Counseling & Psychotherapy Comprehensive

C&PT Reviewer
1. Question: Describe the main focus of psychoanalysis and
psychodynamic therapies and how they differ from other
therapeutic approaches.
a. Answer: Psychoanalysis and psychodynamic
therapies focus on changing problematic behaviors,
feelings, and thoughts by discovering their
unconscious meanings and motivations. Unlike other
therapies that may focus on current problems or
behaviors, these therapies delve into the past and
the unconscious mind to understand present
behaviors.
2. Question: How does behavior therapy view the development
of both normal and abnormal behaviors?
a. Answer: Behavior therapy views both normal and
abnormal behaviors as learned. It emphasizes the
role of conditioning in the development of behaviors.
This approach uses techniques such as classical and
operant conditioning to modify behaviors.
3. Question: What is the main belief of cognitive therapists
about dysfunctional emotions or behaviors?
a. Answer: Cognitive therapists believe that
dysfunctional emotions or behaviors are the result of
dysfunctional thinking. They argue that by changing
their thoughts, people can change how they feel and
what they do.
4. Question: What are the three types of humanistic therapy
and how do they emphasize people’s capacity to make
rational choices and develop to their maximum potential?
a. Answer: The three types of humanistic therapy are
client-centered therapy, Gestalt therapy, and
Existential therapy. These therapies emphasize the
individual’s inherent worth and value, their capacity
for self-determination, and their potential for
self-fulfillment. They focus on the individual’s
experience in the present moment, the
therapist-client relationship, and the environmental
and social contexts of a person’s life.
5. Question: What is the approach of integrative or holistic
therapy in treating clients?
a. Answer: Integrative or holistic therapy does not tie
itself to any one approach. Instead, it blends
elements from different approaches and tailors the
treatment according to each client’s needs. This
approach recognizes the value of flexibility in therapy
and the importance of a personalized treatment
plan.
6. Question: How does the concept of ‘unconscious motivations’
play a role in psychoanalysis and psychodynamic therapies?
a. Answer: In psychoanalysis and psychodynamic
therapies, unconscious motivations are believed to
be the root cause of certain problematic behaviors,
feelings, and thoughts. Therapists using these
approaches aim to uncover these unconscious
motivations to help patients understand and resolve
their issues.
7. Question: What are the key principles of classical and operant
conditioning in behavior therapy?
a. Answer: Classical conditioning involves learning by
association, where a neutral stimulus becomes
associated with a significant stimulus, eliciting a
response. Operant conditioning involves learning
from the consequences of behavior. Positive
reinforcement encourages the repetition of a
behavior, while negative reinforcement or
punishment discourages it.
8. Question: How does cognitive therapy aim to change
dysfunctional emotions or behaviors?
a. Answer: Cognitive therapy aims to change
dysfunctional emotions or behaviors by changing
dysfunctional thinking. The therapy helps individuals
to identify and challenge their negative thought
patterns and beliefs, and replace them with
healthier, more positive ones.
9. Question: How do client-centered therapy, Gestalt therapy,
and Existential therapy, as types of humanistic therapy, differ
from each other?
a. Answer: Client-centered therapy emphasizes the
therapeutic relationship and the client’s capacity for
self-direction and growth. Gestalt therapy focuses on
the individual’s experience in the present moment,
the therapist-client relationship, and the
environmental and social contexts of a person’s life.
Existential therapy focuses on free will,
self-determination, and the search for meaning.
10. Question: What are the benefits and potential drawbacks of
an integrative or holistic approach to therapy?
a. Answer: The benefits of an integrative or holistic
approach include the ability to tailor therapy to the
needs of each individual client and the flexibility to
use the most effective techniques from each therapy
type. Potential drawbacks could include a lack of
structure or focus if not properly managed, and the
need for extensive knowledge and skill on the part of
the therapist to integrate the therapies effectively.
11. Question: Describe the key principles of cognitive-behavioral
therapy (CBT) and how they can be applied in a real-life
scenario.
a. Answer: Cognitive-behavioral therapy (CBT) is based
on the idea that our thoughts, feelings, and
behaviors are interconnected. The key principles
include identifying negative or false beliefs,
challenging these beliefs, and ultimately changing
the behavioral pattern. In a real-life scenario, a
person suffering from social anxiety might believe
that they will always say something embarrassing in
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social situations (negative belief). Through CBT, they
would be encouraged to challenge this belief and
test it out in safe environments, leading to behavior
change.
12. Question: How does a psychotherapist establish a therapeutic
alliance with a client?
a. Answer: A therapeutic alliance, also known as a
working alliance, is established through empathy,
trust, and mutual understanding. The therapist must
show genuine concern for the client’s well-being,
validate their feelings, and work collaboratively
towards the client’s goals.
13. Question: What is the role of transference and
countertransference in psychotherapy?
a. Answer: Transference is when a client projects
feelings about someone else, often from their past,
onto the therapist. Countertransference is when a
therapist projects their own feelings onto the client.
Both can provide valuable insights into the client’s
interpersonal relationships and unresolved conflicts.
However, therapists must be aware of these
phenomena to avoid letting their own feelings
interfere with the therapeutic process.
14. Question: How can a therapist apply the principles of
humanistic therapy in a counseling session?
a. Answer: Humanistic therapy focuses on the
individual’s unique experience. A therapist can apply
its principles by providing an empathetic and
non-judgmental environment, promoting
self-exploration, emphasizing the client’s strengths,
and encouraging self-actualization.
15. Question: Discuss the ethical considerations in
psychotherapy.
a. Answer: Ethical considerations in psychotherapy
include maintaining confidentiality, avoiding dual
relationships, practicing within one’s competence,
respecting client autonomy, and promoting client
welfare. Therapists must adhere to these ethical
guidelines to protect the client’s rights and dignity.
16. Question: A client comes to you expressing feelings of
extreme guilt over a car accident where they were at fault
and the other driver was severely injured. How would you
apply principles of Cognitive Processing Therapy (CPT) in this
case?
a. Answer: CPT is a type of cognitive-behavioral
therapy that helps patients deal with traumatic
events and the negative emotions associated with
them. In this scenario, the therapist would help the
client understand how they are interpreting the
event and how it’s affecting their feelings of guilt.
The therapist might ask the client to write a detailed
account of the accident and their feelings, which can
help the client identify any stuck points or unhelpful
beliefs about the event. The therapist and client
would then work together to challenge these beliefs
and develop more balanced thoughts.
17. Question: You are counseling a teenager who is showing signs
of social anxiety disorder. They are particularly worried about
speaking in front of their class at school. How would you use
exposure therapy in this case?
a. Answer: Exposure therapy involves gradually and
repeatedly exposing the client to the feared situation
until their anxiety decreases. In this case, the
therapist might first ask the client to imagine
speaking in front of the class, then practice speaking
in front of a small group of friends, and finally,
practice speaking in front of larger groups. The
therapist would provide support and guidance
throughout this process, helping the client manage
their anxiety and build confidence.
18. Question: A client comes to you with symptoms of
depression. They express feelings of hopelessness and
mention they have been having difficulty sleeping and eating.
How would you approach treatment from a person-centered
therapy perspective?
a. Answer: Person-centered therapy emphasizes
empathy, unconditional positive regard, and
congruence. The therapist would provide a
supportive and non-judgmental environment where
the client can explore their feelings of hopelessness.
The therapist would validate the client’s experiences
and emotions, helping them understand that it’s
okay to feel this way. The goal is to help the client
find their own solutions and rediscover their capacity
for self-healing.
19. Question: You are working with a client who has recently
been diagnosed with a chronic illness. They are struggling to
cope with the diagnosis and the changes it means for their
life. How would you apply principles of Acceptance and
Commitment Therapy (ACT) in this case?
a. Answer: ACT involves accepting what is out of one’s
personal control and committing to actions that
enrich one’s life. In this case, the therapist would
help the client accept their diagnosis and the feelings
that come with it, rather than trying to avoid or
control them. The therapist would also help the
client identify what is truly important and
meaningful to them in life – their values. The client
would then be encouraged to take actions aligned
with these values, despite the challenges posed by
their illness.
20. Question: A client is struggling with low self-esteem and often
speaks negatively about themselves in sessions. How would
you use techniques from Cognitive Behavioral Therapy (CBT)
to help this client?
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a. Answer: CBT involves identifying and challenging
negative thought patterns. The therapist would help
the client recognize when they are engaging in
negative self-talk and then challenge these thoughts.
For example, if the client says, “I’m a failure,” the
therapist might ask, “What evidence do you have for
that belief?” or “What would you say to a friend who
said that about themselves?” This can help the client
develop a more balanced and positive view of
themselves.
