Tag Archives: Psychotherapy

Draft Counseling and Psychotherapy Syllabus

Below I’m including a drafty copy of our Counseling Theories syllabus from the University of Montana. My apologies for the wacky font action.

Theories III Photo

**Draft – 2016 Standards Alignment in Progress**

 COUN 511: COUNSELING THEORIES & TECHNIQUES

COURSE SYLLABUS – UNIVERSITY OF MONTANA – Fall 2019

____________________________________________________________

INSTRUCTOR INFORMATION HERE:

Office:

Office Hours:

Email:

SCHEDULED CLASS MEETINGS:  Class meets on Mondays from 4:00pm to 6:50pm, beginning Monday, August 26, 2019. The oral final exam for graduate students is TBA.

COURSE CONTENT AND DESCRIPTION:  This course is an overview of major theories of counseling and psychotherapy with a special focus on gender, culture, counselor preparation, and common theory-based assessment and case formulation strategies. Because the purpose of counseling and psychotherapy is to help individuals make personally meaningful changes in their lives, we will consistently examine the means through which traditional theories attempt to produce such changes. Students will read about historical and intellectual foundations of major counseling theories, while at the same time, observing skills and techniques employed by practitioners using those theoretical perspectives. There will be opportunities, through assignments and class discussions, for students to analyze clients as well as themselves through the various lenses of psychological theories. Overall, students are encouraged not only to explore all the major theoretical orientations, but also to explore their personal beliefs and values in an effort to develop and deepen their understanding of counseling and psychotherapy process and outcome.

TEXTBOOK:  Required: Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and Psychotherapy Theories in Context and Practice (3rd ed). Hoboken: NJ: Wiley.

Recommended: Sommers-Flanagan, J., & Sommers-Flanagan, R. (2012). Student manual for Counseling and Psychotherapy Theories in Context and Practice (2nd ed). Hoboken: NJ: Wiley.

COURSE OBJECTIVES: The purpose of this course is to introduce you to theories and techniques used by a variety of mental health professionals, school counselors, and other human service providers. We will explore and discuss the major theories and their practical application.

CACREP-Related Course Objectives: This course is a first Fall semester requirement for graduate students in Counseling at the University of Montana. The course includes content related to CACREP Core Standards and CACREP Specialty Standards. Specific key performance indicators are evaluated through course assignments, midterm and final examinations, and via an oral examination at the end of the semester. The oral examination focuses on the content of counseling theories and their application. The goals of the assessments in this course are to determine (a) how well the Counselor Education faculty is teaching specific CACREP-related objectives, (b) students’ ability to articulate and apply counseling theories, and (c) student readiness to enroll in counseling practicum (COUN 530).

DISABILITY ACCOMMODATIONS: If you are a student with a disability and wish to discuss reasonable accommodations for this course, contact me privately to discuss the specific modifications you wish to request. Please be advised I may request that you provide a letter from Disability Services for Students verifying your right to reasonable modifications. If you have not yet contacted Disability Services, located in Lommasson Center 154, please do so in order to verify your disability and to coordinate your reasonable modifications. For more information, visit the Disability Services website at www.umt.edu/dss/.

ACADEMIC INTEGRITY: All students must practice academic honesty.  Academic misconduct is subject to an academic penalty by the course instructor and/or disciplinary sanction by the University.  All students need to be familiar with the Student Conduct Code.  The Code is available for review online at http://www.umt.edu/vpsa/policies/student_conduct.php.

IN-CLASS BEHAVIOR STANDARDS AND LEARNING ENVIRONMENT: In the Department of Counseling and at the University of Montana we strive to establish and maintain a positive learning environment. The expectation is that we will strive to treat one another with respect . . . even when we disagree. This also means that students (and faculty) will turn off their cell phones and not engage in internet shopping/surfing/social networking during class. If calls and texting are necessary, you should either not attend class or take care of your calling and texting at class break. If you need to be on-call due to employment responsibilities, please let me know.

TEACHING METHODS:

1.  Lectures/class demonstrations.

  1. Guest lectures/student presentations.
  2. Video/DVD/Film presentations.
  3. Class activities.
  4. Class discussions.

GRADING PROCEDURES:  Grades are based on completion of class assignments, midterm and final examination scores, and class participation/attendance. Course assignments are listed and described in a separate section. The grading scale is below:

A   = 93%+                        B-  = 80-82%               D+ = 67-69%

  • = 90-92% C+ = 77-79%               D   = 63-66%

B+ = 87-89%                     C   = 73-76%               D-  = 60-62%

B    = 83-86%                    C-  = 70-72%               F    = Below 60%

APPROXIMATE SCHEDULE OF CLASS TOPICS AND ASSIGNMENTS

Week Date Assigned Reading In-Class Topic Assignments Due
1 8/26 Ch. 1

 

In future weeks, read chapters before class

Syllabus distribution and introduction to counseling and psychotherapy.

 

 

 

Be sure to login to the Moodle course supplement. This is mostly for communication and to give me something to complain about.
XX 9/2 None Labor Day No Class  
2 9/9

 

Ch. 2 Psychoanalytic Theory and Therapy.

