C6436 Individual Counseling and Practices

Argosy University- Tampa Campus

Overview of Stan & His Therapies

Content:

Stan's Background
Psychoanalytic Therapy with Stan
Adlerian Therapy with Stan
Existential Therapy with Stan
Person Centered Therapy with Stan
Gestalt Therapy with Stan
Reality Therapy with Stan
Behavioral Therapy with Stan
Cognitive Behavioral Therapy with Stan
Feminist Therapy with Stan
Family Therapy with Stan

Stan's Background

Stan’s Current Life Circumstance

25 years old
Divorced, currently single
Construction worker, building homes
Part-Time College Student – major in psychology

Stan’s Major Issues

Alcoholic
“Loner” lack of healthy social supports
Fear of what others think of him-Need for Approval, Fear of Rejection
Intimidated by strong & attractive women
Fear not a real “man” – “strong, tough, perfect”
Sexual dysfunction-performance anxiety
Generalized anxiety & Panic attacks
Guilt for not working up to own potential
Sees self as failure, wasted much of his time, let people down a lot
Experiences deep depression in moments of self-pity – Suicidal couple years ago
Avoidance of intimacy with others

Stan’s Self-Identified Strengths

Guts to stop drugs and leave his shady past behind him
He got into college
Determination to “Change”
Recognizes He must change his life on his own
He feels his feelings and is willing to take risks to change

Stan’s Family

Parents fought constantly
Mother: dominant
Father: weak, passive
Oldest sister: Judy-perfect, honor student
Older Brother: Frank-perfect, honor student
Younger Brother: Karl-spoiled rotten-Stan fought a lot with him

Stan’s Family Members’ Traits

Father: Troubled Person
Mother: Enabler
Judy: Looking Good
Frank: Looking Good
Stan: Acting Out
Karl: Entertainer

Stan’s Adolescent Behaviors

Hang out with wrong crowd
Took lots of drugs
Put into youth rehabilitation facility for stealing
Expelled from regular school for fighting
Graduated out of a continuation High School trained as auto mechanic

Messages Stan Got About Himself within His Family

From Father:

You’re really dumb.
Why can’t you be like your brother and sister?
You’ll never amount to a hill of beans.
Why can’t you ever do anything right?

From Mother:

Why do you do many things to hurt me?
Why can’t you grow up and be a man?
Your were a mistake. I wish I hadn’t had you.
Things are so much better around here when you are gone.

Stan’s Marriage

Married soon after Meeting in Las Vegas Gambling Casino-Not long before divorced when wife left him
Impotent in few sexual relations
She: dominant always telling Stan he was worthless & how she couldn’t stand to be near him

Significant Influence in Stan’s Life

Supervisor at Youth Camp-where worked past few summers
Helped Stan get his current job
Encouraged Stan to go to college
Saw lots of potential in Stan for working well with young people
His faith inspired Stan to begin to believe in himself

Personality Traits of Low Self-Esteem in Stan’s Evolution

Childhood: Acting Out
Adolescent: Acting Out
In Marriage: Acting Out-Troubled Person
Currently: Pulling In, Acting Out, Troubled Person
- Still Drinking
- Inferiority Complex
- Incapable of Intimacy
- Anxiety & Guilt

Resistance Issues of 9 Traits of Low Self-esteem

Looking Good-denial of problems- “I am just fine the way I am”
Acting Out-rebel authority of therapist- “You are not the boss of me”
Pulling In-hide from therapist-”I really don’t want to talk about it.”
Entertainer-distract & deflect-”Let me tell you about a funny thing I heard this week.”
Troubled Person-anger at being in therapy-”None of this is my fault, it is there problem”
Enabler-self-pitying-”My life is in ruins, if only he would change my life would be better”
People Pleaser-overly compliant-”I will agree with you to your face but do what I want”
Rescuer-focus on others-”Too many people depend on me the way I am-I can’t change.”
Non-feeling-empty of emotions-”I am lost when you ask me how I feel about …”

