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From one of my favorite SAMHSA Publications
TIP 52 – Clinical Supervision and Professional Development of the Substance Abuse Counselor
Each counselor goes through different stages of development. The movement through these stages is not always linear and can be affected by changes in assignment, setting, and population served.
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1. View of Human Nature
a. A Gestalt means a whole, and Gestalt therapy is based on the person feeling whole or complete in their life.
b. Gestalt therapy is considered to be a here-and-now therapy focusing on awareness with the belief that when one focuses on what they are and not what they wish to become, they become self-actualized. The idea being that through self acceptance one becomes self-actualized.
c. The Gestaltists believe that the individual naturally seeks to become an integrated whole, living productively.
d. Gestaltists are antideterministic because they believe that people have the ability to change and become responsible.
e. Gestalt borrows heavily from the viewpoints of existentialist, experientialist, and phenomenologicalist with the emphasis on the present and awareness. Gestalt focuses on the client’s own inner world of interpretation and assessment of the present life situation
f. Gestaltists believe that individuals emphasize intellectual experience, diminishing the importance of emotions and senses, resulting in an inability to respond to the situations or events in their life
g. Gestaltists believe that thoughts, feelings, and reactions to past events or situations can impede personal functioning and prevent here-and-now awareness. The most common unfinished business is that of not forgiving one’s parents for perceived mistakes in one’s parenting.
h. Awareness is considered on a continuum with the healthiest person being most aware. These people are aware of their needs and deal with them one at a time. The emphasis in on reality and not on embellished or imagined needs. The individual recognizes their internal need and meets that need through manipulation of the need and the environment.
Difficulty may arise in several ways:
i. Loss of contact with the environment and its resources.
ii.. Loss of contact with self through over involvement with environment.
iii. Fail to put aside unfinished business.
iv. Loss the Gestalt resulting in fragmentation or scattering.
v. Experience conflict between what one should do and what one wants to do.
vi Experience difficulty with life’s dichotomies, i.e. love/hate, pleasure pain, masculinity/femininity.
2. Role of the Counselor
a. The counselor creates an environment for the client to explore their needs in order to grow.
b. The counselor is fully with the client in the here-and-now with intense personal involvement and honesty.
c. The counselor helps the client to focus on blocking energy and to positively and adaptively use that energy.
d. The counselor also helps the clients to discern life patterns.
e. Among the rules that counselors use to help client:
i. The principle of the now requires the counselor to use present tense.
ii. I and Thou means that the client must address the person directly rather than talk about them or to the counselor about them.
iii. Making the client use the I instead of referring to own experiences in the second (you) or third (it) person.
iv. The use of an awareness continuum that focuses on how and what rather than on why.
v. The counselor has the client convert questions into statements.
vi. DSM-IV categories and standardized assessment is not considered necessary within this theory (Gladding, 1996)
a. The emphasis is on the here-and-now of the client’s experience
b. The client is encouraged to make choices based on the now as opposed to past
c. Help the client resolve the past
d. Assist the client to become congruent.
e. Help the client to reach maturity intellectually.
f. Help the client shed neuroses.
a. Techniques in Gestalt therapy one of two forms, either an exercise or an experiment
i. Exercises include activities such as:
- frustration actions
- fantasy role playing
ii. Experiments are unplanned creative interventions that grow out
of the here-and-now interaction between the client and the
b. Dream work in Gestalt therapy consist of the client telling the dream and then focusing their awareness on the dream from the perspective of each character or element in the dream.
e. Empty chair is a process where the client addresses parts of the personality , as if it were an entity sitting an empty chair. The client may switch perspectives by switching chairs or may simply address the chair. The technique is contraindicated for severely disturbed clients.
f. Confrontation is another of the Gestalt exercises that is very powerful. Basically, the counselor calls attention to the incongruence between the client’s verbalizations and observed emotions or behaviors.
g. Making the rounds is a group exercise in which the client is instructed to say the same sentence to each member of the group and then adding something personal to each person.
h. I take responsibility is the phrase that follows each statement expressing statements or perceptions that the client states. The process is to help the client to integrate their internal perceptions and their behaviors.
i. Exaggeration is over-dramatizing the client’s gestures and movements to help gain insight into their meaning.
j. May I feed you a sentence is the question that the counselor asks before giving the client a more specific expression of what the counselor believes is the underlying message of the client.
