COUN Exam.pdf

LECTURE 1 AND 2: MENTAL HEALTH PRACTICE: PREVENTIONS AND INTERVENTIONS MENTAL HEALTH is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her...

LECTURE 1 AND 2: MENTAL HEALTH PRACTICE: PREVENTIONS AND INTERVENTIONS MENTAL HEALTH is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2004). Emotional/ Psychological/ Social Mental health is a dynamic state of internal equilibrium which enables individuals to use their abilities in harmony with universal values of society. Quality of Life: An individual's perception of their position in life. It includes subjective evaluations of both positive and negative aspects of life. Evaluate clinical outcomes individual’s own perceptions of how the treatment has influenced their illness experience. Six domains :Level of independence(daily living)/ Social relationships/ Physical(pain,energy)/ Psychological(self-esteem,learning)/Relation to environment(home environment)/ Spirituality, religion and personal beliefs SALUTOGENIC CONCEPT: The ability to use resources such as finances, knowledge, experience, self-esteem, healthy lifestyles, culture, social support is more important than the resources themselves. Sense of coherence (soc): It is defined as a way of seeing life and the ability to successfully manage the many stressors that are encountered during life itself. Cognitive component of comprehensibility (C) which refers to the extent to which one perceive the stimuli that confront one as consistent structured and clear. Positive cases, children have feelings of security and acceptance Instrumental or behavioral component of manageability (Ma) which is the extent to which one perceives that the resources at one’s disposal are adequate to meet the lives demands. Self-efficacy/ Children experience the acceptance of their individual progress. Motivational component of meaningfulness (Me) which refers to the extent to which one feels that life makes sense emotionally.Participate in decision-making processes. THREE LEVELS OF MENTAL DISORDERS PREVENTION Primary Prevention/ Tier 1: universal prevention, refers to programs delivered to all populations, Increasing protective factors in the environment Secondary Prevention/ Tier 2 selective intervention are more targeted and specialized services delivered to support who are at-risk. Tertiary Prevention/ Tier 3 intensive or individualized intervention, refers to programming directed at addressing the needs of people experiencing the most significant mental health problems. BIO-PSYCHOSOCIAL MODEL: Health and illness are caused by multiple factors and produce multiple effects/ Body and mind cannot be distinguished in matters of health and illness/ Multidisciplinary approach/ Explicit the significance of the relationship between patient and the practitioner ECOLOGICAL MODEL(It views human development as the result of the interactions between a person and their environment.) Ssystems affect the individual, Characteristics of the individual (e.g., gender, ethnicity, values) also influence experience of the systems. Bronfenbrenner's ecological model Bronfenbrenner’s theory focuses on the social contexts in which people live and the people who influence their development. Microsystem: Direct interactions with parents, teachers, peers, and others. Mesosystem: Linkages between microsystems such as family and school, and relationships between students and peers. Exosystem: experiences in settings in which a child does not have an active role influences the child's experiences. Macrosystem: The Broader culture in which students and teachers live. Chronosystem: The sociohistorical conditions of a student’s development STRENGTH BASED PRACTICE: Accomplishment, contribute to satisfying relationship to cope with stress/ Focus on client’s difficulties can lead towards negative forms of labelling/ Holistic picture of client/ Buffers against mental illness/ incongruences between Western and Chinese RESILIENCE: Turn adverse situation around and make life more endurable LECTURE 3: COUNSELLING AS A TREATMENT FOR MENTAL HEALTH PROBLEMS Guidance make important choices/ Counselling make changes / COUNSELING: A trained person practices scientifically derived principles for establishing professional helping relationships / Ethically defined mean/ Learning or human development / Preventative programmes/ Having more serious problems Psychotherapy usually a long-term process/ serious problems Counselling psychology grounded in the scientist-practitioner model/ Humanistic values subjective experience of the client DIFFICULTIES FACED BY CURRENT COUNSELLING PRACTICE: Higher standards/ Rigid outcome criteria/ Competition / Short-term/ Unpredictable economic climate / Information becomes more widely available.is recognized in medical fields in the concept of the Expert Patient EFFECTIVE HELPING: 1- SELF-AWARENESS/“value imposition” : Helps protect the client from helpers inadvertently projecting their values onto the helpee. 2- Cultural differences: explore your client’s ways of life 3- Analyze the helper’s own feelings: Accept that they do not have all the answers/ Recognize common feelings(e.g., fear, disappointment, elation, confusion etc.). 