CLS 6805.01 Chapters 14,15 & 16.

CLS Chapters 14,15 & 16

Agenda Chapters 14,15 & 16 Experiential Group Exercises – REBT Therapy, Reality Therapy, Solution-Focused Brief Therapy

Course Competencies Defining the origins of group counseling, including the leaders and time frames Applying specific theories of practice to group counseling Applying group dynamics and processes Modeling appropriate group techniques for use in schools, community, and organizational settings Providing and synthesizing the exchange of feedback between self and other leaders and group members

Rational Emotive Behavior Therapy
Started by Albert Ellis in 1955-grandfather of Cognitive Behavior Therapy; father of REBT Combination of Humanistic & Behavioral Therapy to help deal with issues from past

Rational Emotive Behavioral Therapy (REBT)
Stresses thinking, judging, deciding, analyzing, and doing Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship Is highly didactic, very directive, and concerned as much with thinking as with feeling Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations Is based on the premise that the way to bring about lasting emotional and behavioral change is for members to change their thinking Stresses action in the real world as a way to change

The Therapeutic Process
Group therapy is seen as an educational process Group members learn To identify and dispute irrational beliefs that are maintained by self-indoctrination That events do not cause our problems, but our interpretation of these events do To replace ineffective ways of thinking with effective and rational cognitions To stop absolutistic thinking, blaming, and repeating false beliefs Members are expected to be active and to put into practice into everyday life what they are learning in the group

View of Human Nature We are born with a potential for both rational and irrational thinking We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk We need to acknowledge that we are mainly responsible for our own disturbed thoughts, emotions, and actions We have the capacity to change by using a combination of cognitive, emotive, and behavioral methods

Emotional Disturbance
Through autosuggestion & self-repetition we install & maintain self-defeating beliefs-irrational dogmas & superstitions self-created plus irrational beliefs from significant others Blame is core of emotional disturbance, so to recover--stop blaming self & others We escalate desires & preferences into dogmatic & absolutist “shoulds, musts, oughts, demands, commands-which are irrational beliefs that need to be changed

Irrational Ideas Irrational ideas lead to self-defeating behaviors
Absolute “shoulds,” “oughts,” and “musts” result in our becoming and remaining emotionally disturbed Some examples of irrational beliefs: “I must have love or approval from all the significant people in my life.” “I must perform important tasks competently and perfectly.” “If I don’t get what I want, it’s terrible, and I can’t stand it.”

A-B-C Theory of Personality
When we have an emotional reaction at point C (the emotional Consequence), after some activating event at point A, it is not the event itself (A) that causes the emotional state (C), although it may contribute to it. It is the Belief system (B) or the beliefs that we have about the event that mainly creates the C.

Confronting Irrational Beliefs
Cognitive restructuring is a central technique of REBT Group members learn how to identify and dispute their faulty ways of thinking The process of disputing (D) faulty thinking involves: Detecting irrational beliefs and seeing them as unrealistic Debating these beliefs Discriminating between irrational thinking and rational thinking

REBT Process A = existence of fact, event, behavior, attitude of individual B = person’s belief C = emotional & behavioral consequence or reaction of individual D = disputing intervention-challenge beliefs E = effective philosophy after disputing F = new set of feelings Human beings are largely responsible for creating their own emotional reactions & disturbances Goal: show people how to change irrational beliefs that directly “cause” disturbed emotional consequences

The A-B-C theory

Role of REBT Group Leader
REBT leader teaches members how to challenge their assumptions Leader challenges members’ faulty thinking and teaches them how to apply realistic and constructive thinking to cope with current problems and with future problems Leader uses a variety of cognitive, behavioral, and emotive methods to assist members in modifying their dysfunctional patterns REBT leader assumes the role of teacher and mentor Leader employs a directive role in getting members to commit themselves to practicing in daily life what they learn in the group

Cognitive Methods in REBT Groups
From a cognitive perspective, REBT demonstrates to group members that their beliefs and self-talk keep them disturbed In group there is an emphasis on thinking, disputing, debating, interpreting, explaining, and teaching Some cognitive techniques that are used in an REBT group: Teaching the A-B-Cs of REBT Active disputation of faulty beliefs Teaching coping self-statements Psychoeducational methods Cognitive homework (Ex. REBT Self-help form)