 

 
3 9/16 Ch. 3 Individual psychology and Adlerian therapy – Guest Lecture with Dr. Veronica “Roni” Johnson  
4 9/23 Ch. 4 Existential theory and therapy Initial theories reflection paper due, by midnight 9/22/19  (30 points)
5 9/30

 

 

Review chapters 1-4 and lectures Midterm #1 – 1st hour: Covers chapters 1-4. [From 5:30pm to 6:50pm there will be a WHOLE CLASS skills lab focusing on person-centered therapy and mental imagery] Midterm #1 (50 pts)

Chapters 1-4 plus lecture material

6 10/7 Ch. 5 The person-centered approach.  
7 10/14 Ch. 6 Gestalt theory and techniques.  
8 10/21 Ch. 7 Behavioral theory and therapy.  
9 10/28 Ch. 8 Cognitive approaches (or CBT).  
10 11/4 Review readings and lectures. Midterm #2 – 1st hour.

Covers chapters 5-8, plus lectures. [From 5:30pm to 6:50pm there will be a WHOLE CLASS skills lab focusing on CBT.]

Midterm #2 (50 pts).

Chapters 5-8, plus lectures

9 11/11 Ch. 9 Choice theory and reality therapy  
11 11/18 Ch. 10 Feminist theory and therapy.  
12 11/25 Ch. 11 Constructive theory and therapy.  
13 12/2 Ch. 13 and 14 Multicultural theory and therapy and Counseling integration. Final papers due by midnight on Friday, 12/6/19
14 Week of 12/9 Review readings and lectures. Final examination.

Covers chapters 9, 10, 11, 13, 14

Final exam (50 pts). Chapters 9, 10, 11, 13, 14, plus lectures

The graduate oral final exam is TBD

OFFICIAL ASSIGNMENT DESCRIPTIONS

There are 290 possible points available (YOU CAN CHOOSE TO DO #3 A or B, BUT NOT BOTH).

  1. Two Midterm Examinations (50 points each; 100 total): These are standard multiple choice and short answer exams. They will cover material from all the lectures and chapters as outlined in the syllabus and worth 50 points each. You’ll be expected to take the exams at their scheduled times; if you have a time conflict, contact us in advance and we’ll set up an alternative exam time. If you have a last minute crisis (e.g., an accident, illness, or emergency) contact us ASAP and we’ll be flexible. In all cases, you’ll need to arrange a special time and sit for the exam within one week of the original exam date or you’ll get a zero. We will be flexible the first time. If a pattern of irresponsibility emerges, we’ll become less flexible and you’ll be required to take a much harder examination.
  1. Initial Theories Reflection Paper (30 points; see calendar for due date): This is a short paper designed to accomplish three objectives: (a) give you an opportunity, early in the course, to explore a concept from the text or from class in greater depth; (b) provide you with an initial, simple library-related assignment; (c) provide me with an early sample of your writing skills.

The paper can focus on virtually any topic addressed in class or covered in the first four chapters of the text. Here’s what you should do:

  • Select a topic: Sample topics include
    • The great psychotherapy debate
    • Informed consent
    • Multicultural competence
    • Doing no harm
    • The seduction hypothesis
    • Defense mechanisms
    • Feminism and psychoanalysis
    • Why children misbehave
    • Earliest recollections
    • Paradoxical strategies
  • Read the section in the text about that topic
  • Go to the library (or do an online search) and find a professional journal reference pertaining to your topic and then list it in APA format in the reference section of your paper.
  • Write a three page paper (following APA format) on your selected topic
  • In your paper write (a) a description of the topic or issue and why you think it is an especially important topic for beginning counselors; (b) additional information that you learned about the topic through your library research; (c) a reflection that includes critical comments about the topic/issue; and (d) some concluding comments about how this topic is relevant for you and your work in the future as a counselor

The paper will be graded in the following areas: (a) attention to detail/typos, etc. (3 points; 10%); (b) following APA format (3 points; 10%); (c) writing skills/grammar/organization (6 points; 20%); (d) general summary and accuracy regarding the topic chosen (12 points; 40%); (e) inclusion of some original and interesting thoughts about the topic (6 points; 20%).

  1. Choose ONE of the following assignments to complete:
    1. Theories or Cultural Book Review and Critique (50 points; see calendar for due date): The purpose of this assignment is for you, as an individual, to dive deeper into, and learn more about, a theory of interest to you. I have many books in my office that you can peruse for this assignment or you can go to the library or you can buy something on your own. After you’ve selected a book and check with me to make sure it’s acceptable, there are three parts to this assignment: (a) read your selected book; (b) write a four-page summary and critique of the book (include both a summary and critique—focusing on the book’s strengths and weaknesses as well as a description of how you will apply the information you learned from the book to your life in the future); and (c) be prepared to provide a ten-minute presentation on the book at our final class, although please note that book presentations may or may not happen depending on time – TBA. If they do, you should just say if you recommend the book to others and how you rate it on a 1-100 scale and engage the class in a brief demonstration of something you learned from the book.

Grading Procedures

This assignment is worth 50 points. To earn the 50 points you will need to turn in high quality work. You will lose points for typos, misspelled words, concepts that are defined poorly or used incorrectly, incomplete or unclear descriptions of the text. In particular, you will be graded on the quality of your summary and critique. Your summary will need to be accurate and show that you understand the content of the book. Your critique should show some sophistication of thought and reflection. Although your personal opinion is desired, you should also provide a critique based on a professional source (e.g., the text, a journal article, etc). Failure to cite at least one relevant reference linked to the book content will cause you to lose five points.

  1. Personal Change Project (50 points; see calendar for due date): The purpose of this assignment is for you to apply some sort of personal change strategy to yourself. Previously this was a purely behavior modification project, but due to diverse student interest, you can now engage in any personal change strategy you like.

