Behavior Therapy PDF

6. BT Intervention are individually tailored to specific Behavior Therapy problems of the clients. Guideline: “What treatment, by whom, is most...

6. BT Intervention are individually tailored to specific Behavior Therapy problems of the clients. Guideline: “What treatment, by whom, is most effective for this individual with that specific 1950s – 1960’s: a reaction to Psychoanalytic Perspective problem and under which set of circumstances?” Four Areas of Development: 1. Classical Conditioning (early 1900s) 2. Operant Conditioning (1950s) 3. Social Learning (1960s) Therapeutic Goal 4. Cognitive Behavior Therapy (mid-1970s) Generally, to increase personal choice and to create View of Human Nature new conditions for learning - The Person is the producer and the product of his or her environment. The client, with the help of the therapist, defines specific treatment goals at the outset of the therapeutic process. Six (6) Characteristics & Assumptions of Behavior Goals should be clear, concrete, understood Therapy (BT) and agreed on by client & therapist Continuous assessment is made to measure 1. Experimentally derived principles of learning are progress in the attainment of goals. systematically applied to help people change their maladaptive behavior. Treatment Goals are Concrete Therapist’s Function & Role Treatment goals are agreed upon by the client and therapist 1. Conducts Functional Assessment or Behavioral Analysis Therapist assesses problem behaviors and Assessment Interview is made using ABC Model the conditions that are maintaining them (A) Antecedents 2. BT deals with the client’s current problems and the (B) Behavior factors influencing them. (C) Consequence Uses functional assessment or behavioral analysis: determines what factors (e.g., 2. Formulates initial treatment goals, and designs and environmental events) can be used to modify implements the treatment plan behavior. 3. Follow-up assessments are made to see whether changes are durable. 3. Clients are expected to assume an active role by engaging in specific actions to deal with their problems. Strategies/Techniques Self-monitoring: clients monitor their Instructions behaviors both during & outside therapy Modeling Learn and practice coping skills Performance Feedback Role-playing of new behavior (e.g., Experimenting on new adaptive behaviors assertiveness); Homework Systematic Desensitization (Imagination) Re-Learning new and adaptive behaviors to Warmth, Empathy, Authenticity, replace maladaptive behaviors Permissiveness and Acceptance are necessary but not sufficient 4. BT assumes that change can take place without In Vivo Exposure (Gradual actual exposure) insight. Motivational Interviewing: honoring resistance Changes in behavior can occur prior to or to increase motivation to change simultaneously with understanding of oneself. Flooding (Intense imagined/actual exposure) Knowing that one has a problem is not ABA (Applied Behavioral Analysis): Positive, Negative enough; Knowing how to change is more Reinforcement, Extinction, Punishment important Social Skills Training (e.g., assertion) Behavioral changes lead to self- understanding 5. BT focuses on assessing overt and covert behavior directly, identifying the problem, and evaluating the change through observation and self-monitoring. Cultures, social environments and social support networks are taken into consideration  Forms of Behavior Therapy Gestalt Therapy 1. Phenomenological – because it focuses on the 1. Cognitive Behavior Therapy (CBT) client’s perceptions of reality 2. Rational Emotive Behavior Therapy (REBT) 2. Existential – because it is grounded on the notion that people are always in the process of becoming, 3. Mindfulness – a process that involves becoming remaking and rediscovering themselves increasingly observant and aware of external and Proponents internal stimuli in the present moment and adopting an open attitude toward accepting rather Frederick “Fritz” S. Perls, MD, PhD (1893 – 1970) than judging the current situation. - born in Berlin, Germany - failed Grade 7 twice; expelled from school due to 4. Acceptance-based CBT – is a process involving difficulties with the authorities one’s present experience without judgment or - Psychiatrist, first trained in psychoanalysis before preference, but with curiosity and kindness, and moving on to Gestalt striving for full awareness of the present moment. - Worked with brain-damaged soldiers of WW II and realized the importance of viewing humans 5. Dialectical Behavior Therapy (DBT) – as a whole more than the sum of the parts paradoxical approach: acceptance involves being - Established the New York Institute for Gestalt in the present moment, seeing reality as it is Therapy in 1952 with wife Laura without distortions, without judgment, without - People responded