Defense Mechanisms of 9 Traits

Looking Good-Reaction Formation, Denial, Sublimation
Acting Out-Displacement, Rationalization, Denial
Pulling In-Repression, Displacement, Denial
Entertainer-Regression, Repression, Denial
Troubled Person-Projection, Rationalization, Denial
Enabler-Sublimation, Projection, Rationalization, Denial
People Pleaser- Reaction Formation, Denial
Rescuer-Sublimation, Reaction Formation, Denial
Non-feeling-Repression, Denial

Ethical Issues Therapists Need to Clarify with Stan in Beginning

Differences between Stan’s & therapist’s roles and responsibilities in therapy
Estimated length of time in therapy based on therapy model being used
Costs of therapy based on estimated length of therapy model being used
How Stan’s goals in therapy will be established
What is not allowable by either Stan or the therapist as they enter and continue this therapeutic relationship
How to assess if therapy is productive and healthy for Stan
How Stan’s confidentiality will be honored by therapist

Psychoanalytic Therapy for Stan

Focus on unconscious psychodynamics of Stan’s behaviors
Attention to material he has repressed
Anxiety dealing with his sexuality & aggression
Strong Superego introjecting parental values & standards
Perfectionism-could only be loved if perfect

Dynamic Issues of Stan’s

Self-destructiveness: rather than focus anger on parents & siblings turned inward on self
Alcoholism: oral fixation
Need for Approval & Acceptance: due to lack of love & acceptance during early childhood
Sex-role identification: identified with weak impotent father and fears strong, domineering women who are out to hurt men
Divorce: married a dominant woman like mother to reinforce feelings of impotence

Goal in Stan’s Psychoanalytic Therapy

Develop a transference relationship between female therapist and himself
Have Stan relate to therapist as he did to his mother
Process give him insight into origin of his difficulties with women

Process of Stan’s Analysis

Stress on intensive exploration of past
Make the unconscious conscious so as not to be driven by unconscious forces
Reliving and exploring the past-gives insight & understanding of dynamics of his behaviors
Sees connections between current problems and early childhood experiences
Looks at relationships with parents, siblings, ex-wife – how generalized views of men & women from early family experience
Re-experience old feelings & uncovered buried ones

Questions Asked of Stan in Analysis

What did you do when you felt unloved?
What did you have to do as a child with your negative feelings?
Could you express your rage, hostility, hurt, & fears?
What effects did your relationship with your mother have on you?
What did this teach you about all women?

Contemporary Analysis of Stan

Help him see current behaviors in world as repetition of earlier developmental ones
His dependency (alcoholism, need for approval and acceptance of others) repeating patterns he formed with mother in infancy
He has not accomplished task of separation and individuation-stuck in symbiotic phase-thus he has problems in developing intimate relationships

?’s to Ponder on Stan’s Analysis

How much interest would you have in Stan’s early childhood? What are some ways you’d help him see patterns between his childhood issues and his current problems?
How would you react to Stan’s transference to you as a significant person in his life? What countertransference issues might you have with Stan?

Adlerian Therapy with Stan

Goals:

1. Establish & maintain relationship

2. Explore his dynamics

3. Encourage him to develop insight & understanding

4. Help him see new alternatives & make new choices

Starting Point of Adlerian Therapist

Help Stan focus on feelings of not being equal to others – feeling of inferiority
Help Stan realize he is equal in therapy
To set up goals for counseling mutually
There are no simple formulas as he is requesting
To engage Stan as the equal partner in the counseling process

Adlerian Lifestyle Analysis of Stan

Stan’s social relationships
His relationship with family members
His work responsibilities
His role as a man
His feelings about himself
Stan’s goals in life & his priorities
Consistency between his past & present as he is moving toward the future

Stan’s Early Recollections

6 years old – scared of kids & teacher-told mother he didn’t want to return to school, She yelled at him-called him baby-he felt horrible and even more scared
8 years old – visiting grandparents, kid in neighborhood hit him for no reason, they got in fight, Mother scolded him for being such a rough kid-she didn’t believe him that other kid started fight-felt angry & hurt that she didn’t believe him.