Emotive Methods in REBT Groups
REBT is a multimodal approach to change Members experience a variety of cognitive, emotive, and behavioral techniques Some emotive methods include Unconditional acceptance: group leaders model an accepting attitude Rational emotive imagery: members vividly imagine the worst thing that could happen and are encourage to change feelings & respond differently Use of humor: laugh at self-defeating beliefs Shame-attacking exercises: teaches clients to accept themselves in spite of reactions from others Role playing involving a cognitive evaluation

Behavioral Methods in REBT Groups
REBT group leaders use the entire range of cognitive behavioral techniques Some behavioral methods often used include Self-management methods Behavioral role playing and role rehearsal Homework assignments (Ex. Read a book, visualization, practice behaviors outside the group) Reinforcement and penalties (Ex. Reward yourself with a movie, or penalize yourself by donating $100 to an unworthy organization Skills training (in group or outside of group by taking a workshop)

Self-Talk of Group Leaders
Group leaders can use REBT as a way to identify and challenge their internal dialogue that can get in their way of effectively leading a group Some examples of group leader’s self-talk that can be examined: I must have the approval of all the members of my group I must be the perfect role model at all times I must always perform perfectly I must have the right technique for every problem I must always be in control in my group If I make a mistake, that means I am a failure

REBT with Multicultural Populations
Some advantage of REBT groups as applied to working with multicultural populations: A sensitive leader can challenge members to question messages from their culture Members can learn new ways of thinking and behaving Some limitations to consider: REBT leader needs to use caution in confronting members too forcefully about their beliefs and behaviors Important for leaders to understand and respect cultural differences and not judge these differences Leaders need to be careful to avoid imposing their beliefs and values

Evaluation of REBT in Groups
Contributions and strengths of the approach Can be applied to working with wide range of problems in groups Groups useful in helping members to learn about their self-defeating beliefs and how this influences their current way of acting and feeling The approach stresses the need to put into action newly acquired insights Can be used as a basis for psychoeducation in groups Limitations of the approach Dangers of leader being inappropriately confrontive Possibility of leader deciding for members what is “faulty thinking” Concern about the misuse of leader’s power to pressure members and to persuade them to adopt the leader’s views and values