to him in awe or found him evaluation, without trying to get rid of it. harshly confrontative and saw him as meeting his own needs through showmanship - Fritz was viewed variously as insightful, witty, Self-Modification Programs / Self-directed Behavior bright, provocative, manipulative, hostile, 5 Steps for Self-modification demanding and inspirational - Eventually abandoned his family 1. Selecting Goals: one at a time; measurable, attainable, positive and significant for the Laura Posner-Perls, PhD (1905 – 1990) person - Born in Phorzheim, Germany 2. Translating Goals into Target Behaviors: - Began as a psychoanalyst but eventually identify behaviors targeted for change; then earned a doctoral degree in Gestalt identify potential obstacles and ways to psychology negotiate with them - Met Fritz in 1926 and married him in 1930 3. Self-monitoring: keep a behavioral diary and - Continued to work with the New York track the A, B, C. Institute 4. Working-out a Plan for Change: identify strategy to handle Antecedent(s) and Fritz Laura Adaptive Alternative Behavior; Use Self- Intrapsychic dynamics and Interpersonal reinforcements Awareness 5. Evaluating the Action Plan: evaluate Responsibility to Oneself Contact and Support achievement of goals, revise plan if Responsiveness necessary Each therapist must develop one’s own style; whatever is integrated in our personality becomes Strategies support for what we use technically (Humphrey, 1986) Self-monitoring Self-reward Current Practice: Self-contracting - Characterized as supportive, accepting, empathic, Stimulus control dialogical, and challenging (as opposed to the Rogerian)  View of Human Nature - Unfinished business seek completion, but when they remain so (and become powerful enough), they are - Individuals have the capacity to self-regulate when manifested as a preoccupation, compulsion, wariness, they are aware of what is happening in and around self-defeating behavior (Polster & Polster, 1973), or them physical sensations/problems. - The environment consists of both of the external and internal worlds 6. Contact – means interacting with nature and people – Six Principles of Gestalt Therapy through seeing, hearing, smelling, touching, moving – without losing one’s sense of individuality characterized by 1. Holism – “Gestalt” is the German word for “whole” or zest, imagination and creativity “completion” or a “form that cannot be separated into parts without losing its essence” thus, the whole is not - It is a necessity if change and growth were to occur. equal to the sum of its parts - Contact involves “moments only” and is neither continuous nor permanent; after the contact, there Looking at the Whole: Seeing Figure & Ground is typically a withdrawal Figure – refers to those aspects of the individual’s - Withdrawal – involves the person’s integration experience that are most salient at any moment; (absorption) of what had been learned during the the dominant need of the person at the moment contact influence the process of figure formation (Frew, “To connect and To separate” 1997) Ground – refers to those aspects of the client’s presentation that are often out of his/her awareness (e.g., Non-verbals: Gestures, Voice 6 Forms of Resistance to Contact tone, Demeanor) 1. Introjection – uncritically/passively accepting others’ beliefs and standards without assimilating them to 2. Field Theory – explains that the organism must be make them congruent with who we are (e.g., seen in its environment, or in its context, as part of a impositions of authorities) constantly changing field. 2. Projection – disowning aspects of ourselves by The field is relational, in flux, interrelated and in- assigning them to the environment, those that are process (which includes both therapist and client inconsistent with our self-image or public persona as well as others) 3. Retroflection – turning back onto ourselves what we would like to do to someone, or, doing to ourselves 3. Organismic Self-regulation – a process by which what we would like someone to do to us (e.g., self- equilibrium is ‘disturbed’ by the emergence of a need, mutilation, inward aggression, depression, sensation, or interest; then the organism will do somatization) his/her best to regulate him/herself given his/her own capabilities and the resources of the environment 4. Deflection – distraction that hinders sustained contact (Latner, 1986) (e.g., indecisiveness, overuse of humor, never-ending questioning, beating around the bush, speaking 4. The “Now” - Emphasizes on learning to appreciate through others, speaking for others) and fully experience the present moment 5. Confluence – involves blurring the differentiation - Focusing on the past and the future can be a way between the self and others; involves the belief that to avoid coming to terms with the present. others have the same feelings and thoughts with you - We tend to invest our energies in bemoaning (e.g., enmeshment, fear of conflict, high need for their past mistakes and ruminating about how life acceptance) could and should have been, or fantasizing about the future. 