COUNSELLING

DIFFERENTIATING

Therapeutic interventions with relatively functioning clients who are adjusting to

COUNSELLORS
changes in life circumstances and problems in daily living. Early intervention

CLINICAL Diagnosis, treatment and clinical management of psychopathological symptoms

PSYCHOLOGISTS and severe mental disturbance

PSYCHIATRISTS Medical management, use of medication and therapy

SOCIAL WORKERS Casework and therapy to mediate relationships with social structures like
schools, agencies and healthcare facilities

BLURRED DISTINCTION

￫ Similarities in Counselling and Clinical processes often overlap

WHY?
￫ Identical therapy theories can and are used in both settings

￫ Work with functioning clients struggling to manage/ adjust to life’s

challenges.
COUNSELLING
￫ Helping people find meaning and adjustment in relationships, careers, and
families

￫ Focus more deeply on uncovering unconscious influences

PSYCHOTHERAPIES ￫ Engage in longer-term counselling with people struggling with serious
mental health problems like DSM personality disorder

PSYCHOLOGISTS VS CLINICAL PSYCHOLOGISTS

PSYCHOLOGIST CLINICAL PSYCHOLOGIST

￫ Can do counselling ￫ Stronger focus on serious mental health

￫ Personal/interpersonal health and well-being ￫ Diagnose and provide treatment

across the lifespan

￫ Vocational perspective ￫ Prescribed medications

￫ Most commonly client-centre or humanistic ￫ Healthcare perspective

 FEATURES OF AN EFFECTIVE COUNSELLOR

￫ The interaction/ bond between the professional and patients

￫ An important aspect of the therapeutic process
POSITIVE THERAPEUTIC ￫ Can have an impact on treatment outcomes
RELATIONSHIP/ ￫ Characteristics and features include:
ALLIANCE ↳ Mutually developed treatment goals and alignment tasks.
↳ Mutual respect, trust and honesty
↳ Openness
↳ Acceptance

￫ Temper exhilaration after witnessing phenomenal change

￫ Ablity to cope with
COMMITMENT ↳ The frustration of resistant client
↳ Non-attendance
↳ Dramatic/erratic behaviour

￫ Helping without directing to a particular direction.

NEUTRAL POSTURE ￫ Be aware of values/opinions and block effects.
￫ No investment in client decisions beyond professional responsibility

￫ Controlling personal needs, desires and preferences in favour of the best

SUBJUGATING interests of the client
PERSONAL NEEDS ↳ E.g., Daydreaming or liking/disliking something
￫ Totally immersing yourself in the present moment

￫ Becoming comfortable with the presence of others’ discomfort

￫ A psychologist often encourages discomfort for clients.
COPING WITH
￫ Feeling safe to cry, and able to honestly express pain/ desperation
DISCOMFORT
￫ Only when clients are uncomfortable may we be certain that they are
seriously working on themselves

PREDICTING SUCCESS IN COUNSELLING

￫ Therapeutic alliance/ relationship

￫ Client motivation & severity of the problem
WHAT PREDICTS ￫ Personal attitudes
SUCCESS? ￫ Therapeutic approach used
￫ Training standards
￫ ‘Self’ of the psychologist
 FOUNDATIONS OF COUNSELLING: HISTORY

ANCIENT PHILOSOPHERS

￫ There is no one right

answer
￫ Many interpretations
of the same
experience help
clients find their own
path to inner peace

THE FIRST PSYCHIATRISTS

￫ Introduced ideas medical/ counselling practitioners still use today

↳ Homeostasis: Natural balance of body
HIPPOCRATES (400 BC) ↳ Prognosis: Predicting outcomes based on current symptoms
↳ Importance of obtaining client history before treatment
↳ Trust building in therapeutic relationships
↳ Acknowledged repressed feelings

￫ Pioneered/ built credibility for the cathartic method of talking out problems
￫ Allowed the profession of counselling to be born
FREUD (1900s) ￫ Accomplishments
↳ Plotting the anatomy of the human nervous system
↳ Developed the first anaesthesia
↳ Emphasises unconscious motives behind behaviour
↳ Primary mentor for first generation psychologists e.g., Carl Rogers

INFLUENCES OF PSYCHOLOGY

￫ First 'Professor’ of Psychology

WILLIAM JAMES ￫ Presented concepts of:
(1842-1910) ↳ Free will; Consciousness; Adaptive functioning
￫ Humans = Creatures of emotion and action, but also thought and reason

