Chapter 13: Integrative Theories of Counseling and Psychotherapy

Question 1

Two Contraindications in Psycotherapy and Counseling

Answer 1

Psychotherapists have a strong commitment to a particular psychotherapy approach
Little evidence of the psychotherapy approaches is more effective than another
Societies, institutes, centers, and journals devoted to particular therapy apporaches dominate the field of psychotherapy
Mijority of practicing therapists do not identify themselves as adhering to one particular approach but refer to themselves as eclectic or integrative

Question 2

Sources of Theoretical and Practical Diversity in Psychotherapy

Answer 2

Individuality
Cultural Specificity
Human Conflict

Question 3

Individuality

Answer 3

Adler emphasized that every child born into the same family is at the same time born into a different family; Every perspective is unique; Integrational and eclectic approaches to therapy may allow greater latitude in addressing each client as a unique individual being

Question 4

Cultural Specificity

Answer 4

Some individuals and groups are systematically treated differently, often discriminated against, throughout the world; Many factors distinguish individuals from one another, these factors might determine not only whether someone seeks therapy but also whether they even have access to therapy; Integrational and eclectic therapy approaches must address cultural backgrounds, values, and needs

Question 5

Human Conflict

Answer 5

Conflict should not abe avoided because it can potentially lead to positive transformations

Question 6

Conflict in the field of Counseling and Psychotherapy

Answer 6

Freud was ostracized for suggesting that sexual abuse was at the roots of hysteria;
Adler suggested that women’s psychopathology was at least generated and maintained by social factors, Freud sent him packing from the Vienna Psychoanalytic society
Jung and Freud finalized their theoretical divorce
Adler dismissed Frankl from his study group, Frankl emerged after WWI and championed meaning as central in psychotherapy and human development
Fritz Perls was rebuffed by Freud and became influential and productive
Carl Rogers and BF Skinner had great debates
Feminist therapists have reshaped theories and techniques
Staunch behaviorists threatened tnal Cognitive Therapy and Research
Francine Shapiro’s approach Eye Movement and Desensitization Reprocessing (EMDR) was criticized
Micheal Mahoney et al developed into leading constructivist thinkers

Question 7

Options open to Ethical, Theory-Based Counseling and Psychotherapy

Answer 7

Ideological Purity
Theoretical Integration
Focus on Common Factors
Technical Eclecticism

Question 8

Ideological Purity

Answer 8

Studying and learning one theoretical approach to therapy and applying it ethically and competently; allows the therapist to become a master of one approach; focusing on one approach can ease the ambiguity inherent in practicing therapy

Question 9

Theoretical Integration

Answer 9

Involves the combining of two or more theoretical approaches to maximize therapeutic effectiveness; based on the idea that two heads are better than one

Question 10

Dollard and Miller

Answer 10

Published Personality & Psychotherapy: An Analysis in Terms of Learning, Thinking, and Culture; early effort at integrating psychoanalytic and behavioral principles

Question 11

Wachtel

Answer 11

Published Psychoanalysis and Behavior Therapy: Toward an Integration; his intent was to develop an open and evolving theoretical framework; goal was not designed to be a specific hybrid theory; wanted to develop a system that might change as learning theory and psychoanalytic theory continued to change and develop

Question 12

Alexander and French

Answer 12

Articulated the concept of corrective emotional experience; in all forms of psychotherapy, the basic therapeutic principle is the same: To re-expose the patient, under more favorable circumstances, to emotional situations which he could not handle in the past; The patient, in order to be helped, must undergo a corrective emotional experience suitable to repair the traumatic influence of previous experiences

Question 13

Common Therapeutic Principles

Answer 13

Roger’s Certain Type of Relationship, many theorists integrate Rogers’s concepts of unconditional positive regard, congruence, and accurate empaty into their therapeutic approaches, although some do it more formally and systematically than others

Question 14

Jerome Frank

Answer 14

Developed a comprehensive common factors model of psychotherapy

Question 15

Comprehensive Common Factors Model of Psychotherapy

Answer 15

All psychotherapeutic methods are elaborations and variations of age-old procedures of psychological healing. These incloude confession, atonement and absolutions, encouragement, positive and negative reinfocements, modeling, and promulgation of a particular set of values. These methods become embedded in theories as to the causes and cures of various conditions which often become highly elaborated