The International Classification of Functioning, Disability and Health
(ICF) framework emphasises human functioning in relation to an
individual's activities and participation, influenced by environmental
factors, health conditions and personal factors
The Personal Data Sheet was adapted for children 1924
Negotiating boundaries
● Therapist acts in the best interest of the client, ultimately
responsible for managing boundary issues
Vicarious experiences offered by physical therapists and other patients
reinforce self-efficacy and empowerment
Awareness of one's own culture
● Includes understanding values placed on a person's name,
birth order, and language
Awareness of racism, sexism, and poverty bias
● Counselors discover this awareness by looking closely at their
own personal belief system
As with any online activity, be extremely protective of your personal
information. Do not share anything private unless you feel comfortable
that you and your therapist are using a safe, secure program
Counselors can and should be aware of their biases, areas of denial,
and the issues they find difficult to deal with in their own lives
Counselors
● Have a personal responsibility to be committed to awareness
of their own life issues
● Need a high level of self-awareness to avoid obstructing the
progress of clients
● Must be aware of their own needs, areas of unfinished
business, personal conflicts, defenses, and vulnerabilities
Codes of ethics address the issue of counselors' personal problems and
conflicts interfering with their effectiveness
Counseling is always at the request of the client as no one can properly
be sent for counseling
Process of counseling
● The means by which one person helps another to clarify his or
her life situation and to decide further lines of action
It is important to undertake relevant training and apply for
membership with a professional body like the National Counseling
Society to help potential clients have more faith in your abilities and
also offer protection for both you as a practitioner and for the clients
Accurately defining the differences between counseling and
psychotherapy is difficult, as they are quite similar
Approaches within psychotherapy
● Many key ideas that psychotherapists might work with
Counselors are not there to give advice to clients, but to help them
become more aware of their own inner resources and how they can
use these to help them cope and discover new ways of dealing with
difficult feelings, people or situations
Making unconscious ideas and feelings conscious
● Through exposure, interpretation and contextualization
Early childhood experiences
● Shape our emotional lives and how we think and react to
events in life
Defences built in childhood
● Helped us to feel safe and lower our distress but as an adult
are causing us issues
There is currently no legal requirement in the UK to have any specific
training or experience in order to practice as or call yourself a
counselor
With the right things in place, psychotherapy can help transform a
person's life
Depression
● A mood disorder that makes you feel constant sadness or lack
of interest in life
Those who bristle at the suggestion that they might need to change
are paradoxically giving off the clearest evidence that they may be in
grave need of inner evolution
Appropriateness of a test
● Considering factors such as the client's reading level, language
ability, and whether the test answers the right questions
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Assessment
● The practice of collecting information to identify, analyze,
evaluate, and address the problems, issues, and
circumstances of clients in the counseling relationship
Evaluation, termination, or referral
● Remind the client when the ending is coming up
● Review the progress made
● Allow the client to articulate their feelings about termination
● Be aware of your own feelings about the client's termination
Factors that Influence Change Structure
● Setting
● Client Qualities
● Counselor Qualities
Three psychotherapy techniques to identify a client's real problem
● What are they not getting from their life? (Unmet primal
human needs)
● What faulty pattern matching is going on? (Inappropriate
responses to situations)
● What are their metaphors telling you about what they need
and about them? (Unconscious communication of important
issues)
Options for resolving an unhealthy therapeutic relationship
● Discussing concerns openly with the therapist
● Terminating therapy with that clinician
● Meeting with another therapist for a second opinion
● Filing a complaint with the therapist's employer and/or
licensing board
● Seeking legal counsel or law enforcement support
Empowerment
● The expansion of freedom of choice and action, increasing
one's authority and control over the resources and decisions
that affect one's life
Communication should not only provide information, but displaced
persons must be listened to, and able to tell their stories and
participate in dialogue that provides them with physical, social and
psychosocial support and trauma counselling
Active listening
● Paying close attention to what the displaced person is saying,
using reflections, clarifying with open-ended questions, and
showing interest and creating a positive atmosphere
Poor listening has been attributed to inaccurate diagnosis and
incorrect treatment
Rapport is developed by
● Being genuinely engaged with the client, actively listening,
remembering, and showing true empathy
Listening is more complicated than you might think - most people
don't think about it, it is second nature
Tuning in and out
● On average we think approximately four times faster than we
speak, leading to listeners tuning out, using the space to
address their own thoughts, to daydream rather than staying
tuned into the listener
Treatment planning serves to help clients learn to problem-solve,
develops a roadmap for treatment, helps communicate with the team,
and protects from liability
Analysis of resistance is essential to successful therapy
● why might change be so hard it isn't as if the change resistant
person is merely unsure what's amiss and will managed to
alter course once an issue is pointed out to them as someone
might if their attention were drawn to a strand of spinach in
their teeth
● couldn't they just would no longer quite make sense
Assessment is filled with ambiguity and gray area, as counseling is not
an exact science like a hard science
Cognitive Behavioral Therapy (CBT)
● Normally administered by psychologists and psychiatrists in
6-10 hour long sessions, teaches techniques for arguing
rationally with and controlling the certainties thrown up by
our internal persecutors like paranoia, low self-esteem, shame
and panic
Dimensions of Development Physical Development
● Cognitive Development
● Emotional Development
● Social Development
● Moral Development
It is a misnomer that counselors are not good at assessment - they
often want to think positively about clients and have faith in their
growth, which can blind them to struggles the client is experiencing
we can at best conclude that by the time we've had to raise the
question of change in our minds someone around us has managed not
to change either very straightforwardly or very gracefully
Emotion Matters
● When we learn to see the value of emotions, they can help us
learn and grow
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Ignoring or suppressing emotional response keeps us from learning
and taking action
Important uses of emotions
● Emotions drive our actions (e.g. fight, flight or freeze
response)
● Emotions tell others that we're dealing with stressors and
may need support
Emotions have wisdom
● They tell us something important in our life is changing or
needs attention
we asked to because the one immediately obvious response to
frustration isn't in this case open to us we're not able to simply get up
and go we're too emotionally or practically invest it to give up
something roots us to the spot
Multiple Intelligences Kinesthetic intelligence
● I.Q. (Intelligence Quotient)
● E.Q. (Emotional intelligence)
● Social intelligence
● Moral intelligence
● Musical intelligence
Anxiety
● A threat response in the absence of clear danger (anticipation
or possibility), universal experience, can be useful/functional
Fear
● Focused response to a known or definite threat, necessary for
survival
Signs of Depression
● Feel sad the whole day
● Diminished interest or pleasure
● Weight loss or weight gain
● Psychomotor agitation or retardation
● Fatigue or loss of energy
● Feelings of worthlessness or guilt
● Lack concentration
● Recurring thoughts of death
Signs of Anxiety Restlessness
● Easily fatigued
● Difficulty concentrating or mind going blank
● Irritability
● Muscle tension
● Sleep disturbance
Severe/excessive anxiety
● 3+ signs, duration: 1 month or more, impaired functioning
Types of Anger
● Passive Aggression (silent when you are angry, sulking,
procrastinating, pretending "everything is fine")
● Open Aggression (tendency to lash out in anger and rage,
becoming physically or verbally aggressive and can often
times hurt themselves or others)
● Assertive Anger (thinking before you speak, being confident in
how you say it, yet open and flexible to the 'other side', being
patient, not raising your voice, communicating how you are
feeling emotionally, and really trying to understand what
others are feeling)
One thing is likely already to be evident to us even if people can
change they certainly don't change easily
There is also the worry about the strangeness of it all
It will be you and someone you've never met, to whom your expected
to divulge nothing less than your inner life
Why not talk to a friend? Firstly, because friends aren't properly
trained to listen. As one would have noticed, they interrupt a lot. And
secondly, because it's sometimes easier to tell someone who has no
prior knowledge or expectations of you the big and important things
about who you are
Therapy might be the price of going out for dinner with friends, which
is both a lot, and not so much
Therapy is valuable, because so many of our problems come down to
not having enough insight into how our minds work
Knowing how to live isn't an instinct, we are not born with it
With a fair wind, psychotherapy also has the chance to be the best
thing one ever gets around to doing
It isn't a sign of disturbance to go to therapy it's the first sign of sanity
and of a proper, grown-up commitment to mental health
with the example of one troublesome human in mind we start to
wander outwards about human nature in general what it might be
made of and how malleable it could turn out to be
Psychotherapy won't work for everyone, one has to be in the right
place in one's mind and be in a position to give the process due time
and care
Clients who are not making progress or seem difficult to treat may
require more in-depth assessment to uncover underlying issues
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can people change the question may sound somewhat abstract and
disinterested as if one were asking for a friend or for the universe but
it's likely to be a good deal more personally and painfully motivated
than that
Test results can have a significant impact, both positive and negative,
on the lives of clients
Psychiatric medication
● Helps us get through to the next day and the one after by
playing around with our brain chemistry, but can make us
sleepy, nauseous or foggy
Psychotherapy
● Takes up a large amount of time, demanding perhaps two
sessions a week for a couple of years, and is the most
expensive option, but can be hugely effective in properly
alleviating pain for three reasons: 1) It makes unconscious
feelings conscious, 2) It allows the patient to experience
transference and adjust their behavior, 3) It provides the first
good relationship the patient has experienced
There is the idea that you have to be a little mad or harbor some huge
and strange problem to go and see a therapist
It's entirely ordinary to be rather confused, a bit anxious, and
sometimes challenged by relationships, family life, and the direction of
your career
Therapists
● They are the last people ever to judge
● Their concept of a normal human being is far more expansive
than that held by society at large
● They know how unsual and surprising we are, especially
around sex and anxiety
● Their whole training takes them into the recesses of their own
and others minds
● They know how surprising we can all be
● It doesn't frighten them - it intrigues and motivates them
● They are in the end, interested in mental health, that means,
in helping out
Medical assessment is important to rule out any underlying medical
causes for a client's presenting issues, such as hypothyroidism
Instruments constructed, normed, and validated in the 1980s may be
out-of-date by today's standards
Many state licensing boards have rules that prevent professionals
outside of psychology from using projective tests, such as the
Rorschach Technique
Assessment is an integral part of counseling practice, and therefore
training in assessment is essential
CACREP (2009) identified assessment as one of the "eight common
core curricular areas" required for all students in accredited counseling
programs
Counselors need to be aware of the multicultural and social justice
issues that emerge from testing and comparing populations
AARC and ACA produced statements with respect to counselors' use of
standardized instruments
The JCTP disbanded in 2007, but it published several documents
related to test use
Efforts should be made to communicate test results to clients and
stakeholders in a manner that is understandable and useful while also
addressing any limitations to selected tests
Counselors need to be proactive in addressing issues of informed
consent and confidentiality, especially with regard to who will have
access to the results and the implications of said results
Clients have the right to receive the results and identify qualified
professionals, if any, with whom the results may be shared
NEO Personality Inventory (NEO-PI)
● Assesses individuals on a five-factor model of personality:
openness, agreeableness, neuroticism, extraversion, and
conscientiousness
The responsibility of ensuring appropriate test use lies within the
counselor or educator administering the test
Counselors should have knowledge and skill in areas related to
measurement, test development, administration, scoring, and
communicating results
ACA appointed individuals from AARC/ACA to represent counselors on
the Joint Committee on Testing Practices (JCTP)
Standards for Qualifications of Test Users
● Adopted by the ACA, related to the training and skills
necessary for counselors to use psychological tests
ACA addressed counselors' responsibility to promote fairness in
assessment practices by understanding the role of diversity and the
legal and ethical implications of assessment
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ACA Code of Ethics (2005), Section E Covers evaluation, assessment,
and interpretation, addressing ethics in both formal and informal
assessments
Clients have a right to know the nature of the assessment and how the
assessment results may be used prior to administration
Issues related to educational placement, incarceration, job placement
and promotion, and differential diagnoses permeate the counseling
profession
Confidentiality may not be compromised, and this is an issue that
needs to be addressed before administering an assessment, especially
if the client is referred by an organization, agency, court, or other
professional
Assessment should be integrated along with counseling theory and
never used with populations or issues outside the counselor's scope of
practice
Behavior Assessment System for Children
● Includes report forms for the client and observers (e.g.,
parent, teacher)
The JCTP was established in 1985, along with such groups as the
American Educational Research Association, the National Council on
Measurement in Education, and the American Psychological
Association, to address testing practices in education and clinical
settings
Nonstandardized assessment
● A process of gathering information without adherence to a
strict set of rules or guidelines, such as clinical interviews
Standardized assessment
● A formal process with a specific set of rules and guidelines
related to administration, scoring, and interpretation to
ensure accurate results over time and across populations
Millon Clinical Multiaxial Inventory (MCMI)
● Measures personality issues, focused on Axis II disorders
Differentiating between assessment and testing may be an academic
exercise, as the process of testing cannot be separated from the
assessment process
MMPI Revolutionized personality testing
Personal Data Sheet Precursor for the Minnesota Multiphasic
Personality Inventory (MMPI)
California Psychological Inventory Assesses general personality,
precursor to the NEO Personality Inventory
How a construct is measured
● Identifying a strategy
● The strategy should simulate the character of the client's
problem and be directed towards the goals
● Life stages in client assessment
● Initial disclosure
● In-depth exploration
● Commitment to action
● Counseling intervention
● Evaluation, termination, or referral
MHPSS Crisis Intervention Framework
● Summarizing the problem
● Using a four-dimensional analysis: affective, behavioral,
cognitive, and interpersonal/systemic
Counseling intervention
● Summarize the problem
● Identify a strategy
● Select and implement intervention
In-depth exploration
● Focus on problem assessment, gathering information and
drawing conclusions about the client's concerns
Things to explore/assess
● Identifying data (name, address, age, etc.)
