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Welcome to the Addiction Counselor Exam Review. This presentation is part of the Addiction Counselor certification training. Go to http://www.ALLCEUs.com/certificate-tracks to learn more about our specialty certificates starting at 149 dollars. Hi everybody and welcome to your review of Counseling Theories. In this presentation we're going to be focusing on counseling theories that we typically use with individuals not families family counseling is a different video in this
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one we're going to review the most common counseling theories used with individuals and potentially groups and related interventions we're going to start with my favorite cognitive behavioral the premises of cognitive behavioral are that people respond to their representation of events rather than the events themselves so for example rollercoasters I hate rollercoasters I'm terrified of them some people love rollercoasters now
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the event riding a roller coaster is the same for them and for me we're doing the same exact thing they happen to find it thrilling I have happen to find it terrifying so I'm responding to how I perceive the event learning is cognitively mediated so everything we learn is influenced by everything we've learned up until then if a dog comes charging up the fence at you you know me I've been raised around dogs you know I'm gonna think oh my gosh
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he's protecting his property isn't that sweet I'm probably gonna talk to him and baby talk and we're gonna become best friends or not but that's the way it's gonna go somebody else who has had a bad experience with the dog may perceive that as threatening and become terrified so every experience you encounter your brain goes ok have I done anything like that before and is it safe unsafe good bad you know what am I supposed to do here so you got to remember that
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everybody's experiences are going to affect how they experience things in the future thoughts impact emotional and behavioral reactions if you take the the roller coaster for example if I think that riding a roller coaster is you know dangerous that's my thought it's going to make me feel scared and my behavioral reaction is to say oh no way in the world am I going right that if you have positive thoughts and you say oh my gosh that is so much
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fun that is totally safe and it is a really fun way to you know get your adrenaline going then that person is going to be happy about getting on a roller coaster maybe even downright excited and they're going to be eager to get on there they're going to be moving towards the roller coaster some types of thoughts can be monitored and modified if you have a fear of spiders for example you spiders are everywhere just that's the way it is and if that makes
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your skin crawl those types of thoughts that spiders are dangerous and spiders are gonna crawl on me and spiders are going to bite me those things can be addressed and modified so we want to look at the thoughts that can be addressed other types of thoughts that can be modified are what we call irrational or I call them unhelpful thoughts like everybody is always against me it's probably not true I don't have never met a person yet I have
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not met a person yet where everybody was always against them so they were catastrophizing so we want to change those thoughts and say you know a lot of the people in my family don't seem to support me for example now that's more specific okay well where are the people that do support you so cognitive-behavioral helps people look at a range of cognitive distortions or unhelpful thoughts and you can google those or you can watch our video on
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cognitive behavioral techniques to learn more about those but they address those in order to help people improve their mood feel more empowered and behaviorally act differently act more assertively and less less fearfully and less depressed modifying thoughts can help modify emotions and behavioral responses if you modify your thought about something you're angry about for example then you can de-escalate your anger and it'll
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to fight whatever your behavioral urges are maybe you want to put your fist through the wall well if you're not angry anymore then you're not gonna want to put your foot fist through the wall well isn't that awesome both behavioral and cognitive techniques are useful and can be and probably should be integrated so the goal is to identify and correct unhelpful cognitions or cognitive distortions by clarifying and challenging unhelpful or inaccurate
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cognitive schema which is cognitive schema or the way we think about things our memories if you will and increase the clients problem-solving abilities so when you encounter a situation like this that makes you angry what can you do to deescalate your anger which will also remove the likelihood that you're gonna do something behaviorally that you'll regret a cognitive behavioral assessment these I'm a cognitive behavioral therapist so I tend to think these are
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the easiest to do clinical interviews can clarify antecedents and consequences to emotions and behaviors and strategies that have and have not been helpful in the past what does that mean it means we want to look at when something has happened that has made you angry you know I want to look at what caused you to get angry and then you got angry and what was the result what are the consequences what was the result of you getting angry you know if you got angry
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and threw a temper tantrum and got your way well then you're likely to get angry and throw your temper tantrum again if you were angry and threw a temper tantrum and got fired then you might be less likely to do that in the future maybe not but we want to look at the antecedents what causes it and the consequences of emotions and behaviors and then we also want to look at strategies that the person's used before that's been hot that have been helpful
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because that's where we're going to start we're not going to reinvent the wheel they know what's worked for them at least a little bit and we'll build off of that but we also want to know what they've done that hasn't worked at all because there is no sense continuing to do something that they don't think is going to our inventories and questionnaires are helpful in identifying cognitive distortions so giving people handouts that say you know I believe that all people are against man examples of
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cognitive distortions for example people can go through and check those and you can either use a Likert scale so they don't believe it at all they believe it a little bit they believe it a fair amount or they believe it a whole bunch so 1 2 3 & 4 or a simple yes/no however you want to do it but that can help instead of having to sit there and go through these different questions which takes a long time in the assessment that can give you an idea about their
