Counseling Theories---- Introduction, History

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Counseling Theories---- Introduction, History Powered By Docstoc
					  Counseling Theories----
Introduction, History, and
        Overview
         History of Treatment
   Early treatment approaches      (1300-
    1500 A.D.) - Imprisonment

   Mental Hospitals (1500 A.D.) - Asylums
    (Bethlam or Bedlam) - Often chained
          History of Treatment
   Phillipe Pinel (late 1745’s A.D.) - chainless

   Dorothea Dix (1840’s) – State funded
          History of Treatment
   Josef Breuer (1845 – 1925 A.D.) -

       Hypnosis to help clients talk
             (catharsis therapy)
          History of Treatment
   Medical Hospitals (1900 A.D.) -
    “medical treatment” – lobotomy, ECT

       http://www.mayoclinic.com/health/electrocon
        vulsive-therapy/MY00129


   Deinstitutionalization (1950’s A.D.)
            History of Treatment
   Contemporary Approaches (1900 A.D.)
           Freud (1856–1939) - psychoanalysis
       Psychodynamic Approaches (1890’s)
       Humanistic Approaches (1950’s)
       Cognitive Behavioral Approaches
         Behavioral (1920’s)
         Cognitive (1960’s)
      Who Provides Treatment?
   Psychiatrist - A psychiatrist is a medical
    doctor who specializes in treating
    psychological disorders. A psychiatrist can
    diagnose a mental illness, prescribe
    medication, or administer other biomedical
    treatments.
      Who Provides Treatment?
   Psychologist - A clinical or counseling
    psychologist has a doctoral degree (PhD or
    PsyD) that includes training in diagnosis
    and treatment of psychological illnesses.
      Who Provides Treatment?
   Clinical Social Worker – Has a masters in
    social work and can provide psychotherapy
    for individuals who but can not give
    psychological assessment or offer
    medication.
      Who Provides Treatment?
   Mental Health Counselor – Has masters
    degree in mental health, rehabilitation, or
    school counseling and can provide
    counseling for individuals for which they
    have been trained. Cannot conduct
    psychological assessment or proscribe
    medicine.
      Who Provides Treatment?
   Marriage and Family Therapist - Has
    masters degree in marriage and family
    therapy and can provide counseling for
    those for which they have been trained.
    Can not conduct psychological assessment
    or proscribe medicine.
      Who Provides Treatment?
   Psychiatric Nurse – This nurse generally
    works as part of a team of people in a
    hospital setting. Services include
    monitoring treatments that are prescribed
    by a psychiatrist or psychologist.
      Who Provides Treatment?
   General Medical Practitioner – GP’s do not
    generally practice therapy, however, they
    often will diagnose and proscribe
    medication for different mental illnesses.
           Theoretical Orientations of
                 American Psychotherapists
 rien n
O tatio                    lin
                         C ical          C u selin
                                          o n g P ch            o      o n rs
                                                   sy iatrists S cial C u selo
                           sy o g         sy o g
                         p ch lo ist P ch lo ist                 o er
                                                               Wrk
E          teg e
 clectic/In rativ             2%7           2%
                                             9        3
                                                     5%          4
                                                                3%       7
                                                                        3%
 on e
C g itiv                      2%4           2%
                                             6       1 %         4%      0
                                                                        1%
 sy o y a ic
P ch d n m                    1%4            3
                                            1%       1%
                                                      9          2
                                                                2%       8%
 sy o aly
P ch an tic                     4%           2%      1%
                                                      6         1%
                                                                 1       3%
  terp n
In erso al                      5%           7%       3%         1%      1%
 eh io
B av ral                      1%3            4%      1 %         4%      6%
 x tial/H m istic
E isten      u an               3%           6%       1%         3%      3
                                                                        1%
 y s
S stem (fam ) ily               4%           4%       1%         3
                                                                1%       7%
G estalt                        1%           1%       3%         1%      2%
 erso al-C tered
P n en                          1%           4%       0%         2%      8%
  d
A lerian                        1%           1%      1 %         1%      2%
  th
O er                            3%           4%       3%         4 %     3%
 o rces: P ch a, J. O &N rcro J. C (2 0 ). S stem o p ch th y
Su         ro ask        .     o ss, . 0 3 y s f sy o erap :
                             th
       sth ritical an sis (5 ed B o t, C : W sw rth
Atran eo             aly          .). elm n A ad o .
     Does Psychotherapy Work?
   Smith, Glass, & Miller, 1980

       Meta-Analysis of 475 studies

       On average at the end of treatment the
        average person is 80% better off than
        someone who was not in treatment people
     Does Psychotherapy Work?
   1994 Consumer Reports Study
       2,900 people saw a mental health professional
         Psychologists (37%)
         Psychiatrists (22%)

         Social workers (14%)

         Marriage counselors (9%)

         Other mental health professionals (18%)

         Additional 1,000 saw family physicians.
     Does Psychotherapy Work?
   1994 Consumer Reports Study

       87% - 92% of respondents who started off
        feel poorly and went to therapy were feeling
        better by the time of the survey.
     Does Psychotherapy Work?
   1994 Consumer Reports Study

       Family doctors did as well as mental health
        professionals in the short-term, but worse in
        the long-term

       No difference between therapy alone and
        therapy plus medication for any disorder
Does Psychotherapy Work?
   1994 Consumer Reports Study

       Active shoppers and active clients did better
        in treatment than passive recipients

       No specific modality of psychotherapy did
        any better than any other for any problem
Does Psychotherapy Work?
   Luborsky, Singer, & Luborsky (1975)

       Dodo Bird Effect – “Everyone has won and
        all must have prizes”

       More focus on what works for specific
        disorders and for specific people
                  How Long?
   Lambert, Hansen, & Finch (2001)

       Found 50% of people improved after 7
        sessions and 75% improved after 14 sessions

       In general, longer-term shows better
        improvements
        Current Therapy Debate?
   Empirically Supported Treatment (EST)
       Division 12 Clinical Psychology


   Empirically Supported Relationship (ESR)
       Division 29 Psychotherapy
                What Works?
   Empirically Supported Treatment (EST)

       Efficacious in randomized controlled trials

       Treatment Manuals

       http://www.psychology.sunysb.edu/eklonsky-
        /division12/index.html
                What Works?
   Empirically Supported Relationship (ESR)
       Demonstrably Effective Elements:

       • Therapeutic alliance
       • Cohesion in group therapy
       • Empathy
       • Goal consensus and collaboration
                What Works?
   Empirically Supported Relationship (ESR)
       Promising and Probably Effective Elements:

       • Positive regard & Genuineness
       • Self-disclosure
       • Management of counter-transference
       • Quality of relational interpretation
                What Works?
   Empirically Supported Relationship (ESR)

       http://smhp.psych.ucla.edu/pdfdocs/aboutmh/
        therapyrelationships.pdf