4- Be a model and influence 5- Be altruistic and compassionate: truly care/ open to feedback from clients 6- Ethics: ensure no harm 7- Catalyst(催化) for empowerment: empower a helpee 8- Open mindedness and objective 9- TRUSTWORTHINESS: clear about who you are ETHICAL AND LEGAL: Ethics are moral principles and ideal standards adopted by a professional organization that seeks to guide the professional behavior/ Laws: Rules of behavior established by courts and legislatures for defining the minimum standards ETHICAL DECISIONS 1-Competence: Psychologists areas only within the boundaries 2-Multiple relationships: another role with the same person/ relationship with a person closely→ Misusing power/ Exploiting the client/ Impairing objectivity 3-Informed consent: Provide sufficient opportunity for the client/patient to ask questions and receive answers./ Collaborative partnership/ Educate clients rights and responsibilities/ Encourage an active partner 4-PRIVACY AND CONFIDENTIALITY: Helpers should protect the confidentiality/ except impending( 即將到來的) Harm/ break law LECTURE 4:PSYCHODYNAMIC THERAPY I Psychodynamics means mind in motion/ maladaptive ways of thinking and behaving. Sigmund Freud (1856-1939)：Determinism：the elements that occur in consciousness are not random and unrelated.Past is embedded in the present THE STRUCTURAL MODEL OF THE MIND: Id (Pleasure Principle)basic needs/ Ego (Reality Principle) external world/ Super-Ego (Moral Principle)parental and social values ANXIETY: from repressed feelings, memories and desires.Conflict among the id, ego and superego DEFENSE MECHANISMS LESS ADAPTIVE 1-Splitting(black-and-white thinking )/ 2-Dissociation(disconnecting the self from aspects of one’s current reality)/3-Denial(Refusal to face,potential damage to self-esteem) /4-Projection(seeing one’s own traits in other people)/5-Regression(Go back to an earlier way,clinging to a parent)MORE ADAPTIVE 1-Repression(forget) / 2-Displacement(redirected attitude toward other)/3-Rationalization(False reasons in unacceptable attitudes)/ 4-Somatization(bodily sensation)/5-Reaction formation(opposite to unacceptable impulse)/6-Identification(internalizing, join them) Most adaptive:1-Sublimation(rechannelled into socially acceptable pursuits)/2-Altruism(help same situation people)/3-Humour Goals of psychodynamic Approach: Understand patient’s unconscious / uncovering will help most/ Uncover unconscious & Strengthen the ego function ACHIEVE: patient’s role from passive reporter to active observer/ Understanding the nature of conflicts/ Be mature and rational manner. Step1- ASSESSMENT- COLLECT INFORMATION: History/Capacity for self-reflection/ Psychological mindedness/ Ego function THERAPEUTIC TECHNIQUES Step2- THERAPEUTIC TECHNIQUES:1-FREE ASSOCIATION(making unconscious material conscious/ Tell their analyst everything that occurs to them)/2-INTERPRETATION(offering of a meaning/associate to the various elements such as childhood experience.)/3- ANALYSIS OF RESISTANCE/ 4-DREAM ANALYSIS: MANIFEST (days’ experiences /)AND LATENT(unconscious drives) :Reactions to and impressions of the dream’s meaning/ 5-TRANSFERENCE: patient feel about the therapist STEP THREE: ENDING THERAPY(experience of loss/ Internalization of therapeutic dialogue, reflected in an increased capacity for self-analysis) LIMITATIONS: Not be appropriate for all cultures/Determinism do not emphasize current maladaptive behaviors/ subjective interpretation/ client fantasy/ Lengthy LECTURE 5:PSYCHODYNAMIC THERAPY II ANALYTICAL PSYCHOTHERAPY - CARL JUNG Differences between FREUD(methodical, pessimistic,conflict-ridden) AND JUNG(impressionistic, optimistic,unconscious was the source of great wisdom) TYPES OF UNCONSCIOUS:1-Personal(individual,once conscious)/ 2-Collective(shared pool,inherit by being human) Collective unconscious- Four ARCHETYPES:1-Persona(mask is expected in the world)/2-SHADOW(Aspects like aggression or envy)/ 3-ANIMA(feminine) & ANIMUS(masculine)/4SELF: GREAT MAN (Unification of consciousness and unconsciousness/Product of individuation) THERAPEUTIC TECHNIQUES:Analysis of transference/ Active imagination/ Dream analysis(related to one another)/ Individual psychology-ALFRED ADLER(parents, social influence and feelings of inferiority): optimistic, People be educated developing social interest Object relations theory- Melanie Klein: earlier parent-child relationships (questions own personal worth and lovableness) Attachment theory- JOHN BOWLBY AND MARY AINSWORTH: Fear of being alone, Anxious-ambivalent children(inconsistent care), Avoidant children, Secure children LECTURE 6 CBT: COGNITIVE THERAPY(evidence-based, manualized ) Stages of CBT: 1-Assessment(self-rating/current coping patterns)/ 2-2. case formulation(problem list)/3-Treatment, Goal, and Therapeutic/ 4-Psychoeducation/ 5-Completion and Prevention:Remission(symptoms no longer met) →Recovery(long remission )/ Lapse(temporary symptoms)/ Relapse(recurrence of symptoms & diagnosis )/ Recurrence(recovery & new problem)/ Dependence(client’s inability outside world) Cognitive therapy- AARON BECK(Collaborative empiricism-works together with clients/ Maladaptive core beliefs or schemas(In-Class Exercise 3)/ Cognitive Distortions (BECK, 1995): 1-All-or-nothing thinking/ 2- Catastrophizing(Predicting disaster in future)/ 3- Disqualifying the positive/4-Overgen.(Single incident happen repeatedly)/ 5-Personalization(Thinking own cause negative)/ 6-Emotional reasoning(feels→must)/7-Mind reading/8- Labelling/9-Fortune telling (Predicting with limited evidence) Therapeutic Techniques:Evidence /Alternative /Implications BEHAVIORAL THERAPY CLASSICAL CONDITIONING (Frequency→Automatically) SYSTEMATIC DESENSITIZATION: 1-Vivo exposure (real life situation) desensitization/2-Massed exposure sessions(Flooding)/ 3-Interoceptive exposure(stimuli internal physical cues)/ 4-VR OPERANT CONDITIONING(Reinforcement & Punishment/ Interval & Ratio) SIDE EFFECT OF EXTINCTION: Extinction burst(frequency increase )/ Increase in variability/Emotional behavior(frustration→aggressive reactions)/ Aggression Lecture 2 Bio-Psychosocial model Biological (e.g. Gence) → disorder → do exercise Psycho. (e.g self-esteem ) → Social (Marco perspective → e.g. unemployment rate) → Comprehensive model to micro/macro Lecture 3 Definition of counseling Difference betweem Ethics (e.g informed consent → they have right to withdraw 2. Privacy and confidential) and Law Lecture 4 Psychodynamic