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cognitive style and their thinking style and this distortions that may be contributing to their dysphoria self-monitoring can help identify the frequency antecedents and consequences of unhelpful thoughts and/or reactions so once you've identified some of those unhelpful thoughts and educated them about cognitive distortions then give them a sheet so they can monitor themselves each day and keep a log you know they can just have a hash mark next
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to each time they use a particular cognitive distortion and then they can start looking at how often are these happening what triggers these types of unhelpful thoughts and what are the consequences and generally the consequences are it causes them to get anxious angry or depressed which is why they're in your office so self monitoring helps people get an idea of how often it's occurring what causes it so they can intervene there and if they
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can't intervene there then they can figure out a different way of responding so they don't have the negative consequence data from the assessment helps identify clients problem-solving abilities when things happen do you emotionally disregulated you can't problem-solve or when these things happen what do you do how do you handle it and again what are the consequences if you handle it and it has perfectly good consequences it de-escalates the situation it's a win-win everybody's happy that's
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great but likely the person chooses a problem-solving technique that isn't wholly effective and it ends up having negative consequences so then you're going to look at how can you modify that problem solving strategy in order to help them have more success in problem-solving you're going to look at their attributional style attributions are where you assign responsibilities and so to speak it can be global or specific so if
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somebody's walking down the street and they trip over and they trip a global assessment or attribution would be that person is so clumsy a specific attribution would be that person did something right there that was really clumsy you know maybe if you watched ah Miss Congeniality there were some really good examples in there of where she was very prim and proper and then all of a sudden she would just like fall down somewhere so you want to look as global or stable when we're looking at
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attributions global attributions such as I'm stupid I'm useless are going to contribute to people's misery as opposed to specific attributions such as I am not any good at woodworking or at math those are specific things that I know are not my strengths and you know I'm okay with that because globally I'm a good person and I'm smart but there are some things that not my strengths stable or changeable you know this thing that you've got going on if you you know
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don't like it is it stable is it can it be changed at all if it can great if you're clumsy you that's generally considered a stable trait if you had your shoelace is untied that's changeable so when you're you know walking like when my son was little we started getting in the little velcro shoes because his shoes would always come untied and then he'd trip and you know but that was changeable there was something I could do to change it it
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wasn't about him it was about his equipment and it was fixable and then the final attribution is it internal or external so going back to the tripping an internal attribution would be saying that person is clumsy so it's something about them that made them trip an external attribution would be to say there must have been a crack in the sidewalk that they tripped over as putting the blame somewhere else now to internal or to external can be bad
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because some things are due to you and some things are due to external forces but looking at attributions and challenging those and seeing are there negative things that are changeable external or specific that you're looking at is global stable and internal and it gives you information the assessment that is about their underlying belief systems and the cognitive distortions they use such as everybody's always against me
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and I never succeed at anything I do all of those statements help you start seeing what maybe maintaining this person's unhappiness so what can you do about it daily mood and activity monitoring is the place to start because we're gonna keep track of it increased rewarding behaviors and establish a daily routine so do things that make yourself happy each day you know you need to rest relax sharpen the saw whatever you want to call it and a daily
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routine helps keep your circadian rhythm set so you're getting more quality sleep so your energy levels are more predictable and you have a sense of mastery over you know when you're going to be sleepy when you're going to be awake when you're going to be doing whatever encourage the person to develop an understanding between the relationship of the relationship between their feelings thoughts and behaviors so start with you know when you're
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depressed how does it affect the way you think about things that day and how does it affect the things that you do okay so let's move it and instead of being a feeling let's go to thoughts if you are just being a negative Nelly you are in a negative mood that day how does it affect your mood you know if your thoughts are negative how does it affect your mood and it probably tends to make you more angry and irritable so you're negative you're angry and irritable how
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does it affect what you do and then finally move it around to behaviors and say all right you know so you wake up in the morning and you decide you know what I'm just not going to get out of bed today I don't have it in me and you stay there all day long in the dark watching a Netflix marathon how does that affect your mood you know it's probably going to make you feel tired more depressed you know a little bit more helpless and hopeless you know there are things that
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it can contribute to and how does it affect the way you think you know does your attitude change throughout the day generally if you have time to sit there and dwell on things your attitude is going to get a little bit more negative so you know helping people see that if you inner being anywhere on the three pillars you're going to improve the situation use graded tasks to help clients start approaching and addressing seemingly
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overwhelming problems maybe they have social anxiety okay you know a lot of people do I have a little bit you know I really hate mixers and I just don't introduce myself to people well but so graded tasks would be having people do things that don't make them so nervous like when I go to the grocery store I talked to the cashier when I'm in other situations I try to get out of side of my comfort zone and talk to people I don't know so I get more comfortable
