Counseling Theories NCMHCE and IC&RC review

1. Counseling Theories for
Individuals
Instructor: Dr. Dawn-Elise Snipes
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery & The
Addiction Counselor Exam Review
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 1

2. Objectives
 Review the most common counseling theories and
related interventions
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 2

3. Cognitive Behavioral
 Premise
 People respond to their representation of events rather than the
events themselves
 Learning is cognitively mediated
 Thoughts impact emotional and behavioral reactions
 Some types of thoughts can be monitored and modified
 Modifying thoughts can help modify emotions and behavioral
responses
 Both behavioral and cognitive techniques are useful and can be
integrated
 Goal:
 To identify and correct unhelpful cognitions by clarifying and
challenging unhelpful or inaccurate cognitive schema and increase
the client’s problem-solving abilities
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 3

4. Cognitive Behavioral Assessment
 Clinical interviews can clarify antecedents and
consequences to emotions and behaviors and strategies
that have and have not been helpful in the past
 Inventories and questionnaires are helpful in identifying
cognitive distortions
 Self-monitoring can help identify the frequency,
antecedents and consequences of unhelpful thoughts
and/or reactions
 Data from the assessment helps identify the client’s:
 Problem solving ability
 Attributional style (Global/Stable/Internal)
 Underlying belief systems (Cognitive distortions)
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 4

5. Cognitive Behavioral Interventions
 Daily mood and activity monitoring
 Increase rewarding behaviors and establish a daily routine
 Develop understanding of the relationship between feelings,
thoughts and behaviors
 Graded tasks to help clients start approaching and addressing
seemingly overwhelming problems
 Teach new skills and have client practice them between sessions
 Address automatic thoughts
 Teach the concept
 Elicit the client’s thoughts
 Label the distortion
 Identify, challenge and modify maladaptive schemas
 Develop helpful alternatives
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 5

6. Cognitive Behavioral Interventions
 ABC-DE
 Activating Event
 Beliefs (Automatic)
 Consequences (Emotional and behavioral reactions)
 Dispute cognitive distortions and inaccurate schema
 Evaluate the reaction/consequences for helpfulness
 Cognitive Processing
 Fact vs. emotional reasoning
 Facts for and against
 Big picture or tunnel vision (context/hindsight)
 High vs. low probability
 Cognitive distortions?
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 6

7. Cognitive Behavioral Interventions
 Downward arrow (Follow it through)
 If so, then what…
 Questioning the evidence
 Decatastrophizing
 Cognitive rehearsal
 Problem solving skills training
 Thought stopping
 Behavioral
 Narrowing (unlinking)
 Cue strengthening for positive behaviors
 Self-reinforcement and punishment
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 7

8. Cognitive Behavioral Indicators
 Indications
 Mood disorders (depression, anxiety, phobias)
 Fears of failure, rejection, abandonment
 Eating disorders
 Personality disorders
 Counterindication
 Significant cognitive dysfunction, psychosis or mania
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 8

9. Behavioral Models
 Premise
 Emphasis on current behaviors which are under stimulus
control
 Reject the idea that maladaptive behaviors reflect
underlying pathology
 Elimination of the behavior is the primary goal of treatment
 Assessment takes the form of a functional analysis
 Antecedents, consequences and discriminative stimuli
 Naturalistic observation
 Self monitoring
 Role playing
 Rating scales
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 9

10. Behaviorism Principles
 Operant conditioning
 Behaviors are increased or decreased through
punishment and reinforcement
 Observational learning
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 10

11. Behavioral Therapy
 Goal: Identify stimuli, reinforcers and
punishments in the environment which are
maintaining the problem behavior
 Remove reinforcement and cues for target behavior
 Increase reinforcement and cues for new behavior
 Assessment
 Emphasizes observable, measurable behaviors and
patterns
 Client and therapist agree on the definition of the
problem behavior
 Baseline data is acquired
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 11

12. Behavioral Therapy Interventions
 Systematic desensitization
 Relaxation training
 Anxiety/Anger hierarchy
 Assertiveness training to combat anxiety
 Behavioral rehearsal
 Aversion therapy
 Flooding (in vivo exposure with response
prevention)—Agorophobia
 Increasing behaviors through reinforcement
 Shaping
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 12

13. Behavioral Therapy Interventions
 Premack Principle
 Response cost (having to give away something
each time the target behavior occurs)
 Smoking, speeding, nail biting, poor academic
performance, aggression
 Time out from reinforcement
 Determine the function of the behavior (i.e. to get
attention vs. because of boredom)
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 13

