad, why bother with anything?” 5) Acceptance: “It’s going to be OK.” Worden (2003) re-interpreted phases into tasks: Task 1) To accept reality of loss Task 2) To experience pain of grief Task 3) To adjust to environment which deceased is missing Task 4) To withdraw emotional energy + re-invest in other relations Hiles (1999, 2001) seven-feature process 1) Attachment (unconscious) 2) Loss (awareness) 3) Denial (rationalisation) 4) Abandonment (spiritual emergence) 5) Insight (revelation) 6) Acceptance (transformation) 7) Return (grace, sharing) Factors effecting grieving Facilitating: Appropriate support, cultural practices PermitÝng client control Providing client with perspective Acknowledging reality of loss New understandings of loss + grief Interrupting: Rewarding denial Contributing to frustration Providing secondary gains Mood altering drugs Grieving = individual process that doesn’t always involve simple progression through set stages, must always be seen in cultural context + can be complicated by relational, historical, personal, social + circumstantial factors. Move to look at human response to bereavement + loss from wider perspective. Main criticism of traditional theories is grieving does not follow simple stage model. A new approach by Robert Neimeyer called “meaning reconstruction therapy ” = when we experience a profound loss, we also experience a loss of meaning, a potentially deepgoing disruption of our life-story. Accordingly, the process of grieving can therefore be seen as one of making sense of the loss - answering to our own satisfaction the practical, existential and perhaps spiritual question of why it happened and reconstructing what our life means [ . . grieving involves the struggle] to integrate the significance of the loss into our lives after our previous meaning system has been disturbed. Another perspective argues the “continuing bond” with deceased been overlooked/undervalued in scholarly + clinical work. They observe bereaved children + bereaved adults struggle to find a way of maintaining a connection to the deceased. They also found parallels in the experience of adoptees who had a relationship with a “fantasy” birth parent. In research interviews, found children whose parent died revealed in the first years after death, they developed memories, feelings + actions that kept them connected to parent. Rather than letÝng go, CognitiveBehavioural Approaches they continue relationship. Connections not static but developed over time. Similar findings from interviews with adoptees. This questions the generally accepted view that the purpose of grief is to sever the bonds with the deceased in order to free the survivor to make new attachments. By contrast, the bereaved are seen as needing to remain involved and connected to the deceased, and that the grieving process can involve actively constructing an inner representation of the deceased. Factors important to all theories of psychotherapy 1) Opportunity for open emotional expression 2) Learn and practice new behaviours 3) Hope that therapist will help 4) Therapists show they can help 5) Therapists can explain client problems and how they will help 6) Client-therapist relationship Goals of behaviour therapy Changing target behaviours – ones that can be defined clearly + accurately Goals preferably arrived in collaboration with client by evaluating goals + possible outcomes. Goals for clients who cannot choose, raise ethical questions. Concepts from operant conditioning Positive reinforcement Extinction Generalisation Discrimination Shaping Systematic desensitisation o Relaxation – relax body by learning relaxation methods. Anxiety hierarchies – ladder of graded degrees of anxiety using subjective units of discomfort scale (SUDs). Assertiveness training Concepts from observational learning Attending to a model + Retaining information about model Motor reproduction = reproducing behaviour of model Motivational processes = repeat reinforced behaviour Vicarious selfreinforcement Self-efÏcacy – perceptions of one’s ability to perform in situations Imaginal flooding therapy Develops scenes that are anxiety producing to client Repeats scenes again + again in therapy hour Rationale = fear will be extinguished Modelling techniques, types of modelling: o Live o Symbolic o Role playing o Participant o Covert Behavioural assessment = Assessing discrete behaviours + antecedents + consequences through use of: Behavioural interviews – specific questions, behavioural reports + ratings – e.g., BDI, behavioural observations – natural/simulated, physiological measurements – blood pressure, heart rate, respirations. Lecture 7: CognitiveBehavioural Approaches Meichenbaum’s selfMeichenbaum’s stress inoculation Current trends in behaviour Evolution of rational emotive instructional training approach therapy behaviour therapy Model appropriate behaviour Conceptual phase – gather o treatment manuals o rational therapy Have client practices