Counseling Test 2 (Set 1)

Front 1

What are some difficulties that clients may have about understanding insight?

Back 1

-Difficulty understanding the origins and consequences of feelings and behaviors.
-Get stuck getting past obstacles.

Front 2

What's the deal with defense mechanisms?

Back 2

-People tend to keep defenses that they learned early in childhood as protection against pain and external harm, even though they may not work well now.
-May segregate experiences in minds to avoid thinking about them, makes it difficult to integrate into lives.

Front 3

Why do helpers need to promote insight?

Back 3

to improve client functioning.

Front 4

What does a deep sense of empathy and belief in clients do?

Back 4

-Helps see beyond defenses and inappropriate behaviors to inner self.
-Suspend judgment, look deeper to understand clients, accept and understand themselves

Front 5

What is insight?

Back 5

-Seeing oneself in a new light.
-Making connections or understanding patterns, links, reasons, causes, categorizations, or parallels.
-Having a sense of suddenness, feeling or surprise, or "aha" experience where everything comes together all at once.
-Experiencing a sense of newness, or a feeling of making a new discovery rather than just thinking in the same ways.
-Must be emotional (connects affect to intellect, creates sense of personal involvement and responsibility) as well as intellectual (objective explanation for problem) to lead to action.

Front 6

Why is insight necessary?

Back 6

-We need to make sense of events as humans.
-Evaluate internal and external stimuli in view of assumptions about what is dangerous, safe, important, good, bad, and so on.
-Assumptions become organized sets of highly structured, complex, interacting values, expectations, and images of self (schemata)- closely related to emotional states and feelings.
-These shape, and are shaped, by perceptions and behaviors.
-Helpers need to learn how clients construe events (consciously and unconsciously) to help them develop more adaptive constructs, including awareness and insight into interpersonal interactions.

Front 7

What does Hill believe about insight?

Back 7

Hill believes insight must precede action, or it becomes meaningless. Teaching clients a problem-solving approach. (Cal’s note: there is social psychological research that indicates action can precede and lead to insight.)

Front 8

What are some highlights about psychoanalytic theory?

Back 8

-Believe that early childhood experiences are central to later life functioning.
-Believe unconscious processes influence behaviors of individuals (largest percentage of mental activity), and defense mechanisms (see page 196) are used to reduce anxiety and conflict within individual

Front 9

What does Ben Franklin say?

Back 9

Life is a series of habits interrupted by the occasional thought

Front 10

What does Attachment theory say?

Back 10

-Early childhood, comfortable presence of caregivers, reduces anxiety & promotes feelings of security.
-Will then explore environment.
-Three patterns (carry over to adulthood):
.Secure
.Anxious-ambivalent
.Anxious-avoidant

Front 11

What are some therapeutic goals of psychoanalytic theory?

Back 11

Therapeutic goals include:
-bringing unconscious material to awareness (free association) and developing insight about one's feelings and behaviors (interpretations).
-By analyzing transference and countertransference (according to Hill, two-person psychology, transf & countertransf can’t be separated), working through unresolved issues, interpreting material presented by clients so that unconscious becomes conscious. Clients will repeat early unresolved problems throughout life.
-Also use dream analysis, fantasies, slips of tongue.
Working on therapeutic relationship is emphasized, clarify distortions, model healthy functioning, encourage clients to interact differently outside of session.

Front 12

What does Clara think of psychoanalytic theory?

Back 12

-Clara likes this approach to insight for her 3 stage model.
-Helper coaches client to gain insight (interpretations just beyond client’s awareness), or stimulating client’s own insight.
-She also encourages clients to move to action stage (not typical of this theory)

Front 13

What are the three stages of learning theory?

Back 13

-Knowledge in action
-Reflection in action
-Reflection on action

Front 14

What is knowledge in action?

Back 14

Knowledge-in-action – acting without constant thinking or reflection on the process or outcomes.

Front 15

What is reflection in action?

Back 15

Reflection-in-action – processing interactions/behavior in “real” time when met with surprising reactions.

Front 16

What is reflection on action?

Back 16

Reflection-on-action – processing after the fact, considering context, emotions, higher order cognitive processing.