Reality Therapy William Glasser 1925- Became disenchanted
with Freudian Psychology Created Reality Therapy by we are all responsible for what we choose to do Developed Choice Theory – everything we do is chosen and we can learn to make better choices Reality Therapy is the methodology for implementing the key concepts of Choice Theory William Glasser 1925- Bachelors Degree-Chemical Engineering-Case Western Reserve-Cleveland Ohio MA Clinical Psychology 1948 MD Psychiatry 1957-Board Certified 1961 Created Reality Therapy by 1962-essence we are all responsible for what we choose to do By change to Choice Theory which is now part of Reality Therapy Underlying Problem for all Clients They are either involved in a present unsatisfying relationship or lack what could even be called a relationship. If therapy is to be successful, the therapist must guide the client to a satisfying relationship & teach client to behave in more effective ways Clients find out their problems are the way they chose to behave Innate Needs of Humans All humans are born with five genetically coded needs which they have at varying levels in each one of them Survival Love & Belonging-Primary Need Power Freedom Fun Our brain functions as a control system to get us what we want We do not satisfy need directly In our Brain is our Quality World People we are closest to & enjoy most People we imagine it would be nice to be with Things we own or would like to own Beautiful things in nature important to us e.g. sunsets Systems of beliefs that give us pleasure, religious, political, personal Art of Reality Therapy Therapist must be a person client would consider putting in quality world It is from this relationship with therapist that client begins to learn how to get close to the people they need People who enter therapy typically have no people in their quality world Reality Therapy Concept of Behavior Behavior is purposeful because it is destined to close the gap between what we want and what we perceive we are getting All behavior has four components Acting Thinking Feeling Physiology Reasons why People choose to Suffer If in a frustrating relationship it is normal to choose anger. From angering it is easy to lash out and hurt someone. Depressing & other symptoms can immobilize to restrain anger Depressing is most common way people use to ask for help without begging. When we suffer people reach out to us. Depressing and all other forms of what are called mental illness allow us to avoid doing what we are afraid to do for fear of the possible negative consequences involved Key Reality Therapist Statement “There is no guarantee that life is fair. The only guarantee is that your are the only person whom you know you can change. Complaining may feel good for a short time, but it is completely ineffective behavior. If complaining were effective, there would be a lot more happy people in the world.” Complaining, blaming & criticizing are self-defeating total behaviors which are most ineffective behaviors so not listened to in reality therapy Reality Therapy Basic Beliefs Emphasis is on responsibility Rejection of Transference-welcome responsible involvement with clients Therapist’s function is to keep therapy focused on the present Avoid focusing on symptoms We often mistakenly choose misery in our best attempt to meet our needs We act responsibly when we meet our needs without keeping others from meeting their needs Goals in Reality Therapy Help clients to get connected or reconnected with people they have chosen to place in their quality world To teach clients choice theory Help people extremely resistant to therapy to get involved-disconnected pleasure seeking people-goal is to get therapist connected with these people Therapist’s Function & Role Assist client in dealing with present “Are the total behaviors you are choosing getting you what you need? Is this choice realistic? Is it getting you closer to people you need or want to get to know?” Establish satisfying therapist/client relationship Be role model of a human who knows what life is all about & successful in dealing with life & not afraid to discuss any subject with their clients Client’s Experience in Reality Therapy See reality therapy as safe Gently, but firmly, confronting Sense of urgency-no need for long drawn out process-this session could be the last! “I can use what we talk about today in my life” “My present experiences are focused on and I am not allowed to escape facts” Sees therapist as strong, active, positive force Relationship between Therapist & Client Therapy is a mentoring process-therapist teacher & client student Therapists capable of relating to wide range of people most of whom would not have normally been a part of their lives Sense of paradox Ability to reframe the reality Ability to communicate hope Ability to define problem in solvable terms Ability to use metaphors Being ethical and culturally sensitive Reality Therapy Cycle of Counseling Creating the counseling environment Implementing specific procedures that lead to changes in behaviors Clients led to evaluate their lives & decide to move in more effective directions-make plans to change Following up on how well clients are doing & offering further consultation The Counseling Environment Coercion free – neither client or therapist coerces or controls the other Clients free to be creative & try new behaviors or renew past successful ones Confronting yet always noncriticizing, nonblaming, noncomplaining, caring environment which leads to create new satisfying environments that lead to successful relationships Procedures that Lead to Change Identification of major unsatisfying relationship in life of client-root of problem In that relationship: “Whose behavior can you control?” Once accept can only change self, focus on how client can make better choices Explore tenets of Choice Theory model Identify basic needs Discover client’s quality world Help client understand they choose total behaviors that are their symptoms The “WDEP” System-Promotes Change W Wants: What do you want to be and do? Your “picture album” D Doing and Direction: What are you doing? Where do you want to go? E Evaluation: Does your present behavior have a reasonable chance of getting you what you want? P Planning – “SAMIC” Planning For Change-SAMIC S Simple: Easy to understand, specific and concrete A Attainable: Within the capacities and motivation of the client M Measurable: Are the changes observable and helpful? I Immediate & Involved: What can be done today? What can you do? C Controlled: Can you do this by yourself or will you be dependent on others? Qualities of a Good Change Plan Flexible & open to modification Stated positively in terms client willing to do Plan capable of being done independent of others help or assistance Repetitive & performed daily Carried out as soon as possible Plans contain process-centered activities Evaluate plan if realistic & attainable & if relates to what client needs & wants Firm plan up in writing to help client commit to it Total Behavior: Our Best Attempt to Satisfy Our Needs DOING ~ active behaviors THINKING ~ thoughts, self-statements FEELINGS ~ anger, joy, pain, anxiety PHYSIOLOGY ~ bodily reactions

Assumptions of Reality Therapy
Emphasis is on responsibility We may be the product of our past, but not the victims of our past Leader’s function is to keep therapy focused on the present We often mistakenly choose misery in our best attempt to meet our needs We can only control what we are presently doing Reality therapy is active, directive, structured, psychoeducational, and focuses on doing and action plans

Underlying Problem for all Clients
They are either involved in a present unsatisfying relationship or lack of what could even be called a relationship If therapy is to be successful, the therapist must guide the client to a satisfying relationship & teach client to behave in more effective ways Clients find out their problems are the way they chose to behave

Basic Needs All internally motivated behavior is geared toward meeting one or more of our basic human needs Love and belonging – need to be involved with others Power – need for achievement and accomplishment Freedom – need to make choices Fun – need to enjoy life Survival (Physiological needs) Choice theory posits that all our behavior is an attempt to control the world around us for the purpose of satisfying these 5 basic needs Choice theory is based on assumption that all behavior is purposeful and originates from within the individual Choice theory and reality therapy Choice theory provides an explanation of our human nature Reality therapy offers a method for getting the relationships we need