- Fritz Perls (en.wikipedia.org)
1. View of Human Nature
a. Existentialists believe that the individual writes their own life story by the choices that they make.
b. Psychopathology is defined by existentialists as neglecting to make meaningful choices and accentuating one’s potential.
c. Anxiety is seen as the motivational force that helps the clients to reach their potential. Conversely, anxiety is also seen as the paralyzing force that prevents clients from reaching their full potential. Therefore, through awareness, this anxiety can be helpful in living more fully.
d. Frankl shares that each person searches for meaning in life, and that while this meaning may change, the meaning never ceases to be.
e. According to Frankl, life’s meaning can be discovered in three ways:
i.by doing a deed (accomplishments or achievements),
ii. by experiencing a value (beauty, love, nature, and arts)
iii. by suffering (reconciling ourselves to fate)
2. Role of the Counselor
a. Each client is considered a unique relationship with the counselor focusing on being authentic with the client and entering into a deep personal sharing relationship
b. The counselor models how to be authentic, to realize personal potential, and to make decisions with emphasis on mutuality, wholeness and growth.
c. Existential counselors do not diagnose, nor do they use assessment models like the DSM-IV.
a. A goal of existential counseling is to have the clients take responsibility for their life and life decisions.
b. A goal of existential therapy is to develop self-awareness to promote potential, freedom, and commitment to better life choices
c. A major goal is to help the client develop an internal frame of reference, as opposed to the outward one.
a. The most common technique used in existential counseling is the relationship with the client .
b. Confrontation is also used by existential counselors, when they challenge the clients with their own responsibility for their lives.
1. View of Human Nature
a. Rogers viewed human nature as basically good
b. He believed that if given the appropriate environment of acceptance, warmth and empathy, the individual would move toward self-actualization
c. Self-actualization is the motivation that makes the individual move toward growth, meaning, and purpose
d. Person-centered is considered a phenomenological psychology in which the individual’s perception of reality is accepted as reality for the individual.
e. Person-centered is often referred to as a self theory, because of Rogers’ emphasis on the self being the result of the person’s life experiences and the person’s awareness of comparisons to others as the same or different.
f. Rogers believed that most people were provided conditional acceptance as children, which lead them to behave in ways that would assure their acceptance. However, in their need for acceptance, the individual often behaved in ways that were incongruent with the real self. Thus, the greater this incongruence between the real self and the ideal self, the greater isolated and maladjusted the person became.
2. Role of the counselor
a. The counselor sets up a environment where the client is safe to explore any aspect of the self. The counselor’s job is to facilitate the exploration through a special client-therapist relationship of unconditional positive regard, empathy, and warmth.
b. The personcentered counselor uses psychological testing on a limited basis. The Q-sort is sometimes used in assessment by the person-centered counselor. A series of 100 statements are written on cards. The statements are self-descriptions, i.e. I am capable, I am dependent, I am worthless. The client is asked to read and sort each of these statements into nine piles from most like me to least like me. Then the stacks are recorded. The client resorts the cards into what they would like to be like. The Q-sort gives an indication of the incongruence between the perceived real self and ideal self.
c. The use of diagnostic categories is discouraged as incompatible with the philosophical view of the individual as unique. Diagnosis places the counselor in a position of authority and imposes a treatment plan.
3. Goals of therapy
a. In person-centered theory are directly concerned with the individual.
The counselor facilitates the client toward:
i. Realistic self-perception
ii. Greater confidence and self-direction
iii. Sense of positive worth
iv. Greater maturity, social skill, and adaptive behavior
v. Better stress coping
vi. More fully functioning in all aspects of their lives
a. The techniques used in person-centered therapy have changed over time.
b. Three periods of time in which different techniques were stressed:
i. Nondirective Period (1940-1950). In this period of theory development, the counselor focused on listening and creating a permissive atmosphere. The counselor did not provide interventions, but communicated acceptance and clarification.
ii. Reflective Period (1950-1957). During this period of time,
counselors emphasized being non-judgmental of the client, while responding to the client’s feelings and reflecting the affect accurately.
iii. Experiential Period (1957-1980) This is the period of the EWG: Empathy, Warmth and Genuineness. Empathy is the ability of the counselor to understand the emotions of the client and correctly communicate this understanding. Warmth is also referred to as acceptance and positive regard in person-centered literature. Warmth is the ability of the counselor to convey an unconditional acceptance of the client’s personhood. Genuineness or congruence is the ability to be who one really is without assuming roles or facades.
c. The counselor helps the client through accurate reflections of feelings, keeping the client focused on the concern, and clarification of feelings and information. The counselor uses open-ended questions or phrases to help the clients gain insight into experiences and necessary changes in their lives.
Test your knowledge!
1. View of Human Nature
A) The Adlerian concept of social interest is the individual’s feeling of being part of a whole in the past, present, and the future. Adler believed that people were mainly motivated toward this feeling of belonging. He did not believe that social interest was innate but rather a result of social training.