Analysis of these recollections: Stan sees life as frightening & unpredictably hostile & that he feels he cannot count on women who are likely harsh, unbelieving & uncaring

Stan’s Priorities Evolve in Therapy

Initially stress on superiority-overstress value of being competent, accomplishing one feat after another, of winning, of being right at all costs, moving ahead in most situations
Eventually pinpoints control-due to situations which embarrass or humiliate him-need to control these painful feelings
Uses alcohol, avoids interpersonal situations threatening to him, isolates himself, not counting on other for emotional support- at a big price-others are frustrated and lack interest in him and he pays with distance from others and lowered personal spontaneity & creativity

Stan’s Mistakes Pinpointed

Mistakes: faulty conclusions about life & self-defeating perceptions

I must not get close to people, because they will surely hurt me.
Because my own parents didn’t want me and didn’t love me, I’ll never be desired or loved by anybody.
If only I could become perfect, maybe people would acknowledge and accept me.
Being a man means not showing emotions.

Stan Grows in Self-Understanding

He learns he is not “sick” & in need of being “cured”
He rather is “discouraged” & needs to be “encouraged” to reorient his life
He identifies his private logic as inaccurate
Counselor focuses on Stan’s lifestyle, current direction, goals & purposes & how Stan’s private logic works
Stan given homework to translate insights into new behaviors

Reorientation Phase for Stan

Consider alternative attitudes, beliefs & actions
Stan does not have to be locked into past patterns
He feels encouraged – he has the power to change his life
Accepts he will not change by merely gaining insight But must carry it out through an action oriented plan- He no longer sees himself as a victim of circumstances

?’s to Ponder on Stan’s Therapy

How would you attempt to establish a relationship with Stan based on trust & mutual respect? Can you think of any difficulties you might have in developing this relationship?
What strengths & resources in Stan might you draw on to support his determination & commitment to change?
How would you assist Stan in discovering his social interest and going beyond?

Existential Therapy with Stan

Stan’s Existential Therapy

View of Stan by Therapist

Stan has the capacity to increase his self-awareness & decide for himself his future
He does not have to be a victim of his past
He can redesign and decide his future
He can free himself of self-imposed shackles from his past
He must accept responsibility for his life and the consequences of his decisions

How Therapy Goes with Stan

Existentialist do not emphasize techniques
Emphasize therapist’s understanding Stan’s world
Therapist establishing authentic relationship with Stan

Stan’s “Bad Faith”

Bad Faith-not accepting personal responsibility
“My family never really cared for me; this is why I feel unworthy most of the time.”
“That’s the way I am; I can’t help what I do.”
“Naturally I am a loser, because I’ve been rejected so many times.”

Therapist Confronts “Bad Faith”

Points out in firm but kind manner, how Stan escapes from his freedom through alcohol and drugs
How His passivity is keeping him unfree
That he is responsible for his life, his actions, and for his failure to take action.

Role of Anxiety in Stan’s Life

Therapist does not see Stan’s anxiety as needing to be cured
Therapist sees that Stan must learn that realistic anxiety is a vital part of living with uncertainty and freedom
There are not guarantees & people are ultimately alone
Healthy anxiety, aloneness, guilt, & even despair are normal experiences & how he copes with them is critical

Test of Lethality for Suicide with Stan

Therapist tests the “lethality” of Stan’s suicidal ideation

Do you have a means of suicide in mind?
Is this means of suicide readily available to you at this time?
Is this an effective way to kill yourself?
Have you ever used this means before to attempt suicide in the past?
Are you ready to use this means of suicide at this time?
Is nobody living with you at this time who can take control of this means of killing yourself?

Symbolic Nature of Suicidal Talk

Is “better off being dead” symbolic
Does Stan feel he is a dying person?
Is he using his human potential?
Is he choosing a dead way to merely exist instead of affirming life?
Is he trying to elicit sympathy from family & friends?
Is there any reason for Stan to want to continue living?
What are some projects that enrich your life?
What can he do to find purpose & significance?

Hoped for Goals in Existential Therapy for Stan

Discover his own centeredness
Live by values he chooses & creates for himself
Become a more substantial person
Learn to appreciate himself more
Stop clinging need for other’s approval
Relate to others in strength
Overcome feeling of separateness & isolation

?’s to Ponder on Stan’s Therapy

How could therapist help Stan overcome his resistance to accepting personal responsibility for his own life?
How would you help Stan relate to his anxiety in a more creative way?
How would you address Stan’s talk about Suicide as the means to escape his horrible life of loneliness, rejection, despair, & no meaning?