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doing that the next step would be going to for example presenting and that's weird because I really love presenting but I would do that so I'm in front of you know 150 people but I don't know and then I might go do something else that elicits a little bit more anxiety you know as I master each level and realize that hey I can do this it's not so bad let me try something a little bit more difficult not too much more difficult just a little bit and sometimes there
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has to be a an envisioning step in between there so before I go to a Chamber of Commerce mixer I need to rehearse it in my mind several times or maybe more than that and get to the point where I'm comfortable doing it in my mind I know how I'm going to act I know what I'm gonna do you know I feel confident in my mental rehearsal and then I can actually go do it in person so there are great when they say graded tasks does not like great at ABC but
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it's gradually increasing movement towards those things that are stressful and teach new skills and have clients practice them between sessions I have clients learn a new skill each week like the ABC worksheet cognitive processing worksheet and we'll try different things and I'll say well Dusit we'll try it in in session we'll work through a few examples and then I'll say well why don't you try this during the week and see if it helps
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obviously I choose interventions based off of what they have told me their strengths are so we're building on what they are what already works for them another thing that we do in cognitive behavioral is address automatic thoughts so the first thing is to teach the concept what are automatic thoughts and then you want to elicit the clients thoughts so help them figure out you know when somebody cut you off in traffic and then you got angry you had a
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bunch of automatic thoughts in there that led to you having that stress reaction so what were your thoughts it was dangerous I could have been killed that person was so rude yadda yadda help them start eliciting and figuring out all those things that they're telling themselves in a millisecond label any distortions that you hear or see if you can have them write write it down it's even better I'll generally write it on a whiteboard as we're talking and then
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we'll label each cognitive distortion with all-or-nothing thinking magnification personalization you know you know your distortions and identify and challenge and modify maladaptive schemas so you could have died well that's kind of catastrophic how likely is it that you would have died it was unsafe that's true so we're changing the the thought we're changing the schema we're kind of changing the memory of that event to something that was
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catastrophic and life-threatening to something that was potentially hazardous and unsafe in order to help reduce the anxiety about the situation and then when the person encounters future situations they're gonna have a lower level of anxiety because we've modified that schema and we're going to develop helpful alternatives when this happens how can you handle it and how can you prevent it happening in the first place a B C D and E are you know the basics of
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cognitive behavioral and rational emotive behavioral therapy the activating event getting cut off in traffic the consequences your emotional behavioral reactions but between those is like a little millisecond automatic beliefs that your brain kind of floods you with to tell you whether you're safe or whether there's a threat then you use D and you go back in your dispute those automatic beliefs looking for cognitive distortions and inaccurate schema or
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inaccurate representations or memories of how dangerous it was or what happened and the final step is to evaluate your reaction and the consequences for helpfulness so if you got cut off in traffic and you decided that you were gonna speed up next to the person you were gonna scream at them and flip them off did that do any good was that going to keep them from cutting you off was that really a smart thing to do and the answer is no in both cases so you want
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to evaluate the use of your energy was getting upset over this a good use of my energy was screaming at somebody over this a good use of my energy what would a bet of better use of my energy you know if the person is driving like an idiot maybe calling local law enforcement to you know come check and see if their DUI that could be but most of the time it's just not even worth your energy and you need to let it go cognitive processing is another
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technique where when you have a belief such as you know I am going to be alone the rest of my life you want to ask the person to evaluate whether they're using fact or emotional reasoning do they have the facts that are telling them no doubt objectively you're gonna be alone the rest of your life or are you using emotions because you feel unlovable and abandoned and lonely right now you fear that you're gonna be alone for the rest of your life
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there's a difference once fact once purely in emotion the next step is to identify all of those facts for and against your thought so what are the facts that you will be alone for the rest of your life you know what's let's look at those you know let's look at statistics let's look at data you know let's look at it and what are the facts that support the notion that you won't be alone for the rest of your life because there's going to be facts on
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both sides help the person figure out if they're looking at the big picture or they're looking at tunnel vision sometimes we think that we should have been more responsible or if you know stay with this metaphor of being alone for the for your whole life you know you break up with from one relationship and you say you know what I'm gonna be alone the rest of my life but the big picture is you've dated 30 people and you know 27 of them you're the one who's broken
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up with them because you got bored or whatever you know it's not necessarily that you're going to be alone for the rest of your life you've got tunnel vision right now because you hurt and you're focusing on the hurt the other aspect to look at here is hindsight you know hindsight is 20/20 so when you're looking back at a relationship you know you might have been able to see the warning signs that it was a bad relationship for something and when