approach (id, Ego, superego) Deffense mechanisms → indicate Case study Therapeutic technique → 1. Free Association (Function, Process) 2. Interpretation 5. Analysis of Transference LECTURE 4: PSYCHODYNAMIC THERAPY I Psychodynamics means mind in motion/ maladaptive ways of thinking and behaving. Sigmund Freud (1856-1939)：Determinism：the elements that occur in consciousness are not random and unrelated.Past is embedded in the present **THE STRUCTURAL MODEL OF THE MIND → Personal structured Id (Pleasure Principle): Contains basic needs and wishes ● e.g. “I want it all and I want it now” Ego (Reality Principle): Relates to the external world ● e.g. “You can‘t always get what you want”; negotiates between id and super-ego Super-Ego (Moral Principle): The last part of the mind to develop ● includes parental and social values ● Function of Super-Ego ○ the person’s conscience and their ideals for themselves ○ Overly harsh superego → Feel inappropriately guilty ○ underdeveloped superego → Without a good sense of right and wrong ANXIETY ● Conflict among the id, ego and superego to control psychic energy ○ Id wants its wishes satisfied ○ Ego is threatened by the pressure of unacceptable wishes ● Resulting from Repressed feelings, memories and desires ○ Unacceptable wishes and ideas become charged with unpleasurable feelings ■ Thus, they are blocked from consciousness **Defense Mechanisms ● Are normal behaviors which operate on an unconscious level and tend to deny or distort reality ● Cope with anxiety ● Have adaptive value if they do not become a style of life to avoid facing reality. LESS ADAPTIVE 1. Splitting (black-and-white thinking) a. Preserves good feelings and avoids bad feelings by separating them into different people. 2. Dissociation (disconnecting the self from aspects of one’s current reality) a. Can involve losing one’s consistent sense of identity, memory, and ability to perceive sensations or current sense of reality b. This is often used as a way to cope with situations that are too violent, traumatic, or painful to assimilate with their conscious self 3. Denial (Refusal to face, potential damage to self-esteem) a. Dismissive responses to failure or other people feedback b. External attributions for failure, such as bad luck c. Avoidance responses promote positive outcomes in the short run 4. Projection (seeing one’s own traits in other people) a. People’s conceptions of themselves shape their perceptions of other people. b. A person who is being unfaithful in a relationship may accuse their partner of infidelity. i. By projecting their guilt onto their partner, they are able to avoid confronting their own behavior. c. This can lead to blame-shifting and can cause significant harm to relationships. 5. Regression (Go back to an earlier way, clinging to a parent) a. Commonly used during periods of stress by people who generally function at a very high level b. A woman retreats to her parents’ home in order to feel protected as she did as a child i. She is faced with having to perform at a more advanced level. MORE ADAPTIVE 1. Repression (Exclusion → forget of painful conflicting thoughts, memories or impluses) a. Repress both the affect and the thought b. Repress the thought and leave the affect conscious c. Repress the affect and leave the thought conscious, for example, Intellectualization (理 智化) 2. Displacement (An attitude redirected attitude toward other) a. E.G. The urge to harm one’s father could be transformed into a self-destructive tendency b. People may become angry or hostile toward one target but are required for whatever reasons to avoid aggressing, and so they redirect their aggression toward a safer target 3. Rationalization (False reasons in unacceptable attitudes) a. False reasons are put forward to justify unacceptable attitudes. b. For example, the false belief that someone deserves punishment provides justification for hurting that person. 4. Somatization (bodily sensation) a. Thought or affect is repressed and is experienced as a bodily sensation b. A person who is under a lot of stress work and starts experiencing frequent headaches or stomach aches. 5. Reaction formation (opposite to unacceptable impulse) a. The exact opposite way to their true feelings in order to hide or suppress them b. E.g. Angry with someone, but instead of expressing their anger, Act overly friendly and kind towarsd them 6. Identification (internalizing, join them) a. Feelings such as jealousy and competitiveness are dealt with by internalizing aspects of the other person. (If you cannot beat them, join them) b. E.g. Be bullying others before be bullied c. E.g By parent always complain kid no value, the kids will internalize the aspect which they are no values at all Most adaptive 1. Sublimation (rechannelled into socially acceptable pursuits) a. Uncomfortable thought or affect is repressed to such as art and sport 2. Altruism (help same situation people) a. Doing things for others as a way of dealing with painful affects. 3. Humour a. It is adaptive to moderate anxiety, however the chronic use of humor to avoid painful affects can be problematic. b. A person who just lost their job. Instead of expressing their worry or sadness, they might joke, "Well, at least now I don't have to wake up early for work!" Goals of psychodynamic Approach 1. Understand patient’s unconscious 2. uncovering will help most 3. Uncover unconscious & Strengthen the ego function ACHIEVE 1. patient’s role from passive reporter to active observer 2. Understanding the nature of conflicts 3. Be mature and rational. Step1- ASSESSMENT COLLECT INFORMATION 1. History 2. 3. 4. 5. 6. 