● Problems presented and how they affect daily life
● Client's current lifestyle
● Family history
● Personal history
● Description of the client during the interview
● Summary and recommendations
Focusing helps the therapist work on the most pressing issue
Building the Relationship Restatement/Content Paraphrasing
● Reflection of Feeling
● Summary of Feelings
● Acknowledgement of Non-verbal Behavior
Paraphrasing allows the therapist to get closer to the client's reality
Self-disclosure should be limited, this is the client's time
Client's Readiness or Reluctance or Resistance Readiness:
● Client's motivation to work
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● Reluctance: Client is unmotivated and referred by a third
party
● Resistance: Client is forced to go to therapy and clings to their
issues
Physical Setting
● Psychotherapy works in a place that provides privacy,
confidentiality, quiet and certain comfort
Recognizing patterns and identifying themes helps the client
understand their issues
Follow-Up
● Follow-ups need to be scheduled so as to not take the
responsibility of change away from the client.
Open questions
● Allows the client to answer the question in a free-flowing or
narrative style. Used when you want more detailed and
elaborate answers.
Resistance to Termination
● Therapists & Clients/patients may not want therapy to end.
This may be the result of feelings about the loss and grief or
insecurities of losing the relationship.
Premature Termination by Client/patient
● Many clients may end counseling before all goals are
completed. A termination/review session should be
scheduled so closure may take place.
What the counsellor may do
● Ask questions
● Summaries
● Active listening Paying attention, showing interest, nodding,
using affirming verbals, reflecting feelings, paraphrasing
Termination of a Session
● Start and end on time
● Leave 5 minutes or so for a summary of the session
● Introduce the end of the session normally
● Assign homework
● Set up next appointment
Timing of Termination
● There is no one answer when termination is to take place.
● Questions you may wish to ask include: Have clients/patients
achieved goals? Can clients/patients concretely show
progress? Is the therapeutic relationship helpful? Has the
context of the initial therapy arrangements changed?
Clients may set their own small goals at the end of the session
Content
● What is actually said, including words, expressions and
patterns used
Effective questioning
● Use open questions to clarify understanding, avoid closed
questions and the word 'why'
Process
● All nonverbal communication, including how the content is
being presented
Perception is Reality
● As you work with a client, you may offer new frames to their
pictures of reality (re-framing) and fresh ways to look at
things.
Focusing
● Asking the speaker which issue is the most pressing to work
on first
The more something matters to us, the more metaphorical we become
when talking about it
So that the client can Develop his/her thinking
● Feel safe and respected
● Know you care
● Know he/she is not being judged
● Know you are with him/her
● Get the best help possible
Confronting discrepancies shows the therapist is listening
Therapy relationship is effective because clients carry their old
relationships around with them
Empathy
● Being warm, friendly and reassuring
● Linked with better patient satisfaction and recovery rates, and
subsequently better health outcomes
Therapy relationship
● Two people in a room: a therapist and a client working
something through
● Avoid interrupting or finishing their sentence for them, it
sends the message that you are more important, you know
what they are going to say or you are in a rush
Types of therapy
● Existential
● Psychodynamic
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● Behavioral
Therapeutic alliance
● The collaborative and affective bond between therapist and
patient - an essential element of the therapeutic process
Transference
● The unconscious feelings or emotions that a patient feels
towards their therapist
Therapeutic Relationship
● Communication Skills - Active listening, Empathy, Friendliness,
Encouragement, Confidence, Non-verbal communication
● Practical Skills - Patient education, Therapist expertise and
training
● Patient-Centred Care - Individualised treatments, Taking
patients' opinions and preferences into consideration
● Organisational and Environmental Factors - Giving patients
enough time, Flexibility with appointments and care
Dimensions of patient-centred care
● Utilising a biopsychosocial perspective
● The 'patient-as-person'
● Sharing power and responsibility
● The therapeutic alliance
● The 'doctor-as-person'
A strong therapeutic alliance
● Leads to increased perceived changes following a variety of
conservative treatments, improved disability and function
outcome measures, but no pain
The biopsychosocial model provides the clinician with a better
understanding of the components responsible for the disease while
educating the patient on how to adjust their lifestyles to have a better
quality of life
Shifting patients from 'consumers' to active 'participants' can help
place patients in control of their own illness, which has been
correlated with better health outcomes
When a therapeutic relationship is formed, an individual in therapy
might be more inclined to open up emotionally and provide further
details about his or her concerns
A strong therapeutic alliance
● Can significantly modify perceived pain intensity after
interferential current therapy (IFC)
● Provides patient-centred care, where the therapist is seen as
a facilitator for the patient to achieve their goals, rather than
an authority figure
● Encourages the patient to become more active in their
treatment to engage them in a collaborative, active approach
to recovery
● Addresses psychosocial aspects of pain, which are often
overlooked in traditional unidirectional patient-therapist
interactions
Patient perception of the therapeutic alliance has been found to be a
better predictor of outcome than therapist perception
Empowerment
● Facilitating long-term independence
Choice
● Comes from realising there is a way through an obstacle,
which allows the individual to forge through a specific
challenge
Competence
● Pivotal after recognising the choice
Self-efficacy
● A prerequisite for empowerment
Pain
● Does not cause one to suffer, the perception of pain and how
it demands more of the person than they can manage better
defines the nature of suffering
Self-efficacy
● Actualising one's competency with their skillset to achieve
established outcomes with reliance on interaction with their
environment
Goal-directed physical therapy
● is insufficient for sustainable and comprehensive recovery
Locus of control
● External locus of control is outside the parameters of the
perception of personal competence and motivation
Client grew up with a critical parent Client may now expect criticism
from those in charge
Self-efficacy is a prerequisite for empowerment
Empowerment process
● The discovery and development of one's inherent capacity to
be responsible for one's life
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Patient empowerment
● Helping patients discover and develop the inherent capacity
to be responsible for one's own lives
Engagement toward empowerment must explore areas outside of
one's comfort zone
Choice and competence must be specifically directed to increase an
internal locus of control and motivation
Complex rehabilitation should be considered as a process to discover
and enhance what is possible for an individual and not focus on what
is not possible
High internal locus of control
● The foundation for creating intrinsic motivation that leads to
self-efficacy
Attentiveness and Rapport building
● Be warm and friendly towards the listener
● Ask if they are comfortable
● Remember the listener's name
● Use appropriate eye contact, not staring
● Review notes before the session, don't refer to them during
Communication
● The process of exchanging information, ideas and thoughts
between two or more individuals
Effective and respectful communication is central to working with
displaced persons
Patient-centered care
● Associated with increased patient satisfaction, engagement in
care, quality of life
Communication is an ongoing process between the rehabilitation
professional and clients who have experience of displacement
Establishing common ground is essential for rehabilitation services
Communication training in health care professionals is recommended
as a way of improving the therapeutic alliance and encouraging
patient-therapist collaboration in treatment decisions
Trust
● Assured reliance on the character, ability, strength, or truth of
someone or something
Empowerment as a process
● Requires self-mastery and the ability to transcend through
suffering by challenging adversity
● An approach that considers not only biological but also
psychological and sociological factors is needed to appreciate
the full scope of the problems presented and provide
patient-centred care
Patient-centred care
● Health care that establishes a partnership among
practitioners, patients, and their families to ensure that
decisions respect patients' wants, needs, and preferences and
that patients have the education and support they need to
make decisions and participate in their own care
Empowerment
● A multifactorial trait and layered state that relies on multiple
concepts
Talking about certain events can potentially renew wounds or fears
Asking questions and responding effectively as part of this process
ensure the displaced person is at the centre of the interaction and that
they feel heard, valued, understood and respected
In cases where verbal and non-verbal messages contradict each other,
non-verbal communication tends to outweigh the verbal message
Empathy is expressed by being warm, friendly and reassuring
Suffering
● An existential frustration associated with an unavoidable
experience threatening existence and loss of personal
autonomy
● The state of severe distress associated with events that
threaten the person's integrity, which induces the perception
of impending destruction
Communication around sensitive topics like rape, abuse, harassment,
trafficking and torture requires a sound therapeutic alliance based on
trust and mutual recognition
It is impossible to anticipate all the circumstances that could
re-traumatise your client, but you can minimise the risk by avoiding
settings or behaviour that could remind them of interrogation or
torture experiences
Acceptance of their emotions creates trust and that any anger is likely
aimed at the situation and not directly at you
Trust
● A major influencer of the patient-healthcare professional
relationship, built through exhibiting clinical expertise,
effectiveness, maintaining high standards of professionalism,
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moral responsibility, respect, compassion, integrity, following
a patient-centered approach, understanding the patient's
uniqueness and experience, clear and honest communication
Healthy and trusting relationship between client and therapist Clients
are more likely to achieve their goals
Listening (Attending)
● Make eye contact
● Remove distractions
● Nod head
● Avoid excessive movement
● Make encouraging verbalizations
● Mirror posture and language
● Lean forward
Paraphrasing
● Focusing on the keywords and main ideas that the client has
communicated and communicating them back in a rephrased,
shortened form
Mirroring
● Counsellor repeats what the client has just said word for word
(verbal mirroring) or mirrors the client's nonverbal behaviour
(nonverbal mirroring)
● Mirroring, silence, summarising, and paraphrasing are all
important techniques for counsellors to connect with their
clients and build trust
● Paraphrasing and summarizing Reflecting back to the speaker
what they have said using your own words. Summarizing the
main themes at the end.