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you're looking backwards at it but when you're in it you know you're there's other things going on and other factors contributing to your decision-making so you're going to have a different perspective after the fact than you do in the midst of it so you know cut yourself some slack basically learn from it but cut yourself some slack another thing to ask them is are you confusing high probability with low probability is there a high probability
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you're going to be alone the rest of your life and you know how how long have you gone without being in a relationship you know how many people have you dated looking at that versus low probability you know maybe you're gonna be alone for six months or a year maybe even two years but how likely is it that you're gonna be alone the rest of your life and look for cognitive distortions when people are talking about their thought that you
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know I'm going to be alone for the rest of my life you know that's kind of an extreme statement you know you don't know what's going to happen six months from now or six years from now so let's focus on the present and then start addressing some of the unhelpful thoughts that might be making them feel unlovable or abandoned another technique is called the downward arrow let's follow it through you know you broke up with your boyfriend so you're alone right now all right now what you know are you
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gonna start dating again okay if you start dating again then what happens you meet somebody and it doesn't work out you know you decide you don't like them okay then what happens you keep dating okay then what happens and you work through it and and follow the behavior all the way through to the end until you figure out what happens at the very end of the story you can question the evidence you know and that's kind of what we did in cognitive processing dee
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catastrophize you know when somebody says I'm never gonna get another job or I'm never gonna find somebody to love me again you know we want to take the catastrophe out of that take the never out of it and look at how likely is it that that will happen cognitive rehearsal is something else you can do and I talked about that a little bit earlier and that's imagining you know if you're getting ready to do something scary or getting ready to have
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a tense conversation with somebody you might want to rehearse how it's gonna go in your head a few times before you do it so you know what you're gonna say you know how you're gonna react you're planned it's kind of like when football teams practice you know they're not doing it cognitively they're actually on the practice field but a lot of athletes will actually rehearse in their own mind you know a quarterback may rehearse the perfect pass you know they rehearse what it's going
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to look like so they're prepared and it also helps prepare your mind and body problem-solving skills training always helpful because there's multiple ways to solve any problem thoughts stopping is just what it sounds like and that's helping people figure out how to quiet that annoying voice in their head that is saying that the sky is going to fall or telling them that there good enough how can they stop that thought you know getting themself
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distracted telling themself they're not gonna think about it singing the ABC's what are what can they do and behavioral you can narrow things sometimes things become associated with too much like eating you know people when I was growing up yeah we ate all the time we ate when we were watching TV we ate when we were on the way home from the grocery store we ate at dinnertime we ate when we were bored we ate when we went to the movies we ate we ate we ate and that
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didn't develop really good eating habits so narrowing would be reducing the number of situations when it is quote okay to eat when you choose to allow yourself to eat so for example instead of allowing yourself to eat while you're watching TV sitting on the couch say you know the only time I'm gonna eat is when I'm sitting at the table so then that means you're not eating in the car you're not eating when you're sitting on the couch and you're not eating in bed
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so that narrows the number of stimuli that tell your brain hey it's time to eat cue strengthening for positive behaviors you know we want to trigger the positive reactions we want to trigger people to exercise to eat healthy so you can put apples and oranges and healthy foods healthy fruits and stuff in a basket on the counter that's it cue people see it they're like Oh sounds like looks like something good to eat and they may eat that instead of
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foraging for chocolate or something less healthy you can put your gym bag by the front door to remind you to go to the gym you know there are a lot of different things you can do to prompt yourself to do helpful healthy behaviors and finally self reinforcement and Punishment you know telling yourself if I you know do this whatever it is for the entire week then at the end of the week I will reward myself by doing whatever we do that with our kids when
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they're little you know if you get stars so many stars on your star chart this week the on Saturday you can pick what movie we watch or whatever it is but there's a reinforcement concept to their indications for cognitive-behavioral pretty much anything mood disorders especially depression anxiety and phobias fears of failure rejection and abandonment eating disorders and to a certain extent personality disorders now sometimes personality disorders are ego-syntonic so the person doesn't see
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the problem with the behaviors so it can be sort of an uphill battle here but it has been used the only time you wouldn't use CBT is if somebody has significant cognitive dysfunction you know they have a brain injury or something psychosis or mania they need to be able to think things through and see consequences you're probably not going to use a lot of cognitive behavioral with young children either you know really young children your elementary and middle
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school they can make connections you just have to adjust what you use to meet their cognitive development level behavioral models the premise of behavioral models is that current behaviors are what we focus on current behaviors are under stimulus control that means things that are rewarded happen more frequently things that are punished happen less frequently bada-bing there's no thought there's no feeling it's you know stimulus reaction
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it rejects the idea that maladaptive behaviors reflect underlying pathology an elimination of the behavior is the primary goal of treatment so if you're working with somebody who self-injure z-- you know the primary goal of a behaviorist for a behaviorist will be to eliminate self injurious behavior not to address any underlying intrapsychic conflicts those don't exist so we're going to remove the the behavior assessment takes the form of a