7. Capacity for self-reflection Psychological mindedness Ego function Prioritization of problems Motivation Resources and social matrix ** Step2- THERAPEUTIC TECHNIQUES 1. FREE ASSOCIATION (making unconscious material conscious/ Tell their analyst everything that occurs to them) 2. INTERPRETATION(offering of a meaning/associate to the various elements such as childhood experience.) 3. ANALYSIS OF RESISTANCE 4. DREAM ANALYSIS: MANIFEST (days’ experiences /)AND LATENT(unconscious drives) :Reactions to and impressions of the dream’s meaning 5. TRANSFERENCE: patient feel about the therapist STEP THREE: ENDING THERAPY (experience of loss/ Internalization of therapeutic dialogue, reflected in an increased capacity for self-analysis) LIMITATIONS: Not be appropriate for all cultures/Determinism do not emphasize current maladaptive behaviors/ subjective interpretation/ client fantasy/ Lengthy Lecture 5 PSYCHODYNAMIC THERAPY II ANALYTICAL PSYCHOTHERAPY - Carl Jung ● Developed the concepts of extraversion and introversion; archetypes, and the collective unconscious ● The goal of Jungian analysis is what Jung called individuation ● Individuation: The achievement of a greater degree of consciousness regarding the totality of the person’s psychological, interpersonal and cultural experiences. **Difference between Carl Jung and Sigman freud Freud ● Methodical, Pessimistic, preoccupied with unconscious, and conflict-ridden, instinctual drive states. ● Unconscious was a primitive(原始的) impulse needing to be subdued. Jung ● Impressionistic, optimistic, and preoccupied with unconscious forces, mystery, myth, and symbol. ● Unconscious was the source of great wisdom → to be approached respectfully, hopefully, and with a listening attitude Types of Unconscious ● Personal unconscious: Particular to each individual and is material that was once conscious ● Collective unconscious: Shared poll of motives, urges, fear, and potentialities that we inherit by being human ○ Dreams and fantasies contain impersonal material ○ Jung believed that the collective unconscious consisted of universally shared myths and symbols, common to all humans. The concepts of Archetypes ● Collective unconscious contains patterns and ordering principles that are essential components of the common human experience. ● The four major archetypes → Product of individuation a. Persona b. Shadow c. Anima & animus d. The self e. OTHER ARCHETYPES ■ The father: Authority figure; stern; powerful. ■ The mother: Nurturing; comforting. ■ The child: Longing for innocence; rebirth; salvation. ■ The wise old man: Guidance; knowledge; wisdom. ■ The hero: Champion; defender; rescuer. ● Persona a. It enables us to hold our inner selves together while interacting with the diverse distractions, temptations, provocations, and invitations the world offers us b. It is the mask we wear, or the set of behaviors we engage in to accomplish what is expected in a given relationship. ■ When a persona is too loose ● From outside, this might make someone look inconsistent. ● From inside, the person might struggle to have any sense of who he or she really is. ● SHADOW a. Aspects of ourselves that we have been unable to accept, like aggression or envy. b. We project our shadow archetypes onto other people and then over-react to that projection, as if it were something we were highly allergic to. c. All aspects of the personality – light and dark – are necessary for the personality if it is to become whole and well-grounded. ● Anima & animus a. These archetypal images are based upon both what is found in the collective and personal unconscious. b. All humans are potentially androgynous(雌雄同體的), but for most, one side comes to dominate over the other, thus causing the other to be sublimated or unconscious. ■ In men’s dreams, the anima manifests as female. ■ In women’s dreams, the animus archetype manifests as a male. ■ In many cultures, however, men and women are encouraged to adopt traditional ● Often rigid gender roles ● Jung suggested that this discouragement of men exploring their feminine aspects and women exploring their masculine aspects served to undermine psychological development. ● The self: Great Man a. Unification of consciousness and unconsciousness in a person and representing the psyche. b. Jung believed that this Self within us, when fully realized, helped us connect with the spiritual around us – the larger spiritual truths Therapeutic Techniques: Analysis of Transference 1. Realize the projection → withdraw the projections → integrate them as conscious parts of patient’s own personalities 2. Therapists expand the scope of transference by considering its sociocultural and archetypal components. 3. Patient can begin to relate to therapist as a normal human being Therapeutic techniques: Active Imagination 1. Jung was deeply impressed by what he termed ‘psychic reality’ and he believed that observing the flow of images within one’s imagination gave a person access to the activity of their inner lives. 2. Once an image has been formed and elaborated, the second step is to try to understand it Therapeutic techniques: Dream Analysis ● Dreams can be related to one another. ● Dream is a “basic religious phenomenon and that the voice which transcending us ● According to Jung, Dream is accurate renderings of something that needs attention. Dream is also point to solution to both exterior and interior problems INDIVIDUAL PSYCHOLOGY - Alfred Adler Emphasis on the importance of parents, social influence and feelings of inferiority (自卑). COMPARISON BETWEEN FREUD AND ADLER Sigmund Freud Alfred Adler All human motivation came from sex and aggression. People as being motivated mostly by social influences and the striving for superiority(優越) or success. People have little or no choice in shaping their personality. People are largely responsible for who they are. Can change, Your Choice Present behavior is caused by past experiences. Present behavior is shaped by people’s view of the future. Emphasis on unconscious components of behavior. Psychologically healthy people are aware of what they are doing and why they are doing it (Lifestyle). THEORETICAL PRINCIPLES 1. Adlerian theory is hopeful and optimistic 2. People are not to be blamed, but to be educated 3. Development of social interest or a sense of social responsibility is a goal of therapy. 