The establishment of trust in the relationship is crucial to the success
of the outcome of therapy
Working at an appropriate pace
● Allowing the speaker time to develop and share their story,
not rushing them
The therapy relationship accounts for why clients improve (or fail to
improve) at least as much as the particular treatment method
The formation of a secure attachment to the therapist is significantly
associated with greater reductions in client distress
Only by knowing ourselves can we be fully available and of service to
others
Concreteness
● Staying focused on specific and relevant facts and feelings,
avoiding getting off topic, making sweeping statements, or
talking about the counselor rather than the client
Patient-centered care
● Involves empathy, compassion, respect, engagement,
relationship, communication, shared decision making, holistic
treatment, individualised care, cultural competence
Good listening
● Enables people to tell their story
● Enables a motivating vicarious experience through the
coaching and standards the physical therapist sets, and allows
for appropriate modifications that support the patient's needs
Purpose of a therapeutic relationship
● To assist the individual in therapy to change his or her life for
the better
It is the first setting in which the person receiving treatment shares
intimate thoughts, beliefs, and emotions regarding the issue(s) in
question.
Therapist provides a safe, open, and non-judgmental atmosphere
where the affected individual can be at ease
Components of a good therapeutic relationship
● Trust
● Respect
● Congruence
Therapist behaviors
● Show empathy and genuineness
● Maintain boundaries to define acceptable and unacceptable
behaviors
Accountability in healthcare
● Being answerable for one's actions, decisions, and
performance, to patients, colleagues, regulatory bodies, and
the broader community for the quality and safety of care
provided
Working Alliance Theory of Change Inventory (WATOCI)
● A tool for measuring the therapeutic alliance, derived from
the Working Alliance Inventory
Choice
● May have the greatest impact on empowerment
Importance of trust in a therapeutic relationship
● A person seeking a therapist must trust that the therapist has
the knowledge, skill set, and desire to provide appropriate
care
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● The person in treatment must trust that confidential matters
will remain confidential, and that he or she is safe from harm
or exploitation at the hands of the therapist
● All therapies are equally effective
Keeping notes securely
● Use password-protected digital files, locked physical storage,
remove hard drives from old computers, have a contingency
plan if notes are lost or counselor becomes ill
Giving space
● During discussions the mentee will have silences and spaces,
which will vary in length. Avoid the temptation to rush in and
fill these, as we all have differing periods of reflection and
thinking. It is important to allow the mentee time to
internalise their thoughts. Silence can often be an indication
that thinking is going on
Journaling
● Continues the flow of therapy and makes you more aware
● Organizes disparate thoughts into one linear stream
● Keeps a record of your progress
Good listening skills include
● Paying attention: non-verbal, verbal and allowing people to
finish, being aware of body language
● Checking understanding: paraphrasing, summarising,
reflecting back the words
● Allowing for silence: don't rush in or interrupt, allow
reflection to take place
● Encourage exploration: "tell me more about that", make it
clear that you want to support the person in reflecting and
understanding
The session is a time where many of the insights and observations
happen, but it need not be limited to that hour.
Therapy is more than attending a weekly appointment. It's entering
into a period of introspection that can last weeks or years.
For the best results, therapy should not be limited to the session hour.
The main thing is to make journaling manageable or you won't do it.
It's not so much what you write about but that you take the time to
write.
Some psychoanalytic colleagues view journaling as organizing thoughts
rather than sifting through psychic clutter to reveal traces of the
unconscious.
Journaling helps therapy extend beyond the session.
The glazed look
● There are times when an individual will concentrate on the
speaker (mentee) rather than on what is being said for
whatever reason, bringing on that glazed look on the face of
those listening
The SOLER approach
● Squarely face the person
● Open posture
● Lean towards the person
● Eye contact
● Relax
Examples of questions to use in evaluating the performance of
evidence-based practice
● Do I ask myself why I do the things I do in my clinical practice
● Do I discuss the basis for our clinical decisions with
colleagues?
● Am I asking clinical questions?
● Are my clinical questions well-formulated?
● Do I use different types of clinical questions for diagnosis,
interventions, prognosis, etc?
● Am I searching for evidence?
● Do I know the best sources of current evidence for my clinical
discipline?
● Do I have access to knowledge resources?
● Are my search strategies becoming more efficient?
● Do I read papers?
● Do I use critical appraisal checklists for the different study
designs?
● Am I integrating my critical appraisals into my clinical
practice?
● Do I discuss all options with my patient without any cognitive
biases?
● Do I use high-quality evidence to inform clinical practice?
● How did the patient respond to treatment?
● Did the patient manage to adhere to the treatment plan?
● Were my clinical sessions effective or were there any
modifications along the way?
● Do I audit my performance of evidence-based practice?
● Where do I encounter challenges in the evidence-based
practice process?
Systemic therapy's role
● To help systems change themselves by introducing creative
"nudges"
Researchers have estimated that there's anywhere between 400 and
500 different types of psychotherapy
Morita Therapy
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● Begins with bed rest, taking a restorative approach to allow
natural healing
There are literally hundreds of different types or modalities of
psychotherapy out there
Cognitive therapies
● Based on the idea that faulty thinking or cognitive distortions
can cause and maintain anxiety disorders or mood disorders
Why keep accurate notes
● Part of service records and contracts with funders, general
assessment purposes, risk management, recording session
contents, aid to memory, accurate record of client work,
research, measuring effectiveness of therapeutic relationship,
quasi-medical records
● Notes should contain facts, not suppositions or guesswork
Process of treatment planning
● Assess biopsychosocial needs, strengths, needs and abilities
● Identify areas client is motivated to work on
● Write goal statement answering how will I know when it's
accomplished and what new behaviors/feelings will be
present
Decisional balance exercise
● Identifying the positives and drawbacks of change vs staying
the same
Goal statement
● Answers how will I know when I or the client has
accomplished this, and states what new behaviors and
feelings will be present
Systemic therapies
● Focus not only on the individual but also on the individual's
interpersonal system, how they relate to other people in their
life, how they build and maintain interpersonal relationships
● The concept of the family is more commonly defined in terms
of strongly supportive, long-term roles and relationships
between people who may or may not be related by blood or
marriage
● If notes are requested, seek advice from supervisor,
placement, ethical body, and insurance company before
responding
● Supervision records and process notes may be considered
part of the client record and could potentially be subpoenaed
How long to keep notes
● As long as reasonably necessary, check with agency, insurance
company, and ethical body for guidance
Exceptions Times
● when the problem is not actively affecting the individual
Humanistic therapy
● A type of talk therapy generally based on the concept that
humans have the power to make healthy decisions
Types of humanistic therapies
● Person-centered therapy
● Gestalt therapy
● Rogerian therapy
● Existential therapy
● Narrative therapy
Existential therapy
● Frequently challenges individuals to confront their
responsibility for their life's circumstances and to use free will
to make different decisions
Morita Therapy
● A Japanese psychotherapy which moves patients towards a
position of accepting and living in harmony with nature,
including the emotional fluctuations of their own authentic
human nature, through a process of rest and action-taking
Rogerian therapy
● Developed by Carl Rogers, assumes the individual receiving
therapy is an expert on their own life and the therapist should
be supportive but let the client guide the therapy sessions
Narrative therapy
● Has individuals determine their values, skills, and strengths by
telling their own stories in their own words
Techniques used in humanistic therapy
● Therapist uses active listening techniques to ensure full
understanding of the individual's concerns, needs, and goals
● Therapist assumes the individual is innately good and
practices unconditional acceptance
● Therapist acknowledges the individual's power to decide and
respond to situations
● Therapist treats the individual as a whole person, recognizing
their unique combination of physical, mental, emotional, and
spiritual factors
● Therapist focuses on coping with issues in the here and now
rather than the past
● Therapist encourages the individual to accept responsibility
for meeting their own needs
● Therapist helps the individual discover their own solutions
rather than providing them
Humanistic therapy
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● Focuses on an individual's positive attributes rather than
emphasizing dysfunctions or disorders
● Assumes the individual has the wisdom and tools to manage
problems themselves and make positive choices
● Views personal growth as the goal rather than just treating
specific problems or symptoms
Mental health issues addressed in humanistic therapy
● Depression
● Panic disorders
● Anxiety
● PTSD
● Personality disorders
● Schizophrenia
● Addiction
● Relationship issues
● Family conflict
● Personal development
● Self-esteem
● Life meaning and personal responsibility
● Personal growth
Humanistic therapy is an evidence-based treatment that can produce
significant change in individuals over time
Governments act rationally by Placing the interests of the people they
serve first in order to maximise their welfare
Desire for Life
● A natural and fundamental appetite for self-improvement and
self-actualisation, an innate, purposive drive to strive and
preserve life
● Desire and fear are two sides of the same coin - the stronger
one's desire towards self-fulfilment, the more likely one is to
experience self-concern and disappointment
● Suffering does not indicate a deficit, but an excess - a key
concept in counteracting feelings of inadequacy
The first published randomized controlled trial (RCT) of Morita Therapy
in English-speaking countries has recently been completed: a UK-based
pilot RCT of outpatient Morita Therapy versus treatment as usual for
depression
The qualitative findings suggest that some patients specifically
appreciate the unique components of Morita Therapy and highly value
the focus on allowing (as opposed to controlling) symptoms as natural
phenomena
Conditions Morita Therapy is applied to:
● Anxiety disorders
● Depression
● Bipolar disorder
● Schizophrenia
● Eating disorders
● Borderline personality
● Trauma
● Chronic pain
● Sexual assault victims
● Cancer patients
● Civil war victims and perpetrators
Presupposing change questions
● What's different or better since I saw you last time?