The Details

You’ll be using APA Style. That means you’ll have the following sections:

  • Introduction: In this section you’ll introduce your target behavior and your rationale for choosing to change it. You’ll include a small bit of background research on different methods for potentially modifying your target behavior. This will require at least two professional journal citations (please, DO NOT cite online and unsubstantiated gibberish). Although you may have some incredible ideas yourself, the point is for you to NOT completely rely on your own idiosyncratic ideas about how to change your target behavior. For example, let’s say you chose to reduce your intake of sugar. There have been many books and articles written on diet change. I would expect you to read and reference a few of these.
  • Method: In this section you will identify and define a specific, measurable behavior that you would like to increase, decrease, or eliminate. This behavior is called your “target behavior.” For example, you might choose to increase exercise behavior. To begin this assignment, you need to have a clear, operational description of the behavior and a method for measuring the occurrence of the behavior. For example, if you select “push-ups” as your behavior to increase, you would need to define exactly what you meant by “push-up” and then detail a method for obsessively tracking (measuring) of your push-up behavior. Other behaviors people have chosen in the past include: (a) increasing dream recall; (b) decreasing cigarette smoking; (c) increasing smiling behavior; (d) decreasing fingernail biting behavior; (e) increasing study behavior, etc. Of course, I encourage you to identify what you want to change, rather than simply choosing one of the aforementioned target behaviors. The method also includes a description of your change plan. Describe it so well that it could be replicated. Your plan SHOULD NOT rely exclusively on your WILLPOWER. It should flow from your introduction or brief look at the scientific literature. When I grade your assignment I’m interested in the specific techniques you’ve gleaned from the text or outside readings. For example, if you’re using a behavioral approach, I’d look for you to use strategies like: (a) positive reinforcement; (b) punishment; (c) response cost; (d) negative reinforcement; (e) stimulus control; (f) stimulus generalization; (g) fading; (h) unconditioned stimulus; (i) conditioned stimulus, etc. If you choose to use a cognitive approach, consider using the three column technique, shades of gray, visualization, rational disputing, etc. Your method section includes the method through which you plan to make your changes. Please inform John of your target behavior before proceeding with the assignment. Email me at sf@mso.umt.edu or pass me a note in class informing me of your chosen behavior and general strategy. Tip: Don’t select an infrequent behavior because then it will take you several years to get done. Write a contract for yourself (e.g., “I Rita SF, do solemnly swear. . .”). Include the behavior, the plan, your goals, and a space for you and a witness (someone in your social environment) to sign and co-sign the contract.
  • Results: I’ll be looking for two main things in your results section. First, I want to see numbers or a chart or graph that you’ve used to track your target behavior. This will include a baseline measurement of your target behavior over at least one week. I need to be able to see and understand your progress or lack thereof. Second, to capture your qualitative experience, I want to see a weekly journal entry about how it’s going. Discuss your feelings, your personal experience and perspective, and why you think the project is working or not working. You can also modify your change plan during the semester, as long as you clearly identify how and why you’re going to change your approach in your weekly journal entry, also noting that in your results section. Remember that good counselors are very flexible and creative in their approach.
  • Discussion: The discussion is your reflection on the project. It focuses on “what happened” (the results) but also provides a platform for you to speculate on what helped, what didn’t, and why.
  • References: You need at least two professional citations in APA format.
  • Appendix: Include a signed (and countersigned) contract to yourself as a commitment to this behavior change project.

Grading Procedures

This assignment is worth 50 points. To earn the 50 points you will need to turn in high quality work. However, your grade on this project is NOT AT ALL based on your success or failure in changing your behavior.

You will lose points for typos, misspelled words, concepts that are defined poorly or used incorrectly, incomplete or unclear descriptions of what you did and what happened, etc. Failure to cite at least a couple of relevant studies, articles, or books will also lose significant points. Follow the outline and you’ll have a good start. Please do your best work. Good luck and have fun!

  1. Attendance (30 points): We’ll take attendance at every class. Perfect attendance is worth 30 points. You’ll lose an increasing number of points for each class missed (even if you miss class for legitimate reasons). You lose 0 points for missing one class (everyone deserves a mental health day), 6 points for missing two classes, 9 more (total = 15) for the third, 15 more (all 30 points are lost) for the fourth. There will be in-class reflection assignments. If you don’t turn these in or do a poor job you’ll lose attendance points. To be fair, you can earn back points from missing class by completing additional assignments. You can earn attendance points back by listening to recorded lectures (as available), contacting Kindle Lewis (the TA) who will give you an additional assignment (e.g., writing an essay or responding to several lecture-related questions). Alternative assignments may be used at our discretion. If you’re motivated you can recover lost points.
  1. Graduate Skills Lab (30 points): All students enrolled in COUN 511 or taking the course for graduate credit will participate in a Counseling Skills Lab. We will break into smaller groups for this and the exact time and place for the lab is TBA. It will consist of 6-8 meetings (two of which will be after the first midterm) during which you practice the skills associated with specific theories on each other. We will start communicating about lab meeting times during the first week of the semester. If you miss one Grad Lab, you lose 15 points. If you miss two Grad Labs, you lose all 30 points.
  1. Final Oral Examination (50 points): For all graduate students, you will sit for a small (about 10 students) 90 minute group examination. You will be given short answer questions and a role-play assignment at least one week prior to the exam to help you prepare and study. During the exam, you’ll be asked, at random, several questions from the questions you’ve been given (and hopefully have studied) and you’ll be asked to demonstrate via role-play several skills associated with at least one theoretical orientation. This exam format is designed to help you learn to orally articulate and apply some of the theories concepts we’ve studied during the semester.