14. Behavior Therapy Contracts
 Contingency contract
 Explicit definition of behavior (go to bed by 10pm)
 Behaviors that can be monitored (observable, measurable)
 Sanctions for failure (punishment)
 Record keeping to provide feedback (logs)
 Token Economy
 Define target behaviors
 Select the reinforcers
 Monitor the behaviors
 Fade out reinforcers
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 14

15. Humanistic
 Premise
 To understand a person, one must understand her
subjective experience
 Emphasis on the uniqueness and wholeness of the
individual
 Belief in the persons inherent ability for growth and
self-determination
 Therapy involves authentic, collaborative interactions
 Rejection of traditional assessment techniques and
diagnostic labels
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 15

16. Person Centered
 The self is a consistent conceptual gestalt composed of
perceptions of “I” and the relationships of “I” with the
world and the values attached to those perceptions
 To grow the person must remain unified and organized.
 Disorganization occurs when there is incongruence
between the self and experience. (conditions of worth)
 I am lovable for who I am vs. You are lovable if you make me
proud.
 Therapeutic goals are to help clients achieve congruence
between self and experience (eliminate the shoulds) by
providing an authentic atmosphere with unconditional
positive regard.
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 16

17. Person Centered Assessment
 Assessment
 Examine the difference between who the client IS and
who the client perceives herself to be.
 Believes the client to be the expert on herself
 Techniques
 Unconditional positive regard
 Accurate empathy
 Genuineness and congruence
 Avoid interpretation, manipulation, probing or advice
giving
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 17

18. Gestalt Therapy
 Premises
 People seek closure
 Peoples “gestalts” reflect current needs
 Behavior represents a whole that is greater than the sum of
it’s parts
 Behavior must be understood in context
 A focus on the here and now to increase self-awareness and
help client’s live in the now
 The self is the creative, forward moving aspect of self
 The self-image is the part that imposes external demands
 Historical information is only relevant to the extent that it is
impacting the present “unfinished business”
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 18

19. Gestalt Therapy
 Problems
 Arise from abandonment of the self for the self-image
 Stem from disruption of the boundary between self and
external environment resulting in failure to meet personal
needs
 Boundary Issues
 Introjection: Accepting things from the environment without
understanding or questioning
 Projection: Disowning aspects of the self and putting them on
other people
 Retroflection: Do to the self what you want to do to others
 Confluence: Intolerance of differences between self and
others (guilt and resentment)
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 19

20. Gestalt Techniques
 Directed awareness
 No questions (especially why) to prevent
intellectualizing
 Instead of “What is your foot trying to communicate” say,
“Tell me about what your foot is communicating.”
 Use I language
 Assume responsibility
 Empty chair
 Role reversal
 Role rehearsal
 Dream work
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 20

21. Psychodynamic therapy
 Premises
 Internal conflicts, and their relation to the problem are
central themes of treatment
 Psychopathology develops especially from early childhood
experiences
 Internal representations of experiences are organized
around interpersonal relations
 Life issues and dynamics will re-emerge in the context of the
client-therapist relationship as transference and counter-
transference
 Distress is masked by defense mechanisms
 Behavior is influenced by unconscious thought, and once
vulnerable or painful feelings are processed the defense
mechanisms reduce or resolve
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 21

22. Psychodynamic therapy
 Interventions
 Use of free association as a major method for exploration of internal
conflicts and problems
 Focusing on interpretations of transference, defense mechanisms, and
current symptoms and the working through of these present problems
 Review emotions, thoughts, early-life experiences, and beliefs to gain
insight into their lives and their present-day problems.
 Encouraging clients to trust that insight about how their past is
impacting their present is critically important for success in therapy
 Interpretation of transference reactions
 Examine
 Acts of the self toward others
 Expectations about others' reactions
 Acts of others toward the self
 Acts of the self toward the self (introjection)
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 22

23. Summary
 Cognitive behavioral approaches address the connection
between unhelpful thoughts, feelings and behaviors
 The focus is often on changing thoughts and/or behaviors
 Behavioral interventions focus only on observable,
measurable behaviors, thoughts and feelings are
irrelevant.
 Humanistic therapist focus on helping people live as an
authentic, integrated whole
 Psychodynamic techniques focus on how the past is
influencing current behaviors
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 23