WATSON AND SKINNER ￫ Studies of reinforcement influencing behaviour (Behabiouism)

￫ Learning does not necessarily follow an orderly progression,

WERTHEIMER AND
￫ Sudden insights can play a role
KOHLER
￫ A person conceptualises the whole as greater than the sum of its parts
 HISTORICAL APPROACHES PSYCHOLOGY

￫ Early 20th century

￫ The creation of programs to help place people into correct careers
THE GUIDANCE ERA ↳ Influenced by the industrial age
↳ Vocational/career counselling
￫ WW1 introduced standardised tests for abilities and personality
￫ WW2 introduce the use of professionals to help soldiers adjust after war

￫ Clifford Beers (1945) A Mind That Found Itself.

↳ Encouraged the establishment of the National Association for Mental
THE COUNSELLING ERA Health in the USA
↳ Proposed a compassionate friend = Most important thing for an
emotionally disturbed person (Counselling provides elements of this)

￫ Emphasised diagnosis for psychopathology

￫ Mental disorders = Seen as an illness → Product of biological problems
THE MEDICAL MODEL ￫ Treated with medical options (like a broken arm)
(1940s) ↳ Electroconvulsive Shock Therapy
↳ Frontal lobotomies
↳ Psychopharmacology

￫ Proposed people with emotional problems are not 'mentally ill,

￫ Most people just need a safe environment to work out their difficulties
￫ 1960s Roger's 'Person-centred' counselling became the theoretical focus
PERSON-CENTRED ￫ 1970s CBT began to challenge person-centred approach
COUNSELLING ↳ Lead by Ellis and Beck

CARL ROGERS (1950s) ￫ Provided early mental health framework = Foundational element
￫ Trust in the client’s ability to move forward in a constructive manner
￫ People are trustworthy and capable
￫ Counselling happens in the context of the Therapeutic Relationship
￫ Quality of the therapeutic relationship = Primary agent of growth/ change
 INSIGHT-ORIENTED APPROACHES

PERSON-CENTRED COUNSELLING: CARL ROGERS (1950)

￫ Client autonomy
GOALS ￫ Self- actualisation
￫ Self-discovery
￫ Self-acceptance

￫ Non-directive (no homework)

￫ Humanistic
￫ Emotion-focused
TECHNIQUES/ SKILLS ￫ Active listening
￫ Empathy
￫ Congruence
￫ Unconditional positive regard
↳ Validate the emotion not the content

EXISTENTIAL COUNSELLING: YALOM, MAY

“focusses on the meaning of human existence and man’s search for meaning.
LOGOTHERAPY According to logotherapy, this striving to find meaning in life is the primary
motivational drive in a man” - Viktor Frankl

￫ Meaning to life and suffering

￫ Expand self-awareness
GOALS ￫ Increase potential choices
￫ Accept responsibility for choices
￫ Experience authentic existence
￫ Roots in philosophy
↳ Socrates, Kierkegaard, Nietzsche

PSYCHODYNAMIC: FREUD (1900S)

￫ Conscious:
↳ Phenomena individuals are aware of at any given moment
LEVELS OF AWARENESS/ ￫ Preconscious:
CONSCIOUSNESS ↳ Phenomena individuals can become aware of if they attend to them.
↳ Sits on the threshold of awareness
￫ Unconscious:
↳ Phenomena individuals are not, and usually cannot become aware of
 ￫ ID: Present from birth
↳ Operates entirely at the unconscious level
↳ Seeks immediate release of tension and energy
↳ Operating according to the pleasure principle
￫ SUPEREGO:
↳ Operates mostly at a preconscious level
STRUCTURE OF PSYCHE ↳ Ideals and moral
↳ Strives for perfection
↳ From parents
￫ EGO:
↳ Operates mainly at a conscious level
but also at a preconscious level
↳ Rational
↳ Mediator between ID and the Superego