Quality World We possess these basic needs in differing degrees and fulfill them in various ways We develop a quality world and choose to behave in a way that gives us the most effective control over our lives and satisfies our view of our quality world

Key Concepts of Choice Theory
Existential and phenomenological orientation We perceive the world in the context of our own needs The focus of choice theory is on internal control and the subjective world We choose our own goals and are responsible for the kind of world we create Total behavior Includes four inseparable components: acting, thinking, feeling, and physiology We have most control over our acting and thinking Axiom of choice theory Although the past may have contributed to a current problem the past is never the problem

Total Behavior Acting—behaviors such as talking, jogging
Total behavior is our best attempt to satisfy our needs Components of total behavior Acting—behaviors such as talking, jogging Thinking—thoughts, self-statements Feelings—anger, joy, pain, anxiety Physiology—bodily reactions such as headaches If we choose to change what we are doing, the thinking, feeling, and physiological components will change, as well.

Reality Therapy in Groups
Leaders encourage members to move from talking about the past and their symptoms to discussing their present unhappy relationships Because almost all symptoms are caused by unhappy relationships, members must do what they can to correct their present relationships

Questions in Reality Therapy
Group leaders challenge members with this question: “Is what you are now choosing to do getting you what you want?” Skillful questioning is part of reality therapy and some questions include: Do you want to change? What do you want in your life that you do not have now? If you changed, how would your life be different? What do you have to do now to make the changes happen?

Role & Functions of Leader
Reality therapy group leaders strive to establish a therapeutic alliance that allows for the effective use of reality therapy Reality therapy leaders assume an active and directive role in group Some functions of the reality therapy group leader: Teaches members they have some control over their feelings by choosing to act and think differently Facilitates discussion of how members are currently behaving Helps members make an evaluation of their present behavior Teaches members to design and carry out plans to change what they are doing to get what they want Helps members to evaluate the level of commitment to their action plans

Cycle of Counseling Consists of two major components:
Counseling environment – consists of specific guidelines for implementing interventions and is the foundation from which procedures are built Procedures – lead to changes in behavior – the WDEP system

The Counseling Environment
Personal involvement with the group members Group leader aims to establish a safe climate as the basis for effectively implementing reality therapy procedures For involvement to occur leaders need to have personal qualities: warmth, understanding, acceptance, care, respect for members, openness, and nondefensiveness Counselor attitudes and behaviors that promote change Group leaders strive to teach members to accept responsibility for their total behaviors Leaders help members to see that reasonable consequences are necessary and useful Leaders do not give up easily in members’ ability to find a more responsible way of living

Procedures in Reality Therapy
The WDEP Framework – therapist & client join together to determine goals and plans W Wants—Well timed questions can get members to think about what they want and whether their behavior is leading them in the direction they want to go (Picture Album) Ex. What do you want? D Doing and Direction—members look at their behavior to determine if what they are doing is getting them what they want. Ex. What are you doing? E Evaluation—members evaluate the quality of their behavior, what may be contributing to their failures & what changes they can undertake. Ex. Does your present behavior have a reasonable chance of getting you what you want? P Planning—the process enables people to gain effective control over their lives: “SAMIC”

Planning For Change - SAMIC
S Simple—Easy to understand, specific and concrete A Attainable—Within the capacities and motivation of the group member M Measurable—Are the changes observable and helpful? I Immediate and Involved—What can be done today? What can you do? C Controlled—Can you do this by yourself or will you be dependent on others? Effective planning involves process-centered activities. Ex. Pay your child 3 compliments, jog 30 min a day, Volunteer 2 hrs a week, take a vacation

Multicultural Reality Therapy
Reality therapy can be modified to fit the cultural context Reality therapy can be adapted to non-Western people Group members are asked to determine what changes they may want to make Leaders refrain from deciding what behavior should be changed Group work can be cast in framework of a teaching and learning process Many members will find the structure and focus on action plans appealing in a reality therapy group A possible limitation is that this approach may not fully take into account environmental forces

Evaluation of Reality Therapy Group
Contributions and strengths of the approach The emphasis on personal accountability The stress given to members making their own evaluation of what they are currently doing Emphasis on creating an action plan to get what members want A straightforward and clear approach Limitations of the approach Some leaders might assume role of judge for members of what behavior to change Not much attention is given to expressing and exploring feelings The role of the past is given scant attention

