Chapter 6 - Action Oriented Approaches

Chapter 6

Action Oriented Approaches

© 2015. Cengage Learning.All rights reserved.

Behavioral Counseling

• Emphasis on the present rather than the past • Attention to changing specific dysfunctional

behaviors• Reliance on research as an integral partner for

developing and testing interventions


Behavioral Counseling

• Preference for carefully measuring treatment outcomes

• Matching specific treatments to particular presenting problems


Learning New Skills

• Behavioral assessment and identification of target symptoms

• Reinforcement (both operant and classical)• Social modeling of skills, desirable behaviors• Skills training• Environmental changes that will encourage

identified goals• Objective measurement of changes over time


Behavioral Technology Aid

• Valuable tool for researchers and behaviorists is time-series charts– Graphic portrayal of client change– Helps the counselor study a single case

intensively, plotting baseline data and the results of therapeutic interventions

– Aids in quantitatively and specifically describing the behaviors targeted for changes and in noting the effects of any action


Strategies

• Operant-conditioning procedures– Methods in which the frequency of behavior may be

increased or decreased according to the type and timing of stimuli presented

– In positive reinforcement strategies, the counselor hopes to increase behavior by rewarding the client

– Negative reinforcement also produces an increase in desired target behaviors such as assertiveness, but does so by removing a stimulus the client perceives as aversive


Strategies

• Punishment strategies are used to reduce the frequency of a client’s behavior by presenting an aversive stimulus– Many parents and teachers rely too heavily on this

strategy because of its seeming convenience– Usually produces negative side effects in the child

such as withdrawal, aggression, and generalized fears


Strategies

• Contingency contracting– Use of a behavioral contract that defines the

necessary contingencies on which a reinforcer will be presented

• Shaping– A process in which complex terminal behaviors

are reinforced in approximate successive stages


Strategies

• Classical or Pavlovian conditioning– Presented stimulus elicits automatic response– Systematic desensitization is the most common of

these methodologies• Clients are taught to substitute relaxation responses for

anxiety when confronted by previously frightening situations such as tests or social events


Strategies

• Flooding– An opposite strategy is employed to erode the

stimulus/response sequence– A phobia, fear, or bad habit can be extinguished

by bombarding the person with the stimulus until fatigue sets in or until (in the case of a habit) the stimulus loses its pleasurable value


Cognitive Behavioral Therapy (CBT)

• In childhood, we learn a set of assumptions and beliefs (schemas) that influence our interpretations of daily situations and incidents throughout life– We experience these as the thoughts that

instinctively flit across our conscious minds right after the event itself and when we later ruminate about the meaning of the event



• Self-critical belief systems learned in childhood can be activated by certain life situations – Can generate distorted, unrealistic, automatic

thoughts, which negatively affect our mood



• Teach the client the categories of cognitive distortions– Beck and his colleagues developed a list of the

typical kinds of unrealistic, distorted thoughts clients experience• List was subsequently modified by other cognitive

theorists, the most popular of which was developed by Burns (1999) and often given to clients to learn



• Create a thought diary– Clients record in a chart their irrational thoughts

following a mood-affecting situation, the category the thoughts belong to, and more realistic alternative thoughts



• Engage in a Socratic dialogue– Counselor questions the client’s thinking

processes, persistently challenges illogical ideas, and gradually leads the client to appreciate that his or her negative cognitive response to an event does not make rational sense

• Test the evidence– Counselor assigns the client the task of testing the

validity of a negative belief


CBT Distortions

• All or nothing thinking– Life is seen in black or white terms.

• Mind reading– Assuming you know what others are thinking

about you


CBT Distortions

• Should statements– Saying “I should,” “I must,” or “I ought to”

statements that are common attempts to motivate ourselves is more likely to make us feel anxious or depressed

– Ellis’s REBT makes similar point, calling this tendency Musterbating


CBT Distortions

• Catastrophizing– Making a mistake or having a bad experience and

assuming it will lead to the worst possible outcome

– REBT counselors call this Awfulizing• Labeling– Calling ourselves a derogatory name, something

we all do from time to time, inevitably making us feel worse


CBT Distortions

• Disqualifying the positive– Ignoring our positive qualities and achievements

and only seeing our negative characteristics or mistakes

• Magnification– Overemphasizing the importance of one negative

event• Fortune telling– Assuming we know what’s going to happen


Rational Emotive Therapy Behavior (RETB)

• Ellis developed an “ABC Theory” of emotions to help explain the ways irrational beliefs lead people to negative emotional outcomes– A: Activating Emotional Experience• Reading chapters on counseling approaches that

present a dozen complex theories

– B: Belief or Interpretation of Experience• “I feel so stupid that I can’t understand all of this stuff.”