information, teach client how to think (1956) o eye movement behaviour about problem. o rational emotive desensitisation + Client repeat’s instructions to Skills acquisition – teach relaxation, therapy (1959) processing self cognitive restructuring, selfo rational emotive o acceptance + reinforcement Instructions may be tapes behavioural therapy commitment therapy Records of practicing Application – rehearse statements, (1992) instructions made visualise scenes, practice behaviours. Philosophy of REBT Eliis’ view of factors that affect A-B-C model (REBT) Responsive hedonism – A) Activating events support/interfere with goals potential for therapeutic change seeking pleasure + Biological tendencies to make B) Beliefs of individuals are in response to activating events avoiding pain. things worse C) Consequences (emotional/behavioural) are experienced in Humanism – human Social institutions may have values response to activating event interests more important that interfere with functioning REBT goals of therapy = minimise emotional disturbances, decrease than those of deities. Vulnerability to disturbances – self-defeating behaviours, become self-actualised, think rationally, feel Rationality – be flexible + individuals vary as to the degree to appropriately, act effectively, deal effectively with negative feelings + logical in achieving goals. which they hold irrational beliefs beliefs, learn ABC philosophy to prevent new symptoms emerging. REBT Therapeutic Approach – ABCDE REBT therapeutic techniques – cognitive approaches A) Activating event = separate what happened Disputing = coping self-statements, cost-benefit analysis, psychoeducational from what was perceived to happen methods, teaching others, problem solving. B) Beliefs = irrational beliefs are focus of therapy Emotive techniques = imagery, role playing, shame-attacking exercises, forceful C) Consequences = important to discriminate self-statements, forceful self-dialogue. between beliefs+ consequences Behavioural techniques = activity homework, reinforcement + penalties, skills D) Disputing irrational beliefs by = detecting, training. discriminating, debating Current trends in REBT = increasing in complexity, incorporate techniques, has E) Effect = clients develop effective philosophy constructivist aspects, self-management + rational training (SMART) Goals of cognitive therapy involve removing bias + distortions in thinking to produce effective functioning, produce +ve feelings, behaviours + thinking, specify goals clearly + concretely, prioritise goals + develop them in collaboration with the client. Assessments are specific + continue through therapy. Interviews – frequent questions, self-monitoring thoughts, feelings + behaviours outside ofÏce. Process of making therapeutic changes in cognitive therapy = three question technique: 1) what is evidence? 2) how can you interpret situation? 3) what are implications if true? Methods for changing cognitive distortions = understanding idiosyncratic meaning , challenging absolutes, reattribution, labelling distortions, decatastrophising, challenge all-or-nothing thinking, listing advantages + disadvantages, cognitive rehearsal. Lecture 8: The Counselling Relationship & Research Reality therapy: influences + developments of William Glasser (CHOICE THERAPY) = focus on pictures of reality rather than reality itself. Choice theory involves making choices to satisfy one’s needs. Basic process involves friendly involvement , exploring total behaviour, evaluative behaviour, make plans to do better, commitment to plans. Common reality therapy strategies questions serve to enter client’s world to gather info, give info, help client take control. Solution-focused therapy concepts + goals focus on solutions rather than development. Questioning techniques like those that describe changes already made, miracle questions, coping, scaling, Why do counselling research? Research = important issue for counselling psychology. McLeod (2003) proposes research aimed at: gaining wider perspective, accountability, developing new ideas + approaches, applications of counselling in new areas, personal + prof development. Stress placed on evidence-based practice . There is danger of overemphasising evidence-based research in establishing what is regarded as good practice. Counselling/psychotherapy needs to be based on two features: reflective-based + evidence-based practice. McLeod (1996) – emphasis on qualitative research o Call for qualitative approach o Promise of better integration of inquiry with practice o Defensiveness of qualitative research o Philosophical + practical issues o Concern 1 = sensitivity o Concern 2 = conceptualisation Challenges of qualitative research o Relationship with research participants o Ethical dilemmas o Reflexivity o Methodological choices o Communicability o Perspective o Obviousness Underlying themes of counselling/psychotherapy (they are promoted in relationship + last 3 acknowledged importance