4. social interest → Capacity for empathy and altruism (利他主義) 5. Symptoms help individuals avoid facing life tasks for which they feel ill-prepared or inadequate a. BASIC MISTAKES i. Overgeneralizations ii. False or impossible goals of security → society as working against him or her iii. Misperceptions of life and life’s demands → “I never get a break” iv. Minimization or denial of one’s worth → “I am stupid” v. Faculty value → “You have to cheat to get your way” Therapeutic Strategy ● Be a friendly, supportive model ● Use encouragement to help clients ● Help clients have insight into their style of life ● modify their basic mistakes Object relations theory - Melanie Klein ● Focuses on the dynamics and motivation → Earlier parent-child relationships ● Her work built on the knowledge gained by Freud in his work with adults ○ our understanding of personality development ● OVERVIEW ○ Focuses on individual’s internal representations of their relationships with the external world ○ How formative relationships with early caregivers become incorporated into the sense of self. ○ Caregiver is responsive → Child experiences a sense of security, control, and understanding ○ Support and nurturance is unresponsive (absence, ambivalence, rejection, or hostility) → child becomes fragmented, resulting in feelings of helpless,and ineffective ○ Unstable and disguised patterns → The child is unable to structure a clear sense of distinguished individuality and questions her or his own personal worth and lovableness ● Three Types of Children (Ainsworth, 1978) 1. Secure children (provide a secure base) – high selfesteem, positive attitude 2. Avoidant children (caregiver dislike hugs and bodily contact) – angry, cold and distant attitude toward people, repeating cycle of breaking up and getting back together with same romantic partner 3. Anxious-ambivalent children (caregiver are inconsistent or chaotic) – anger, insecure → uninterested in romantic relationships, dislike people who share personal information Lecture 6 Cognitive behavioral therapy I: cognitive therapy Cognitive behavioural Therapy: evidence-based, manualized treatment for a particular problem ● Reinforcing positive behaviors ● ‘identify cognitive patterns that are linked with behaviors Collaborative Empiricism ● Transparency about the therapy and the therapeutic process. ● Clients are actively involved in planning the interventions, and they do all of the work involved outside of the session. Stages of Cognitive Behavioural Therapy 1. Assessment(self-rating/current coping patterns) a. Current coping and approach-avoidance patterns b. Skills deficits, lack of knowledge c. Current social support d. Development and timeline of problem e. History of treatment 2. Case formulation(problem list) ● Case formulation (case conceptualization) is the bridge from assessment to treatment. ● Developing the problem list (The major purpose of CBT) ○ Early success in therapy helps to engage the client in the therapy process. ● Developing the initial case formulation ○ The interaction among life events, core beliefs and current thoughts, emotions, and behaviors. ○ Obstacles also need to be identified both to minimize their negative impact on therapy and to develop possible solutions to them. ● Communicating the case formulation and assessment results ○ Consider using quotes from what client has already told → particularly in relation to the client’s core beliefs 3. Treatment, Goal, and Therapeutic a. Formal contracts are defined i. Improve adherence and motivation ii. Clear intentions and goals for change iii. Less therapist input and more input on part of client b. Establish concrete criteria i. Goal attainment scaling ii. Goals can be divided into affective, behavioral, cognitive, and interpersonal. 4. Psychoeducation ● Teaching relevant psychological principles and knowledge to client ● Self-help manuals 5. Completion and Prevention of Relapse (復發) a. Remission (Symptoms no longer met) b. Recovery (Long remission than a prespecified period) c. Lapse (temporary recurrence of symptoms) d. Relapse (反復出現) (Recurrence of symptoms & diagnosis ) e. Recurrence (Occurrence of symptoms or problem behavior following recovery & new problem) f. Dependence (client’s inability to form healthy relationships outside of therapy) Cognitive therapy- AARON BECK(Collaborative empiricism-works together with clients/ Maladaptive core beliefs or schemas(In-Class Exercise 3)/ CBT → Concepts of Cognitive therapy AARON BECK ● He is widely regarded as the father of cognitive therapy. ● His theories are widely used in the treatment of clinical depression. ● Beck also developed self-report measures of depression and anxiety including Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Concepts of Cognitive therapy → collaborative Empiricism ● Collaborative Empiricism → Works together with clients to help them discover for themselves the maladaptive nature of their automatic thoughts ● Requires therapist to work within client’s frame of reference, trying to see world through client’s eyes Characteristics of Beck’s Theory ⇒ COGNITIVE THERAPY ● Individuals are exposed to a variety of specific life events or situations, some of which trigger automatic, maladaptive thoughts. ● Maladaptive thoughts are usually derived from deeply held maladaptive core beliefs or schemas ● Individual acquire these core beliefs during childhood ** Concepts of Cognitive Therapy State 1-3 → Unconscious information processing State 4,5,6 → Based on situation → automatic thought → come to behavior 1. Childhood Experience 2. Core Belief/ Schema → Focus Present Feeling a. Schema concept refers to cognitive structures of organized prior knowledge, abstracted from experience with specific instances; schemas guide the processing of new information and the retrieval of stored information” (Kovacs & Beck, 1978) b. As in psychoanalytic theory, the notion of cognitive schemas suggests the power of unconscious processes in influencing thought, affect, and behavior i. Unlike the psychodynamic unconscious, schemas exert (使用) their influence through unconscious information processing, rather than through unconscious motivation and instinctual drives. c. **Core Beliefs Influence Thoughts (Three basic core beliefs) i. About self: I am smart, , I am lovable, I am selfish, I am incompetent, I am unlovable. ii. About others: Others are kind, others will take care of me, others are mean, others will take advantage of me. iii. About the world: The world is just, the world is stable, the world is dangerous, the world is unjust 3. Intermediate beliefs (Conditional Assumptions) → how can I get what I want a. Beliefs at an intermediate level are in the form of "if. .. then" rules. i. “If I do whatever people want, then they will like me.” ii. “If I trust others, I'll get hurt.” iii. “Unless I am perfect, I will fail.” 4. Situation 5. Automatic Thoughts a. Automatic thoughts are moment-to-moment cognitions that occur without effort, or spontaneously,in response to specific situations. b. For example, anxiety is based on anticipating problems as threat and danger in the future : i. “I will die” ii. “I will lose my job” iii. “I will make a fool of myself. ” Example (Negative Automatic Thoughts ): (Core Belief) (Intermediate Beliefs) (Situation) “I am incompetent” “If I try to do something difficult, I will fail” “If I avoid doing it, I will be ok.” “Reading a new test” (Automatic Thought) (Reaction) “I’ll never master this.” “This is just too hard.” Emotional: Discouragement Behavioral: Avoid task Physiological: Heaviness in body 6. Emotion Behaviour **COMMON COGNITIVE DISTORTIONS(1. Name 2. Elaboration 3. Example) 1. All-or-nothing thinking (or “black and white” thinking) a. To place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. b. We must be perfect or we’re a failure - There is no middle ground. c. “If I cannot get 100 marks, I am a failure.” 2. Catastrophizing a. Predicting disaster in future and ignoring a possible positive future. b. “I will be so upset; I won’t be able to function at all.” 3. Disqualifying the positive a. Not attending to, or giving due weight to, positive information. b. “I did that project well, but it is only because I got lucky.” 4. Overgeneralization a. View a single incident as a predictable pattern for the future. b. After one bad date and think “I will never find a partner.” 5. Personalization a. Blaming yourself for something you are not entirely (or at all) responsible for i. e.g. “Our team lost because of me.” 6. Emotional Reasoning a. Assuming that your emotions reflect reality, and reason or draw conclusions form how you feel. i. "I feel it, therefore it must be true." ii. “I know I do a lot of things okay at work, but I still feel like I am a failure.” 7. Mind reading a. Making assumptions about what someone else is thinking i. He’s thinking that I am lacking knowledge on this area 8. Labelling a. An extreme form of overgeneralization b. Putting a general label on someone or something, rather than describing the behaviors or aspects of the thing. i. e.g. “I’m a loser.” 9. Fortune telling a. Predicting the future with limited evidence. i. “I must fail the exam tomorrow.” THERAPEUTIC TECHNIQUES Examine the evidence → Identifying unrealistic expectations → Examine attribution biases How can we challenge cognitive distortion (Intervention for Negative thinking) 1. What is the EVIDENCE for and against this thought? 2. What are the ALTERNATIVE ways to think in this situation? 3.What are the IMPLICATIONS of thinking this way? EXAMPLE: ANXIETY ● Client’s avoidance in action ○ Avoidance can lead clients to want to stop counselling ○ It is important to elicit specific thoughts, in statements rather than questions. ● Client's Need for Reassurance (安慰) ○ Gaining reassurance means that the responsibility for making decisions is passed on to someone else Lecture 7 → No Short/ Long Question Lecture 8 Personality Structure (Self worth/ Self -image/ ideal Self) - CARL ROGERS CARL ROGERS 1. Founder of Nondirective – Clientcentered / Person-centered Therapy (PCT) 2. A major spokesperson for humanistic psychology 3. Academic major changed from agriculture to history, then to religion, and finally to clinical psychology 4. First to record counselling session A reaction against the directive and psychoanalytic approaches 1. The assumption that “the counselor knows best” 2. The validity of advice, suggestion 3. Clients cannot understand and resolve their own problems without direct help 4. The focus on problems over persons Humanistic worldview 1. People are basically good and will actualize in the absence of interference. a. Absence of interference → Your strength have not fit environment to actualize 2. At their core, humans are trustworthy and positive 3. Society, rather than restraining negative forces, leads people astray(偏離正軌地) 4. Society does this by providing conditional positive regard View of human nature ● Reality is subjective, no one can fully understand experiences of another ● Human beings are inherently good, can change (antideterministic), also self-directing and accept full responsibility ● If a relationship is characterized by acceptance, a person can regain his or her emotional and spiritual equilibrium ● People can understand their defensiveness and move towards actualizing their full potential. Free Choice: People can choose what they become. Actualizing tendency: Gravitate toward self-actualization and reaching full potential. Growth Orientation: People have a tendency toward growth and actualization People are experts about themselves → As a result, therapy is generally insight-oriented and nondirective **Humanistic View of Personality Development The humanistic approach states that the self is composed of concepts unique to ourselves. Self worth (self-esteem) what we think about ourselves Self-image (Actual Self) How we see ourselves Ideal self The person who we would like to be **Why do people have psychological disorders? ● Psychological disorder and distress develop through the assimilation of worth conditions into an individual’s own identity ● Congruent person → Perception of self is consistent with what he experiences ● Incongruence is the root of psychological or emotional dysfunction. ○ Incongruence is a discrepancy between the self concept and reality. ● When incongruence occur , as we prefer to see ourselves in ways that are consistent with our self-image, we may use Defense Mechanism like denial or repression in order to feel less threatened ** Core Conditions in Person-Centered therapy → Growth 1. Two persons are in psychological contact. a. Empathy is required. b. Can openly express feelings and attitudes that are present in the relationship with the client 2. The client is experiencing incongruence a. Serves as a model of a human being struggling toward greater realness 3. The therapist is congruent or integrated in the relationship. 4. The therapist experiences unconditional positive regard or real caring for the client. a. Provides a supportive therapeutic environment in which the client is the agent of change and healing. 5. The therapist experiences empathy for the client’s internal frame of reference and endeavors to communicate this to the client. 6. The communication to the client is, to a minimal degree, achieved We believe human being have potential, During Counseling session (e.g Empathic Understanding) **Growth 1. Empathic understanding 2. Congruence 3. Unconditional positive regard 4. Inner resources/ Actualizing tendency HOW TO DEMONSTRATE? LISTENING AND FEEDBACK 1. Genuineness a. Therapist’s behaviors match his or her words b. Not hiding self c. Natural and spontaneous 2. Unconditional positive regards a. By allowing clients freedom to discuss themselves b. By demonstrating that you hear and remember specific parts of a client’s story c. Acceptance and genuine caring about the client as a valuable person. 3. Empathic understanding a. Rogers (1965) was intent on facilitating clients’ access to their inner experience so that they could nurture an in-built capacity to evaluate their experience. b. To symbolize inner subjective experience → To reflect on problematic aspects → To develop new ways of seeing and behaving c. Person-centered therapy encourages a greater tolerance for ambiguity and a capacity to look at things from different angles, thereby admitting alternative explanations for events. d. Increased cognitive complexity STAGES OF THERAPY (Being Accepted by others → Self Accepting → Toward Self-Fulfillment → Growth) 1. The client comes in for therapy 2. Define helping relationship with client 3. Counselor provide a safe place where clients free to express all feelings 4. Negative feeling will arise, it can be examined and gain insight 5. After negative feelings, positive feelings and thoughts will begin to arise, sometimes a surprise for clients. 6. Both negative and positive feelings that arise will be accepted, examined, and processed. 7. The exploration of all feelings within a safe, accepting climate leads to an understanding and acceptance of self. 8. As counselling continues increased insight is achieved and possible course of action are decided 9. To make small but important positive behavioral changes in daily life 10. Self understanding become more complete and more accurate 11. Increase self-direction in his/her life and become less fearful about making choices that will lead to more productive relationships and effectiveness. 12. Become increasingly autonomous and gradually develop a sense that a therapist is no longer needed. Fully functioning person ● The good life is a process of movement (not a state of being) in a direction (not a destination) 1. An increasing openness to experience 2. Increasingly existential living 3. An increasing trust in one’s organism a. i.e., as a means of arriving at the most satisfying behavior in each existential situation 4. An increasing experience and acceptance of one’s feelings Contribution of person-centered therapy ● Wide variety of helping situations (group counselling, family counselling, classroom learning) ● Remove the helping process from the exclusive control of highly trained professionals ● Make psychotherapy understandable and usable to all people Limitations of person-centered therapy ● Too Individualistic (Contradictory to chinese culture) and optimistic view of human nature people ● Does not focus on the use of specific techniques, making this treatment difficult to standardize ● Beginning therapists may find it difficult to provide both support and challenges to clients Lecture 9 Rational Emotive Behavioral therapy REBT Albert Ellis → It’s never the events that happen that make us disturbed, but our view of them (Ellis, 2005). Rational Emotive Behavioral therapy REBT 1. Cognitive/ Behavioral approach 2. Beliefs system 3. How People (who want happiness) can inadvertently(不經意地) create personality and emotional disturbance. ● Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations VIEW OF HUMAN NATURE ● We are born with