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functional analysis that means they look at the behavior so we'll stick with self-injury at this point and we say what are the antecedents what happens that triggers somebody to want to self-injure what are the consequences of self-injury does the person get a lot of attention when they're doing it does it give them a sense of personal control does it release endorphins so they get a little bit of a rush because they're feeling depressed you know what are the consequences and what are the
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discriminative stimuli that means what are the things in the environment that kind of make it possible for this to happen in order to do the functional analysis you can do it through naturalistic observation and that can be observing in a classroom of going to somebody's house and observing or even observing a videotape that the parent brings in for example self monitoring you know obviously the person can identify and we do this a lot in
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dialectical behavior therapy role-playing so if there's a particular type of situation that triggers behaviors when my son was little I wanted to play with him and he didn't want to play with me and you know I couldn't figure out why you know I was trying really hard and you'll find out in a few minutes what happened but I talked to his preschool teacher and I'm like Jessica you know he plays with you guys so well and he just doesn't seem to
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be interested in playing with me what am I doing wrong so she came to the house and she said okay you know let's sit down and show me what you do and so I started showing her what I do and all my playing was more educational playing it wasn't fantasy cars and stuff and after about you know three minutes she's like okay you can stop right there I'm like you got what you needed she's like yeah you're boring and I said oh okay well then but she had
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no way of knowing that until she saw how I interacted Sean got bored which isn't a term the behaviorist would use Sean was interacting with me was not being rewarded would be what a behaviorist would say so I needed to alter the way I interacted with him in order to make it more rewarding when it was rewarding for him to interact with me he was more willing to hang out with mom so role-playing is you know something you can do in the office you know if I
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would have had that a family come in with a similar situation I would have said sit down and show me or if the parent would have come in I would say okay let me be jr. and I'll sit down here and I'll pretend to be jr. and you show me what you do so I can get an idea if I can't observe the situation itself let's reenact it and then finally rating scales rating scales are great for helping people get a sense of the frequency intensity and
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duration of things such as you know temper tantrums or crying episodes or you know anything that is observable and measurable behaviorist use principles operant conditioning classical conditioning and observational learning we're going to focus mainly on operant conditioning which means behaviors are increased or decreased through punishment and reinforcement and you can reinforce things by adding something positive like giving somebody a token or
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a hug or taking away something unpleasant so you can say if you eat your main course then you don't have to eat your green beans you know that would be rewarding for some for some kids so reinforcement is either adding something positive or taking away something unpleasant punishment is just the opposite punishment is either adding something unpleasant like having to go out we would make my son go out and pick up sticks in the yard that had fallen down if he had
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misbehaved and he hated to go out in the Florida Sun so that was punishing for him or punishment can mean removing something positive like taking away somebody's iPhone so there are basically you either punishment means you make it unpleasant some way reinforcement means you make it Pleasant in some way observational learning means that people can also experience reinforcement and punishment for actions by seeing it happen to others so if they see somebody you know throw a chair at in school and
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then get sent to the principal's office you know that's a negative consequence so they're like well probably not going to do that but if they see somebody smoking in the bathroom and getting a lot of positive attention for it from their peers then they're gonna go oh well maybe if I try that I'll get positive attention so we learn vicariously by seeing reinforcement and punishment of behaviors in other people as well as experiencing it directly our self behavioral therapies goal is to
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identify the stimuli that prompt the behavior the reinforcers things that are maintaining the behavior and punishments in the environment what can we do to make this behavior less pleasurable in order to figure out how to change it we want to remove the reinforcement and cues for their target behavior so with alcohol for example if people drink take antabuse when they drink they don't get the sensation of getting buzzed or whatever so the reinforcement is gone
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and the punishment comes in pretty quickly when they get violently ill so that thought of drinking starts to become less and less pleasurable and less and less frequent and we want to increase reinforcement and cues for a new behavior because you don't want to just eliminate stuff you want to add stuff so let's look at why were you drinking and you know if you were drinking because you were stressed what else could you do to deal with stress
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besides drinking if you were drinking because you liked the taste of it what else can you do to stimulate your taste buds besides drinking the assessment emphasizes observable measurable behaviors and patterns we're not going with thoughts or feelings we're looking at what happened what rewarded it what would punish it the client and therapists agree on the definition of the problem behavior so what is exactly that we're looking at and baseline data
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is required so if you're looking at temper tantrums the parent or the person is going to go home and keep track of how many temper tantrums had that week how long they lasted and maybe what triggered them so that'll bring a lot of information back to the therapist interventions that can be used includes systematic desensitization which starts with relaxation training you've got to learn how to relax and then you work through that anger or
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anxiety hierarchy so you first think about something that makes you you know your heart start beating really really fast that's measurable and then you know if you've got a heart rate monitor you practice relaxation until you can think about that situation and your heart rate hardly goes up at all and then you move to the next step you know let's take spiders so you're looking at an aquarium full of spiders you're not touching them you're
