Individually based theory and therapy models

Person Centered Therapy

Theoretical Foundations
■ Focus is on the person and not the presenting problem

■ Humanism
        o Philosophical movement that emphasizes worth of the individual and the centrality of human values
        o Attends to matters of ethics and personal worth
        o Gives credit to the human spirit
        o Emphasis on creative, spontaneous, and active nature of humans
        o Optimistic
        o Human capacity to overcome hardship and despair

■ Non-Deterministic        o Beliefs that it is oversimplification to view people as controlled by fixed physical laws.
        o Encouragement of therapy that considers individual initiative, creativity, and self fulfillment

■ Self Actualization        o Innate process by which a person tends to grow spiritually and realize potential

■ The Experiencing Person        o Important issues must be defined by the client
        o Special concerns are discrepancies between what a person thinks of himself and the total range of things he experiences


Techniques

■ Listening
■ Accepting
■ Respecting
■ Understanding
■ Empathic Responding

Individually based theory and therapy models

Gestalt Therapy

Five Major Channels of Resistance
■ Introjection
        o Tendency to uncritically accept other’s beliefs and standards without assimilating them to make them congruent with who one is
        o Passively incorporate what the environment provides, spending little time on becoming clear about what we need or want.

■ Projection
        o Disown aspects of self by assigning them o the environment
        o Trouble distinguishing between inside and outside world
        o Disown attributes of self that are inconsistent with self image and put onto other people
        o Avoid taking responsibly of feelings and person one really is
        o Keeps self powerless to initiate change

■ Deflection
        o Process of distraction
        o Keeps difficult to sustain sense of contact with reality
        o Overuse of humor, abstract generalization, and questions rather than statements, resulting in emotional depletion
        o Diminished emotional experience by seeking through and for others

■ Retroflection
        o Do things to self rather than others

■ Confluence
        o Blurring differentiation between self and environment
        o Fitting in, absence of conflict, belief all people feel and think the same way
        o High need for acceptance and approval
        o Stay safe, never express own feelings
        o Therapist uses W’s questions to get client to open up


Other Forms of Resistance
■ Control of environment        o Resistance to contact
        o Boundary disturbance

■ Blocks to energy manifested by        o Tension in part of body
        o By posture
        o Keeping body tight and closed
        o Not breathing deeply
        o Looking away from people when speaking
        o Numbing feelings
        o Speaking with restricted voice

Individually based theory and therapy models

Gestalt Therapy

Techniques

■ The experiment in Gestalt therapy
        o To assist clients self awareness of what they are doing and how they are doing it
        o Expanding awareness of client
        o Opportunity to “Try on” new behavior
        o Experiments bring struggles to life, inviting client to enact them in the present
        o Major emphasis on preparing clients for experiments though trusting relationship

■ Confrontation
        o Imposing stance
                ● Therapist meets own agenda for the client
                ● Acts as expert, power and control in therapist
        o Competing stance
                ● Therapist promotes rugged individualism with lots of negotiation compromise and                 confidence
        o Confirming stance
                ● Acknowledging the whole being of client
                ● Client’s needs and experience center of relationship
                ● Ideal type of confrontation
                ● Invites client to look at incongruities in verbal and nonverbal language, in words
                versus action.

■ Internal Dialogue        o Identifies the struggle for control in a person, fragmented between controller and controlled, through Introjection of aspects of others
        o Between top dog and underdog
        o Between critical parent should and oughts and passive recipient without responsibility and with excuses
        o Empty chair
                ● Shift client into two chairs for dialogue role lay.
                ● Experiences conflict

■ Reversal technique        o Role play the opposite of symptoms and behaviors client suffers
        o Client tries the very thing fraught with anxiety, therefore submerged and denied
        o Help clients to accept personal attributes that they have tried to deny

■ Rehearsal exercise        o Behavioral rehearsal: role play a planned for new behavior with a person or people in client’s environment.
        o Reduce stage fright, anxiety or fear
        o Encourages spontaneity and willingness to experiment with new behaviors

■ Exaggeration Technique        o Exaggerate movement or gesture repeatedly to intensify feelings attached by behavior to make inner meaning clear
        o Trembling hands or feet, slouched posture, bent shoulders, clenched fists, tight frowning etc.

■ Staying with Feelings        o Keep client from escaping fearful stimuli and avoiding unpleasant feelings
        o Encourage to go deeper into feeling or behavior they wish to avoid
        o Facing, confronting, and experiencing feeling makes them able to unblock and make way for new levels of growth
                ● Takes courage and pain.

Individually based theory and therapy models

Gestalt Therapy

Major Principles
■ Holism
        o Interested in the whole person
        o Emphasis on integration of thoughts feelings, behaviors, body and dreams

■ Field Theory        o Organism must be seen in its environment or its context as part of a constantly changing field
                ● Relational
                ● In flux
                ● Interrelated
                ● In progress

■ Figure Formation Process        o How client organizes environment from moment to moment
        o Background
                ● The undifferentiated field or ground
        o Figure
                ● The emerging focus of attention

■ Organismic Self Regulation        o Restore equilibrium or contribute to growth and change


Therapy Process
■ The Now        o Power in the present
        o Nothing exists except the now
        o The past is gone and the future has not yet arrived
        o For many people the power of the present is lost
                ● They may focus on their past mistakes or engage in endless resolutions and plans                 for the future.

