Chapter 10 - Cognitive Behavior Therapy

1. Who is associated with the theory?
- Albert Ellis, Aaron Beck, Judith Beck, Donald Meichenbaum.

2. What are the basic assumptions underlying this approach?
- It emphasizes therapy as a learning process, including acquiring and practicing new skills, learning new ways of thinking, and acquiring more effective ways of coping with problems.

3. What are a few of the key concepts that are essential to this theory?
- Rational Emotive Behavior Therapy (REBT) is based on the assumption that everyone is born with a potential for both rational and irrational thinking.  People learn irrational beliefs from their significant others during childhood.  If we want to become psychologically healthy, we have to stop blaming ourselves and others and learn to fully and unconditionally accept ourselves despite our imperfections.  ABC Framework is central to REBT, it provides a useful tool for understanding the client's feelings, thoughts, events, and behavior.  A = the existence of a fact, an activating event, or an inference about an event, of an individual.  C = is the emotional and behavioral consequence or reaction of the individual (can be either healthy or unhealthy).  B = is the person's belief about A.  A (the activating event) does not cause C (the emotional consequence).  Instead B (person's belief about A) largely creates C (emotional reaction).

4. What do you consider the most important goals of this theory?

- Teaching clients how to separate the evaluation of their behaviors from the evaluation of themselves and how to accept themselves in spite of their imperfections.  Help clients differentiate between realistic and unrealistic goals and also self-defeating and self-enhancing goals.  A basic goal is to teach clients how to change their dysfunctional emotions and behaviors into healthy ones.  

5. What role does the therapeutic relationship plays in terms of therapy outcomes?

- The therapist acts as a teacher and client as a student.  The therapist is highly directive and teaches clients how to change their cognitions.  It is a collaborative relationship, in which both parties need to work together to be effective.

6. What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?

- I really like the use of homework assignments in this therapy.  I believe that homework can be extremely effective in counseling sessions.

7. What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?

- CBT has been very effective with depression and anxiety.  It has been used with a wide range of client populations and a variety of problems.  

8. What do you see as the major strength of this theory from a diversity perspective?

- The focus on teaching and learning tends to avoid the stigma of mental illness, which clients may value so they do not feel "bad" for going to therapy.  

9. What do you see as a major shortcoming of this theory from a diversity perspective?

- Some clients may become dependent on the therapist to decide what is considered the appropriate way of doing things. 

10. What do you consider to be the most significant contribution of this approach?

- I believe the most significant contribution of this approach is the fact that it incorporates techniques from other approaches.

11. What do you consider to be the most significant limitation of this approach?

- I believe the most significant limitation of this approach is that it tends to play down emotions and sometimes doesn't give enough weight to the client's past.

Chapter 9 - Behavior Therapy

1. Who is associated with the theory?
- B.F. Skinner, Albert Bandura, Arnold Lazarus

2. What are the basic assumptions underlying this approach?
- Focus on observable behavior, current determinants of behavior, learning experiences that promote change, tailoring treatment strategies to individual clients, focusing on the client's current problems and the factors influencing them, and rigorous assessment and evaluation.

3. What are a few of the key concepts that are essential to this theory?
- We are producers and products of our environment.

4. What do you consider the most important goals of this theory?
- Increase personal choice and create new conditions for learning.

5. What role does the therapeutic relationship play in terms of therapy outcomes?
- A collaborative working relationship with the client.  Must be flexible and versatile.  Therapists conduct a thorough Behavioral Analysis to identify the maintaining conditions by systematically gathering information about situational antecedents (ABC Model).

6. What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
- I would definitely incorporate Systematic Desensitization into my counseling practice.  I believe this technique is very useful and effective.  Also, I like how the client and counselor have a strong sense of rapport with one another.  I believe that strong rapport is needed in any type of counseling, because without it the client may not be willing to disclose information to the counselor.  I would also incorporate social skills training and flooding into my counseling practices.

7. What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?
- It can be used with a variety of populations, such as individual and group.  You can use it for stress reduction (mindfulness), Acceptance and Commitment Therapy (ACT), and progressive muscle relaxation can be used with individual and groups.