CACREP KPIs for Core and Specialty Counseling Competencies

All courses in the Department of Counseling include content related to our national Counseling and Counseling-Related Educational Programs (CACREP) accreditation. CACREP identifies specific Core Standards as well as Specialty Standards. The following Table includes a listing of the CACREP Core and Specialty Standards covered by COUN 511 course content. Additionally, some of the standards listed below are the focus of Key Performance Indicators (KPIs). KPIs are specific CACREP standards that are systematically evaluated in order to determine whether students are learning key CACREP-related course content. In this course (COUN 511), the KPIs are evaluated through using the course assignments, experiential laboratory activities, midterm and final examinations, and via an oral examination at the end of the semester.

Core Standard Content Found Key Performance Indicator
2. SOCIAL AND CULTURAL DIVERSITY    
b. theories and models of multicultural counseling, cultural identity development, and social justice and advocacy

 

COUN 511 – Students read about how each theory addresses culture, sexuality, and spirituality.

 

c. multicultural counseling competencies

 

COUN 511 – Students read about the MCCs in Chapter 1 and Chapter 13 of the textbook

 

 
d. the impact of heritage, attitudes, beliefs, understandings, and acculturative experiences on an individual’s views of others

 

COUN 511 – Students read about this content in Chapter 13 and participate in a classroom activity.

 

 
5. COUNSELING AND HELPING RELATIONSHIPS    
a. theories and models of counseling

 

COUN 511 – Students read about theories and models of counseling in their textbook and practice techniques linked to the theories in their counseling labs. Two midterm examinations and one oral final examination are used to measure student knowledge three times during the course.
b. a systems approach to conceptualizing clients

 

COUN 511 – Students read about systems approaches in Chapters 11 and 12.  
f. counselor characteristics and behaviors that influence the counseling process

 

COUN 511 – Students read about specific counselor characteristics and behaviors that influence counseling process and outcomes in the textbook.

 

 
g. essential interviewing, counseling, and case conceptualization skills

 

COUN 511 – Students read about how to engage in case formulation and treatment planning in every theories chapter of the textbook.

 

 
h. developmentally relevant counseling treatment or intervention plans

 

COUN 511 – Students read about counseling theories, treatments, and interventions that are more or less useful with specific developmental populations in the textbook.

 

None
i. development of measurable outcomes for clients

 

COUN 511 – Students read about measuring outcomes in every theories chapter of the textbook.

 

 
j. evidence-based counseling strategies and techniques for prevention and intervention COUN 511 – Students read about evidence pertaining to counseling strategies and techniques associated with each theory in the textbook.  
n. processes for aiding students in developing a personal model of counseling COUN 511 – Students read about how to integrate their personal ideas with existing theoretical models in the textbook. Students take a theoretical orientation test and write a one-page reflection on their initial preferred model of counseling.
8. RESEARCH AND PROGRAM EVALUATION    
a. the importance of research in advancing the counseling profession, including how to critique research to inform counseling practice

 

COUN 511 – Students read about research linked to each theory presented in the textbook.  
b. identification of evidence-based counseling practices

 

COUN 511 – Students read about evidence-based counseling practices in every chapter of the textbook.  
d. development of outcome measures for counseling programs

 

COUN 511 – Students read about theory-based counseling outcome measures in every theories chapter.

 

 
e. evaluation of counseling interventions and programs

 

COUN 511 – Students read about theory-based counseling outcome measures in every theories chapter.

 

 

 

 

 

 

 

 

The Evidence Base for Psychoanalytic Therapies: It Just Might Be Better Than You Think

Sunset 2019In recent days there’s been a bit of a kerfuffle on Twitter regarding the relative efficacy of psychoanalytic and cognitive-behavioral therapies (CBT). Of course, the standard mantra in the media and among many mental health professionals is that the science shows that CBT is superior and the treatment of choice for many, if not most, mental and emotional problems. Well, as is often the case in life and psychotherapy, reality is much less clear.

This post isn’t about fake news or alternative facts. Instead, I hope it’s about a balanced perspective. As a psychotherapist-counselor-professor-clinical psychologist, I like to think I don’t have an allegiance to any single therapy approach. Although I know I can’t claim perfect objectivity, I do have a broad view. One factor that has helped me have a broad view is that I read lots of professional journal articles in order to be able to write my theories of counseling and psychotherapy textbook.

Below, I’ve inserted an excerpt from the end of the psychoanalytic chapter of our textbook. Whether you’re a CBT or psychoanalytic fan, or perhaps a fan of a different approach, I hope you find this short review of psychoanalytic treatment efficacy interesting. The bottom line for me is captured by an old quotation from Freud (who wasn’t known for his flexible thinking). Purportedly, he said, “There are many ways and means of conducting psychotherapy. All that lead to recovery are good.” I might add the following to Freud’s comment: There are many different clients with many different problems and many different individual and cultural perspectives. I’m convinced that most clients are best served if therapists tweak their approaches to fit the client, rather than expecting the client to fit into narrow clinical procedures based on pure (or rigid) theoretical perspectives.

Here’s the excerpt . . .

