Reality, Feminist, PostModern Approaches & Family Counseling PDF

REALITY THERAPY BACKGROUND INFORMATION William Glasser Psychiatrist for the Ventura School Girls in California. Was able to published a research “ Mental Health” or “Mental Illness”  Introduction Reality therapists believe the underlying problem of most clients is the same: they a...

REALITY THERAPY BACKGROUND INFORMATION William Glasser Psychiatrist for the Ventura School Girls in California. Was able to published a research “ Mental Health” or “Mental Illness”  Introduction Reality therapists believe the underlying problem of most clients is the same: they are either involved in a present unsatisfying relationship or lack what could even be called a relationship. Reality therapy is based on a Reality therapy has been used in a variety of settings. The approach is applicable to counseling, social work, education, crisis intervention, corrections and rehabilitation, institutional management, and community development View of Human Nature Choice theory posits that we are not born blank slates waiting to be externally motivated by forces in the world around us. Rather, we are born with five genetically encoded needs that drive us all our lives: survival, or self-preservation; love and belonging; power, or inner control; freedom, or independence; and fun, or enjoyment.  Characteristics of Reality Therapy Reality therapists do not listen very long to complaining, blaming, and criticizing, for these are the most ineffective behaviors in our behavioral repertoire 1. Emphasize Choice and Responsibility- If we choose all we do, we must be responsible for what we choose.  2. Reject Transference Reality therapists strive to be themselves in their professional work. By being themselves, therapists can use the relationship to teach clients how to relate to others in their lives. 3. Keep the Therapy in the Present Glasser (2001) disagrees with this assumption and contends that whatever mistakes were made in the past are not pertinent now. An axiom of choice theory is that the past may have contributed to a current problem but that the past is never the problem. 4. Avoid focusing on symptoms Glasser (2003) contends that people who have symptoms believe that if they could only be symptom-free they would find happiness. The therapeutic Process To help clients get connected or reconnected with the people they have chosen to Therapist’s Function and Role How would you most like to change your life? What do you want in your life that you are not getting? What would you have in your life if you were to change?. Client’s Experience in Therapy Clients are not expected to backtrack into the past Therapists will gently, but firmly confront clients. Clients can expect to experience some urgency in therapy.  REALITY THERAPY Focus on the role of control. (choice theory) Here and Now and how to build better future. Glasser suggests that “ 99% of the problem in relationships stem from external control psychology characterized by “I know what is right for you” Heart of reality therapy –”it is what you choose to do in a relationship, not what others choose to do” Clients seek to discover what they really want and whether what they are currently doing (how they are choosing to behave) is actually bringing them nearer to, or farther away from, that goal  The Counseling Process The primary goal of reality therapy is to help client choose to live their lives in the manner that is responsible and does not interfere with the rights of the others. Focuses on present behavior and makes no attempts to explore past events such as childhood trauma. Does not recognize mental disorders because they represent negative labels.  TECHNIQUES Teaching the clients how to use choice theory to meet their basic needs in a responsible manner. “Eight set approach for implementing reality therapy” 1. Create a relationship 2. Focus on current behavior 3. Invite clients to evaluate their behavior 4. Make a plan of action 5. Get a commitment 6. Refuse to accept refuses 7. Refuse to use punishment 8. Refuse to give up * In applying these steps Glasser suggested flexible approach*  Approach: WDEP 1. W- wants ,needs and perceptions * exploring what client wants out of life by asking questions * Exploring client’s inner “picture album” 2. D – doing and the direction * Focuses on evaluating the client’s current behaviors as expressed in the here and now (rather than delivering into the past)  Approach: WDEP 3. E – self-evaluation * involves helping the client engage in a process of self-analysis * critical stage in counseling in terms of getting client to be motivated 4. P- plan * plan to make necessary changes * plan should be : simple, attainable, measurable, immediate, involved, controlled by the client, committed to and consistent. SUMMARY AND EVALUATION Popular short-term form of intervention that focuses on behavior that is occurring in the present. Attractive type of treatment with people who have acted to be irresponsible. Can be used in group counseling with addicts to enhance self-esteem. FEMINIST THERAPY  KEY CONCEPTS OF FEMINIST THERAPY Problems are viewed in a sociopolitical and cultural context Acknowledging psychological oppression imposed through sociopolitical status of and minorities The client knows what is best for her life and is the expert on her own life It is assumed that individual change will best occur through social change  FOUR APPROACHES TO FEMINIST THERAPY 1. Liberal Feminism-EQUALITY Focus Helping individual women overcome the limits and constraints