Person-Centered Therapy with Stan

This therapy focuses on understanding Stan from his internal frame of reference
Therapist has faith in Stan’s ability to find his own way & trusts that he has within himself the necessary resources for personal growth
Stan is encouraged to speak about the discrepancies between the person he would like to become, his feelings of being a failure, being inadequate, unmanly, his fears, uncertainties and hopelessness

Therapeutic Atmosphere for Stan

Freedom & Security
Encouraging of Stan to explore threatening aspects of himself
Counselor listening intently to word & manner
Understanding what like to live in his world
Convey basic attitude of understanding & acceptance
Positive regard-encourage Stan drop pretenses & more freely explore personal concerns

Discoveries from Stan’s Therapy

Stan has low evaluation of self-worth
He want to be loved “I hope I can learn to love at least a few people, most of all, women.”
He want to feel equal to others
He wants not to apologize for his being
He is keenly aware of his inferiority

How therapy helps Stan

Therapist creates supportive, trusting & encouraging environment helps Stan feel therapist genuinely interested in him
Use relationship to learn to be more self-accepting of both strengths and assets
Openly express fears of women, not being able to work with people, of feeling inadequate & stupid
Explore feelings of being judged by parents’ & authorities & express his guilt-not up to parents’ expectations & Hurt over never felt loved & wanted by them

Express loneliness & isolation & need to dull feeling with alcohol & drugs

Results of Therapy for Stan

Expresses feeling, no longer alone-by taking risk to let therapist in
Gets sharper focus on his life, clarify own feelings & attitudes & that he has capacity to use strengths to make his own decisions
Free him from his self-defeating ways
Increase his own faith & confidence in his ability to resolve his own problems & discover new ways of being
Views self in positive light-more sensitive to messages inside of self-recognize he can depend on himself

?’s to Ponder on Stan’s Therapy

How much faith do you have that Stan has capacity to find own way without active intervention of part of therapist?
Describe Stan’s deeper struggles and what his world is from his viewpoint.
To what extent do you think the relationship you could develop with Stan help move him forward in a positive direction?
What if anything might get in the way of a relationship with Stan?

Stan’s Gestalt Therapy

Gestalt Therapy Goals with Stan:

Focused on Stan’s Unfinished Business – his resentment – turned towards self
Old baggage he is carrying around
Present behaviors and how the old stuff is interfering
Recreate context of earlier decisions no longer serving him well

What Stan needs to Learn in Gestalt Work

Decision of how he survived his childhood years - may no long be appropriate
One of his primary decisions: “ I am stupid, and it would be better if I were not here. I’m a loser.”
Explore his cultural values and messages he has received – which are no longer functional
- “Don’t talk about your family to strangers”
- “Don’t show your vulnerabilities, hide your feelings and weaknesses”

Interventions by Gestalt Therapist

“What are you experiencing as we are getting started today?”
Encourage Stan to tune into present experience to allow figures to emerge
Focus on figure of interest – holds most energy or relevance for Stan
Heighten Stan’s awareness of thoughts, feelings, body sensations, or insight through experiments focused on the figures he’s identified

Goal of Experiments Used

To create awareness on Stan’s part
To create contact possibilities between Stan & therapist
For Therapist to be fully present as possible to Stan so as to understand his world
Therapist only uses self-disclosure to benefit Stan & strengthen therapeutic relationship

How Stan Deals with Present Struggles in Gestalt Work

“Become” individuals who told him how to think, feel & behave as a child
Then become the “child” that he was and respond to them from the place where he feels the most confusion & pain
Hopefully, he experiences new ways the feelings that accompany his beliefs about self-for deeper appreciation of how past feelings & thoughts influence his behavior today

How Therapist Uncovers Stan’s Feelings over Ex-wife

Therapist uses questions to help him “get into his feelings”
“What are you aware of now having said what you did?” – to put him into ex-wife events to re-experience his feelings
He feels pain & is frightened due to it for fear of being hurt again
Experiment: talk directly to ex-wife in various scenes from past
He tells ex-wife of his resentments & hurts & moves to completing unfinished business with her-to unlock himself from the past