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Conducting rigorous research on longer-term treatments, such as psychoanalytic therapy, is challenging and cost prohibitive. Psychoanalytic approaches are often less symptom- or diagnosis-focused, seeking instead to facilitate client insight and improve interpersonal relationships. Because empirically supported treatments focus on whether a specific psychological procedure reduces symptoms associated with a medical diagnosis, “proving” the efficacy of complex therapy approaches is difficult—especially when compared to the lesser challenges inherent in evaluating symptom-focused treatments. Partly because of these complexities, some reviewers contend that psychoanalytic psychotherapies are less efficacious than cognitive and behavioral therapies (Busch, 2015; Tolin, 2010).

The good news for psychoanalytic therapy fans is that evidence is accumulating to support treatment efficacy. The less good news is that some of the research support remains methodologically weak and the wide variety of psychoanalytic approaches makes it difficult to come to clear conclusions. Nevertheless, the most recent meta-analytic studies, literature reviews, and individual randomized controlled studies support the efficacy of psychoanalytically oriented therapies for the treatment of a variety of mental disorders. According to Leichsenring, Klein, and Salzer (2014), there is empirical support for the efficacy of psychoanalytic psychotherapies in treating:

  • Depressive disorders.
  • Anxiety disorders.
  • Somatic symptom disorders.
  • Eating disorders.
  • Substance-related disorders.
  • Borderline personality disorder.

The evidence for the efficacy of psychodynamic approaches for depressive disorders is strong. In a recent meta-analysis, Driessen and colleagues (2015) evaluated 54 studies, including 3,946 patients. They reported that short-term psychodynamic psychotherapy (STPP) was associated with improvements in general psychopathology and quality of life measures (d = 0.49–0.69) and all outcome measures (d = 0.57–1.18); they also noted that patients continued to improve at follow-up (d = 0.20–1.04). Further, no differences were found between STPP and other psychotherapies. On anxiety measures, STPP appeared significantly superior to other psychotherapies at post-treatment (d = 0.35) and follow-up (d = 0.76).

In a previous meta-analytic review, Shedler (2010) also concluded that psychodynamic therapies were equivalent to “. . . other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based’” (p. 107). He also reported that psychodynamic therapies had more robust long-term effects.

Table 2.2 provides a sampling of meta-analytic evidence supporting psychodynamic therapies. For comparison purposes, the original meta-analyses conducted by Smith and colleagues are included (Smith & Glass, 1977; Smith et al., 1980). Notably, Smith, Glass, and Miller reported that psychodynamic approaches were significantly more efficacious than no treatment and approximately equivalent to other therapy approaches.

Table 2.2 also includes the average effect size (ES or d; see Chapter 1) for antidepressant medications (ES = 0.31 for serotonin-specific reuptake inhibitors or SSRIs). This comparison data shows that psychodynamic psychotherapy is more effective than SSRI treatment for depression. Additionally, the benefits of psychoanalytic therapy tend to increase over time (Driessen et al., 2015; Shedler, 2010). This implies that psychoanalytic psychotherapy clients develop insights and acquire skills that continue to improve their functioning into the future—which is clearly not the case for antidepressant medication treatment (Whitaker, 2010). One of the ways psychotherapists explain this difference in longer term efficacy is with the statement: “A pill is not a skill.”

Table 2.2 A Sampling of Psychodynamic Psychotherapy Meta-analyses

Authors Outcome focus Number of studies ES or d
Abbass et al. (2009) General psychiatric symptoms 8 0.6
Anderson & Lambert (1995) Various 9 0.85
de Maat et al. (2009) Long-term treatment 10 0.78
Driessen et al. (2015) Depression 54 0.57–1.18
Comparison research
Turner et al. (2008) Meds for Major depression 74 0.31
Smith et al. (1977) Different therapies 375 0.68
  Many problems    
Smith et al. (1980) Different therapies 475 0.75
  Many problems    

Note: This is a sampling of meta-analytic psychoanalytic psychotherapy reviews. We’ve omitted several reviews with very high effect sizes partly because of criticisms related to their statistical methodology (see Driessen et al., 2015, and Shedler, 2010, for more complete reviews). This table is not comprehensive; it’s only a reasonable representation of psychoanalytic psychotherapy meta-analyses.

We recommend you take the preceding research findings (and Table 2.2) with a grain of salt. Conducting systematic research on something as subjective as human mental and emotional problems always includes error. One source of error is the allegiance effect (Luborsky et al., 1999). The allegiance effect is the empirically supported tendency for the researcher’s therapy preference or allegiance to significantly predict outcome study results.  Luborsky and colleagues (1999) analyzed results from 29 different adult psychotherapy studies and reported that about two thirds of the variation in outcome was accounted for by the researcher’s theoretical orientation (e.g., psychoanalytic researchers reported more positive outcomes for psychoanalytic therapy and behavior therapists discovered that behavior therapy was more effective).

The implications of the allegiance effect help explain why, shortly after Shedler’s (2010) publication extolling the virtues of psychodynamic psychotherapy, several critiques and rebuttals were published (Anestis, Anestis, & Lilienfeld, 2011; McKay, 2011). The critics claimed that Shedler’s review was biased and accused him of overlooking weaknesses within the meta-analyses he reviewed (e.g., poor outcome measures, pooling the effects of small samples with little power and poor designs, lack of treatment integrity effects). Although Shedler’s critics raised important points, the critics themselves had their own biases. The problem is that all researchers (and writers) have an allegiance of one sort of another.