of their socialization patterns Aims to change current legal structures and interventions to promote access for women Major goals Personal empowerment of individual women Dignity Self-fulfillment Equality  FOUR APPROACHES TO FEMINIST THERAPY 2. Cultural Feminism Focus Oppression stems from society’s devaluation of women’s strengths Emphasize the differences between women and men Believe the solution to “We found that one important source of healing emerged when we got in touch with all the factors in our lives that were oppression lies in feminization causing particular pain. For black females, and males too, of the culture that means learning about the myriad ways racism, sexism, class exploitation, homophobia, and various other structures Society becomes more nurturing, of domination operate in our daily lives to undermine our capacity to be self-determining.” cooperative, and relational -- Bell Hooks  FOUR APPROACHES TO FEMINIST THERAPY 3. Radical Feminism- re-ordering of society. Focus The oppression of women that is embedded in patriarchy Seek to change society through activism Therapy is viewed as a political enterprise with the goal of transformation of society Major goals Transform gender relationships Transform societal institutions Increase women’s sexual and procreative self-determination.  FOUR APPROACHES TO FEMINIST THERAPY 4. Socialist Feminism- Socialist feminists believe that women's liberation must be sought in conjunction with the social and economic justice of all people. Focus Goal of societal change Emphasis on multiple oppressions Believe solutions to society’s problems must include consideration of: Class Race Other forms of discrimination Major goal to transform social relationships and institutions  PRINCIPLES OF FEMINIST THERAPY The personal is political- slogan”PRIVATE IS POLITICAL Personal and social identities are interdependent Commitment to social change The counseling relationship is egalitarian Women’s and girls’ experiences and ways of knowing are honored Definitions of distress and “mental illness” are reformulated There is an integrated analysis of oppression GOALS OF FEMINIST THERAPY To affirm diversity and strive for social change and equality To encourage clients to act as advocates on their own behalf and on the behalf of others To become aware of one’s gender- role socialization process To identify internalized gender-role messages and replace them with functional beliefs  INTERVENTION TECHNIQUES IN FEMINIST THERAPY Gender-role analysis and intervention- An exploration of the impact of gender roles on mental health may be conducted in order to develop the person in treatment's insight. To help clients understand the impact of gender-role expectations in their lives Provides clients with insight into the ways social issues affect their problems Power analysis and power intervention- Therapists and those in treatment often examine the various ways unequal power has impacted the ability to grow and achieve. Emphasis on the power differences between men and women in society Clients helped to recognize different kinds of power they possess and how they and others exercise power  INTERVENTION TECHNIQUES IN FEMINIST THERAPY Bibliotherapy Reading assignments that address issues such as Coping skills Gender inequality Gender-role stereotypes Ways sexism is promoted Power differential Society's obsession between women and men with thinness Sexual assault Self-disclosure- Therapists may share their own experiences, when appropriate, in an attempt to normalize, equalize, and liberate the experiences and emotions of the person in therapy. To help equalize the therapeutic relationship and provide modeling for the client Values, beliefs about society, and therapeutic interventions discussed Allows the client to make an informed choice  INTERVENTION TECHNIQUES IN FEMINIST THERAPY Assertiveness training Women become aware of their interpersonal rights Transcends stereotypical sex roles Changes negative beliefs Implement changes in their daily lives Reframing-shift Changes the frame of reference for looking at an individual's behavior Shifting from an intrapersonal to an interpersonal definition of a client’s problem INTERVENTION TECHNIQUES IN FEMINIST THERAPY Relabeling Changes the label or evaluation applied to the client's behavioral characteristics Generally, the focus is shifted from a negative to a positive evaluation Social Action- Therapists may encourage those in therapy to engage in social activism as a method of achieving greater empowerment. Encourages clients to embrace social activism Develops clients’ thorough understanding of feminism by building a link between their experiences and the sociopolitical context they live in APPLICATION OF FEMINIST THERAPY TO GROUP WORK Group provides an outlet for social support and political action Forms a diverse community where members share the goal of supporting women's’ experiences Group setting decreases feelings of isolation and loneliness LIMITATIONS OF FEMINIST PSYCHOTHERAPY Therapists do not take a value neutral stance Therapists must be careful not to impose their cultural values on a client Therapists may challenge societal values that subordinate certain groups without first gaining a clear understanding of the client’s culture. This may alienate clients. POSTMODERN /BRIEF APPROACHES  CONSTRUCTIVIST NARRATIVE PERSPECTIVE (CNP) Focuses on the stories people tell about themselves and others about significant events in their lives “NEW NARRATIVES-develop healing stories Therapeutic task: Help clients appreciate how they construct their realities and how they author their own stories  QUESTIONS IN SOLUTION-FOCUSED BRIEF THERAPY Skillful questions allow people to utilize their resources “What have you already tried and what has been useful? Asking “how questions” that imply change can be useful “How will you feel when that happens? Effective questions focus attention on solutions Questions can get clients to notice when things were better Useful questions assist people in paying attention to what they are doing Questions can open up possibilities for clients to do something different “why?