Monday, August 31, 2015

Managing Transference and Countertransference


Transference

⋄ Feelings client projects onto the counselor.
⋄ Have to do with relationship client has experienced in the past.
⋄ Intensity of feelings has to do with unfinished elements of client’s life.
⋄ Client may identify in the therapist characteristics that are reminiscent of the person they are transferring their emotions from.
⋄ Feelings can be productively explored so client becomes aware of how they are keeping an old pattern functional in other present time relationships.
⋄ Therapy becomes an ideal place to become enlightened to patterns in relationship of psychological vulnerability.
⋄ Clients gain insight into how their unresolved issues lead to dysfunctional behavior.
⋄ Group therapy may provide a microcosm of how people function in general social settings.
⋄ Ask client to tell more about how the therapist has affected them to elicit additional information about how the client developed the transference.
⋄ Do not become defensive.
⋄ “I wonder if I remind you of anyone you have had similar feelings with?”
⋄ There is potential for rich therapeutic progress!
⋄ Carefully take on a symbolic role and allow the client to work through their unresolved conflict.


Counter-transference

⋄ Feelings aroused in the counselor by the client.
⋄ Feelings have to do with unresolved conflict from other past or present relationships rather than the therapeutic relationship with this particular client.
⋄ Discuss how you are affected by certain clients in supervision on with a colleague.
⋄ Get other’s perspectives on whether you are maintaining unconditional positive regard.
⋄ Self-knowledge is the basic tool in dealing with Counter-transference.
⋄ Unacknowledged, this can lead to an unproductive group. If leaders are not willing to deal with their own issues, how can they expect clients to do so?
⋄ Counter-transference in groups can be indicated by exaggerated and persistent feelings that tend to recur with various clients of different groups.






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Monday, August 24, 2015

Individually based theory and therapy models

Psychoanalysis- Freud/Erikson/Mahler
Role of Therapist

■ Invisible- Blank Screen (detachment)
■ Fosters transference
■ Focus on Resistance


Therapeutic Goals

■ Bringing the unconscious to the conscious
■ Strengthen the ego


Key Ideas

Deterministic- problems are rooted in the first six years of life and trapped in unconscious motivations
Reality Principle- maximize gratification minimize punishment
Biological Drives- sex and instincts
Parts of Personality- Id/Ego/Superego
Id- Pleasure principle, “Demanding Child,” deterministic, unconscious, satisfy basic survival
Ego- Reality principle, “Traffic Cop,” mediator between Id and Superego
Superego- Moral Principle, “The Judge,” strive for perfection


Psychosexual Stages of Development

Oral Phase- 0-1 years, greedy, mistrust, unable to form intimate relationships
Anal Phase- 1-3 years, anal retentive, aggressive
Phallic Phase- 3-6 years, identity disturbance (Oedipal/ Electra complex)
Latency- 6-12 years, Socialization stage
Genital- 12+, Interpersonal relations freedom to love/work


Techniques

■ Brief psychodynamic therapy (BPT)- treating selective disorders within an established time.
■ Hypnosis
■ Dream Interpretation
■ Free Association
■ Projective Techniques
■ Freudian Slips





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Monday, August 17, 2015

Risk factors, stages and patterns of grief response

•        DSM Diagnosis under Other Conditions That May be Focus of Clinical Attention, V62.82, Bereavement- used for death of a loved one.
•        Depression in this case is considered “normal” but individual my be seeking treatment to relieve symptoms such as insomnia or anorexia.
•        Expression of “normal” bereavement time is relative to different cultures.
•        Major Depressive disorder is not diagnosed unless symptoms last longer than two months after loss.

Stages of Grief:
•        Denial
•        Anger
•        Bargaining
•        Depression
•        Acceptance







Reactions commonly seen in children:
        o        Disbelief- children may act as if it did not happen.
        o        Complain of headaches, stomachaches, or fear of their own death.
        o        Anger- concern over own needs and about being alone, or with God.
        o        Guilt- feelings of causing death, or not having been “better”
        o        Anxiety/Fear: may become clingy and need validation of love.
        o        Regression: revert to bed wetting or thumb sucking
        o        Sadness: lethargy and isolation

Short Term Treatment Goals
•        Express fear and anger, grieve in a healthy way.
•        Loss and Grief Counseling Group
•        Recall fond memories
•        Create a phone list of supportive people to call
•        New coping techniques
•        Find a “safe place” to spend limited time thinking about deceased
•        Exercise regiment
•        Relaxation techniques- progressive muscle relaxation, guided imagery

Long Term Treatment Goals
•        Reach a point of coping without being overcome with grief.
•        Regain normal activity.
•        Reduce feelings of guilt and anger towards self, others, and God.
•        Re-mature over regressed behaviors
•        Understanding of death and life.