Front 17

What are defense mechanisms?

Back 17

Are unconscious methods for dealing with anxiety through the denial or distortion of reality. Can be healthy if used appropriately and in moderation.

Front 18

What are some questions that come to mind when develeoping hypotheses?

Back 18

-Descrepancies or contradictions in feelings, actions, thoughts?
-What’s causing client to behave this way at this time?
-What keeps client from changing?
-What are defenses, resistances, tranferences in this situation?
-How am I feeling in therapeutic relationship?

Front 19

What are the major goals during the insight stage?

Back 19

-Major goal during insight stage is to foster awareness (more conscious of thoughts, feelings, behaviors, impact on others). Leads to fostering insight: construct new understandings, determine their role in creating and maintaining problems, address issues in the therapeutic relationship.

Front 20

What does the Goldfried research say?

Back 20

Having an explanation, right or wrong, helps most people feel more in control of their world

Front 21

What do interpersonal interactions do for the client during the insight stage?

Back 21

Another goal of insight stage is for clients to gain awareness and insight in their interpersonal interactions.
Provide feedback on how they come across
In action stage, generalize to other interactions.

Front 22

What should the helpers perspective be like during the insight stage?

Back 22

-Should not force clients to accept our perspectives. Use perspectives to help clients come to new awarenesses. Helpers may suggest insights, but clients need to discover if they fit rather than accepting them blindly (central rather than peripheral route processing).
-When helpers motivated by countertransference (or personal ideologies), interventions may be less helpful.

Front 23

Which skills foster awareness?

Back 23

Challenge thoughts & discrepancies

Front 24

What skills facilitate insight?

Back 24

-Probe for insight
-Interpretation
-Disclose insight

Front 25

What skills work on the Therapeutic Relationship?

Back 25

Immediacy (comment on relationship, assume it holds things in common with other relationships)

Front 26

What are some difficulties in the insight stage for the counselor?

Back 26

-Taking too much responsibility for insights
-Getting stuck on one theoretical perspective
-Forgetting to be empathic
-Work together, don’t project your own needs/understandings/solutions on to client

Front 27

What are some difficulties that the client might have during the insight stage?

Back 27

Clients may not need or want insight (may need/want support for behavioral change rather than insight). Assess these needs and reduce emphasis on insight or refer to other sources

Front 28

What are challenges?

Back 28

Challenges are invitations to clients to become more aware of themselves, issues, feelings, and behaviors.

Front 29

What do challenges point out?

Back 29

Point out discrepancies or contradictions, defenses, or irrational beliefs that client is unaware or unwilling or unable to change.

Front 30

What are some types of discrepencies that can occur?

Back 30

-Between two verbal statements
-Between words and actions
-Between two behaviors
-Between two feelings
-Between values & behaviors
-Between perception of self and experience
-Between ideal and real self
-Between helper’s & client’s opinions

Front 31

What are challenges used for?

Back 31

-Reduce ambiguities and incongruities in client's experiencing and communication.
-Demonstration to client of his or her resistance, should be delivered prior to interpretations to aid in understanding.
-Help clients become aware of feelings, motives, and desires that they do not like to acknowledge to themselves (can be positive).
-Can cause disruption because helper no longer accepts what clients say at face value – mini-crisis that can motivate clients to change.

Front 32

What are some benefits of Challenges and how must they be used?

Back 32

-Help clients become aware of their defenses.
-Can lead to insight.
-Can help clients become aware of ambivalent feelings.
-Enable clients to admit to having different or deeper feelings than they had acknowledged.
-Must be done gently to be effective.

Front 33

What percent of therapists statements are challenges?

Back 33

1-5%

Front 34

How can challenges be effective?

Back 34

In pointing out contradictions, but must be done carefully and empathically

Front 35

What is something about challenges that can be touchy?

Back 35

Challenge can imply criticism, but should encourage deep self examination

Front 36

What is the proper way to go about a challenge?

Back 36

-Do carefully, gently, respectfully, tentatively, thoughtfully, and with empathy.
-Goal of understanding client and facilitating movement toward growth.
-Helper indicates puzzlement rather than hostility

Front 37

When you challenge someone what must you do first?