- rationalize/ “What would you like to see by the end of our session today”  THREE KINDS OF RELATIONSHIPS IN SOLUTION-FOCUSED THERAPY Customer-type relationship: client and therapist jointly identify a problem and a solution to work toward Complainant relationship: a client who describes a problem, but is not able or willing to take an active role in constructing a solution Visitors: clients who come to therapy because someone else thinks they have a problem”child”  TECHNIQUES USED IN SOLUTION-FOCUSED BRIEF THERAPY Pre-therapy change (What have you done since you made the appointment that has made a difference in your problem?) Exception questions (Direct clients to times in their lives when the problem did not exist) Miracle question (If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?) Scaling questions (On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________? MECSAT- M Miracle questions -Imagine that, while you are sleeping tonight, a miracle happens. You wake up tomorrow, and you sense that you are on track toward making a decision. What will you be doing differently that will tell you that you are on track? Imagine 6 months into the future, after you have successfully solved the problem that brings you here today. What will be different in your life that will tell you the problem is solved? E Exception questions -Are there times now that a little piece of the miracle happens? Tell me about these times. How do you get that to happen? What will you do to make that happen again? C Coping questions -How did you manage to get yourself up this morning? How are you preventing things from getting worse? That sounds nearly overwhelming. How do you manage to cope? S Scaling questions -On a scale of 1 to 10, where 10 is the problem solved and 1 is the worst it has ever been, where is the problem today? On a scale of 1 to 10, with 10 meaning you have every confidence this problem can be solved an T Time-out -s. Time-out allows both clients and counselors to reflect on conversations they have just concluded. When a session has been observed by colleagues behind a one-way mirror, counselors use the time-out for consultation. A Accolades -: it validates any progress that patients make; it encourages patients by reminding them of personal power over their well-being; it emphasizes strengths and abilities; it sets up the expectation that past success is an excellent indicator of future possibilities; it fosters confidence; and it facilitates relationship building and maintains rapport. T Task-The homework task is discussed at the end of the session, after the time-out. APPLICATION OF SFBT TO GROUP COUNSELING Group is focused on solutions and the members’ ability to find solutions in their own lives Leader shifts focus from the problem by providing members the opportunity to view themselves as resourceful and competent Group members provide a supportive audience to observe one another being confident and competent  KEY CONCEPTS OF NARRATIVE THERAPY Listen to clients with an open mind Encourage clients to share their stories Listen to a problem-saturated story of a client without getting stuck Therapists demonstrate respectful curiosity and persistence The person is not the problem, but the problem is the problem  THE THERAPEUTIC PROCESS IN NARRATIVE THERAPY Collaborate with the client in identifying (naming) the problem Separate the person from his or her problem Investigate how the problem has been disrupting or dominating the person  THE FUNCTIONS OF THE NARRATIVE THERAPIST To become active facilitators To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination To believe in the client’s abilities, talents and positive intentions To adopt a not-knowing position that allows being guided by the client’s story  THE ROLE OF QUESTIONS IN NARRATIVE THERAPY Questions are used as a way to generate experience rather than to gather information Questions are always asked from a position of respect, curiosity, and openness Therapists ask questions from a not-knowing stance  EXTERNALIZATION Living life means relating to problems, not being fused with them Externalization is a process of separating the person from identifying with the problem Externalizing conversations help people in freeing themselves from being identified with the problem  DECONSTRUCTION AND CREATING -BREAKING DOWN Problem-saturated stories are deconstructed (taken apart) before new stories are co-created The assumption is that people can continually and actively re-author their lives Unique possibility questions enable clients to focus on their future An appreciative audience helps new stories to take root APPLICATION OF NARRATIVE THERAPY TO GROUP COUNSELING Narrative therapy has been used for group work in school settings Group work provides an appreciative audience with which a client can discuss the new developments of his or her life New identities can be rehearsed in the group setting Wide range of uses for group-based