Rational Emotive Therapy Behavior (RETB)

– C: Consequences• Anxiety • Fear • Confusion • Frustration • Anger

– D: Disputing Irrational Beliefs • “Of course I feel overwhelmed — that is what an

introductory student is supposed to feel…”


Limitations of Behavioral Approach

• Criticized most often because of its narrow focus on observable human behavior and lack of attention to feelings and thoughts– Make up significant part of a person’s functioning

• Works only with the presenting complaint– Could be a symptom of underlying conflicts• Many insight-oriented theorists believe symptoms thus

cured will inevitably be replaced by others because the internal condition has not been altered



• CBT and REBT are probably less effective with some kinds of clients– Those who already have problems with over

intellectualizing or who don’t have the capacity to reason logically• Young children, schizophrenics, some clients with

personality disorders, or clients with minimal intelligence



• Many cognitive-behavioral counselors complain of boredom and burnout from continuously repeating the same arguments and processes with all clients

• CBT and REBT are difficult for some professionals to practice if they are not outgoing and assertive and don’t enjoy vigorous debate and confrontation



• Counselor’s role is so verbal, active, and directive– Client may feel overpowered, dominated, and not

responsible for the outcome


Personal Implications

• We create our own emotional misery through distorted thinking– We can potentially change these negative feelings

by changing the way we think about our situations• Carefully monitor our language for words such

as “should,” “must,” and “ought”– Imply irrational beliefs


Solution-Focused Therapy

• If it doesn’t work, do something different– If it works, do more of it

• Clients have strength and resources to change• Problems from not recognizing alternatives

rather than from underlying pathology– Change comes from focusing on future possibilities

and solutions– A small change in any aspect of a problem begins

the process of solving it© 2015. Cengage Learning.

All rights reserved.

Solution-Focused Interventions

• The miracle question– “If a miracle occurred and the problem was fixed,

what would be different? How would I know?”• Pretending– Madanes preferred when working with children

who have disruptive symptoms– After the child has been deliberately directed to

engage in the symptoms, they lose their controlling power



• Exception finding– Counselor and client play detective, searching for

times in the client’s life when the problem did not occur

• Scaling questions– Throughout treatment, counselors ask clients to

rate their progress in achieving their goals



• Task assignments– Ultimately, the success of this theory relies on the

counselor’s assigning clients to perform specific tasks between sessions


Limitations of Solution-Focused Therapy

• Real test of any theory is utility after initial feelings of hopefulness fade and the client must face the challenge of changing– Hard to know if solution-focused counseling is

more than a placebo, because it is so brief• Clients may not grow from the experience or

learn new skills



• Some clients need the opportunity, at least initially, to talk about their problems and explore their meaning

• Insight is unnecessarily downgraded or totally ignored as a distracting variable– Self-understanding is an important goal of many

clients



• Focus is on solving problems– Could rely largely on a male-oriented, control-

based methodology that is inconsistent with the values of some cultures.

• Many strategies are intuitively constructed– Are difficult to learn and apply reliably

• Limited empirical base– Number of studies demonstrating efficacy is small

• Some are significantly flawed in their research design


Solution-Focused Questions

• What’s the trouble? • Why are you here and what do you expect? • How is that a problem for you? • When, where, and with whom does the

problem occur? • What are some exceptions to the times when

you experience this as a problem?



• If you woke up tomorrow without the problem, what would be different?

• If your problem was solved by a miracle, what form might that take?

• What have you already tried to do to solve the problem that doesn’t work?

• What have you tried that does work sometimes?



• When is the problem not a problem? • When is the problem the worst? • How did you manage to overcome your

problem in the exceptions you described previously?