6. Blocks to Energy – a defensive behavior manifested by tension in some part of the body, by posture, tight or 5. Unfinished Business – Refers to those figures that closed, numbing of feelings/sensations, restricted have not been completed and resolved voice - May be in the form of unexpressed resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment  Therapeutic Goals Therapist’s Role and Function 1. Become more aware of all their senses, the internal In partnership, the therapist invites clients to engage and external environment; accepting oneself (Contact in “experiments” to try-out new ways of being and is achieved) behaving, and notice what happens, and learn about - Geared to the surfacing of unfinished business themselves “the client becomes the hurt child” - Awareness is curative in itself Interventions in Gestalt Therapy 2. For clients to deal with their problems themselves 1. Listening to the Language “It” instead of “I” (Depersonalizing) 3. Two Agenda: “You” instead of “I” (Generalizing) a) Moving the client from environmental support Language that Denies Power (“I guess/Daw”, to self-support “Perhaps/Basi”, “I can’t”) b) Integrating the disowned parts of one’s Listening to metaphors (“Daw ma lupog ako”) personality Listening to “pregnant phrases” 4. Assuming ownership of their experience (as opposed to making others responsible for what you are 2. Experiments and Exercises thinking, feeling, and doing); and accepting the a. Experiment – a method that shifts the focus of consequences of their actions counseling from talking about a topic to an activity that will heighten the client’s awareness and 5. Develop skills and acquire values that will allow them understanding through experience (Frew, 2008) to satisfy their needs without violating the rights of others - Fundamental to Gestalt therapy - Grows out of the therapeutic interaction, and 6. Equilibrium – individuals can take actions and make emerge within the dialogic process contacts with the environment that will restore - A way to bring out some kind of internal equilibrium or contribute to growth and change; conflict by making the struggle an actual process; facilitating the client’s ability to work - therapy allows the awareness of needs/figures to through the stuck points of his/her life be able to regain equilibrium (Polster, 1987) - Equilibrium is achieved when there is: closure of e.g., dramatizing, imagining, exaggerating unfinished business, destroyed fixed gestalts, incorporation of more satisfying gestalts - Evolves from the themes during the dialogue - Spontaneous, and relevant to a particular moment; not designed for a particular goal 7. Paradoxical Theory of Change (“let’s try…) - What is learned in the experiment surprises - The more we work at becoming who or what we both client and therapist; it is a collaborative are not, the more we remain the same process between client and therapist with full - We change when we become aware of what we participation of the client are as opposed to trying to become what we are - Sessions offer a balance between support not! and risk; the C is neither blasted into - To “be” as fully as possible in the current experiences that are too threatening nor condition, rather than striving to become what allowed to stay in safe but infertile territory they “should be.” (Polstrer & Polster, 1990) 8. Be able to ask for, and get help from others and be b. Exercises – are ready-made techniques that are able to give to others used with specific goals; these are performed experiments Internal Dialogue, Empty Chair, Reversal, Rehearsal, Exaggeration, Staying with the Feeling, Making the Rounds, Dreamwork Exercises I. Internal Dialogue - Performed through the Empty Chair technique - Goal: awareness of, integration, and acceptance, of personality aspects that have been denied and disowned - Based on the assumption that within the personality is the Top Dog and the Under Dog ▪ Tyrannical Top Dog – is self-righteous, authoritarian, moralistic, demanding, bossy and manipulative ▪ Underdog – defiant, manipulative, defensive, apologetic, helpless, and weak, feigning powerlessness, passive, and finds excuses ▪ Empty Chair externalizes the conflicted internal dialogue: where the two dogs struggle to CONTROL each other II. Reversal – letting the client do the opposite personality type III. Rehearsal – performing what the client thinks he/she cannot do IV. Exaggeration – to become more aware, the c is asked to exaggerate an emotion, gesture, posture, habits V. Staying with the Feeling – owning and facing up to, appreciating the feeling (e.g., “damahin mo”) VI. Making the Rounds – done in group work to confront, disclose, experiment on new behavior VII. Dreamwork Examples of Process Questions: What is going on now? (in your mind, feelings) What are you experiencing as you sit there? How are you experiencing your fear/sadness/frustration/apprehension? What does that feeling/thought/behavior do to you?  