B) Adler expressed that people strove to become successful and overcome the areas that they perceived as inferior. He referred to this process of personal growth as striving for perfection. Those who did not overcome feelings of inferiority developed an inferiority complex. Those who overcompensated for feelings of inferiority developed a superiority complex.
C) Adler believed that a person’s conscious behavior, not their unconscious, was the mainstay of personality development. Because of this concept, Adlerian theory emphasizes personal responsibility for how the individual chooses to interpret and adjust to life’s events or situations.
D) Maladjustment is defined in Adlerian theory as choosing behavior resulting in a lack of social interest or personal growth. Adler believed that misbehavior would take place when the person had become discouraged or when positive attempts at good behavior had failed to get the needed results. Encouragement to good behavior was often the recommended antidote to misbehavior.
E) Another concept is that of teleology, which simply put means that a person is as influenced by future goals as by past experiences.
F) Adlerian espoused the belief that the birth of each child changed the family substantially. He thought that the birth order of the children in the family influenced many aspects of their personality development. Briefly, characteristics of these birth positions are:
I) Oldest children are usually high achievers, parent pleasers, conforming, and are well behaved.
II) Second born children are more outgoing, less anxious, and less constrained by rules than first born children. They usually excel as what the first born does not.
III) Middle children have a feeling of being squeezed in and are concerned with perceived unfair treatment. These children learn to excel in family politics and negotiation. However, they can become very manipulative. This position also tends to develop areas of success that are not enjoyed by their siblings.
IV) The youngest child is the most apt at pleasing or entertaining the family. While they run the risk of being spoiled, they are also the most apt at getting what they want through their social skills and ability to please. They are often high achievers, because of the role models of their older siblings.
G) Only children or children born seven or more years apart from siblings are more like first born children. Children with no siblings often take on the characteristics of their parents birth order, as the parents are the only role models. While these children may mature early and be high achievers, they may lack socialization skills, expect pampering, and be selfish.
H) Adler saw the family as the basic socialization unit for the child. He believed that children’s interpretation of the events in their life was determined by the interaction with family members before the age of five. The family interactions taught the children to perceive events and situations through certain subjective evaluations of themselves and the environment, called fictions. Basic mistakes could be made based on these fictions.
Adlerians believe that some of those mistakes are (Mozak, 1984):
I) Over-generalizing in which the individual believes that everything is the same or alike.
II) False or impossible goals of security which leads the individual to try to please everyone in seeking security and avoiding danger.
III) Misperceptions of life and life’s demands which leads the individual to expect more accommodation than is reasonable and to interpret their failure to get accommodation as never getting any breaks.
IV) Minimization or denial of one’s worth results in the individual believing that they cannot be successful in life.
V) Faulty values results in a “me first” mentality with little or no regard for others.
VI) Adler believed that life took courage or a willingness to take risks without knowing the outcome. He believed that a person with a healthy life style contributed to society, had meaningful work, and had intimate relationships. He espoused cooperation between the genders as opposed to competition. He believed that well-adjusted people lived in an interdependent relationship with others in a cooperative spirit.
2. Role of the counselor
A) The counselor is as a diagnostician, teacher and model. The counselor helps the client to explore conscious thoughts, beliefs and logic for behaviors that are not in the client’s best interest or social interest. The client-counselor relationship is an equal one with the counselor sharing insights, impressions, opinions, and feelings with the client to promote the therapeutic relationship. Therapy is very cognitive with an emphasis on the examination of faulty logic and empowering the client to take responsibility to change through a re-educational process.
B) The counselor encourages the client to behave “as if” the client were who they wished to be and often provides the client with “homework” assignments outside the sessions. Adlerians are eclectic in technique with an emphasis on encouragement and responsibility.
3. Goals of Adlerian counseling
A) Goals focus on helping the client develop a healthy lifestyle and social interest. The counselor assists the client through four goals of the therapeutic process:
I) establishing a therapeutic relationship
II) examining the style of life
III) developing client insight
IV) changing behavior
B) The behavior change is the result of the individual taking personal responsibility for behavior .
Confrontation – Consists of challenging the client’s private logic and behavior.
Asking “the Question” – Consists of asking the client how their life would be different if they were well? The question often asked to parents is, what would be the problem if this child were not the problem?
Encouragement – Consists of the counselor supporting the client by stating the belief in the client’s ability to take responsibility and change behavior.
Acting “as if” – Consists of instructing the client to behave “as if” there were no problem or as the person that the client would like to be.
Spiting in the client’s soup – It means that the counselor points out the purpose of the client’s behavior. Afterward, the client may continue the behavior, but cannot do so without being aware of their motivation for engaging in the behavior.
Catching oneself – Consist of helping the client learn to bring destructive behavior into awareness and stop it.