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completely safe from them but you're looking at the aquarium your heart rate goes up you practice relaxation and you get to the point where you can be in the same room with the aquarium and your heart rate doesn't really go up at all and the next step is taking the lid off the aquarium so there's a chance that the spider could crawl out you see where we're going with this assertiveness training can be used to combat anxiety because the belief is assertive
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behaviors are completely counter to anxious behaviors anxious behaviors make you make people tend to run tend to you know get nervous tend to flee assertive behaviors are the opposite behavioral rehearsal so practice doing things you know if you've got to go give a speech go to wherever it is that you're going to give the speech and practice giving the speech their aversion therapy make it unpleasant just like taking antabuse for example makes drinking unpleasant
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flooding and this flooding needs to be used with great caution it is the treatment of choice for agoraphobia but you know you need to know what you're doing it is in vivo exposure with response prevention which basically means you take somebody and put them in the situation that freaks them out and don't let them leave it there stuck there so they've either got spiders crawling all over them or with agoraphobia you make somebody go out into public and you don't let them
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retreat back into their home and help them deal with the the feelings and the thoughts that they're having during that extremely stressful period you can increase behaviors through reinforcement so if you want your kids to do more chores or you know your your child to get his homework done before six o'clock at night you can add reinforcement so if you do that then you get an additional hour of TV time or you can stay up an hour later so you can
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increase behaviors by adding rewards shaping means rewarding what we call successive approximations so if I want my son to keep his room clean that's you know a big step so the first thing I'm going to say is you know in order for your room to pass inspection you can't have laundry on the floor you know we got it let's start by working on getting the laundry off the floor once he's doing that regularly I can say all right now you've got the whole getting the
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laundry up down really well now I want you to start making your bed - okay he gets that down so shaping is rewarding a behavior until it's consistent and then saying okay you don't get the reward anymore until you do that plus something else or until you do that a little bit better the Premack principle is one of my favorite it pairs high frequency or high likelihood activities with low likelihood activities or pleasurable activities
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with less pleasurable activities so for example I fold laundry while I watch TV I love watching TV so you know it makes it less yucky when I used to do my my calculus homework I always used to save my M&Ms for the day until I did my calculus homework and that's when I could eat my mmm so it made it a little bit more tolerable not necessarily the healthiest but so paring things that somebody doesn't really want to do something that's
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so bad a lot of people like to listen to podcasts or watch their favorite television show while they're at the gym so getting an iPad so they can watch it while they're on the treadmill or whatever that's the Premack principle response cost is having to give away something each time the target behavior occurs so speeding is the perfect example you get caught speeding you have to pay a fine you have to give away money and
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most of us don't like to do that but you can use it with other things like nail biting each time you bite your nails you have to put a quarter in the nail biting jar each time you say a swear word you have to put a quarter in the in the swear jar whatever it is and timeout we all know what timeout is but we have to use it correctly if the function of whatever the person's doing is to get quiet time because they're over stimulated then timeout is probably just
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going to reward that behavior because they're like hey if I do this I get to go where it's quiet so we want to determine the function of the behavior if it's to get attention then putting somebody in timeout is punishing because they're not getting attention anymore and they're like well this is no fun if they're doing something out of boredom then putting them in timeout which is still boring boring probably isn't going to have much of an effect so you want to
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figure out what the reinforcer is and give them time out from the reinforcer so timeouts are not all the same behavior therapy contracts contingency contracts have an explicit definition of the behavior such as Johnny will go to bed by 10:00 p.m. the behaviors can be monitored they have to be observable and measurable so I can look in his room and say you're asleep or you're in bed or you're not in bed sanctions for failure
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so there has to be a punishment if you're not in bed by 10:00 what happens and there has to be record-keeping with contingency contracts I also like to put reinforcers in there so if you do go to bed by 10 o'clock each day this week then on Saturday you can choose whatever from this list possible rewards which takes us to our token economy you want to define the target behaviors when I ran the adolescent treatment center we used a
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token economy and the youth had things they had to do every day from making their bed to participating in their schoolwork participating in treatment doing their chores bathing you know there was a list of about 10 things and the counselors would monitor and mark those off and for each level of completion we had a 70% level an 80% level in 90 % level and 100 percent level they would get a different number of points so at the end of the week that
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we would tally their points and they could cache those points in in the store and that's where they could buy tokens for video time or snacks or there are a variety of things they could get to reward their behavior but the token was were the points so we were giving them these tokens and they were able to cash them in at the end of a week you want to be able to select the reinforcers that are gonna work for that person video games wouldn't work for me you
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know there are a bunch of other reinforcers that might so select appropriate reinforcers monitored the behaviors then eventually you're going to have to fade out reinforcers where the person's just doing it because it's what they do not because they're hoping for a token but that's way down the line the humanistic perspective so we're switching gears now we did cognitive behavioral which focused on the cognitive then we went to straight-up