of relationship) Acceptance of responsibility for self The therapeutic alliance where resources of one used to explore, clarify, identify, Take oneself seriously activate + express personal resources. It is active listening + person-centred to promote alliance. Client needs to speak their mind with confidence they are Discovering + examining personal meaning heard. Dryden (1992) sees therapeutic alliance as integrating framework with 3 Recognition of personal growth + components: opportunities for change 1) Bonds = sense of common outlook, commitment + shared o Experience acceptance + positive regard understanding o Exploration of self in relationship with 2) Goals = shared articulation of desired outcome another 3) Tasks = specific activities that alliance will engage in to explore + o Recognising + working with boundaries in facilitate growth + change relationship Images of therapeutic relationship McLeod (2003) says although counsellor can use theory to make sense of client’s difÏculties, may have range of techniques to reveal + overcome difÏculties. Theory + technique delivered through presence + being of counsellor as a person. McLeod offers images of therapeutic relationship: o o o o o o o o o 3 dimensions of therapeutic relationship Lapworth (2001) points out human personality formed in Therapist as container relationship. We are in the process of developing as people. Sense of self dependent formed by (psychoanalytic) relationship between self + other. Lapworth proposes 3 areas of therapeutic relationship. Therapist as 1) The professional relationship = area of relationship defined + imposed by roles of participant – the therapist + client. Concerned with contract between therapist + client + with boundaries, authentic presence containment + direction. (humanistic) 2) The projective relationship = area created by assumptions, expectations + constructions of each Therapist as teacher, party. Has 2 aspects, (i) transference relationship where client/therapist related to other based coach, scientist, on own constructions than here and now through projection of important past relationships philosopher onto current and (ii) the reparative or developmentally needed relationship where therapist Therapist as editor (a repairs deficit in client’s experience. narrative, not 3) The personal relationship = area which partners in relationship meet as person to person. This knowing stance) is “real” relationship. Client feels understood + validated. Relationship seen in wider cultural + The all-purpose socio-political context + includes what Clarkson calls transpersonal relationship – connection therapist (eclectic + between people beyond simple awareness + deeper level of intersubjectivity. integrative approach) Building + maintaining relationship o Trust o Respect o Rapport o Clients agenda o Present-centredness (here + now) o Co-presence o Advanced empathic understanding o Unconscious communication o Exploration of blocks, resistance, denials, projections, transferences, counter- Discovering personal meaning Client discourse dominated by stories. Client brings these to sessions. Will reveal meanings client trying to reach, make sense of, bring into being. More important than counsellor’s skills or what counsellor does. Boundaries o Inter- & intra-personal boundaries o time + space o “50-minute hour” o Contracts – open, fixed o Intimacy o Other roles, mutual places of contact o Confidentiality Counselling VS psychotherapy Counselling relationship between these can be examined from several perspectives: o Counselling + other disciplines o Difference in training o Professional differences o Support vs. facilitating change o Underlying theory o What counsellor/therapist offers o Needs of the client o transferences Empowerment o o Breaks, missed sessions Endings Lecture 9: New Perspectives Narrative/constructivist perspective o o o Circumstances = emphasis on clients interpretation of circumstances find themselves than with the other approaches reviewed. Support/growth = emphasises client’s active role in construction of self + reality. Draws on social constructivist approach which emphasises how human behaviour + experience is function of social + cultural reality that is enforced. Personal narratives seen to play role in growth + change. Narrative seen as means to construct identity positions . Client supported in examining narratives closely + exploring possibilities of narrative reframing. Self = tension between saturated self + the “self” constructed in narrative i.e., narrative = understanding the self. Counselling + psychotherapy seen as forms of situated occasioned action i.e., as a discursive encounter where particular meaning making offered + explored. Discursive contexts of projection, transference, human identity (subjectivity) + neurosis need to be explored in approach. Aim of analysis = restore loose ends + looser beginnings to story. If story fixed, if patient ends up speaking psychoanalysis – we