Task setting consists of helping the client set short-term goals leading toward the attainment of long-term goals.
Test your knowledge!
- Art Therapy and Autism | Adler Graduate School (artofscience.wordpress.com)
View of Human Nature
- Freud’s view of human nature is considered to be dynamic, meaning that there is an exchange of energy and transformation. Freud used the term catharsis to describe this release of this energy.
- Freud saw the personality as composed of a conscious mind, a preconscious mind and an unconscious mind. The conscious mind has knowledge of what is happening in the present. The preconscious mind contains information from both the unconscious and the conscious mind. The unconscious mind contains hidden or forgotten memories or experiences.
Structure of Personality
- The personality has three parts: the id, the ego, and the superego
- The id is present at birth and is part of the unconscious. The id is the site of the pleasure principle, the tendency of an individual to move toward pleasure and away from pain. The id does not have a sense of right or wrong, is impulsive, and is not rational. It contains the most basic of human instincts, drives, and genetic endowments.
- The ego is the second system to develop and it functions primarily in the conscious mind and in the preconscious mind. It serves as a moderator between the id and the superego, controlling wishes and desires. The ego is the site of the reality principle, the ability to interact with the outside world with appropriate goals and activities.
- The superego sets the ideal standards and morals for the individual. The superego operates on the moral principle which rewards the individual for following parental and societal dictates. Guilt is produced when a person violates the ideal ego denying or ignoring the rules of the superego.
- Oral stage is centered on the mouth as a source of pleasure.
- Anal stage is centered on the anus and elimination as a source of pleasure.
- Phallic stage is centered on the genitals and sexual identification as a source of pleasure.
- Oedipus Complex is described as the process whereby a boy desires his mother and fears castration from the father, in order to create an ally of the father, the male learns traditional male roles.
- Electra Complex is described a similar but less clearly resolved in the female child with her desire for the father, competition with the mother and thus, learns the traditional female roles.
- Latency stage is a time of little sexual interest in Freud’s developmental view. This stage is characterized with peer activities, academic and social learning, and development of physical skills.
- Genital stage begins with the onset of puberty. If the other stages have been successfully negotiated, the young person will take an interest in and establish sexual relationships.
Ego Defense Mechanisms
- Were believed by Freud to protect the individual from being overwhelmed by anxiety. He considered them normal and operating on the unconscious level. Some of the ones most often referred to are:
- Repression is the defense mechanism whereby the ego excludes any painful or undesirable thoughts, memories, feelings or impulses from the conscious.
- Projection is the defense mechanism whereby the individual assigns their own undesirable emotions and characteristics to another individual.
- Reaction Formation is the defense mechanism whereby the individual expresses the opposite emotion, feeling or impulse than that which causes anxiety.
- Displacement a defense mechanism whereby the energy that is generated toward a potentially dangerous or inappropriate target is refocused to a safe target.
- Sublimation is a positive displacement is called whereby the frustrating target is replaced with a positive target.
- Regression is the defense mechanism whereby returns to an earlier stage of development.
- Rationalization is the defense mechanism in which an individual creates a sensible explanation for an illogical or unacceptable behavior making it appear sensible or acceptable.
- Denial is a mechanism whereby an individual does not acknowledge an event or situation that may be unpleasant or traumatic.
- Identification is a defense mechanism whereby a person takes on the qualities of another person to reduce the fear and anxiety toward that person.
Role of the Counselor
To encourage the development of transference, giving the client a sense of safety and acceptance. The client freely explores difficult material and experiences from their past, gaining insight and working through unresolved issues. The counselor is an expert, who interprets for the client.
Goals of therapy include
a. Helping the client bring into the conscious the unconscious.
b. Helping the client work through a developmental stage that was not resolved or where the client became fixated.
c. Help the client adjustment to the demands of work, intimacy, and society.
- Free Association is a process where the client verbalizes any thoughts that may without censorship, no matter how trivial the thoughts or feeling may be to the client
- Dream Analysis is a process where the client relates their dreams to the counselor. The counselor interprets the obvious or manifest content and the hidden meanings or latent content .
- Analysis of transference is a process where the client is encouraged to attribute to counselor those issues that have caused difficulties with significant authority figures in their lives. The counselor helps the client to gain insight by the conflicts and feelings expressed .
- Analysis of resistance is a process where the counselor helps the client to gain insight into what causes form the basis for a hesitation or halting of therapy.
- Interpretation is a process where the counselor helps the client to gain insight into past and present events .
Test your knowledge!
- Ep 185: The Dynamics of Therapy: Transference and Counter Transference: An Interview with Kerry Malawista (thepsychfiles.com)
- Psychological Perspectives (dranilj1.wordpress.com)