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behavioral which only looked at observable measurable external behaviors now we're moving over to a whole different school of thought called humanistic the premise is of humanistic is to understand a person one must have understand his or her subjective experience so remember I said we can go through the same thing and interpret it differently like riding a roller coaster well to understand why somebody really loves riding roller coasters I have to
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try to understand their experience because my experience is different emphasis on the uniqueness and wholeness of the individual because each person is unique and all of their characteristics combined create who they are a belief in the person's inherent ability for growth and self-determination if they're provided a good environment they will grow and prosper therapy involves authentic collaborative interactions and rejection of traditional assessment
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techniques and diagnostic labels the self is a conceptual Gestalt composed of perceptions of I Who am I and the relationship of Who I am with the world and values attached to those perceptions so you know I know who I am and if I think I am adequate and lovable and I think those values are important then I'm going to feel pretty darn good if I think I am inadequate and incompetent or untrustworthy or whatever you know how I for you myself then I'm going to look at
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you know is this a good thing or a bad thing and I'm going to value whether I'm a good person or a bad person based on that to grow the person must remain unified and organized disorganization occurs when there's in congruence between the self and the experience so for example the person believes I'm lovable for Who I am you know they're going along great and then all of a sudden things change and the parents are like no no you are only lovable if you
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make me proud those are the conditions of work I don't love you for who you are I love you for what you do and then that kind of shakes the person's world because they're like no no I'm lovable for who I am and the parents are sending the message no you're lovable if you do what I want you to do and it creates sort of a schism or a disorganization therapeutic goals are to help the client achieve congruence between self and experience by providing an authentic
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atmosphere with unconditional positive regard so this atmosphere says you are an awesome person you are a good person now sometimes you may make poor choices but you're you are a good person and that removes the blocks and empowers people to grow assessment is pretty minimal in person-centered it examines the difference between the who the client is and who the client perceives herself to be so if I am for example really successful at what I do
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and whatever but I perceive myself to be inadequate you know then that's something we're going to work on in counseling is to fix that gap and it also believes that the client is the expert on themselves so we're not going to start offering a whole lot of opinions techniques include unconditional positive regard accepting the person for who they are as a good person providing accurate empathy you know really connecting with the client
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being genuine and congruent you know admitting how you feel you know if you feel frustrated saying you know what I'm feeling frustrated right now I'm wondering how you're feeling so being you know transparent basically an avoiding interpretation manipulation probing or advice-giving Gestalt therapy is another humanistic therapy and the premise it's based on are that people tend to seek closure and people's Gestalt reflect their current needs so
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things they're doing reflect their current needs behavior represents a whole that is greater than the sum of its parts so behavior is you know just what we're seeing but it is a representation of something much greater there was one video with Fritz Perls and I can't remember the woman's name I should I saw it enough times but she was shaking her shaking her foot and pearl said tell me what your foot is trying to communicate because that behavior was what was observable but
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what was underneath it was anxiety and frustration and fear that you know he wouldn't be able to help her or whatever so that behavior was just kind of the the tip of the iceberg behaviors have to be understood in context so shaking your foot may mean that you're nervous or you're frustrated or it couldn't mean that you're cold or a variety or your foots asleep you know when your foots asleep you may shake it to try to get it to wake up a focus on the here and now
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is needed to increase self-awareness and help clients live in the now we can't change the past we can't forecast the future so let's look at what's going on with you now and improve the present moment it believes that the self is the creative forward moving aspects of the person and the self image is the part that imposes external demands so the self is who you are and this wonderful forward moving person the self image is
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that idea you have of who you should be and that can place external demands that say you are not good enough unless historical information in Gestalt therapy is only relevant to the extent that it's impacting the present so we look at you know if you have unfinished business with your in your family of origin and it impacts your current ability to trust in relationships we're going to look at it in terms of that but we're not going to start dealing with
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all that stuff in your past we're dealing with how your past experiences made you who you are right now and are impacting your present problems are believed in gestalt therapy to arise from abandonment of the self for the self image so instead of being true to yourself and thinking I'm good gosh darn it saying I'm gonna be who everybody else thinks I should be whose society says I need to be which creates a lack of authenticity a lot of times problems
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stem from disruption of the boundary between self and the external environment resulting and failure to meet personal needs so when you're doing what everybody else wants you to do or what you think you should do sometimes you neglect what you actually really need and that causes problems and emotional distress boundary issues in Gestalt therapy are seen as reactions to problems or problems introjection means that people accept things from the environment without understanding or