8. What do you see as the major strength of this theory from a diversity perspective? 
- It stresses changing specific behaviors and developing problem-solving skills.  It includes specificity, task orientation, focus on objectivity, focus on cognition and behavior, action orientation, dealing with the present more than the past, emphasis on brief interventions, teaching coping strategies, and problem-solving orientation.

9. What do you see as a major shortcoming of this theory from a diversity perspective?
- The challenge is to develop empirically based recommendations for how behavior therapy can optimally serve culturally diverse clients.

10. What do you consider to be the most significant contribution of this approach?
- It challenges us to reconsider our global approach to counseling.

11. What do you consider to be the most significant limitation of this approach?
- Behavior therapy may change behaviors, but it does not change feelings.

Chapter 8 - Gestalt Therapy

1.  Who is associated with the therapy?
     - Frederick (Fritz) Perls and Laura Posner Perls.

2.  What are the basic assumptions underlying this approach?
     - Gestalt Therapy stresses dialogue and relationship between client and therapist.  It focuses more on process than on content; increase client's awareness on what they are doing and how they are doing it.  Individuals have the capacity to self-regulate when they are aware of what is happening in and around them. 

3.  What are a few of the key concepts that are essential to this therapy?
     - Some of the key concepts of Gestalt Therapy is focusing on the what and how of experiencing in the here and now to help clients accept all aspects of themselves.  It focuses on the clients internal and external awareness.  Gestalt therapists are interested in the whole person, not just one or two certain aspects.  They attend to a client's thoughts, feelings, behaviors, body, memories, and dreams.

4.  What do you consider the most important goals of this therapy?
     - I believe that the most important goals of this therapy is to help increase the client's awareness of the present and help them make better choices for him/herself.  Gestalt Therapy focuses on the whole person, not just certain aspects of the client.  There are 6 vital components of Gestalt Therapy: a) the continuum of experience, b) the here and now, c) the paradoxical theory of change, d) the experiment, e) the authentic encounter, and f) process-oriented diagnosis.

5.  What role does the therapeutic relationship play in terms of therapy outcomes?
     - The therapist does not interpret for clients, but helps assist the clients in developing ways for clients to make their own interpretations.  Therapists pay attention to nonverbal cues from clients and the language they use to express feelings, thoughts, and attitudes.  Focuses on a person-to-person relationship rather than a therapist-client relationship.
 
6.  What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
     - I believe that I would like to use the therapeutic relationship technique that is used in this approach.  I believe that using a person-to-person relationship, rather than a therapist-client relationship would be more beneficial to most clients.  Many therapist-client relationships tend to be top-down communication patterns.  Instead of having the therapist talk down to the client and give them specific directions on how to "correct" their problems, using a person-to-person relationship allows the client to figure out how they can solve their own problems.

7.  What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?
     - Gestalt Therapy can be used in a variety of settings and with a variety of populations.  It can be used for crisis situations, treatment of a range of psychosomatic disorders, couples and family therapy, awareness training, behavior problems in children, and teaching and learning.  It works well with both individual and group counseling.

8.  What do you see as the major strength of this theory from a diversity perspective?
     - I believe the major strength of this theory from a diversity perspective is that it focuses on the client expressing him/herself.

9.  What do you see as a major shortcoming of this theory from a diversity perspective?
     - Clients who have been culturally conditioned to be emotionally reserved may not embrace this approach.

10.  What do you consider to be the most significant contribution of this approach?
     - I believe the most significant contribution of Gestalt Therapy is the emphasis on direct experiencing and doing, rather than just talking about feelings.

11.  What do you consider to be the most significant limitation of this approach?
     - I believe the most significant limitation is that Gestalt Therapy places a high value on contact and dialogue with the client and therapist, and for it to be effective the therapist must have a high level of professional development. 

Chapter 7 - Person-Centered Therapy

1. Who is associated with the theory?
     - Carl Rogers, Abraham Maslow

2. What are the basic assumptions underlying this approach?
     - This theory takes away the power from the therapist and honors the inherent power of the client.  The therapist must be empathetic towards understanding the client's world and to be able to nonjudgementally communicate with the client.  The client gains an increase in self-awareness and trust in themselves.