● How come things aren't worse for you?
● What stopped total disaster from occurring?
● How did you avoid falling apart?
SFBT treatment plan
● Includes reason for referral, diagnosis, medications, current
symptoms, support for the client, modality/frequency of
treatment, goals and objectives, measurement criteria, client
strengths, and barriers to progress
CBT
● based on the idea that our thoughts affect our feelings and
our behaviors
Potential limitations of SFBT for clients
● include the focus on quick solutions missing important
underlying issues, the lack of emotional connection between
therapist and client, and the frustration if the client wants to
discuss factors outside their immediate ability to effect
change
SFBT and positive psychology
● Share a focus on the positive
● Consider the individual to be their own best advocate, the
source of information on their problems and potential
solutions, and the architect of their own treatment and life
success
● Assume the inherent competence of individuals
Core beliefs
● Beliefs that we hold at the core of who we are that shape how
we see the world
Core beliefs
we see the world
● A type of psychotherapy that deals with our thoughts
(cognitive) and our behaviors (behavioral)
Potential disadvantages of SFBT for therapists include
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● clients focusing on secondary problems, clients deciding
treatment is complete before the therapist, and the
therapist's hard work being ignored
Disorders that CBT can treat
● Depression
● Anxiety
● Trauma
● Phobias
● Addictions
● Eating disorders
CBT can be used to get at core beliefs and change the ones that aren't
beneficial
Automatic thoughts
● Thoughts that happen quickly, outside of our awareness
Currently, multicultural programs only look at the cultures of Japan,
China, and Korea
Irrational belief
● A belief that is not supported by evidence
Steps in CBT
● Identify irrational beliefs
● Challenge irrational beliefs
● Address behaviors that contribute to negative thoughts and
feelings
CBT is a type of psychotherapy that addresses how a person thinks,
and what they do in an attempt to change how they feel and function
in their life
CBT is based on the idea that our thoughts affect our feelings and our
behaviors
You want to be aware of any updates or changes that may affect the
way that you operate as a counselor
Thoughts about a friend not answering the phone
● Person A: "My friend must be busy"
● Person B: "My friend doesn't like me"
● A type of psychotherapy that deals with our thoughts
(cognitive) and our behaviors (behavioral)
Multicultural Awareness Continuum
● A linear tool used to help a counselor gain cultural
competence
CBT
● It has been thoroughly researched and found to be an
effective treatment for all sorts of disorders
● The treatment can be effective in as few as 8 sessions
● The effects are long lasting
● It has been thoroughly researched and found to be an
effective treatment for all sorts of disorders
● It can be effective in as few as 8 sessions
● The effects are long lasting
Core beliefs
we see the world
What a CBT therapist does
● Helps the client identify their irrational beliefs
● Helps the client challenge their irrational beliefs
● Helps the client change behaviors that contribute to negative
thoughts and feelings
You should always have a code of ethics on hand in your work as a
counselor; and you should review it regularly
Exception Questions
● Questions that ask about clients' experiences both with and
without their problems, to distinguish between circumstances
in which the problems are most active and the circumstances
in which the problems either hold no power or have
diminished power
Scaling Question
● A question that asks clients to rate their experiences (such as
how their problems are currently affecting them) on a scale
Solution-focused brief therapy (SFBT)
● A therapy approach that focuses on the positive, on what
people already have going for them, and on what actions they
can take
Exception questions
● Tell me about the times when you felt the happiest
● What was it about that day that made it a better day?
● Can you think of times when the problem was not present in
your life?
SFBT
● Puts problem-solving at the forefront of the conversation and
can be particularly useful for clients who aren't suffering from
major mental health issues and need help solving a particular
problem
SFBT and positive psychology
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● share a focus on the positive, and consider the individual to
be their own best advocate and the source of information on
their problems and potential solutions
Limit setting
● Ensuring both parties know what can and cannot be done
within the therapy
Allow the conversation to flow organically
● Don't have preconceived notions about where the
conversation will go
In all the gray area, it's important to follow one guideline: do what's in
the best interest of your client
The biggest thing in dual relationships is the potential to cause harm
for a client, and as therapists, it is our duty to protect
Hugging your therapist is okay as long as it's in a non-sexual way and
both parties have consented to it
Common delivery methods for online therapy
● Self-help programs through an app
● Teletherapy through video chat
● Text therapy
Research into the effectiveness of online therapy is ongoing, but
several studies suggest that high-quality online therapy can be just as
effective as in-person treatment.
An online practice may allow therapists to reach people who need
therapy the most, and can also add a new stream of revenue.
Both parties should do what they can to ensure that online therapy
does not introduce any security-related stressors to the relationship
Online therapy
● Also known as teletherapy, virtual therapy, or internet/online
counseling
Email counseling
● Involves an exchange of emails over time
Limitations of online therapy
● Privacy
● Practicing across jurisdictions
● Duty to warn
● Establishing rapport
Online therapy
● Receiving help for mental health issues via the internet by
video, phone, live chat, or email
Therapist can switch to audio-only if video connection is poor
Transition to working online Anxiety for therapist and client
Importance of discussing the transition and new setup with the client
Therapist should encourage client to try online therapy, especially if
the therapist has positive experience with it
Online therapy may continue to be used by some therapists even after
the pandemic, providing flexibility
Online therapy can shift the power dynamic, requiring the therapist to
be more flexible
Therapist should proactively discuss backup plans for technology
issues
Lack of digital proficiency is frequently a barrier to telehealth services
for older adults
Client environment
● Connecting from a garage
● Connecting with children/family present
● Showing therapist the view from their window
Summarize back
Pause and summarize what you've learned to show you've been
listening
The primary goal is to promote client welfare
The assessments selected for this course are those commonly used by
counselors in clinical practice
Counselors should be aware of guidelines in the Responsibilities of
Users of Standardized Tests (RUST, Appendix H), Standards for
Qualifications of Test Users, and the ACA Code of Ethics, as well as the
qualification requirements for each test publisher
Many instruments today are used less for diagnosis and more for
identifying problem areas or strength-based areas
Responsibilities of Users of Standardized Tests (RUST) Developed to
educate counselors and educators on ethical use of standardized tests,
addressing guidelines across seven areas: (a) Qualifications of Test
Users, (b) Technical Knowledge, (c) Test Selection, (d) Test
Administration, (e) Test Scoring, (f) Interpreting Test Results, and (g)
Communicating Test Results
Transference
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● The process whereby clients project onto the therapists past
feelings or attitudes they had towards significant people in
their lives
Counselor
● A professional who works intimately with others
Countertransference
● The therapist's reactions and orientation in response to the
client's transference
Substance abuse counselors who have been abstinent for only a few
weeks may present themselves as qualified to advise others, which
sets up tremendous risk
Transference and countertransference occur at some level in most
relationships and can have a direct bearing on the therapeutic
outcome
Counseling
● The process where a counselor sees a client in a private and
confidential setting to explore a difficulty the client is having,
distress they may be experiencing, or perhaps dissatisfaction
with life or loss of a sense of direction and purpose
● A talking treatment where the counselor listens to the client's
problems sensitively and with an open mind to understand as
fully as possible what is concerning them and how it is
affecting their life without judging or offering advice
If a client presents with a problem the counselor feels unable to help
with, it is important to explain to the client that it would be in their
best interest to refer them to a counselor or psychotherapist with
more experience in that area
Skills/qualities needed to be a counselor
● Empathy
● Sincerity
● Integrity
● Resilience
● Respect
● Humility
● Competence
● Fairness
● Wisdom
● Courage
Genuineness
● Being oneself, open and transparent in the relationship, not
hiding behind a mask of professionalism (also known as
congruence, realness or authenticity)
Respect
● Not judging or demeaning the client for their values or
behavior, not telling them how to live their lives or imposing
your own values, but listening to and acknowledging them as
a unique human being
Psychotherapy
● A talking treatment where the psychotherapist is interested in
personality change of some sort, and generally undergoes
more in-depth and experiential training in how to work with a
variety of people with a wide range of emotional stress,
mental health issues and difficulties
● Can be a hugely effective choice to alleviate emotional
suffering
Repeated exposure to an empathic relationship with a therapist
● Can help patients develop a model for a safe, boundaried
relationship
Unconscious feelings
● Psychotherapy helps us to make these conscious so that we
can understand how our inner conflicts affect us in the
present day
Counselor/Psychotherapist
● Trained listeners who work with clients to help them
overcome problems or difficulties they may be experiencing
● Provide a supportive, non-judgmental and confidential
environment where clients can explore emotional or
psychological problems
Therapist-patient relationship
● Patients can be helped to notice and observe what is
happening and explore any distortions in their ways of
thinking so that they can be more free to think, act and feel in
ways that feel better for them
Psychotherapy
● Requires hard work and emotional effort
● Requires that the patient is in the right place in mind
● Requires finding a good therapist who is right for the patient
● Requires the patient to be able to give the time and care
needed for the process
Transference