Question 16

Components that continue to be relevant to practicing therapists

Answer 16

The Demoralization Hypothesis

Shared Therapeutic Components

Question 17

The Demoralization Hypothesis

Answer 17

People who come for therapy are also experiencing a common form of distress; he refers to common distress as the demoralization hypothesis; Demoralization occurs when, because of lack of certain skills or confusion of goals, an individual becomes persistently unable to master situations which both the individual and others expect him or her to handle or when the individual experiences continued distress which he or she cannot adequately explain or alleviate. Demoralization may be summed up as a feeling of subjective incompetence, coupled with distress

Question 18

Demoralization Symptoms

Answer 18

Low self-esteem, anxiety, sadness, and hopelessness; initial target of effective therapy

Question 19

Shared Therapeutic Components

Answer 19

An emotionally charged, confiding relationship with a helping person.
A healing setting
A rationale, conceptual scheme, or myth
A ritual

Question 20

Factors that Selection of Particular Therapy Technique is Based On

Answer 20

Relevant or empirical outcomes research
Pragmatics of the Situation
Clinical Intuition

Question 21

Syncretism

Answer 21

Choosing what to do with a client in a whimsical, unreasoned, or even impulsive manner

Question 22

Eclecticism

Answer 22

Selecting what appears to be best in various doctrines, methods, or styles

Question 23

Behavioral Theory and Therapy

Answer 23

Most flexible of all theoretical orientations; behaviorists contend that they practice a form of therapy based on scientific research and observable processes; their interest is not in a static theory but in what has been tested in the laboratory and in what has been demonstrated as effective

Question 24

Gordon Paul

Answer 24

What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances, and how does it come about (who-how-whom question)

Question 25

Primary purpose of the Diagnostic system of the DSM

Answer 25

To identify specific disease entities that are best ameliorated through the application of specific (often pharmacological) treatments

Question 26

Main Eclectic or Integrative Forms of Therapy

Answer 26

``` Multimodal Therapy Eye Movement Desensitization Reprocessing Interpersonal Psychotherapy Process-Experiential Psychotherapy Dialectic Behavior Therapy Acceptance and Commitment Therapy Cognitive-Constructivist Psychotherapy The Transtheoretical Change Model The Last Best Therapy Dialectic ```

Question 27

Preparing Your Client for Eclectic or Integrative Therapy

Answer 27

Avoid the word eclectic or define it simply. Indicate reasons for not adhering to a certain theory or set of techniques. Explain how you will choose the kinds of techniques you will use Discuss your overall theory of human change and why you think your services might be of help. Mention the theoretical origins of any techniques you might commonly use. Indicate a willingness to discuss the reasons for choices you might make during the course of the client's work with you

Question 28

Arnold Lazarus

Answer 28

Coined the term Technical Eclecticism; noted the following: to attempt a theoretical rapprochement is as futile as trying to picture the edge of the universe. But to read through the vast amount of literature on psychotherapy, in search of techniques, can be clinically enriching and terapeutically rewarding.

Question 29

Lazarus' Opinion about why Techinical Eclecticism is preferable to Theoretical Purity

Answer 29

The most essential ingredients for an effective psychotherapist are flexibility and versatility. This implies an ability to play many roles and to use many techniques in order to fit the therapy to the needs and idiosyncrasies of each patient. By contrast, therapists with pet theories or specially favored techniques usually manage, in their own minds at least, to fit their patients' problems within the confines of their particular brand of treatment

Question 30

Mutimodal Therapy

Answer 30

Applies specific techniques and adopt specific interpersonal styles in an effort to help clients obtain their goals.

Question 31

Primary Foci of Multimodal Therapy

Answer 31

Assessment Technical Applications Therapist Interpersonal Style

Question 32

Assessment

Answer 32

Multimodal orientation is predicated on the assumption that most psychological problems are multifaceted, multidetermined, and multilayered, and that comprehensive therapy call for careful assessment of parameters of modalities

Question 33

Modalities of Multimodal Orientation; Areas of Functioning

Answer 33

``` Behavior Affect Sensation Imagery Cognition Interpersonal Relationships Drugs ```