■ Unfinished Business        o Feelings about the past are unexpressed
        o These feelings are associated with distinct memories and fantasies
        o Feelings not fully experienced in the background and interfere with effective contact
        o Preoccupation, compulsive behavior, wariness oppressive energy and self defeating behavior.

■ Layers of Neurosis        o Perls likens the unfolding of adult personality to the peeling of an onion.
        o Phony layer- stereotypical and inauthentic
        o Phobic layer- fears keep clients from seeing themselves
        o Impasse layer- giving up power
        o Implosive layer- fully experiencing deadness
        o Explosive layer- letting go of phony roles

Individually based theory and therapy models

Gestalt Therapy

Foundations

■ Existential and Phenomenological
        o Grounded in the client’s “here and now”

■ Initial goal is for clients to gain awareness of what they are experiencing and doing now

■ Promotes direct experiencing rather than the abstractness of talking about situations

■ Rather than talk about childhood trauma, the client is encouraged to become the hurt child

■ Holistic approach to personality vs. mechanistic approach of Freud.

■ Value of examining present situations vs. repressed intra-psychic conflicts from early
childhood

■ Focus on process versus content

■ On presently experienced vs what is revealed by client from memory

■ Self understanding comes from individual’s behavior in the present versus why they behave as they do

■ Therapist goal: create experiments for client to assist their self awareness of what they are doing and how they are doing it.


Therapy Process
■ Promote awareness in client through
        o Insight
        o Self acceptance
        o Knowledge of the environment
        o Responsibility for choices
        o Paradoxical theory of change       
        o Ability to make contact with others
        o Clients expected to do their own seeing, feeling, sensing and interpreting vs passively allowing therapist to give insight and answers

■ Concepts of human nature
        o Clients are manipulative
        o Avoid self reliance
        o Avoid taking on personal responsibility
        o Clients have to stand on own two feet to deal with life problems themselves
        o Move clients from environmental supports to self-support
        o Help clients reintegrate disowned parts of personality

Individually based theory and therapy models

Experiential Therapy
Aim of Existential Therapy

■ Rejects deterministic outlook on mankind

■ People are free and responsible for their choices and actions

■ People are the authors of their lives

■ Existential therapy encourages clients to:
        o Reflect on life
        o Recognize range of alternatives
        o Decide among them

■ Goal
        o Help clients recognize ways they passively accepted circumstances and surrendered control
        o Help clients to start to consciously shape their own lives by exploring options for creating a meaningful existence.


Tasks of the Therapist
■ Invite clients to recognize how they have allowed others to decide for them

■ Encourage clients to take steps toward autonomy

■ The Question        o “Although you have lived in a certain pattern, now that you recognize the price of some of your ways, are you willing to consider creating a new pattern?”

■ Relationship between therapist and client
        o Therapy is a journey taken by BOTH therapist and client
                ● The person to person relationship is key
                ● The relationship demands that therapists be in contact with their own                 phenomenological world
        o The core of the therapeutic relationship
                ● Respect and faith in the client’s potential to cope.
                ● Sharing reactions with genuine concern and empathy

Individually based theory and therapy models

Experiential Therapy 
Basic Dimensions of the Human Condition
■ The capacity for self awareness:
        o The greater our awareness, the greater our possibilities for freedom
        o Awareness is realizing
                ● We are finite- time is limited
                ● We have potential, the choice to act or not to act
                ● Meaning is not automatic- we must seek it
                ● We are subject to loneliness, meaninglessness, emptiness, guilt and isolation

■ The tension between freedom and responsibility        o People are free to choose among alternatives and have a large role in shaping personal destinies
        o Manner in which we live and what we become are result of our choices
        o People must accept responsibility for directing own lives

■ Creation of an identity and establishing meaningful relationships        o Identity is the courage to be
        o We must trust ourselves to search within and find our own answers
        o Our great fear is that we will discover there is no core, no self
        o Aloneness
                ● We must tolerate being alone with self
                ● We must have a relationship with ourselves first
        o Struggling with identity
                ● We are trapped in doing mode to avoid experience of being
        o Relatedness
                ● At their best our relationships are based on our desire for fulfillment, not our                 deprivation

■ The search for meaning        o Like pleasure, meaning but be pursued
                ● Finding mening in life is a byproduct of a commitment to creating, loving, and                 working
        o Life is not meaningful in itself, the individual must create and discover meaning
        o Goals deal with
                ● Discarding old values
                ● Coping with meaninglessness
                ● Creating new meaning

■ Accepting anxiety as a condition of living        o Anxiety arises from striving to survive and maintain own being
        o Existential anxiety is normal- life cannot be lived, not can death be faced, without anxiety
                ● Anxiety can be a stimulus for growth as we become aware of and accept our                 freedom
                ● We can blunt our anxiety by creating the illusion that there is security to life
                ● If we have the courage to face ourselves and life we may be frightened, but we will                 be able to change
        o Neurotic anxiety creates guilt

■ The awareness of death and nonbeing        o Awareness of death is a basic human condition which gives significant to our living
        o We must think about death if we are to think significantly about life
        o If we defend against death our lives can become meaningless
        o We learn to live in the “now”
        o One day at a time results in a zest for life and creativity