Back 37

-Spend time in exploration to build relationship.
-Also to observe client and see defenses, irrational ideas or "sour notes" (doesn't sound right, make sense, doesn't fit with other statements, lots of 'shoulds', cause ambivalences, struggles, etc.)
-Collect several examples before jumping in.
-Look for markers like expressions of ambivalence, contradictions, discrepancies, or confusions or feeling stuck. Spend time thinking why client may feel stuck, understand client's dynamics.
-Is therapeutic relationship strong enough to handle challenges? Client feel safe? Trust helper? Been enough exploration? Adequate rapport?

Front 38

What do you NOT do when applying challenges?

Back 38

-Direct blunt challenges may not be appropriate with Asian, Latina-Latino, and American Indian clients.
-Probably appropriate with acting out males or for folks in precontemplation and contemplation stages.
-Don't make judgments when challenging, shouldn't be a criticism. Air of understanding or puzzlement, not hostility. Be Columbo!
-May require repetition over time. Use them when inconsistent behaviors occur.

Front 39

What are some examples of how to phrase challenges?

Back 39

-On the one hand _____, but on the other hand___.
-You say ______, but you also say _____.
-You say _____, but nonverbally you seem _____.
-I'm hearing _____, but I’m also hearing ______.
Really? Oh, yeah? Hmmmm.
-Humor may help.
-Timing, may be accurate, but too early.

Front 40

What is cognitive restructuring?

Back 40

Recognize faulty thinking and change it.

Front 41

What are the ABCs according to Ellis?

Back 41

A – activating event
B – irrational beliefs
C – consequent native emotional reactions or behaviors
D – debunk, replace B with more rational cognitions
E – results in more positive emotions

Front 42

According to Beck, how do major problems come about?

Back 42

Automatic thoughts & dysfunctional interpretations -> major problems

Front 43

What's with Beck and cognitive therapy?

Back 43

-Misconstrue events by faulty logic & beliefs re: self, world, future.
-See self as defective, inadequate, or unlovable
-World as unmanageable, uncontrollable, overwhelming
-Future as bleak & hopeless
-Beck is more gentle than Ellis
-Point out cognitive themes & underlying assumptions
-We draw conclusions without adequate evidence
-Take details out of context, general rules from isolated incidents, make things more or less important than they are
-Engage in rigid either-or thinking

Front 44

How does Greenberg's two chair therapy work?

Back 44

-Identifying unrecognized feelings
-Polarity of feelings (love-hate)
-Denial of feelings
-Conflict of two opposing sides
-Put one side in one chair, the other in the other chair
-Client voices each side, sitting in each chair

Front 45

What can humor do for a session and how should you use it?

Back 45

-Can soften challenges
-Laugh with rather than at
-Can help them see things in different light
-Have established relationship so not misread

Front 46

What does Gestalt say about foot tapping and other distractors?

Back 46

-Be your foot
-Exaggerate feeling

Front 47

What are some statements that are associated with "owning responsibility"?

Back 47

-“I” rather than “you” statements
-“Can’t” versus “won’t”
-“Shouldn’t” versus “choose to”

Front 48

What are some difficulties for helpers when using challenges?

Back 48

-May not do enough, use too few.
-Use inappropriately, can minimize negative feelings, falsely reassure.
-Use too many challenges or too harshly (“Gotcha!”)
-Clients may disagree or be defensive, etc.

Front 49

How do you begin the insight stage?

Back 49

Begin with attitude of empathic curiosity

Front 50

What are some open questions to use during the insight stage?

Back 50

-Invite client to think about deeper meanings for thoughts, feelings, behaviors
-“What are your thoughts about what is going on there?/”
-“What do you make of your feelings about ending the relationship?”
-“What connection do you make between your feelings and the event?”

Front 51

When can you use 'why' questions if they're done well?

Back 51

During the insight stage---open questions for insight.

Front 52

During the insight stage what should you be thinking about?

Back 52

Think about parts of narrative that don’t fit.

Front 53

What are interpretations?

Back 53

Interpretations are interventions made by helpers that go beyond what a client has overtly stated or recognized

Front 54

What meaning do interpretations bring?