Solution-Focused Brief Therapy
Steve de Shazer, Insoo Kim Berg – 1980’s Solution-focused brief therapy (SFBT)—a future focused, goal-oriented therapeutic approach to group work Shifts focus from problem-solving to solutions SFBT looks at the strengths of a person and past successes In a solution-focused group, the member, not the therapist, is the expert Leader engages members in conversations about what is going well, their resources, and future possibilities SFBT based on an optimistic assumption Members are viewed as resilient, resourceful, competent, and able to construct solutions that can change their lives The leader supplies optimism and recognizes resources members already possess

Key Concepts Therapy grounded on a positive orientation—people are healthy and competent Past is downplayed, while present and future are highlighted Therapy is concerned with looking for what is working Group leader assists members in finding exceptions to their problems – Ex. “Look back over your week & tell me what seemed to go slightly better for each of you.” There is a shift from “problem-orientation” to “solution-focus” Emphasis is on constructing solutions rather than problem solving

Basic Assumptions People can create their own solutions
Small changes lead to large changes It is not necessary to know the cause of a problem to solve it The best therapy involves a collaborative partnership A group leader’s not knowing stance affords the member an opportunity to construct a creative solution Group members are empowered Little attention given to diagnosis, history taking, analysis of problems, or exploration of problems

Role & Function of Leader
A not knowing position Members think about their future and what they want to be different in their lives Group leader has expertise, but is not an expert in how members should live Members are experts on their own lives Creating a therapeutic partnership Leader prefers a collaborative or consultative stance Emphasis is on leader creating a therapeutic partnership with members; empathy is more important than technique Leader has task of keeping members on solution track rather than a problem track – Ex. “While we will discuss your reason for being here, we will shift the focus to what you want to accomplish.” Leaders show members how they can use the strengths and resources they already have to construct solutions

Questions One function of the leader is to ask questions of members, listen to answers, and generate further questions Skillful questions allows people to utilize their resources Asking “how questions” that imply change can be useful Effective questions focus attention on solutions Questions can get members to notice when things were better Useful questions assist people in paying attention to what they are doing and what is working Questions can open up possibilities for members to do something different Ex. “What do you want from coming here?”, “How would that make a difference to you?”, “What might be some signs to you that the changes you want are happening?”

Process of Solution-Focused Group
Philosophical stance of accepting people where they are and assisting them in creating solutions Steps in the change process Setting the tone for the group Assisting members in developing well-formulated goals Searching for exceptions to the problem Instilling hope and encouraging motivation Assisting members in designing out of group tasks Terminating A key question is: “When the problem is solved, what will you be doing differently?” Members are helped to identify barriers that could get in their way of maintaining the changes they made

Techniques and Procedures
Pre-therapy change – “What have you done since you made your appointment that has made a difference in your problem?” Questioning – primary communication tool and main intervention Exception questions – explore times when it was reasonable to have expected the problem to occur, but somehow it did not Ex. “Tell me about the times when things are going your way.” Miracle question – “If a miracle happened and the problem you have was solved, what would be different?” Scaling questions – “On a scale of 0-10, with 0 being how you felt when you first came to group and 10 being how you felt after your miracle occurs, how would you rate your anxiety now?” Formula first session task (FFST) – homework using observation Feedback – encouragement, suggestions for homework

SFBT in a Multicultural Context
Many characteristics of SFBT make it an ideal approach in group work The approach stresses learning about the experiential world of the members Some questions in understanding multicultural influence on members: Talk about the influence that [some aspect of your culture] has played in your life What challenges have you faced growing up in your culture? How have you been able to draw on strengths and resources from your culture?

Evaluation of SFBT Group
Contributions and strengths of the approach Rests on optimistic assumption that people are competent Focuses on possibilities rather than limitations Operates from a nonpathologizing stance Use of questioning as centerpiece of this approach Is a brief approach and makes each session count Limitations of the approach In a short time, leaders need to make assessments, assist members in formulating specific goals, and make effective interventions Inexperienced leaders may be enamored by SFBT techniques and not give enough attention to creating a therapeutic alliance with members

CLS 6805.01 Chapters 14,15 & 16.

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CLS 6805.01 Chapters 14,15 & 16.

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