3.  What are a few of the key concepts that are essential to this theory?
     - One of the major concepts in this theory is a basic sense of trust in the client's ability to move forward in a constructive manner if conditions fostering growth are present.  There are 3 therapist attributes that create a growth-promoting climate in clients that can help them move forward and become what they are capable of becoming.  These 3 attributes are 1) congruence (genuineness/realness); 2) unconditional positive regard (acceptance/caring); and 3) accurate empathic understanding (an ability to deeply grasp the subjective world of another person).  Rogers stated that if therapists can communicate these attributes, then clients will become less defensive and more open to themselves and their world, and they will behave in prosocial and constructive ways. Another major concept is actualizing tendency, which is a directional process of striving toward realization, fulfillment, autonomy, and self-determination.  

4.  What do you consider the most important goals of this theory?
     - The main goal of this theory is to help the client achieve a greater degree of independence and integration.  The person-centered approach focuses on the person, and never on the person's presenting problem.  Rogers believed the goal is to assist clients in their growth process so clients can better cope with problems as they identify them.  

5.  What role does the therapeutic relationship play in terms of therapy outcomes?
     - In the person-centered approach the therapeutic relationship is the primary purpose.  The therapist uses him/herself as an instrument of change to help the client find his or her inner resources.  This approach relies heavily on the relationship as a person-to-person relationship, rather than the therapist having knowledge in theories or techniques.

6.  What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
     - This therapy uses very few techniques and stresses the importance of the therapist-client relationship.  I believe I would use this because the relationship between the therapist and client is important to build a trusting, open relationship. 

7.  What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?
     - This theory can be used for a wide variety of individual and group counseling sessions.  It can be used with a wide variety of populations and settings.  It is extremely effective for crisis counseling, where the therapist needs to create a strong relationship with the client.

8.  What do you see as the major strength of this theory from a diversity perspective?
     - I believe the major strength of this theory from a diversity perspective is that it can be used with a wide variety of populations.  It can be used in many different settings and for different problems.

9.  What do you see as a major shortcoming of this theory from a diversity perspective?
     - I believe that a major limitation to this theory is the fact that the therapist does not have a direction or clear structure during the session.

10.  What do you consider to be the most significant contribution of this approach?
     - I believe that the most significant contribution of the person-centered approach is the strong relationship built between the therapist and client.

11.  What do you consider to be the most significant limitation of this approach?
     - I believe that the most significant limitation of the person-centered approach is the fact that the therapist does not have a structured or clear direction for the counseling session.

Chapter 6 - Existential Therapy

1. Who is associated with the theory?
     - Viktor Frankl, Rollo May, Irvin Yalom, James Bugental

2. What are the basic assumptions underlying this approach?
     - The basic assumptions of Existential Therapy include a focus on the human nature of anxiety, despair, grief, loneliness, isolation and death.  This approach explores "themes such as mortality, meaning, freedom, responsibility, anxiety, and aloneness as these relate to a person's current struggle" (p. 139).  It takes on a here-and-now approach.

3. What are a few of the key concepts that are essential to this theory?
     - Existential Therapy is essentially an experiential approach to counseling rather than a firm theoretical model (p.474), it does not have a set of techniques to use like other theories.  It bases therapeutic practice on an understanding of what it means to be human (p.145).  Existential tradition "seeks a balance between recognizing the limits and tragic dimensions of human existence on one hand and the possibilities and opportunities of human life on the other hand" (p. 145).  This theory was aimed to help people engage in the dilemmas of life (isolation, alienation, and meaninglessness).  The current focus of this approach is on the individual's experience of being in the world alone and facing the anxiety of this isolation.  There are six basic dimensions of the human condition according to the existential approach; these dimensions are: 1. the capacity for self-awareness; 2. freedom and responsibility; 3. creating one's identity and establishing meaningful relationships with others; 4. the search for meaning, purpose, values, and goals; 5. anxiety as a condition of living; and 6. awareness of death and nonbeing.

4.  What do you consider the most important goals of this theory?
     - The central goal of Existential Therapy is to increase awareness, which allows clients to discover that alternative possibilities exist where none were recognized before (p. 155).  Clients come to realize that they are able to make changes in their way of being in the world (p. 155). 