● Experiencing some of the same feelings you have toward
someone close to you - or had towards someone in the past -
towards your therapist now
Therapy isn't in fact for the select, disturbed few, it's for everyone
How therapy works
● Talking a lot to someone who listens very carefully, over many
weeks
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● Patterns start to emerge, a particular way of approaching
relationships, or dealing with defeat, a recurrent, not very
helpful, approach to jealousy, an ongoing thing with your
sister or father
Assessment as a therapeutic intervention
● Using assessment findings as a conversation starter to explore
their meaning and impact
There is a lot that holds us back from trying out psychotherapy
The only qualification for going to therapy is to be a normal human
being
Therapy is a skill, and one of the places you learn it is in the
outworldly, slightly unusual but in fact, deeply normal and productive
setting of a therapist's office
7 Basic Psychological Principles
● I matter
● I make a difference
● I am not a non-entity
● Need of Personal Significance
● Need for affection, unconditional acceptance and basic trust
● Need for clear and consistent limits
● Sense of Competence
● Need for Affiliation
● Need for a wide scope of self-expression
● Need for Transcendence
Carandang's Multi-dimensional Model
● 1st Dimension: A View of the Client as a Total Person
● 2nd Dimension: The Person's Developmental Level
● 3rd Dimension: Contextual consideration
● 4th Dimension: The Person's Inner World
Sadness
● Emotional pain associated with, or characterized by, feelings
of disadvantage, loss, despair, grief, helplessness,
disappointment and sorrow
Clients may focus more on negative aspects of test results, even if
there are more positive findings
Stages of Grief
● Denial (thinking "this can't be happening," or refusing to
accept the severity of the situation)
● Anger (looking for someone to blame or raging at the
unfairness of the situation)
● Bargaining (trying to exert control to change the situation,
even if it's generally out of your control)
● Depression (withdrawing, disconnecting, or experiencing low
motivation and having trouble going on as normal)
● Acceptance (understanding you can't change the situation
and resolving to live within the reality of your grief or loss)
Risk Factors for Depression
● Family and stability of environment (serious family fights and
conflicts, abusive or unpredictable behavior of parents,
isolation, alienation from family members or friends, multiple
losses)
● Exposure/Experience (exposure to suicidal behavior or actual
suicide of a family member or close friend/social media, one
or more prior suicide attempts)
● Comorbidity: Anxiety, ADHD, Conduct Disorders
How to help a Grieving Person
● Acknowledge that you are grieving (it helps to bring the
unconscious into the conscious, acknowledging your grief will
help you process it)
● Share your grief (it creates a sense of belonging, which helps
to stabilize us when our foundation is unstable)
● Rely on ritual (a 2017 study found that people who were
grieving found rituals helpful, even if they didn't lessen the
grief people felt)
Counselors in training often view the roles of counselor and assessor
as two different activities, but over time they come to understand the
two functions are quite similar and central to working with clients
Clients actively using substances may avoid discussing their substance
use, as they may not be ready to work on it
Reasons why assessment is important for counselors
● Counselors have to diagnose clients, which requires accurate
assessment
● Assessment helps track client outcomes and prevent
premature termination
● Counselors can have biases that lead to making early
assumptions about clients, so structured assessment is
important
● Clients are not always open and honest, so counselors need
to assess carefully even when clients are not disclosing
everything
Midwife metaphor
● Counselors are like midwives - they help clients "give birth" to
new life, but also need to recognize when there are
complications that require more intervention
Psychological testing can be helpful in differentiating between
conditions with similar symptoms, such as ADHD and bipolar disorder
Clients with trauma may have avoidance symptoms and fear of
re-traumatization when discussing their experiences
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Assessment findings
● Usually a point-in-time snapshot, not a lifetime diagnosis
Clients may not be open and honest with counselors for various
reasons, such as trauma, shame, and substance use
in other words the unchanging person doesn't only lack knowledge
they are vigorously committed to not acquiring it and they resist it
because they're fleeing from something extraordinarily painful in their
past that they were originally too weak or helpless to face and still
haven't found the wherewithal to confront
Assessments explored in this course
● Mental status examination
● Outcomes and session rating scales
● Mini-mental state exam
● Adult attachment interview
● Minnesota multiphasic personality inventory
● Beck inventories for anxiety and depression
● Sentence completion test
Association for Assessment and Research in Counseling (AARC) A
division of the American Counseling Association (ACA), whose mission
is to promote and recognize excellence in assessment, research, and
evaluation in counseling
Testing is part of the assessment process
The items may not have been developed to measure a particular
symptom
Assessment
● Used as a basis for identifying problems, planning
interventions, evaluating and/or diagnosing clients, and
informing clients and stakeholders
● Not just a means to an end like providing a label or diagnosis
Items on the MMPI and MMPI-2 may seem to lack evidence based on
test content
The MMPI and associated instruments (i.e., MMPI-2,
MMPI-2—Restructured Form [MMPI-2-RF], and MMPI-A [for
adolescents]) are among the most widely used instruments with over
19,000 articles and books published in relation to these instruments
In the 1960s to the present, measures were developed to focus on
specific psychological constructs, such as depression, with the Beck
Depression Inventory
16 Personality Factor Questionnaire (16-PF) Assesses general
personality, precursor to the NEO Personality Inventory
MMPI development
● Large sets of items were developed and selected based on
how homogeneous groups of psychiatric patients answered
the items
● Items that discriminated between diagnostic categories were
retained
Many of these instruments continue to rely on self-report, which may
be problematic in terms of producing a valid response from a client
who may not be well
Construct
● A phenomenon that exists but cannot be directly observed,
such as emotional states, cognitive traits, or psychological
states
The right for counselors to practice assessment is dictated by state
licensing boards
Assessment is essential to all elements of counseling, whether
practicing in a school, private practice, agency, or other health care
setting
Child Behavior Checklist Includes report forms for the client and
observers (e.g., parent, teacher)
Mental Health
● A state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity, rather it is
a state of overall Wellbeing (World Health Organization, 2020)
Acknowledgement of Non-verbal Behavior
● You are noting to the client what you are seeing. You are not
interpreting the non-verbal content.
Initial disclosure
● Main focus is relationship building, establishing rapport with
the client based on trust, respect, and care
Goal setting
● Goals should be connected to the desired end, explicit and
measurable, attainable, within the counselor's
knowledge/skill set, and focused on positive growth
Initial disclosure
● Practice basic counselor skills like empathy, genuineness,
unconditional positive regard
● Introduce yourself, be personable and inviting
● Allow the client to talk about their reason for coming in
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C&PT Reviewer
● Be patient and sensitive, give the client room to move at a
natural pace
Commitment to action/goal-setting
● Client identifies specific ways to move towards change and
the best course of action with the help of the counselor
Termination should be one of the first topics the counselor and client
discuss
Importance of Mental Health Psycho-social Support (MHPSS)
● Implementing the intervention Use affective interventions to
help the client express, manage, and identify feelings
● Use cognitive interventions to alter the client's way of
thinking about an event, person, self, or life
Lack of self-efficacy
● Poses a challenge to the patient asking for help to manage
their recovery
Empowerment
● A complex experience of personal change
Interventions are assigned to therapist or client with time-limited
achievable dates
Motivation Emotional, cognitive, physical, social, environmental
factors that drive change
Restatement/Content Paraphrasing
● A re-statement of what you heard the client say in slightly
different words.
Non-Helpful Behaviors in Counseling
● Advice Giving
● Lecturing
● Excessive Questioning
● Storytelling
● Asking "Why?"
Reflection of Feeling Similar to a re-statement, but you are
concentrating more on the emotional aspect & the non-verbal
communication.
Closed questions
● This type of question requires only a one or two word
response. Usually Yes or No.
Initial session
● It is during this time both the client and the counselor are
assessing one another to see if the relationship will work. It is
here the subject of the subsequent sessions will be discussed
and determined.
Requests for Clarification
● Asking the client for more information.
Skills useful during initial phase of psychotherapy/counseling
● Gathering Information
● Open questions
● Closed questions
● Probes
● Requests for Clarification
Probes
● A question which begins with a who, what, where, how, or
when.
Summary of Feelings
● A simple summary paraphrase of several feelings which have
been verbalized (non-verbal and verbal).
Premature Termination by Therapist
● At times, therapists have to end the therapeutic prematurely.
A summary session is in order and referrals are made, if
appropriate, to another therapist.
So that the client can Develop her/his own thinking
Hear her/his thoughts and know she/he is understood
Goals within counseling
● Help to set the tone and direction one travels with their
client. Without goals, the sessions will wander aimlessly.
Referrals
● Reason for the referral
● Note specific behaviors or actions which brought the need for
a referral
● Have the names of several other therapists ready for referral
● Cannot follow up with the new therapist to see if the
client/patient followed through (Confidentiality issue)
What the counsellor must do
● Listen
● Not judge
● Pay attention
● Accept the client's feelings
● Understand the client's world and feelings. Express that
understanding.
Body Language of the Therapist
● Facial expressions, angle of body, proximity, placement of
arms and legs
● Communication is 55% body language, 38% tone and 7%
words
● Therapist should send a message that they are listening
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C&PT Reviewer
S.O.L.E.R.