Personal Applications

• At some point, you have found a way to solve even the most daunting of challenges

• When you try something and it doesn’t work, don’t do the same thing– Try anything else other than what you are doing

• When you are facing a problem that feels insurmountable, reframe it in a way that makes it more manageable


Personal Applications

• Assume you are a client who feels stuck– First, you are asked to practice traveling into the

past and future through the use of fantasy– Once you can easily move forward or backward at

will, you are asked to travel into the future to a time when your problem is resolved• Are you there yet?• Okay, then — what did you do to fix your problem?


Multimodal Counseling

• Seeks to understand and intervene at the levels of all seven modalities of the human personality– People are capable of experiencing sensations,

feelings, thoughts, images, observable behavior, interpersonal responses, and biochemical and neurophysiological reactions



• These human components are conveniently organized into the acronym BASIC ID

• Multimodal assessment permits the practitioner to understand at a glance:– How the client characteristically functions– How, where, and why the presenting problem

manifests itself– How specifically to use the profile as a blueprint

for promoting change© 2015. Cengage Learning.

All rights reserved.


• Avoids the use of formal diagnostic labels and psychological jargon in favor of more down-to-earth terms


Reality Therapy

• Didactic approach that stresses problem solving, personal responsibility, and the need to cope with the demands of a person’s “reality”

• Based on the assumption that all individuals need to develop an identity, which can be either a “success identity” or a “failure identity”


Reality Therapy

• Counselor’s job is to become highly involved with the client and to encourage motivation toward a plan of responsible action that will lead to constructive behavior change and a “success identity”


Expressive Therapies

• Art therapy– Has long been a form of treatment for children

• Helps them express feelings actively and talk through images represented in their drawings

• Music and dance therapy– Movement bypasses intellectualization and verbal

defenses to help people become more self-expressive, in touch with their bodies and minds, and inclined to explore their potential in creative ways



• Biofeedback– Gives clients accurate information about their

psychophysiological responses• Readings can be taken of bodily functions such as brain

activity, heart rate, muscle movement, blood pressure, and skin responses in order to improve muscular and neurological control



• Play therapy– Most counseling with children employs play• Drawing, playing cards or games, building structures,

dressing up in costumes, playing catch with a ball– From age 2 until the teen years (especially during

early childhood and elementary school years), play is the primary form of expression for children

– Counselor seeks to establish trust, facilitate communication and solve problems through the interactive nature of play



• Hypnotherapy– Requires additional training and certification– Has been applied widely in therapeutic situations

since Freud’s day• Behavioral counselors who wish to intensify systematic

desensitization techniques• Psychoanalysts in order to access the unconscious• Many other clinicians who use imagery, rehearsal, and

fantasy techniques



• Exercise– Running, walking, bicycling, rowing, aerobic

dance, swimming, weight lifting, and the martial arts have therapeutic benefits

• Bibliotherapy– Therapists recommend to their clients that they

read certain books that complement or reinforce the ideas that come up in sessions

– Also make use of films (cinematherapy)


Mindfulness

• Person strives for focused attention on whatever he or she is experiencing in the present moment– Maintains a stance of nonjudgmental acceptance

toward whatever he or she experiences in the present moment


Mindfulness

• Whether emotional or physical, the problem gets worse when we try to avoid it, ignore it, or fight it– Pain actually reduces when we accept it by simply

taking note of it with no attempt to do anything about it

– “Acceptance way of being” gives us some distance from our distress• We are not “in our pain” but rather in a state of observing

it — that is, being mindful of it


Mindfullness Approaches

• Mindfulness-Based Stress Reduction (MBSR)– Clients are taught a variety of mindfulness

meditation techniques• Mindfulness-Based Cognitive Therapy (MBCT)– Clients asked to accept their irrational thoughts

without trying to change or stop them


Mindfullness Approaches

• Dialectical Behavior Therapy (DBT)– Practitioners teach their clients mindfulness so

they can achieve a state of nonjudgmental acceptance of their feelings, rather than resort to self-destructive avoidance maneuvers

• Acceptance and Commitment Therapy (ACT)– Similar to other mindfulness therapies– Emphasizes the value of accepting one’s painful

thoughts and feelings rather than escaping them


Education

Chapter 6 - Action Oriented Approaches