narrative therapy in schools including: Anger management Grief counseling Academic management An adventure-based program MARRIAGE AND FAMILY INTERVENTION I regard parenting as the hardest, most complicated, anxiety-ridden, sweat-and-blood-producing job in the world. Succeeding requires the ultimate in patience, common sense, commitment, humor, tact, love, wisdom, awareness, and knowledge. At the same time, it holds the possibility for the most rewarding, joyous experience of a lifetime, namely, that of being successful guides to a new and unique human being. Virginia Satir The Beginnings of Marriage and Family Counseling Marriage and family counseling is both an art and a science. If it is an art, then it becomes part of the counselor's innate affective and relational qualities. If it is a science, then it refers to the skills that the counselor has developed as a result of the training that he or she has taken in counseling.  Evolution of Marriage and Family counseling Group Therapy- 1910, Moreno developed what can be considered the earliest uses of group processes in counseling. Changing Family Structure Marriage Counseling/Couples Counseling  THE FAMILY LIFE CYCLE- Duvall has proposed an eight-stage model for understanding family life. Married Couples Wife Establishing a mutually satisfying marriage. 2 yrs. Husband Childbearing families(0-30 Wife (M) Husband (F), Infant Giving birth, adjusting and encouraging the devt. Of 2-5 months) (son/daughter) infants Families with family Wife, Husband, son Adapting to the needs of preschool children. Coping 3-5 preschool children (0-6yrs) Daughter with energy depletion and lack of privacy as parents Families with school-age Wife (M), Husband (F), son (B), Fitting into the community of school-age families; 7 children (6-13) daughter (S) encouraging educ. Achievements Families with teenagers Wife (M), Husband (F), son (B) Balancing freedom and responsibility 7 (13-20) Daughter (S) Families as launching centers Wife (M-GM), Husband (F-G-F), Releasing young adults into work, college, marriage 8 son (B-U) Daughter ( S-A) Middle-aged parents Wife –M-GM Rebuilding the marriage relationship 15 + - Husband – F-GF Aging Family members Widow/Widower Coping with bereavement and living home 10- 15 +- Wife –M-GM Adjusting to retirement Husband – F-GF  Marriage Counseling Marital problems rank highest as the reason for referral to mental health services. People tend to seek marriage counseling when a family system is experiencing a state of disequilibrium: infidelity, sexual incompatibility, disagreement over child-rearing practices, concerns about divorce/annulment, ineffective communication and issues relating to power and control.  Marriage Counseling Marriage counseling can be also useful to treat individual problems such as depression and alcoholism. THE COUNSELING PROCESS Tends to be brief, problem-centered and pragmatic. The most popular form of marriage counseling currently is conjoint marriage counseling.  Skills-Based Marriage Counseling Principles in skills-based counseling 1. Healthy productive marriages require time and commitment. 2. The skills necessary for a satisfying marriage can be learned. 3. Change requires each partner to assume responsibility 4. Positive feelings such as love and caring can return with behavior change. 5. Small changes can help bring about big changes.  10 skills that are believed to contribute to effective marriages are both partners: 1. Individually accept responsibility for their behavior and self-esteem. 2. Identify and align their personal and marital goals. 3. Choose to encourage each other 4. Communicate their feelings with honesty and openness. 5. listen emphatically when feelings are expressed. 6. Seek to understand the factors that influence their relationship 7. Demonstrate that they accept and value each other. 8. Choose thoughts, words, and actions that support the positive goals of their marriage. 9. Solve marital conflicts together. 10. Commit themselves to the going process of maintaining an equal marriage.  Marriage and Family Counseling Approaches 1. Psychodynamic Family Therapy 2. Bowen Family Therapy 3. Experiential Family Counseling 4. Behavioral Family Counseling 5. Structural Family Therapy 6. Strategic (Brief) and Solution- Focused Theories 7. Narrative Family Therapy  Approaches Psychodynamic Family Theory Theorists S. Freud, N. Ackerman, etc. Underlying Premises Unconscious processes link family members together and influence individuals in the decisions about whom they marry. Unconscious forces must worked through. Role of the Counselor The counselor is a teacher and interpreter of experience. Unit of treatment Individuals, sometimes the individuals within a family Goals of Treatment To break dysfunctional interactions within the family based on unconscious processes; to resolve individual dysfunctionalilty as well. Techniques Transference, dream analysis, confrontation, life story  Bowen Family Theory Theorists Murray Bowen, Michael Kerr Underlying Premises Theory and therapy are the same. Family patterns are likely to repeat. It is important to differentiate oneself from one’s family origin. Uncontrolled anxiety results in family dysfunctionality. Role of the Counselor The counselor acts as a coach teacher and concentrates on boundary and differentiate issues. Unit of treatment Individual or couple Goals of Treatment To prevent triangulation and help couples and individual relate of a cognitive level; to stop dysfunctional repetitive intergenerational patterns of family