Therapeutic Interventions
•        Writing Activities
        o        Letter to deceased for closure
        o        Journal of thoughts (may be shared in counseling, in group, or with family members)
•        Art therapy:
        o        Finger paints are useful in expressing feelings
        o        Draw pictures of activities enjoyed with deceased (useful with children).
        o        Collage on a theme
        o        Splatter room: area where (particularly children) are free to throw violent splotches of paint to get anger out.
•        Play Therapy:
        o        Model clay or dough to vent anger or create ritual objects
        o        Puppetry- to express feelings
        o        Sand tray to play out themes, “burry” deceased for closure, or rake sand for relaxation or meditation.
•        Bibliotherapy:
        o        Appropriate self help books
        o        Books related to symptoms client is displaying
•        Loss Graph or Timeline:
        o        Used to discuss types of loss
        o        Used to recall fond memories and celebrate life
•        Storytelling:
        o        Fantasy monologues
        o        Mutual storytelling
•        Therapeutic Metaphors
        o        Helpful in understanding concept of death
•        Empty Chair
        o        Gestalt technique
        o        Imagine deceased in chair and speak to them for closure






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Monday, August 10, 2015

Individually based theory and therapy models

Adlerian Therapy
Therapy Focus
Importance of the feelings of self (ego) that arise from interactions and conflicts.

The sense of self, or The Ego is the core individuality/personality of a person

Adlerian therapy got its start from psychoanalysis.

It places emphasis on motivation and social interaction

A phenomenological approach

Social interest is stressed

Study of birth order and sibling relationships.

Purpose of therapy is teaching, informing, and encouraging.

Basic mistakes of client logic

  • o Overgeneralization
  • o Exaggerated need for security
  • o Misperceptions of life
  • o Denial of ones worth
  • o Faulty values


The therapeutic relationship is a collaborative partnership.

Focus on the importance of each person’s:

  • o Unique motivations
  • o Perceived niche in society
  • o Goal directedness



Phenomenological Approach
Adlerian's attempt to view the world from the client’s subjective frame of reference.

Belief in how life in reality is less important than how the individual believes life to be.

Belief that it is not the childhood experiences that are crucial, but rather our present interpretation of these events.

Belief that unconscious instincts and our past do not determine our behavior.






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Monday, August 3, 2015

Effect of substance abuse & dependence on individual and family functioning


⋄ Chronic substance abusers tend to be isolated from their families after a long period of damaging relationships.
⋄ Substance abuse affects more than the immediate family.
⋄ Extended family members often report feeling abandoned, embarrassed by, ashamed of, and withdrawn from the substance abusing family member, often choosing to break relational ties.
⋄ Different family structures in which abuse affects the family relationship:
⋄ Client who lives alone or with a partner.
⋄ Both partners need treatment.
⋄ Groups are offered both for addicts and for non-addict partners of addicts.
⋄ The treatment of either partner will affect both.
⋄ Often, codependence is an issue.
⋄ Enabling may have to be explored
        o Client who lives with a spouse (or partner) and minor children.
⋄ Parental substance abuse has a detrimental affect on children.
⋄ There may be triangulation or enmeshment issues if children are either placed in the middle or if non-using parent is overly protective and bonded with children due to the substance abuser’s lack of responsibility.
⋄ Issues of neglect or trauma may be present if both parents are abusing drugs.
        o Client who is part of a blended family.
⋄ Substance abuse can intensify already shaky ground of newly blended families and become an impediment to integration and stability.
        o An older client who has grown children.
⋄ As with child abuse and neglect, elder maltreatment can be subject to statutory reporting requirements for local authorities.
        o Client is an adolescent and lives with family of origin.
⋄ Non-using children may find themselves neglected or ignored emotionally due to the focus of parents on the using child.
⋄ Often, at least one of the parents uses as well..
        o Someone not identified as the client is abusing substances.
⋄ Issues of blame, responsibility, and causation will arise.
⋄ Scapegoating may be an issue.
⋄ Therapist must work towards uncovering the underlying motivations for substance abuse and other behavioral issues that bring the family into counseling.





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