One of our favorite ways of understanding the allegiance effect is articulated in a story about the great New York Yankee baseball player, Yogi Berra. One day, when a player on Yogi’s team was called out on a close play at second base, Yogi went charging on to the field to protest. The umpire explained that he, unlike Yogi, was an objective observer and that he, unlike Yogi, had been only about 5 feet from the play, while Yogi had been over 100 feet away, in the dugout. When Yogi heard the umpire’s logic, he became even angrier and snapped back, “Listen ump, I wouldn’t have seen it, if I hadn’t believed it” (adapted from Leber, 1991).

The “I saw it because I believed it” phenomenon is also called confirmation bias (Masnick & Zimmerman, 2009; Nickerson, 1998). Confirmation bias involves seeking, interpreting, and valuing evidence that supports pre-existing beliefs, while ignoring and devaluing evidence contrary to preexisting beliefs. Consequently, psychoanalytically oriented individuals see support for their perspective and behavior therapists see support for theirs. However, despite these caveats, based on accumulating research, psychodynamic approaches have a reasonably good record of efficacy.

***********************************

Although this particular review has many limitations, I’m convinced that most of us, most of the time, are better off following the advice of Marvin Goldrfried (and others) and focusing on the common therapeutic factors, or, as Norcross calls a subset of common factors, empirically-supported relationships.

For more information, check out Goldfried’s recent article on obtaining consensus in psychotherapy:  https://www.stonybrook.edu/commcms/psychology/_pdfs/clinical/Goldfried%20AP%20Consensus%20AP.pdf

 

Two Announcements: A New Article on EBRFs and a New Milestone

Coffee

Two things.

First, Kim Parrow, a doctoral student at the University of Montana emailed me a copy of our hot new journal article. The article explores evidence-based relationship factors as an exciting focus of research, practice, and training in Counselor Education. The article is published in the Journal of Mental Health Counseling. Here’s a link so you can read the article, if you like: EBRFs in JMHC 2019

Second, today when I logged into my WordPress blog, something seemed different. As it turns out, my official number of followers had turned from 999 to 1,000. I’m not sure what that means, other than a woman named Shaina from Thrive has won a special prize. Maybe I’ll see you on Thursday evening Shaina.

I hope you’ve all had a great day, especially all the veterans out there, who IMHO deserve deep appreciation for their service.

Why Bother Studying Counseling and Psychotherapy Theories?

rita-and-john-tippet

A photo of me and my feminist inspiration.

People are often curious about why I would bother writing (and revising) a book on Counseling and Psychotherapy Theories. I usually tell them “I do it for the money” and then laugh like the witch in The Wizard of Oz.

Okay. So it’s obviously not about the money, and I don’t really laugh like that witch, because that would just be frightening and weird and ever since I fell down and hit my head while engaging in a frightening and weird act, I’ve had a pact with myself not to do things that are frightening and weird.

Anyway, to refocus . . . in response to this “Why bother” question, and to elaborate on the post from last week about “What’s your theoretical orientation?” I’m including an excerpt from Chapter One of our Theories textbook. Enjoy.

*********************************

About a decade ago, we were flying back from a professional conference when a professor (we’ll call him Darrell) from a large Midwestern university spotted an empty seat next to us. He sat down, and initiated the sort of conversation that probably only happens among university professors.

“I think theories are passé. There has to be a better way to teach students how to actually do counseling and psychotherapy.”

When confronted like this, I (John) like to pretend I’m Carl Rogers (see Chapter 5), so I paraphrased, “You’re thinking there’s a better way.”

“Yes!” he said. “All the textbooks start with Freud and crawl their way to the present. We waste time reviewing outdated theories that were developed by old white men. What’s the point?”

“The old theories seem pointless to you.” I felt congruent with my inner Rogers.

“Worse than pointless.” He glared. “They’re destructive! We live in a diverse culture. I’m a white heterosexual male and they don’t even fit me. We need to teach our students the technical skills to implement empirically supported treatments. That’s what our clients want, and that’s what they deserve. For the next edition of your theories text, you should put traditional theories of counseling and psychotherapy in the dumpster where they belong.”

John’s Carl Rogers persona was about to go all Albert Ellis (see Chapter 8) when the plane’s intercom crackled to life. The flight attendant asked everyone to return to their seats. Our colleague reluctantly rose and bid us farewell.

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On the surface, Darrell’s argument is compelling. Counseling and psychotherapy theories must address unique issues pertaining to women and racial, ethnic, sexual, and religious minorities. Theories also need to be more practical. Students should be able to read a theories chapter and finish with a clear sense of how to apply that theory in practice.

Darrell’s argument is also off target. Although he’s advocating an evidence-based (scientific) orientation, he doesn’t appreciate the central role of theory to science. From early prehistoric writing to the present, theory has been used to guide research and practice. Why? Because theory provides direction and without theory, practitioners would be setting sail without resources for navigation. In the end, you might find your way, but the trip would be shorter with GPS.

Counseling and psychotherapy theories are well-developed systems for understanding, explaining, predicting, and controlling human behavior. When someone on Twitter writes, “I have a theory that autism is caused by biological fathers who played too many computer games when they were children” it’s not a theory. More likely, it’s a thought or a guess or a goofy statement pertaining to that person’s idiosyncratic take on reality; it might be an effort to prove a point or sound clever, but it’s not a theory (actually, that particular idea isn’t even a good dissertation hypothesis).

Theories are foundations from which we build our understanding of human development, human suffering, self-destructive behavior, and positive change. Without theory, we can’t understand why people engage in self-destructive behaviors or why they sometimes stop being self-destructive. If we can’t understand why people behave in certain ways, then our ability to identify and apply effective treatments is compromised. In fact, every evidence-based or empirically supported approach rests on the shoulders of counseling and psychotherapy theory.