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questioning so I since I'm a female then I should get married I should have children I should do this I should do that you know these cultural mores that are kind of programmed into us introjection means I take those in I don't question them I'm just like this is what I do I don't say is this what I want I'm looking at the self-image at that point projection is disowning aspects of the self and putting them on other people so
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if a person tends to be grumpy all the time and they're like they look at everybody else they're like everybody is so negative all the time they're projecting that grumpiness onto other people in 12-step recovery a lot of times we say the things that you dislike most and other people are often a reflection of what you dislike most in yourself ret reflection is doing to the self what you want to do to others so if you want to
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abandon them you know your tire their their stuff and you just want them to go away instead of abandoning them you may abandon yourself if you get angry at them and you want to lash out you may lash out internally at yourself and finally confluence is intolerance of differences between self and others which leads to feelings of guilt and resentment so you know all of these boundary issues can be issues that are handled in Gestalt therapy techniques
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that are used include directed awareness which is being aware of yourself in the here and now kind of like mindfulness what are you doing and what does it mean no questions are allowed which prevents intellectualizing so instead of pearls saying what is your foot trying to communicate he said tell me what your foot is communicating there was no question in there it was a statement tell me what it is use I language so you're owning stuff and assumed responsibility saying I take
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responsibility for how I react in this situation the empty chair technique can be really useful for dealing with issues with other people or for behavioral rehearsal you know pretend your boss is sitting in that chair and you're gonna ask for a raise tell me how it would go or you know you have a lot of stuff that you need you feel like you need to say to your mother pretend she's in that chair and and go for it tell her what you need to tell her role reversal is another technique where
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you take on the persona the client takes on the persona of the other person so in the last example maybe you have a lot of resentment towards your mother so role reversal you would take your mother's perspective and you would act as if you were your mother and try to get into her head to understand her perspective a little bit role rehearsal is just what it sounds like envisioning what you're going to do and rehearsing it and Gasol also works with dream work
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which we're not going to get into a lot here but you know it's one of the few techniques that still does do a fair amount of dream work and finally psychodynamic therapy is rest on the premises that internal conflicts and their relation to the problem are central themes of treatment so we want to look at you know you're depressed or whatever this is this is the problem what internal conflicts are causing that psychopathology develops especially from
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early childhood experiences so psychodynamic therapists believe things happened in childhood and they're continuing to negatively impact you today and that's what's causing problems internal representations of experiences are organized around interpersonal relations so psychodynamic is very interpersonally focused so when we look back at experiences and we get current experiences we're looking at the relationships between people and
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maybe you know how does this person remind you of your mother how have you recreated your family of origin life issues and dynamics will re-emerge in the context of the therapeutic relationship as transference and countertransference so we figure that people have a relatively ingrained way of responding so they're going to act in therapy the way they act in the outside world so to speak so we can start addressing some of those issues distress
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is often marked by defense mechanisms and behavior is influenced by unconscious thought and once voll neural or painful feelings are processed the defense mechanisms tend to reduce or resolve so you know you have this distress which is why somebody's coming to treatment well a lot of that distress is caused by defense mechanisms because you're sitting there going I'm not going to deal with it I'm not going to deal with it I don't feel it and underneath
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you're just like it's like acid it's burning so once you deal with these underlying conflicts you don't need the defense mechanisms to avoid dealing with it because it's not there anymore there's peace so to speak interventions in psychodynamic therapy use of free association is a major method for exploration of internal conflicts and problems so it's a lot less directive there's a focus on interpretations of transference defense
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mechanisms current symptoms and the working through of these present problems there's a lot of interpretation in psychodynamic therapy clients often review emotions thoughts early life experiences and beliefs in order to gain insight into their lives and their present-day problems they can see why they react this way to this situation because of what happened back then and then they can choose how they're gonna react henceforth and ever forevermore
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but first they need to understand how they got to this place psychodynamic therapy encourages clients to trust that insight about how their past is impacting their present is critically important for success in therapy so they have to be willing to buy into that whole stuff from the past is impacting the present in psychodynamic therapy the therapist will examine acts of the self towards others you know how do you interact toward other people do you
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trust them do you let them in do you have zero boundaries what are your expectations about others reactions in the present and that will help me learn a little bit about what may have happened in the past acts of others toward the person so how do you how do people respond to you and acts of the self toward the self how do you act toward yourself are you demeaning and hateful towards yourself or are do you care for yourself so cognitive
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behavioral approaches address the connection between unhelpful thoughts feelings and behaviors the focus is often on changing thoughts or behaviors and the feelings tend to improve behavioral interventions focus only on observable measurable behaviors thoughts and feelings are irrelevant so behavioral is just what what can you see humanistic therapists focus on helping people live as authentic integrated whole organism and that includes person-centered as well as Gestalt therapy and
1:00:15
psychodynamic therapies focus on how the past is influencing the person's present behaviors
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