a potential for both rational and irrational thinking. ● We have the capacity to change our cognitive, emotive, and behavioral processes. ● We have an inborn tendency toward growth and actualization. Basic Propositions of REBT ● Neurotic thinking is the result of unrealistic, illogical thinking. ● Culture and family can perpetuate (使永久) irrational thinking. ● A warm therapeutic relationship may be desirable, but it is not necessary or sufficient condition for change. ● The focus is not symptom removal but cognitive and behavioral change. Rational Beliefs 1. Internally Consistent 2. Are empirically Verifiable 3. Are not Absolutist 4. Results in adaptive emotions 5. Helps us attain our goals Irrational Beliefs 1. Logically inconsistent 2. Inconsistent with empirical reality 3. Are absolutist and dogmatic (教條主義) ● iB’s are often over learned, rehearsed since childhood, and are frequently based on grandiose(不切實際的) demands placed on the self, others. (Ellis 1979) *The 3 Core Irrational Beliefs - 3 Must toward Self, Other and World 1. APPROVAL (upset to the Self-image): I must do well and win the approval of others or else I am no good, inadequate and unlovable person. a. Anxiety, Depression, Shame and Guilt 2. JUDGEMENT (Demands about Others/ Low Frustration-tolerance, LFT): Other people must do ‘the right thing’ or else they are no good and deserve to be punished a. Rage, Passive-aggression and acts of violence 3. COMFORT (Demands about the World/ Low Discomfort-tolerance, LDT): Life must be easy, without discomfort or inconvenience. I should be able to feel happy all the time. a. Self-pity and Procrastination Cognitive distortion in REBT (Name/ Elaboration/ Example/ Result) 1. Absolutist must and should a. Individual believe that he/she must or should act a certain way in life i. I must be the best lover b. Result: Setting up failure and excessive demands 2. Awfulizing a. Exaggerates events by making them horrible, terrible, awful or catastrophic. i. If I don’t get into the university my life will be shattered. b. Excessive fear and panic 3. Can’t-Stand-It-It is (discomfort intolerance) a. It continually see events as being unbearable i. I just can’t stand with my boss anymore b. Excessive worry and depression 4. People rating a. Judging the total value or worth of a person. It represents an overgeneralization whereby a person evaluates a specific trait, behavior or action according to some standard of desirability or worth. i. I did a bad thing; therefore I am a bad person. ii. I love you so much, why do you leave me? b. Negative self and emotions **The ABCDE model (Ellis & Harper, 1975) A ⇒ Activating event B ⇒ Belief system (iB = irrational belief) C ⇒ Emotional/ behavioral consequences of A and B D ⇒ Disputing irrational thoughts and beliefs (Treatment of REBT) E ⇒ Cognitive and Emotional effects of revised Example: A Activating event B Beliefs and meanings C Emotional/ Behavioural Consequences of A and B D Disputing irrational beliefs (Cognitive Techniques) i.e. Challenge by evidence/ logic/ consequences Lover has not phoned as he/she promised They are losing interest in me Sad They are thoughtless and unkind Anger They are usually reliable. Something must have happened to them Anxiety Empirical Encourage client to look for empirical evidence that confirm or disconfirm their irrational beliefs, usually iB is counter with reality Logical Encourage clients to look to examine whether or not the iB are logical. ‘Does it make sounds that if you fail one test in police recruiting means you will fail again?’ Functional : Pragmatic(務實) Detach (分開) the clients from their beliefs by emphasizing the consequences, ask them whether the iB helps to pursues the goals. ‘What happens if you continue to engage in casual sex relationship, does it help you to find the true one?’ Double-standard dispute If the client is holding a ‘should’ about their behaviour, ask whether they would globally rate another person (e.g, best friend, therapist, etc.) for doing the same thing, or recommend that person hold their demanding core belief. Treatment ⇒ Role Reversal Playing ● Clients take the role of counselor, learn how to dispute his or her own iB. ● Allow the client to view interactions from another person’s perspective. ● Useful exercise when a client is experiencing conflict of values or feelings or a conflict with his or her self-image but is unable to isolate and understand the nature of the conflict. (Behavioral Techniques) Operant Conditioning ● Help Client arrange reinforcements and penalties ● Use most of the standard behavioural therapy approaches Skill Training and Modeling ● Teach client various skills ● E.g., social skills, assertion skills. and time management Exposure ● Test the validity of one’s fears ● De-awfulize them (by seeing that catastrophe does not ensue) ● Develop confidence in one’s ability to cope (by successfully managing one’s reactions) ● Increase tolerance for discomfort (by progressively discovering that it is bearable) ⇒ Enhancing personal ability Treatment ⇒ Shame-Attacking Exercise ● Purposely acting out of a situation that might normally cause embarrassment in public ○ E.g. Asking Stranger for dollars bills, Singing in the street ● Help client understand approval from clothes not necessary for self-acceptance ● Not illegal, immoral but silly and weird ● ● ● ● Treatment ⇒ Rational Emotional Imagery (REI) Client ask to close their eyes and focus intensely on the situation that is causing extreme emotional disturbances After reconstruct the image and signals, the counselor then ask the client to change the upsetting feelings to a more reasonable emotions. By using REI, client able to control their thoughts and ultimately control their emotions and behaviors. 兒時經歷時，覺得洪水猛獸，人成長後回望可能承受得到 Lecture 10 → No Short/ Long Question