Question 34

Technical Applications

Answer 34

Multimodal therapists consider using any therapy technique that seems appropriate based on empirical research or a logical or practical rational; multimodal therapists also use their intuition when determining what therapy approach to use

Question 35

Therapist Style

Answer 35

Because every client is different, it is essential for therapists to change their style based on each new client; a flexble therapist has no fixed pattern of approaching new patients; usually perceives what his patient needs and then tries to fit the role

Question 36

Becoming an Authentic Chamelion

Answer 36

Shifting one's therapeutic style

Question 37

Interpersonal Variables Therapists should consider varying depending on their clients' needs, preferences, or expetations

Answer 37

``` Level of formality or informality Amount of personal disclosure How much or how often a new topic of conversation is initiated Level of directiveness Level of supportieness Level of relectiveness ```

Question 38

Eye Movement Desensitization Reprocessing (EMDR)

Answer 38

Specific treatment approach developed by Francine Shapiro; originally designed to address trauma smptoms in general and to alleviate distributing traumatic memories in particular

Question 39

Why EMDR is considered to be an interative treatment

Answer 39

It includes principles from the following theoretical perspectives: Psychodynamic - there is a focus on past events and traumas that form the foundation for dysfunction Behavioral- there is a focus on present stimuli, with specific behaviors expected of the client Cognitive - there is a focus on negative and positive beliefs, as well as utilization of an information-processing model Person-centered - EMDR therapists follow the client's lead rather than always dictating the course or direction therapy Physiological or body-centered - there is a focus on physical-affective links associated with trauma experiences

Question 40

Phases of the Standard EMDR Procedure

Answer 40

``` History Preparation Assessment Desensitization Installation Body Scan Closure Reevaluation ```

Question 41

Interpersonal Psychotherapy (IPT)

Answer 41

New therapeutic approach that integrates principles of traditional psychodynamic therapy (Harry Stack Sullivan) with more pragmatic, empirical formulations of depression;

Question 42

Gerald L. Klerman

Answer 42

Developed IPT

Question 43

Main Characteristics of IPT

Answer 43

It is time-limited It focuses on one or two interpersonal problem areas It focuses on current, rather than past, interpersonal relationships It has an interpersonal, rather than intrapsychic, emphasis It addresses cognitive-behavioral issues but wmphasizes these factors only in terms of how they affect important social relationships It recognizes, but does not focus on, personality variables It is based on a medical model in which the client is viewed as having clinical depression, a specific medical disorder for which a specific treatment is most appropriate

Question 44

Main Foci of IPT is to help clients do the following:

Answer 44

Recognize the relationship between depressie symptoms and interpersonal problems Find ways to deal more effectively with interpersonal problems, thereby alleviating depressive symptoms

Question 45

Treatment Phases of IPT

Answer 45

IPT is a time-limited (acutely, 12-16 weeks) treatment with three phases: a beginning (1-3 sessions), middle, and end (3 sessions). The initial phase requires the therapist to identify the target diagnosis (MDD) and the interpersonal context in which it presents.

Question 46

Possible specific Interpersonal Situation linked to a client's depressive symptoms

Answer 46

Grief Interpersonal Role Dispute Role Transition Interpersonal Deficit

Question 47

Grief

Answer 47

Complicated bereavement folowing the death of a loved one

Question 48

Interpersonal Role Dispute

Answer 48

Conflicts in an important social relationship

Question 49

Role Transition

Answer 49

A change in life status, including the beginning or end of a relationship, retirement, graduation, medical diagnosis, and so on

Question 50

Interpersonal Deficit

Answer 50

When a client lacks specific social skills that contribute to relationship problems

Question 51

Process-Experiential Psychotherapy

Answer 51

Rooted in person-centered theory; emphasizes the formation of a relationsihp based on Rogers's core conditions and then, from the trusting relationship foundation, seeks to explore and resolve the client's affective problems.