In life and psychotherapy, there are repeating patterns. I recall making an argument similar to Darrell’s while in graduate school. I complained to a professor that I wanted to focus on learning the essentials of becoming a great therapist. Her feedback was direct: I could become a technician who applied specific procedures to people or I could grapple with deeper issues and become a real therapist with a more profound understanding of human problems. If I chose the latter, then I could articulate the benefits and limitations of specific psychological change strategies and modify those strategies to fit unique and diverse clients.

Just like Darrell, my professor was biased, but in the opposite direction. She valued nuance, human mystery, and existential angst. She devalued what she viewed (at the time) as the superficiality of behavior therapy.

Both viewpoints have relevance to counseling and psychotherapy. We need technical skills for implementing research-based treatments, but we also need respect and empathy for idiosyncratic individuals who come to us for compassion and insight. We need the ability to view clients and problems from many perspectives—ranging from the indigenous to the contemporary medical model. To be proficient at applying specific technical skills, we need to understand the nuances and dynamics of psychotherapy and how human change happens. In the end, that means we need to study theories.

Contemporary Theories, Not Pop Psychology

Despite Darrell’s argument that traditional theories belong in the dumpster, all the theories in this text—even the old ones—are contemporary and relevant. They’re contemporary because they (a) have research support and (b) have been updated or adapted for working with diverse clients. They’re relevant because they include specific strategies and techniques that facilitate emotional, psychological, and behavioral change. Although some of these theories are more popular than others, they shouldn’t be confused with “pop” psychology.

Another reason these theories don’t belong in the dumpster is because their development and application include drama and intrigue that rival anything Hollywood has to offer. They include literature, myth, religion, and our dominant and minority political and social systems. They address and attempt to explain big issues, including:

  • How we define mental health.
  • Whether we believe in mental illness.
  • Views on love, meaning, death, and personal responsibility.
  • What triggers anger, joy, sadness, and depression.
  • Why trauma and tragedy strengthens some people, while weakening others.

There’s no single explanation for these and other big issues; often mental health professionals are in profound disagreement. Therefore, it should be no surprise that this book—a book about the major contemporary theories and techniques of psychotherapy and counseling—will contain controversy and conflict. We do our best to bring you more than just the theoretical facts; we also bring you the thrills and disappointments linked to contemporary theories of human motivation, functioning, and change.

What’s Your Theoretical Orientation?

Corey Wubbolding and SF

On CESNET, several people asked about a “cheat sheet” to help students understand the distinctions between different counseling and psychotherapy theories,. Although many excellent options exist and some were offered up on CESNET, I’m adding mine here.

Here’s a Table with brief descriptions of each theory: Theoretical Orientation Summary Table

Here’s a short self-report “test” that students can take to self-identify their natural theoretical perspectives: What’s Your Theoretical Orientation – Short Questionnaire

I also have a longer self-report test that I can send you upon request. Just email me at john.sf@mso.umt.edu and I can send it along.

Thanks for your interest in counseling theories.

The files on this post are adapted from Chapter 1 (Psychotherapy and Counseling Essentials) of Counseling and Psychotherapy Theories in Context and Practice (2018, 3rd edition, John Wiley & Sons) by John and Rita Sommers-Flanagan.

You can request a free evaluation copies of the text through John Wiley & Sons: https://www.wiley.com/en-us/Counseling+and+Psychotherapy+Theories+in+Context+and+Practice%3A+Skills%2C+Strategies%2C+and+Techniques%2C+3rd+Edition-p-9781119279136

 

 

Inspiring Cooperation in Your Children

Moose

**Photo courtesy of the amazing Dudley Dana**

As Ella Fitzgerald and Louis Armstrong sang in 1957, it’s “Summer time and the living is easy.”

In fact, if you’re a parent living on planet Earth (or the Missoula valley) and you’re trying to regulate your children’s access to electronic devices, the living may not be easy; it may be infuriating.

Way back in 1998-2000 I had a biweekly Missoulian parenting column. One of the most popular columns I ever wrote was about a popular and challenging phenomenon among children in 1999. It started . . .

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Here’s a quick parenting quiz.

Question: “How do you spell opportunity?”

Answer: “P-O-K-E-M-O-N.”

As if you didn’t know, Pokemon paraphernalia – the movie, action figures, and yes, Pokemon trading cards – are red hot items among many grade-school children.  Some adults question whether Pokemon obsessions are healthy.  Others contend that Pokemon monsters are evil.  Still others fuel their children’s Pokemon desire through unchecked spending.

When parents ask for my professional opinion about the Pokemon phenomenon, I put on my psychologist face.  I cradle my chin in my hand and look upward in a sort of reflective way.  Then I slowly speak Latin (not bothering to mention that I’m using ½ of my Latin vocabulary).  I say,

“Carpe Diem!”

Then, just in case the person I’m talking with speaks even less Latin than I do, I repeat myself in English.

“Seize the day!”

This is a precious moment in history.  We have at our fingertips – thanks to Pokemon monsters – frequent, repeating, and unparalleled parenting opportunities.

It doesn’t matter whether your child is into Pokemon, Furbys, Heavy Metal music, whining, or chocolate, limit-setting issues will undoubtedly arise.  And limit-setting is absolutely essential.  Parents must set limits — because their children won’t.

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Here’s the new question: If Pokemon monsters were all-the-rage and immensely challenging back in 1999, what monstrosities are plaguing Montana parents THIS SUMMER??

Cell phones and other electronic devices!