● S: Face the client squarely
● O: Adopt an open posture
● L: Lean toward the client
● E: Maintain eye contact
● R: Relax
Sessions don't always go as idealized in this presentation
Clients want to be heard and listened to
Therapist
● Therapists like to work with clients similar to themselves
Clients initially like to work with therapists perceived as experts,
attractive, trustworthy
Some Basic Principles
● Each client must be accepted as an individual
● Psychotherapy is a permissive relationship
● Counseling emphasizes thinking with the individual
● Decision-making may rest with either the client or therapist
● Psychotherapy is centered on the difficulties of the client
● Therapy is a learning situation which results in behavioral
change
● Effectiveness depends on client readiness and therapeutic
relationship
● The therapeutic relationship is confidential
We are all driven by the same hopes, fears, inspirations and aspirations
Therapists can get hypnotized by the details of a client's life, forgetting
to look at the larger underlying patterns
The light from the sun Is transformed into rainbow rays by the stained
glass window
People look and seem different from each other, but this is just local
shape and colour created by our perceptual filters
Counseling process
● Exploring
● Understanding
● Action
Stained glass window is a metaphor for human life
Ending phase
● Summarizing
● Allowing client to evaluate
Exploring phase
● Contracting
● Attending
● Silence
● Reflecting feelings
● Paraphrasing
● Focusing
Goal Guidelines
● Mutually agreed on by the client/patient and therapist
● Specific
● Relevant to behavior
● Achievement & success oriented
● Quantifiable & measurable
● Behavioral & observable
● Understandable & can be re-stated clearly
We can only start to overcome prejudice when we understand that
despite differences, we all share the same problems and needs in life
Developing a relationship with a client is an important part of the
counselling process
Challenging
● Pointing out themes or patterns in the speaker's story, done
thoughtfully and with support
Checking understanding with the speaker
● Clarifying details to ensure the listener has fully understood
what the speaker has said
Transference and immediacy
● The listener may generate feelings in response to the
speaker's story. Acknowledging and exploring these feelings.
Awareness of boundaries and referrals
● Recognizing when the speaker is asking for something the
listener is not trained to provide, and making an appropriate
referral
Empathic listening
● The ability to understand and share the feelings of another.
Responses should contain the emotion of what the speaker
said.
Reflecting on the patient's feelings
● Going back over what the client has communicated directly
through words and nonverbal behaviors, and making a fair
deduction about what the client may be feeling emotionally
Observing (Listening)
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C&PT Reviewer
● Retaining and understanding the verbal and nonverbal
information being conveyed by the patient
Counselors can't change people, but can be helpful in encouraging
clients to move towards change
Positive outcomes in counseling
● Less predicated on a certain type of therapy, more on the
counselor's ability to be enthusiastic, confident, and present a
belief in the patient's ability to change
Perception Check
● Allowing the client to confirm or deny the precision of the
counselor's paraphrase
Genuineness Counselor's actions reflecting their words, being honest,
comfortable, and themselves
Unconditional Positive Regard
● Expressing kindness and caring regardless of what the client
says, gently encouraging them to see things through the
scope of reality
Open Questions
● Questioning method to get the client to clarify or explore
thoughts and feelings, without requesting specific
information or limiting the response
Interpretation
● Counselor providing a new perspective, provoking thoughts or
feelings, or presenting an explanation for behaviors, outside
of what the client has said or may be aware of
Empathy
● Communicating the perception of the client's experience back
to them to clarify what they have said
● Involves nonverbal and verbal attending, paraphrasing,
reflecting on feelings, and perception checks
Counselor Self-Disclosure
● Counselor sharing personal feelings, life experiences, or
certain reactions to the client, only when clinically necessary
and with relevant content
Paraphrasing
● Counsellor repeats part of the story back to the client,
including what the person says and the emotion they're
expressing
● A sense of collaboration, warmth, and support between a
client and their practitioner, associated with emotional
flexibility, interpersonal communication, and trust
Mirroring
● Helps build a connection between the client and counsellor
● Helps the client feel they are really being heard and
understood
Information Giving and Removing Obstacles to Change
● Humbly presenting data, facts, wisdom, resources, or answers
to questions, and identifying and addressing potential
problems hindering the client's growth process
Silence
● Allows the client to speak about their issues without
interruption
● Gives the person space to process their feelings and thoughts
with no distraction
● Can encourage a client to talk as people feel uncomfortable
with silence
The therapeutic relationship itself is essential to the success a patient
experiences
Therapeutic alliance Empathy and genuineness
In counseling
● Client can try a different kind of relationship, one defined by
positive regard instead of criticism
This helps the therapist to better comprehend the affected person's
point of view, feelings, and motives, allowing them to provide the most
appropriate treatment and employ the most effective strategies
The presentation does not constitute counseling training, it's an
overview of counseling skills. Anyone wishing to practice counseling
should undertake appropriate training and have relevant supervision.
By experiencing a secure attachment with the therapist The person can
feel safe to start to resolve some of their old traumas and evolve their
model of relating
Therapeutic relationship
● The close and consistent association that exists between at
least two individuals: a health care professional and a person
in therapy
Skills needed by therapists
● Knowing when to speak and when not to
● Knowing when to show empathy, and when to push
● Careful not to bring their own bad relationships into the room
Therapeutic relationship
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C&PT Reviewer
● The quality and strength of the collaborative relationship
between client and therapist, typically measured as
agreement on the therapeutic goals, consensus on treatment
tasks, and a relationship bond
Collaborative Goal Setting
● Set SMART (Specific, Measurable, Attainable, Relevant and
Time Limited) goals
● Agreement of goals between patient and therapist increases
adherence to those goals
● Adherence leads to improved outcomes, patient satisfaction
and motivation
Empowerment
● By recognising a patient's powerlessness or sense of
powerlessness
Dimensions of empowerment
● Meaning
● Competence
● Choice
● Impact
Active listening
● Resisting the temptation to interrupt
● Using silence to give the speaker space and time to think
about, construct and say what they mean
● Encouraging the speaker to explore their thoughts
● Making it clear that you are interested in helping them to
develop their thoughts and ideas
Empathy has been linked with better patient satisfaction and recovery
rates, and subsequently better health outcomes
Intrinsic motivation
● The perception of self-competency shapes it, successful
attempts and acquisition of new skills and task completion
reinforce competency, which fuels motivation
Locus of control
● Internal locus of control is the perception of one's control
over personal competence and motivation
● As the person peels back the layers of their defenses, they can
start to recognize their unique wants and needs, what they
wish to change or who they hope to become
Effective communication
● Can create a more effective therapeutic setting, thus leading
to improved outcomes and the attainment of goals
The variability and intensity of the programme, along with the group
dynamic, reinforced Ellen's empowerment
Creating a therapeutic space
● Foster trust, safety and respect
● Encourage participation of the patient in creating goals
● Adjust the physical space to create a positive environment
that ensures privacy
Interpreter
● A skilled and trained person who converts oral information
into another language
The researchers handpicked this interviewee as someone who
exemplifies empowerment
Non-verbal communication
● Gestures, facial expressions, movements and tone of voice
can convey receptivity, interest, comprehension, hostility,
disinterest, anxiety or discomfort
● Non-verbal communication tends to outweigh the verbal
message
● Empathy and emotion are communicated more clearly via
non-verbal communication than verbal communication
Providing space for managing anger or frustration
● Experience of conflict, human rights abuses and displacement
may increase feelings of insecurity, fear, anger or frustration
● It is important to create an environment in which displaced
persons can fully express their anger, or frustration,
particularly where it impacts on their health and well being
● Acceptance of their emotions creates trust and that any anger
is likely aimed at the situation and not directly at you
Shared Decision Making
● Choice Talk - Step back, Offer choice, Justify choice, Check
reaction, Defer closure
● Option Talk - Check knowledge, List options, Describe options,
Harms and benefits, Provide patient decision support,
Summarise
● Decision Talk - Focus on preferences, Elicit preferences, Move
to a decision, Offer review
Warning signs of inappropriate therapist behavior
● Pays no attention to the changes the client wants to make and
the goals they wish to achieve
● Is judgmental of the client's conduct, lifestyle, or situation
● Encourages the client to blame friends, family members, or a
partner
● Provides no explanation of how the client is supposed to
know their therapy is complete
● Tries to be the client's friend outside of therapy or start a
romantic relationship
● Tries to touch the client without prior consent
● Talks too much or not at all
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● Attempts to push their spiritual beliefs on the client
● Tries to make decisions for the client
Responsibility in healthcare
● The obligation of healthcare professionals to perform their
duties competently and ethically, including providing quality
care, upholding ethical standards, fulfilling duties associated
with one's role
Reflective practice
● Thinking critically about practice
Communicating with displaced persons
● Pay attention to cultural considerations
● Utilise a client-centred approach
● Provide culturally sensitive care
● Acknowledge and respect differences in beliefs, values, and
ways of thinking
● Avoid generalisations about cultural groups
● Facilitate the dialogue so the client has an opportunity to
present their story
● Use active listening techniques
Rapport
● The relationship between the client and therapist in therapy
Vulnerability
● An individual's condition or life circumstances may
disadvantage them compared to others
Components of a therapeutic alliance
● Agreement on goals (Collaborative Goal Setting)
● Agreement on interventions (Shared Decision Making)
● Effective bond between patient and therapist (The
Therapeutic Relationship)
Rapport is the foundation and cornerstone of the therapy process and
without it, progress cannot be made
Rapport
● Includes the connection, the trust, the sharing, the safety, the
communication, and the dynamic of a relationship
Social support and reinforcement complete the transcendence of
empowerment
Rapport must be earned through trust and comfort in the relationship
Different characteristics will need to be present to have a positive and
healthy rapport with different people
Therapeutic rapport is more effective in making progress in therapy
than any other specific therapy techniques
Active listening
● Physically adjust your body to encourage two-way
communication
● Listen carefully without judgement, by giving your full
attention and avoid interrupting
● Pay attention and minimise distractions
● Show interest and create a positive atmosphere
● Use reflections
● Don't get emotionally involved
● Use non-verbal cues to show you are listening, such as
nodding or say "I see"
● Invite further disclosure with phrases such as "tell me more"
● Clarify with open-ended questions, particularly when seeking
a description or an elaboration on an answer
● Paraphrase what they have said to demonstrate that you have
listened, understood correctly and to show that it is
important to you
● Use non-judgmental phrasing in your responses and follow-up
questions
Talking to persons who are distressed
● Individuals who have experienced traumatic events may be
unable to speak of them or may be triggered easily by certain
topics of communication
● Clients with post-traumtic stress disorder may fall silent,
lapsing into a dissociative state to avoid the memory
● Talking about certain events can potentially renew wounds or
fears
● Individuals with strong numbing symptoms may present as
withdrawn, unresponsive and may be difficult to engage with
● It is impossible to anticipate all the circumstances that could
re-traumatise your client, but you can minimise the risk by
avoiding settings or behaviour that could remind them of
interrogation or torture experiences
Patient empowerment
● Begins with patient education and ends with the patient's
active participation in their physical therapy, transcendence
and sustainable management of the patient's impairment or
dysfunction by the patient being given autonomy and
authority over their rehabilitation and life
If rapport is not formed, it is almost impossible for forward progress to
be made in therapy
Patient safety, ethical practice, professional integrity, building trust,
and legal obligations are important aspects of responsibility and
accountability in healthcare
Communicating with interpreters
● Use certified interpreters with adequate language and
interpreting skills
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C&PT Reviewer
● Consider the age, gender and diversity characteristics of the
interpreter
● Address and make eye contact directly with the displaced
person, not with the interpreter
● Avoid talking to the displaced person "through" the
interpreter
● Shorten the sequence of your sentences
● Select your words carefully
● Adjust the kind of language that you normally use
● Ensure that the information and correct meaning is not lost in
translation
● Apply triangulation techniques to minimise loss of
information
● Encourage the interpreter to translate EXACTLY what the
patient has said
● Ensure interpreters have breaks and adequate rests
Translator
● A skilled and trained person who converts written information
into another language
How to build rapport
● Listen actively, show respect, demonstrate empathy, validate
the client, be honest, demonstrate competency, meet the
client at their level, pace progress and take small steps, use
self-disclosure appropriately
Listening
● A great skill that builds trust and encourages problem solving,
but it takes practice
Intuitive listening
● What the listener feels about the person, attending to the
patterns and areas that are avoided
The ICF framework focuses on positive reviews and enablement rather
than negativity and disabilities, and provides rehabilitation
professionals with a common language to describe rehabilitation
processes according to its positive features.