relations. Techniques , person to person relationship, differentiate of self Unique Aspects Emphasis on intergenerational relationships and repeating pattern, systematic, in- depth theory  Experiential Family Counseling Theorists Virginia Satir, Walter Kempler, Peggy Papp Underlying Premises Family problem are rooted in suppression of feelings, rigidity, denial impulses, lack of awareness Role of the Counselor Counselors use their own personalities. They must be open, spontaneous, emphatic and must demonstrate caring and acceptance. To teach family members new skills that clearly communicate their feelings Unit of treatment Focuses on individuals ad couples dyads Goals of Treatment To emphasize he growth, change, creativity, flexibility, and playfulness. To make covert from overt, to increase emotional closeness Techniques clear communication skills, humor, family art therapy, role playing, creates an emotionally intense atmosphere Unique Aspects Encourages family members to change roles and increase understanding themselves, increase awareness of feelings.  Behavioral Family Counseling Theorists B.F. Skinner, John Watson, Richard Stuart Underlying Premises Behavior is maintained or eliminated by consequences. Maladaptive behaviors can be unlearned or modified. Adaptive can be learned. -Modified (irrational thinking) to bring changes Role of the Counselor Direct, careful assessment and intervention, the counselor seen to be as a teacher, expert and reinforcer, with focus on presenting the problem. Unit of treatment Parent training, marriage relationship and couple communication, Goals of Treatment To bring about behavioral changes by modifying the antecedents or consequences of an action, to pay close attention to modifying the consequences, to teach social skills and prevent problem from reoccurring. Techniques Operant conditioning, classical conditioning, social learning theory, fading, extinction, modeling Unique Aspects Approach are straight forward with attention paid to observation, measurement  Structural Family Theory Theorists Salvador Minuchin, Charles Fishman, Thomas Todd Underlying Premises Family functioning involves family structure, overt and covert rules and hierarchies must be understood and changed to help family adjust to new situations. Role of the Counselor Counselors map families mentally and work actively in counseling session. They instruct family members to interact through enactment and spontaneous. Unit of treatment The family is treated as a system , yet individuals needs are not ignored. Goals of Treatment To bring problematic behaviors out in the open so that counselors can observe and can help change them. Techniques Joining, accommodating, restructuring, working with interaction, reframing Unique Aspects First developed for families with low socioeconomic status, very pragmatic; effective in working with families of addicts.  Strategic (Brief) and Solution-Focused Theories Theorists Jay Hayley, Cloe Madanes, etc. Underlying Premises People and families can change quickly. Treatment should be simple and concentrate on changing rigid rules. Role of the Counselor Is responsible for overcoming resistance in the family and designing novel strategies for solving problems. The counselor is much like a physician in taking responsibility for the success of treatment and must plan ahead and develop the strategies. Unit of treatment The family as a system, although these approaches can be selectively used with dyads and individuals. Goals of Treatment To resolve present problems, find solutions, bring about change, to target definable behavioral goals, to minimize insight, ignore what is not a problem Techniques Reframing, discouraging interpretation, ordeals, rituals, pretending, etc. Unique Aspects There is a emphasis on seeing symptoms in a positive way. Treatment is short-term ( 10 sessions). Focus on changing present problematic behavior. Techniques are tailor-made for each family.  Narrative Family Theory Theorists Michael White, David Epston Underlying Premises People live their lives according to stories and their meaningfulness. Families that reauthor their lives and make their stories more meaningful live healthier. Role of the Counselor Te counselor questions and examines the meaningfulness of situations for families and helps them create new stories for their lives. Unit of treatment The entire family when possible Goals of Treatment To get families to look for exception to their dilemmas and to focus on solutions to their problem. Techniques Externalization of problems, examining how problems and people influence one another, raising dilemmas, predicting setbacks, using question to challenge family perceptions, writing letters of families Unique Aspects His approach is based on narrative reasoning rather than systems theory. It emphasizes externalizing problems, reauthoring lives and writing letters to families as a way of providing them feedback and doing clinical notes. Limitations of the Family Systems Approach An overemphasis on the system may result in the unique characteristics of the individual family members being overlooked Concern with the well-being and function of the system may overshadow the therapist’s view of the needs and functioning of the individuals in the system Practitioners are cautioned not to assume that Western models of family are universal and must be culturally competent Therapists with a Westernized view of the family may inadvertently overlook the importance of extended family when working with families from other cultures