5. What role does the therapeutic relationship play in terms of therapy outcomes?
     - The therapeutic relationship plays a major role in this approach.  It is important because the quality of the client-to-therapist encounter is the stimulus to positive change.  The core of the relationship is respect between the therapist and client.  Presence serves the dual functions of reconnecting people to their pain and to attuning them to the opportunities to transform their pain.

6. What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
     - Since Existential therapy does not use a rigid set of techniques, I would like to incorporate how these practitioners work on each client a different way.  These practitioners are creative and uncertain and different for each client.  Since each client has different views on their life, these therapists must use different techniques for each client.  I really like how these therapists constantly are encouraging their clients to assume responsibility and take action for their current situations.  I would incorporate how these therapists assist clients in facing life with courage, hope, and a willingness to find meaning in life.

7. What are some of the ways that this theory is applied to client populations, settings and treatment of problems?
     - This theory can be applied to a variety of client populations, settings and treatments.  Existential therapists have used this therapy to include substance abuse, ethnic and racial minorities, gay and lesbian clients, and psychiatric inpatients.  Van Deurzen suggests that this form of therapy is most appropriate for clients who are committed to dealing with their problems about living, for people who feel alienated from the current expectations of society, or for those who are searching for meaning in their lives.  This approach has been applied to groups and brief therapy.

8.  What do you see as the major strength of this theory from a diversity perspective?
     - The major strength of existential therapy is that it enables clients to make conscious choices when it comes to the values they live by.  Therapists assist clients in critically evaluating the source of their values and making a choice rather than uncritically accepting the values of their culture and family.

9.  What do you see as the major limitation of this theory from a diversity perspective?
     - One potential major limitation is that existential therapy is "highly focused on the philosophical assumption of self-determination, which may not take into account the complex factors that many people who have been oppressed must deal with" (p. 162).  Another major limitation is that clients expect the therapist to provide them with concrete direction on how to manage their problems.

10. What do you consider to be the most significant contribution of this approach?
     - To me, the most significant contribution of existential therapy is that it provides a perspective for understanding anxiety, guilt, freedom, isolation, commitment, and death.

11. What do you consider to be the most significant limitation of this approach?
     - To me, the most significant limitation of existential therapy is that it lacks a systematic statement of principles and practices of therapy.

Chapter 5 - Adlerian Therapy

1. Who is associated with the theory?
     - Alfred Adler, Karen Horney, Erich Fromm, Harry Stack Sullivan

2. What are the basic assumptions underlying this apporach?
     - This theory stresses the unity of personality, saying that people can only be understood as integrated and complete beings.  Places high importance on purposeful behavior, emphasizing that where we have come from is not as important as where we are striving to go. 

3. What are a few of the key concepts that are essential to this theory?
     - Believes that humans start to develop an approach to life in the first six years of life.  Behavior is purposeful and goal-oriented.  The theory states consciousness (not unconsciousness) is the focus of therapy.  This approach is unique for the fact that it pays attention to the relationships between siblings and order in which they were born (oldest children, second child, middle child, youngest child, and only child).

4. What do you consider the most important goals of this theory?
     - The main goal of the Adlerian approach "is to develop the client's snese of belonging and to assist in the adoption of behaviors and processes characterized by community feeling and social interest" (p. 109).  Other main goals are fostering social interest, helping clients overcome feelings of discouragement and inferiority, changing faulty motivation, recognizeing equality among people and helping clients become contributing members of society.

5. What role does the therapeutic relationship play in terms of therapy outcomes?
     - The relationship in Adlerian therapy revolves around "cooperation, mutual trust, respect, confidence, collaboration, and alignment of goals" (p. 112).

6. What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
     - In the Adlerian approach there are four objectives that correspond to four phases of the therapeutic process.  These phases weave together are not rigid steps.  These phases are "establish[ing] the proper therapeutic relationship, explor[ing] the psychological dynamics operating in the client (an assessment), encourag[ing] the development of self-understanding (insight into purpose), and help[ing] the client make new choices (reorientation and reeducation, p. 113)."

7. What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?
     - The Adlerian approach can be applied to a wide variety of client populations whom are seeking growth.  It is ideally suited to preventive care and alleviating a broad range of conditions that interfere with growth.