Even though your children’s relationships with their electronic devices is filled with crazy-making energy for parents, I deeply believe that my carpe diem advice from the 1990s still stands. All this points to using knowledge about your child, limit-setting, and logical consequences to transform the pain of dealing with electronic devices into the pleasure of having well-adjusted children.

If you want to take advantage of your child’s obsessions, consider making a short list of mutually agreeable rules (based on your family values or principles). For example:

  • Tell your child that rule violations will result in a warning or consequence
  • Follow-through and use empathy as appropriate
  • Remember that children need to learn from mistakes
  • If your child throws a fit or behaves aggressively, NEVER give in

Here’s an electronic device limit-setting example:

Let’s say you’ve talked with your son or daughter and decided that everyone in your family needs time free from all electronic devices. You make it clear that there will be no phones (or other devices) during family meals, during family chores, and during the hour before bedtime. The agreed upon consequence for violating this rule might be something like loss of phone privileges for 6 hours (if you make the consequence small, it will be easier for you to enforce and easier for your child to comply without completely freaking out). Then, if your child violates the rule, you can either give a warning-reminder (“I notice your phone is out. Please put it away or I will put it in our family phone lock-box”) or simply remind your child of the house rule and put the phone in the lock-box.

The cool thing about giving your children warnings is that it gives them a chance to change or improve their behavior. If, upon being warned, your child puts the phone away, you can praise the excellent decision-making by saying something like, “I noticed you put your phone away when I gave you the warning.” If your child makes a poor decision and temporarily loses phone privileges, then you can be empathic and encouraging, “I’m sorry you lost your phone for a while. That’s must feel upsetting. I bet you’ll make a better choice next time.”

Rather than droning on about the virtues of limit-setting to teach your children well, I’m stopping here to point out yet another fantastic opportunity.

The featured Practically Perfect Parenting episode of this week is creatively titled, Inspiring Cooperation in Your Children. And so, for more fun and entertaining information on this parenting topic, you can go to one of the following links.

On Libsyn: https://practicallyperfectparenting.libsyn.com/

On Apple: https://podcasts.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304

As always, feel free to comment, share, like, or shun this blog and the accompanying podcast.

Thinking About Counseling and Psychotherapy Theories

Theories III Photo

Definitions happen.

The process through which words and concepts are defined is fascinating. By definition, definitions need to be sharp and make distinctions, and yet they also sometimes be inclusive and blurry on the edges.

In the latest (3rd) edition of Counseling and Psychotherapy Theories in Context and Practice, Rita and I take aim at the definitions of counseling and psychotherapy. Read on, and if you’re inspired to do so, let me know what you think.

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Definitions of Counseling and Psychotherapy

Many students have asked us, “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”

This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and psychiatric nursing. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. As time permits, we also share our thoughts about less-confusing topics, like the meaning of life.

Sorting out differences between mental health disciplines is difficult. Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power, the differences are irrelevant” (p. 165). Obviously, many different professional tracks can lead you toward becoming a successful mental health professional – despite a few ideological, salary, status, and power differences.

In this section we explore three confusing questions: What is psychotherapy? What is counseling? And what are the differences between the two?

What Is Psychotherapy?

Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), called her treatment the talking cure. This is an elegant, albeit vague, description of psychotherapy. Technically, it tells us very little but, at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing.

As we write today, heated arguments about how to practice psychotherapy continue (Baker & McFall, 2014; Laska, Gurman, & Wampold, 2014). This debate won’t soon end and is directly relevant to how psychotherapy is defined (Wampold & Imel, 2015). We explore dimensions of this debate in the pages to come. For now, keep in mind that although historically Anna O. viewed and experienced talking as her cure (an expressive-cathartic process), many contemporary researchers and writers emphasize that the opposite is more important – that a future Anna O. would benefit even more from listening to and learning from her therapist (a receptive-educational process). Based on this perspective, some researchers and practitioners believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).

We have several favorite psychotherapy definitions:

  • A conversation with a therapeutic purpose (Korchin, 1976, p 281).
  • The purchase of friendship (Schofield, 1964, p. 1).
  • When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).

What Is Counseling?

Counselors have struggled to define their craft in ways similar to psychotherapists. Here’s a sampling:

  • Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior (Burke, 1989, p. 12).
  • Counseling consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems (Krumboltz, 1965, p. 3).
  • [Counseling is] an activity … for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems (Kottler & Brown, 1996, p. 7).

We now turn to the question of the differences between counseling and psychotherapy.

What are the Differences Between Psychotherapy and Counseling?

Years ago, Patterson (1973) wrote: “There are no essential differences between counseling and psychotherapy” (p. xiv). We basically agree with Patterson, but we like how Corsini and Wedding (2000) framed it:

Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do. (p. 2)

This statement implies that counselors and psychotherapists engage in the same behaviors—listening, questioning, interpreting, explaining, and advising—but may do so in different proportions.

The professional literature mostly implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed; some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less.

A Working Definition of Counseling and Psychotherapy

There are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. Sometimes we use the word therapy as an alternative.

To capture the natural complexity of this thing called psychotherapy, we offer the following 12-part definition. Counseling or psychotherapy is:

(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically-based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.

Although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit for any self-administered forms of therapy, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance state.

*To learn more about our Counseling and Psychotherapy Theories text, all you have to do is Google it. If you’re looking for an instructor’s copy, Google the book title and then go to the Wiley website and request one. If you have troubles with that, email me . . . and I can likely help out.