Question 52

Dialectical Behavior Therapy

Answer 52

Developed by Marsha Linehan et al at University of Washington Suicidal Behaviors Research Clinic

Question 53

Dialectical Behavior Therapy

Answer 53

Developed as a specific treatment for women who were exhibiting parasuicidal behavior and suffering from BPD; blends cognitie-behavioral and Eastern meditation practices with elements of psychodynamic, person-centered, Gestalt, strategic, and paradoxical approaches

Question 54

Parasuicidal Behavior

Answer 54

Includes all intentional self-injurious behavior, some of which is also characterized by suicidal intent

Question 55

Functions Delivered in Various Modalities of DBT

Answer 55

Enhancing the client's skills and capabilities Improving the client's motivation Generalizing the client's skills and capabilities from therapy to the client's life outside therapy Improving the therapist's capabilities and motiation to treat BPD patients Structuring hte client's environment to support and validate the client's and therapist's capabilities

Question 56

Acceptance and Commitment Therapy

Answer 56

Emphasize that current medically based therapy systems are operating ont he wrong paradigm; the assumption of healthy normality and the assumption that abnormality is a disease are both flawed and that the disease, disorder, or psychopathology model has fared quite poorly over the years

Question 57

Transtheoretical Change Model

Answer 57

Focuses on how people change, proposed by James Prochaska; Emphasizes both common factors and theoretical integration

Question 58

Transtheoretical Model Seeks to

Answer 58

Respect the fundamental diversity and essential unity of therapy systems Emphasize empricism Account for how people changei nside and outside of therapy Address physical and mental health problems Encourage therapists to be innovators and now simply borrowers from various systems

Question 59

Dimensions of Change that the Transtheoretical Model Focuses on

Answer 59

Change processes Stages of Change Levels of Change

Question 60

Common Change Processes

Answer 60

``` Consciousness Raising Dramatic Relief Self-Re-evaluation Environmental re-evaluation Self-liberation Social-liberation Counterconditioning Stimulus Control Reinforcement Management Helping Relationship ```

Question 61

Consciousness Raising

Answer 61

Processes of personal insight and awareness that stem from feedback and education; rooted in Psychodynamic Theory and Feminist Theory

Question 62

Dramatic Relief

Answer 62

Catharsis and expressive procedures; Gestalt Theory

Question 63

Self-Re-evaluation

Answer 63

An examination of self, self-schema, and other variables; Cognitive therapy, constructivist, and Adlerian Theories

Question 64

Environmental Re-evaluation

Answer 64

Information processing with environmental focus; cognitive and constructivist theory

Question 65

Self-Liberation

Answer 65

A focus on personal freedom; Existential and Choice Theory

Question 66

Social-Liberation

Answer 66

A focus on freedom from social oppression; Feminist, Existential, and Constructivist Theory

Question 67

Counterconditioning

Answer 67

New learning that overcomes old learning; behavioral

Question 68

Stimulus control

Answer 68

Management of environmental stimuli; behavioral

Question 69

Reinforcement Management

Answer 69

Management of environmental contingencies; behavioral

Question 70

Helping Relationship

Answer 70

The healing potential of a helping relationship; person-centered

Question 71

Stages of Change

Answer 71

``` Precontemplation Contemplation Preparation Action Maintenance Termination ```

Question 72

Precontemplation

Answer 72

During this stage, the individual has little or no interest in changing his behavior

Question 73

Contemplation

Answer 73

During this stage, the individual is aware that a problem exists, but she has not yet made a clear commitment to making personal change

Question 74

Preparation

Answer 74

During preparation, there may be some intention and effort made toward change; There may be occasional ventures forth into action, but mostly these individuals are so deep into contemplation that they're beginning some minimal action toward change but are not yet into the action stage

Question 75

Action

Answer 75

During action, people are plunging into the change process. These are the clients whom most therapists love to see because their motivation is so high that they quickly engage in the therapy process and often make considerable and imediate progress; the successful alteration of a problem behavior for a period from 1 day to 6 months

Question 76

Maintenance

Answer 76

People continue with their action and deepen their commitment toward permanent change. There is continual work or action toward relapse prevention. This stage continues from 6 months to infinity, but relapse often occurs at some point durin gmaintenance

Question 77

Termination

Answer 77

People have 100% confidence (self-efficacy) that they will not engage in the problem behavior again; Prochaska uses a 5-year criterion of symptom liberation, plus 100% confidence, for classification into this stage

Question 78

Levels of Change

Answer 78

``` Symptom/Situational Problems Maladaptive Cognitions Current Interpersonal Conflicts Family-Systems Conflicts Intrapersonal conflicts ```