Person-Centered Therapy Both the Client and Therapist by Carl Rogers To live fully and authentically, with the realization that existence demands a continuing struggle; man never Four Periods in the Development of the arrives at a final state of being self-actualized Person-centered Approach: 1. Non-directive Counseling Therapist’s Function and Role - 1940s - Revolutionary: Challenged the notion that the When the therapist is able to experience and “counselor knows best” communicate his/her realness, support, caring, - Challenged procedures such as advice, nonjudgmental understanding, significant suggestion, direction, persuasion, teaching, changes in the client are likely to occur. diagnosis, and interpretation Founded the therapist’s Way of Being and Attitudes: 2. Client-centered Therapy - 1950’s “The Therapist Is the Tool/Message” - Emphasis on the Client instead of Method 3 Therapist Attributes and Core Conditions that Create 3. On Becoming a Person a Growth-Producing Climate: - 1950s – 1970s Congruence - addressed the nature of becoming the self Unconditional Positive Regard that a person truly is Accurate Empathic Understanding - focusing on how people progress in therapy - Rogers would rather ask how the client may “These are necessary and Sufficient” grow rather than what caused the maladaptive behavior 1. Congruence – implies that the therapist is real, 4. Person-centered Approach genuine, integrated, and authentic during the - 1980’s-1990s therapy hour; - Broadening application of the approach beyond - no false front; fully present the client in counseling - inner experience and outer expression - “An evolutionary process that continues to match remain open to change and refinement” - openly expresses feelings, thoughts reactions, and attitudes that are present in the relationship with the client The “Third Force”: - The Client’s Trust is generated when the Existentialism (Fromm) & Humanism (Rogers) Therapist is Congruent; though congruence More commonalities: client’s subjective may not be fully achieved at all times experience, uniqueness, positive and constructive choices Existentialist Humanistic 2. Unconditional Positive Regard - a caring that is not possessive and is not contaminated by Man is faced with Seed will a naturally judgment of the client’s Feelings (F), Thoughts (T) the anxiety of grow into a plant & Behaviors (B) choosing to create - “I’ll accept you as you are…” and not “I’ll an identity accept you when you… “ Man is geared toward - It does not involve approval self-actualization View of Human Nature 3. Empathy – refers to the therapist’s grasp of the - Client has the capacity to move forward in a client’s private world as the client sees and feels it constructive manner if conditions foster (without losing one’s separateness of identity) growth - Involves Therapist’s Accurate Empathic - Self-Actualizing Tendency: Man is trustworthy, Understanding – as if the client’s feelings resourceful, capable of self-understanding, were the therapist’s own feelings self-direction, and productive lives; has an internal source for healing  - Involves the therapist’s ability to reflect on the experience of clients, especially those at the edge of awareness - Full empathy entails understanding the meaning and feeling of a client’s experiences (active verb) - Empathy helps clients: Pay attention to and value their experiencing See earlier experiences in new ways Modify their perceptions of themselves and others Increase their confidence in making choices and in pursuing a course of action Therapists are invested in broadening their own life experiences and engage in the continuous pursuit of self-knowledge. The quality, depth, and continuity of their experience is the cornerstone of their competence as therapists. Therapeutic Goals: Independence & Integration Understanding One’s self and Resolving Their Own Problems without direct intervention from the therapist Four Characteristics of an Actualizing Client: 1. An openness to experience 2. Trust in one’s self 3. An internal source of evaluation 4. A willingness to continue growing Process: - Remove the masks you wear - Recognize that you have lost contact with yourself because of the facades you have put up - A shared journey in which therapist and client reveal their humanness and participate in a growth experience; the therapist is a guide because he/she is more experienced and psychologically mature