Back 54

Interpretations present a new meaning, reason, or explanation for behaviors, thoughts, or feelings so that clients can see problems in a new way.

Front 55

What do interpretations do?

Back 55

-They make connections between seemingly isolated statements or events; point out themes or patterns in a client's behaviors, thoughts, or feelings; explicate defenses, resistance, or transference; or offer a new framework to understand behaviors, thoughts, feelings, or problems.
-Explicate defenses, resistance, transference

Front 56

How often are interpretations used?

Back 56

6-8% of the time.

Front 57

How can interpretations be effective?

Back 57

Can be effective when crafted to the beliefs and needs of the client when fairly well adjusted.

Front 58

What do interpretations provide?

Back 58

Provide conceptual framework that explains problems and offers rationale for overcoming them. Increase client's sense of security, mastery, and self-efficacy. Relieve distress by relabeling client emotions to make them more understandable.

Front 59

What do psychoanalists work to do?

Back 59

Psychoanalytic - work by replacing unconscious processes with conscious ones, thus resolve unconscious conflicts.

Front 60

When do psychoanalists focus on interpretations?

Back 60

Role of early childhood is important and often focus on interpretations - form foundation for all ensuing relationships

Front 61

What is the most significant interpretation?

Back 61

Interpreting transferance.

Front 62

What is interpreting transference?

Back 62

Distortion by client of helper based on early childhood relationships

Front 63

What does information processing reveal?

Back 63

Information-processing - reveal discrepancies between views of therapist and client.

Front 64

What are the three directions that a client can go in in order to change?

Back 64

-Client must go with therapists views
-Try to change therapist's views
-Discredit the therapist

*If accepts therapist's views, is able to relabel and reconstrue how s/he views issue.

Front 65

What do cognitive psychologists think?

Back 65

- all thoughts, feelings, sensations, memories, and actions are stored in schemas (schemata).

Front 66

In terms of cognitive psychology what's the deal with interpretations?

Back 66

Interpretations help change the way schemas are structured, bring back memories and come to new understandings based on more current and complete information (see childhood or other events from adult perspective).

Front 67

In cognitive psychology how do interpretations lead to change?

Back 67

-Repeated interpretations with expansions to other areas allow for connections to be made and retained.
-Action and behavior change consolidates changes in thinking.

Front 68

What are some ways that interpretation can work, regardless of theory style?

Back 68

In summary, may work because unconscious is made conscious, revealing discrepancy between perspectives propels clients to change to resolve discrepancy, or because interpretations change schematic connections.

Front 69

What does the evidence say about interpretations?

Back 69

Interpretations can be powerful interventions if delivered with care, are of moderate depth, specific to the client, repeated often, applied to numerous situations, provided within context of empathy, interwoven with other interventions.

Front 70

How do past experiences effect present interpretations?

Back 70

Past experiences - how interacted with significant others; characteristic way of responding to others

Front 71

How does the verbal content of a client's speech affect interpretations?

Back 71

Verbal content of client’s speech -may compartmentalize and not make connections by themselves

Front 72

How do defenses affect interpretations?

Back 72

Defenses - understand role defenses play, see them as no longer functional

Front 73

How does culture influence how one might interpret a client's behavior?

Back 73

Developmental Stages and Culture – where are they for their developmental stage within their culture (How old does this client seem to be?)

Front 74

What are some existential issues according to Yalom that affect people regularly?

Back 74

-Struggle with death anxiety
-Freedom (lack of external structure, personal responsibility)
-Isolation (from others and the world)
-Meaning of life
-All affected by religion/cultural beliefs

Front 75

What are some unconscious things that can be interpreted?

Back 75

Unconsious sources – dreams, fantasies, slips of tongue

Front 76

What do psychoanalysts say about accuracy of interpretations?

Back 76

They say that accuracy is very important.

Front 77

What do theorists other than psychoanalysts say about accuracy of interpretations?

Back 77

That it's not as important to be accurate but it is very important to be make sense or have the client believe it.

Front 78

What happens with the client when interpretations are beleived and go well?

Back 78

-“aha”, something “clicks”
-Clients feel energized, excited
-Clients present additional important information
-Clients start thinking about what to do differently