8. What do you see as the major strength of this theory from a diversity perspective?
     - I believe the major strength of this theory is the fact that it is cultureally diverse, because it is grounded in the client's culture and worldviews, rather than trying to place a client into preconceived groups or models.

9. What do you see as a major limitation of this theory from a diversity perspective?
     - The major limitation of this theory from a diversity perspective is that some cultures (i.e. Asian) believe it is inappropriate to reveal family information, and may be hesitant to reveal their past struggles that brought them into counseling in the first place.

10. What do you consider to be the most significant contribution of this approach?
     - I believe the most significant contribution of the Adlerian approach is the fact that it is flexible and its integrative nature.

11. What do you consider to be the most significant limitation of this approach?
     - I believe the most significant limitation of the Adlerian approach is that there is not much supporting evidence of the effectiveness of the approach.

Chapter 4 - Psychoanalytic Therapy

1. Who is associated with the theory?
     - Sigmund Freud, Erik Erikson, Carl Jung
 
2. What are the basic assumptions underlying this approach?
     - The basic assumptions of the Psychoanalytic Theory are that we as humans are basically determined by early experiences, both conscious and unconscious.  Development in early childhood is of extreme importance because our personality problems later in life are due to our childhood conflicts.
 
3. What are a few of the key concepts that are essential to this theory?
     - A few of the key concepts to the Psychoanalytic Therapy are the structure of personality.  According to Freud, the personality consists of three systems - the id, the ego, and the superego.  The id is "roughly all the untamed drives or impulses that might be likened to the biological component" (p. 64).  Id is the original system of personality.  The ego "attempts to organize and mediate between the id and the reality of dangers posed by the id's impulses" (p. 64).  The ego governs, controls and regulates the personality.  The superego "is the internalized social component, largely rooted in what the person imagines to be the expectations of parental figures" (p. 64).  The superego could be compared to the judicial branch of personality.  "It includes a person's moral code, the main concern being whether an action is good or bad, right or wrong" (p. 65).
 
4. What do you consider the most important goals of this theory?
     - The most important goal of the Psychoanalytic Theory is to increase adaptive functioning, which involves the resolution of conflicts.  Freud wanted to make the unconscious conscious and to strengthen our ego's so that our behaviors are based on reality and not instincts or irrational thoughts.
 
5. What role does the therapeutic relationship play in terms of therapy outcomes?
     - The role of the therapeutic relationships in the Psychoanalytic Theory is for the analyst to teach the client how to make the connection between their current behaviors and how it is related to their past.
 
6. What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?
     - The therapy is focused on limited objectives, not restructuring the client's personality.  The therapist is less likely to sit on a couch.  There are fewer sessions each week.  There is more frequent use of supportive interventions such as reassurance, expressions of empathy and support, and suggestions.  There is more emphasis on the here-and-now relationships between therapist and client.  The main techniques therapists use are free association, in which "clients are encouraged to say whatever comes to mind, regardless of how painful, silly, trivial, illogical, or irrelevant it may seem" (p. 79).  Interpretation "consists of the analyst's pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistances, and the therapeutic relationship itself" (p. 80).  Dream analysis "is an important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems" (p.80).

7. What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?
     - This theory can be used with almost any client population for the fact that every person has had a childhood and past experiences that have caused some sort of crises in their lives.  The setting for therapy can pretty much anywhere that the client and therapist can have 1-on-1 private interactions.
 
8. What do you see as the major strength of this theory from a diversity perspective?
     - The major strength of this theory from a diversity perspective is the fact that it can be used for practically any diverse population, because everyone has had a childhood and past experiences which caused crises in the clients lives.
 
9. What do you see as the major limitation of this theory from a diversity perspective?
     - The major limitation of this theory is that it usually is costly and generally perceived as being based on upper- and middle-class values. 
 
10. What do you consider to be the most significant contribution of this approach?
     - I believe the most significant contribution of this approach is the fact that it has helped provide a very detailed description of personality stages, structure, and functioning.
 
11. What do you consider to be the most significant limitation of this approach?
     - I believe the most significant limitation of this approach is that the therapists need a lot of training to be able to be effective and efficient with this approach, which can be costly and time consuming.