Language barriers can lead to negative health outcomes, decreased
adherence to treatment plans or a patient's unwillingness to
participate in rehabilitation treatment
Nancy Kline (1999): 'To help people think for themselves, first listen.
And listen, then listen.'
Research suggests that the way people deliver a message accounts for
93% of its meaning
As a mentor You will 'tune-in' to people
You will understand where they are coming from
You will understand what they are trying to say
The art of listening requires
● Prepare yourself
● Hold the focus
● Show that you are listening
External listening
● What the listener hears from the person, the words they say
and how they say them - how they see things
Good listening involves
● Maintaining good eye contact
● Encouraging people to talk
● Reflecting back what you hear
● Not interrupting
Mirroring
● Using the same words as the speaker is very helpful
Blocks to effective listening
● Knowing the answer
● Trying to be helpful
● Trying to influence or impress
● Making assumptions
● Only hearing what you want to hear
● Daydreaming
● Being in a hurry
● Looking for points to argue with
● Feeling nervous or vulnerable
Negative listening habits to avoid
● The FAKER: mind is elsewhere
● The INTERRUPTER
● The INTELLECTUAL or LOGICAL LISTENER: interprets and
judges
● The HAPPY HOOKER: steals the focus
● The REBUTTAL maker: looking for a mistake, an argument or
dismissal
● The ADVICE giver: can be good but can be a turn off
Why rapport is important
● Therapy is a hard process and at times uncomfortable, so
clients must feel safe to disclose painful emotions and
experiences
Mentee-centred
● It is important to remember that the person is more
important than the issues discussed. Our discussions should
always work around the development of the mentee and not
the subject
Becoming heated
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C&PT Reviewer
● Certain trigger phrases, words and views may cause mentors
to feel as if they should dive in with their own opinions;
resulting in the mentee becoming irritated, upset and
switching-off
Holding silence
● Giving people time to think and then speak, hard to do
The active listener
● Will notice any misconceptions or prejudices
● Will be skilful in reflecting back what the speaker has said to
clarify understanding and let the speaker know that you are
focusing on what they mean
● This helps the speaker clarify complex thinking and provides
an opportunity for them to elaborate
Reflexive listening
● What the listener hears in their own mind, can lead to
assumptions that are wrong
Useful phrases for active listening
● Confirming: Let me confirm..., Can I make sure I understand
what you've said..?, Can I just check?
● Summarising: Can I summarise what you've said please?, I
think you said...
● Checking: Is that right?, Have I understood you correctly?
Things to consider journaling about
● What was covered in the last session
● What you'd like to discuss in the future
● What you're noticing about yourself this week
● What you'd wish for if you had three wishes
● Your dreams
● How you feel about therapy and/or the therapist
● What you're feeling and thinking at the very moment you're
writing
● Your worries
● Your blessings
● Your goals
● Your memories
● Your writer's block
Journaling can work in harmony with psychodynamic therapy by
helping keep the process rolling, holding the defenses at bay and
helping the work flow from session to session.
Clients are allowed to introspect all they want between sessions, and
writing is a great way to focus and articulate their thoughts and
feelings.
Discriminative stimuli
● Sights, sounds, smells, activities associated with old behavior
that trigger cravings and urges
Treatment plans
● Roadmaps that help clients learn to set goals, provide an
objective reference for progress, and are necessary for ethical
and reimbursable practice
Counter conditioning
● Causing discomfort instead of pleasure, e.g. snapping a
rubber band when driving past a dealer's location
KSA's (Knowledge, Skills, Abilities) Framework for writing treatment
plans
● Knowledge - Learn about the problem
● Skills - Develop and practice coping skills
● Abilities - Successfully use skills in natural environment
Addressing discriminative stimuli
● Eliminate
● Counter-condition
● Change to elicit different behavior
In counseling, we learn about the symptoms, impacts, and how to
tailor methods to the individual
Coping skills Ways to deal with stress
● New behaviors must accomplish the same goal as old
behaviors, but in a healthier way
● Binge eater Someone who tends to binge on certain foods like
pizza, chocolate, and candy
● Depression What it is, what causes it, what triggers it, and
what mitigates it
● Self-esteem The difference between your real self and your
ideal self
● Certain medications can make people sick if they drink
Healthy social support
● Learning what a healthy relationship looks like, developing
effective communication skills, identifying important traits in
friends, and finding ways to meet new people
Happiness
● Highly personal and abstract, needs to be defined by the
individual
Anxiety
● The 6 basic fears that trigger the fight-or-flight response:
unknown, loss of control, rejection/isolation, failure, death
The first published randomized controlled trial of Morita Therapy in
English-speaking countries demonstrates the promise of Morita
Therapy in treating Western patients
26

C&PT Reviewer
The presentation will be comprehensive and around 20 minutes long
Split notes system
● Separate client details from case notes, use a code number to
link them
Characteristics of good goals
● Observable
● Measurable
● Time-limited
● Achievable
Many clinicians draw on more than one type of psychotherapy and
develop integrative treatments to meet specific needs
Process notes
● Counselor's personal reflections on the therapeutic
relationship and process, can include comments on
transference and countertransference
Case notes
● Details of main focus of session, important information such
as referrals or additional support, information demonstrating
good practice, other relevant information
Humanistic therapies
● Focus on people's ability to make choices and to develop their
potential
Systemic therapy addresses other living systems in addition to the
family, e.g. businesses, education, politics, psychiatry, social work, and
family medicine
Psychodynamic therapies
● Aim to change behavior, thoughts and emotions
Focus on motives and unconscious drives that may be behind these
thoughts, behaviors or emotions
Family therapy
● A branch of psychotherapy that works with families and
couples in intimate relationships to nurture change and
development, viewing change in terms of the systems of
interaction between family members
Systemic therapy differs from analytic forms of therapy in its focus on
practically addressing current relationship patterns rather than
analyzing causes
Four broad types of psychotherapy
● Cognitive and behavioral therapies
● Psychodynamic therapies
● Humanistic therapies
● Systemic therapies
Systemic therapy
● A form of psychotherapy which seeks to address people not
on individual level, but as people in relationship, dealing with
the interactions of groups and their interactional patterns and
dynamics
Salvador Minuchin
● A contemporary psychiatrist who helped to develop family
therapy and pioneered the field of structural family therapy,
which strives to identify subsets within a family construct in
order to isolate dysfunctional subsets and remap them into
more harmonious, healthy relationships
Psychodynamic therapy
● Patient lying on a couch and the therapist sitting behind
taking notes
● Many are done face-to-face, brief and effective
Systemic therapy
● Has its roots in family therapy, or more precisely family
systems therapy
● Traces its roots to the Milan school of Mara Selvini Palazzoli,
and the work of Salvador Minuchin, Murray Bowen, Ivan
Boszormenyi-Nagy, Virginia Satir and Jay Haley
● Was based on cybernetics in early forms, then shifted towards
"second order cybernetics" which acknowledges the influence
of the subjective observer
● Approaches problems practically rather than analytically, does
not attempt to determine past causes or assign diagnosis, but
seeks to identify stagnant patterns of behavior and address
them directly
Cognitive and behavioral therapies
● Focus on learning good new or more adequate behaviors and
strategies
● Focus on getting rid of inappropriate or bad or inadequate
strategies
● Focus on how we think, on our cognitive processes
The first randomized controlled trial of Morita Therapy to be published
outside of China has recently demonstrated the promise of the
approach in treating Western patients
Nature (in Morita Therapy) Not only the natural world as distinct from
humans, but more broadly the reality of all phenomena, encompassing
both the environment and human nature
Morita Therapy Holistic, experiential approach which aims to
re-orientate patients in nature
27

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Counseling & Psychotherapy Comprehensive

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