￫ Psychological manoeuvres that protect us from anything painful to

consciously experience → Defences distort reality
￫ Regression:
↳ To retreat to an earlier stage of development because of fear/ anxiety
↳ Plays a role in psychosis and neurosis
￫ Primal Repression:
↳ Repressed idea or impulse is fixated or frozen in development.
↳ No further modification or maturation of the repressed content can
occur
DEFENCE MECHANISMS ￫ Repression Proper:
↳ Ejecting offending ideas by pushing them away from consciousness.
↳ Ideas etc. linked to the primally repressed impulse = Denied access to
consciousness.
￫ Projection:
↳ Dealing with emotional conflict or internal/ external stressors
↳ Falsely attributing their own unacceptable feelings, impulses, or
thoughts to another
￫ Denial:
↳ Distortion of reality by pretending undesirable truths, feelings, or events
are not happening
￫ Sublimation:
↳ Conversion of forbidden impulses into socially acceptable behaviour
↳ E.g., boxer
￫ Rationalisation:
↳ Intellectualised justifications for our behaviour
 GESTALT THERAPY: FITZ PERLS (1893-1970)

￫ Focuses on the ‘here-and-now’ experience

￫ Unfinished business affects the present
GOALS ￫ Increase awareness and greater choice
￫ Making contact with the environment and oneself
￫ Accepting oneself so unfinished business has the chance to emerge

￫ Empty Chair
￫ Resentment expression
TECHNIQUES
￫ Hot seat
￫ Owning the projection

ACTION-ORIENTED APPROACHES

BEHAVIOURAL

￫ Ivan Pavlov Russian Psychologist (1920s):

↳ Discovered classical conditioning
↳ Associating an involuntary response and a stimulus effects behaviour
MAJOR THEORISTS
￫ B.F Skinner (1940s)
↳ Voluntary behaviour changes based on the use of a reinforcement
↳ Human control and manipulation

￫ John Krumboltz
↳ Reminded that the purpose of counselling is to foster behavioural
change

￫ Operant/ Classical Conditioning

￫ Reinforcement
TECHNIQUES ￫ Extinction
￫ Contingency Contracting
￫ Shaping
￫ Flooding

CBT: ALBERT ELLIS

TECHNIQUES ￫ Identify and modify patterns of maladaptive thinking

￫ Homework sheet/ Thought Diary
↳ Record; Reflect; Replace
￫ Catagorise Distortions
 REBT: AARON BECK

TECHNIQUES ￫ We are born with the potential for rational and irrational thinking
↳ Rational: self-constructive thinking
↳ Irrational: self defeating thinking
￫ Based in logic and rational analysis
￫ ABC theory of emotion

SOLUTION FOCUSED COUNSELLING

MAJOR THEORISTS ￫ Insoo-Kim Berg

￫ Steve de Shazer
￫ Influenced by Milton Erickson who believed
↳ Everyone possessed the skills and abilities to solve their own problems
↳ Small changes can lead to bigger changes

THEORY ￫ If it doesn’t work, do something different, and if it works, do more of it.

￫ Clients have the strengths and resources to change
￫ Small changes in any aspect of a problem begins the process of solving it

EMERGING THERAPIES

ACT: STEVEN HAYES (1980)

THEORY ￫ Made popular in Aus by Russ Harris

￫ 6 Core processes:
1. Contact with the present moment
2. Defusion
3. Acceptance
4. Self-as-context
5. Values
6. Committed action

NARRATIVE THERAPY: WHITE AND EPSTON

THEORY ￫ Develop new narratives of the self

￫ Techniques → Externalising

COMPASSION FOCUSED THERAPY: PAUL GILBERT, KRISTEN NEFF

 APPROACHES OF FAMILY THERAPY
BOWEN FAMILY THERAPY (BOWEN 1913-1990):
○ Differentiation of self
○ Ideas of triangles and nuclear family
○ Multigenerational transmission processes
○ Importance of sibling positioning
○ Emotional cut-off

STRATEGIC FAMILY THERAPY (BATESON, HALEY, WATZLAWICK, ERICKSON,

TOMM, PENN, SATIR, ET.AL):
○ Based on communication theory
○ Use of questions (circularity)
○ Focused on the problem
○ Family homoeostasis
○ “More of the same” solutions

STRUCTURAL FAMILY THERAPY (MINUCHIN 1921-2017):

○ Boundaries between members
○ Attention to hierarchies
○ Alliances

EXPERIENTIAL FAMILY THERAPY (WHITAKER 1912-1955 AND SATIRE 1916-1988):

○ Get in touch with real feelings, hopes, desires, fears and anxieties
○ Evoking strong emotions and create a person to personal encounters
○ Assisting family members to take risks

SOLUTION FOCUSED THERAPY (DE SHAZER 1940-2005 AND KIM BERG

1934-2007):
○ Focuses on the solution and not the problem
People are resilient and resourceful (solution are within)
Change cannot not happen
○ Use of metaphors and use of language (assuming change)