must assume something has been lost in translation. Psychoanalysis aim = not to cure but show people there is nothing wrong with them. Narrative therapy focuses on narrative resources of client. Role of therapist = facilitator of narrative thinking. Psychotherapy + counselling considered opportunity to reframe experience of reality. McLeod outlines range of narrative based interventions: o o o o o o o o Use of metaphor to capture whole meaning of the story/suggest new version of the story Use of fantasy to identify existing story-lines or create new ones Autobiographical/life-history writing Offering clients stories, such as myths or folk-tales, from which they can draw meaning Use of evocative language by therapist to heighten meaningfulness of parts of story Responding to clients active voice Acting out stories, as in psychodrama Controlling emotional distance of story-telling episode The model of narrative reframing Model is an attempt to put into perspective what is involved in process of narrative reframing. Model distinguishes core, constructed, shared + reframed narratives. These types of narratives draw on each other + on variety of narrative resources. Core narratives draw on deeper existential/ultimate concern of human actions, experienced as protonarratives that can express underlying archetypal + transpersonal concerns. Constructed narratives draw on culturally available codes + familiar personal scripts that promote explicit narrative expression, they are usually available codes + familiar personal scripts that promote explicit narrative expression, they are usually contingent on events in our lived experience. Personal narratives are embedded into culturally circulating narratives, necessarily fitÝng in with/deferring to dominant narratives that are circulated in family/wider group. Therapeutic encounter + lived experience seen as opportunities to reframe narratives that have become compromised by process of socialisation + cultural embedding. The model emphasises the situated occasioned actions in which narrative thinking operates. There is explicit acknowledgement of tension between compliance + integration in human subject. Model emphasises cyclic/spiral process. Narrative reframing is not a linear process but needs to be worked through each time. Lecture 10: Professional Issues Eclectic practice = to what extent can counsellors use a range of “techniques” from different theoretical positions? Holistic approach. McLeod summarises BACP (2001) ethical framework: qualities that should be deeply rooted in Ethical issues person concerned + developed out of personal commitment. o Confidentiality o Empathy = ability to communicate understanding of another person’s experience from that some limitations talking about clients person’s perspective. client’s responsibility o Sincerity = personal commitment to consistency between what is professed and what is done. o Research issues potential for harm o Integrity = personal straightforwardness, honesty + coherence. confidentiality o Resilience = capacity to work with client’s concerns without being personally diminished. informed consent o Respect = showing appropriate esteem to others + understanding of themselves. publication and use o Humility = ability to assess accurately + acknowledge one’s own strengths + weaknesses. o Possibility of exploitation o Competence = effective deployment of skills + knowledge needed to do what is required. adequate supervision o Fairness = consistent application of appropriate criteria to inform decisions + actions. over-dependence o Wisdom = possession of sound judgement that informs practice. punctuality o Courage = capacity to act in spite of known fears, risks + uncertainty. unclear contact premature ending 2 Ethical dilemmas of psychotherapists failure of confidentiality 1) Dilemmas that fitted the traditional form of ethical codes for professionals. o Counselling contract 2) Tensions between preferred practice + constraints imposed by organisation within which o Ending counselling person works. o Referral o Clients in crisis BACP values of counselling + psychotherapy include a commitment to: o o o o o o o o o o Respecting human rights + dignity Ensuring integrity of practitioner-client relationships Enhancing quality of professional knowledge + its application Alleviating personal distress + suffering Fostering sense of self that is meaningful to person concerned Increasing personal effectiveness Enhancing quality of relationships between people Appreciating variety of human experience + culture Striving for fair and adequate provision of counselling + psychotherapy services Values inform principles. They represent important way of expressing general ethical commitment that becomes more precisely defined and action-orientated when expressed as a principle. Ethical principles of counselling + psychotherapy Principles direct attention to important ethical responsibilities: o o o o o o Being trustworthy: honouring trust placed in practitioner (fidelity) Autonomy: respect for client’s right to be self-governing Beneficence: commitment to promoting the client’s well-being Non-maleficence: commitment to avoiding harm to the client Justice: the fair and impartial treatment of all clients and provision of adequate services Self-respect: fostering practitioner’s self-knowledge and care for self Lecture 11: Integrating Theory & Practice: Growth, transformatio n & change Counselling practice: unity vs. diversity McLeod (2003) lists possible uses of theory in counselling: o Something to hang on to – the need of the counsellor for structure in the face of chaos o Offering the client a way of making sense o Establishing professional status o The creation of knowledge communities And, McLeod suggests that the diversity of theories might be put down to: o Alternative ‘images of the person’ o The personal dimension of theory o The social context of theory construction o The mental health industry: brand names and special ingredients In discussing the possibilities of unity and integration, McLeod cites Mahrer’s (1989) six different strategies for achieving integration: 1) development of a substantive new theory 2) development of one of the current theories 3) development of a common language 4) identify transtheoretical concepts 5) identify common techniques 6) concentrate on ‘what works’. Features of framework The client = placed at centre of model. Too much emphasis on counsellor + skills. Active listening = client needs to feel they are being listened to + taken seriously. Client feels held when listened to. Therapeutic alliance = concerns quality of therapeutic relationship that the client experiences. Promoted by skills + training of counsellor, but focus is on the client + complexities of intersubjectivity involved. All approaches recognise crucial role played by active listening, authentic human encounter , present centredness, the core conditions, empathic understanding, providing support/facilitating growth, unconscious communication. Givens = these are “existential givens” of human existence i.e., what it is to be a human being i.e., fundamental givens, death, freedom, isolation, meaninglessness, the will to meaning, thrownness: life’s circumstances, relationship to world, spiritual tasks: transpersonal issues + growth, developmental tasks. Qualities = focus is on individuals qualities of client. Theory obscures uniqueness of person i.e., extraversion/introversion, distortions of personality, transitional objects, loci of concern. Resources = clients possess resources they can’t access, forgotten, overlooked or need support to develop. Counsellor facilitates use of these resources to help the client help themselves. Growth + change = counselling focuses on subtle activation of these processes within the client, rather than more blunt instruments of change such as education, treatment, behavioural reinforcement, social conformity, punitive regimes. Authentic human encounter We do not relate to another person as if they are an object we perceive another person as a conscious being but without ever being able to directly experience their consciousness. One relevant issue = intersubjectivity. This is shared knowledge between two people regarding another’s conscious mental states. Established through shared emotional experiences. It poses problem of how we can establish shared knowledge when it is impossible for us to access directly someone’s experiences. Our experience is enriched + confirmed by sharing with another person. The problem of intersubjectivity has been given little emphasis in psychology, until recently at least. Yet it is an issue that runs through the seminal work of many of the pioneers of the human sciences and modern European thought (see Edmund Husserl, Maurice MerleauPonty, Jean-Paul Sartre, etc). Where it has been of influence in psychology, this has been only very limited, i.e.: o o o taking the role of the other (G.H. Mead) o role enactment mother-child intersubjectivity theory of mind o o "distance" and "relation" the intersubjectivity of the social world mediated by common sense, shared understanding and reciprocity of perspectives The problem of whether it is possible to have knowledge of other minds is probably best left to the discipline of Philosophy, and to Phenomenology in particular. However, the issue for psychology, and counselling practice in particular, is, within the limits of what is meant by knowledge of other minds, how we can learn to access, relate and respond to the perceived contents of another person's mind. It seems quite clear that the crucial counselling skills of empathy, active listening, authentic encounter , etc., all rely on the phenomenon of intersubjectivity. Therefore, without a thorough analysis and grasp of the intersubjective nature of human inter-relationships, it is unlikely that these skills can be refined and used in anything more than a crude fashion.