Process of Gestalt Therapy with Stan

After a figure emerges for Stand - an experiment agreed upon – enacted & debriefed
Then Stan invited to bring out new figure which emerges
Stan’s figure must be sovereign and prominent for him
Therapist leaves out own personal ideas, observations & feelings so as not influence Stan
Therapist only gives self-disclosure to add to & deepen Stan’s exploration of key issues
Therapist’s timing, attunement & experience are crucial to success of Gestalt Therapy for Stan

?’s to Ponder on Stan’s Therapy

What other unfinished business can you identify in Stan’s case? Does any of his experience of being stuck remind you of aspects of yourself?
What types of techniques and experiments would you develop for Stan to help him deal with the still unfinished business which you have identified above.

Stan’s Reality Therapy

Reality Therapist guided by Choice theory to:

Identify Stan’s Behavioral dynamics
Provide a direction for him to work towards
Teach him better alternatives for getting what he wants

Stan finds out in Reality Therapy

He has chosen painful symptoms not effective in getting him what he needs-a satisfying relationship
His choices help him to restrain his anger
- To ask for help
- To avoid facing his real problems
He has chosen to a victim of his past
To blame his present misery on what has happened to him

Stan’s Victimhood

He has been living the life of a victim
Blaming others
Looking backward instead of forward
He does not to be a victim of his past unless he chooses to be
He has many options if he wants to change
It is easier to talk about the past than to talk about and face the present

Stan’s Realizations in Therapy

Although his problems originated in his childhood there is little he can do to undo what has happened
He has little control over changing others
He has a great deal of control over what he can do now for himself
He initially focused on his depression, anxiety, inability to sleep and wanted someone to listen to him and criticize him for what he was saying.

Phases of Reality Therapy

Early Phase: therapist listens and reinforces idea that he will not be criticized and establishes good foundation

Mid Phase: He is helped to face fact that he needs a good relationship in his life now and that his symptoms and avoidance are not getting him what he wants

Later Phase: Therapist listens & also challenges as he focuses on misery & Symptoms

Confrontations with Stan

You have an ideal picture of what you want but do not possess effective behaviors for meeting these needs
Your total behavior is made up of acting, thinking, feeling & physiology
Much of what you currently are doing is leading to your unpleasant feelings of anxiety and depression & physiological reactions
Your depressing is the action part of your choice
You can take action to change your depressing experience

Questions asked of Stan

“Is what you are choosing to do getting you what you want?”
If he says it is all happening to him and he is not choosing it then…
“If this is so, why isn’t it happening here?
“What pictures are in your head of what you want out of your life?”

Stan’s Picture of His Life

Become a counselor with kids
Acting confident in meeting people
Thinking of himself as a worthwhile person
Enjoying life

Steps Stan Can Do to Actualize these Pictures

Practice seeking out contacts with others by initiating them
Practice seeking out people he would like to get to know better
Get into volunteer work with young people in a community agency
Doing more of the things the wants to do rather than focusing on his deficits

As Stan Begins to Implement Plans Within a Year

He experiences success in real world
If backslides makes plans to get back on track
His therapist does not give up on him encouraging his increase in self-confidence
He is given books to read on Choice Theory to help support his therapy
Comes to accept he is the only person who can control his own behaviors
If he wants a better life he must choose to do things that get him closer to other people

?’s to Ponder on Stan’s Therapy

How would you handle Stan’s request to cure him of his depression?
Stan asks to go on medications because his mood is getting the best of him what would you say?
What are some basic needs of Stan currently not being met?

Stan's Behavioral Therapy

Stan’s Behavior Therapy

Stan has a comprehensive assessment to identify interrelated problems for work with the Multimodal model
Therapist helps him define specific areas where he wants to make changes
Translate general goals to concrete measurable
Use of modeling, role playing, Systematic Desensitization & behavioral rehearsal to try out new behaviors to get the changes he wants
Learning new appropriate coping strategies

Stan’s Problems Identified

*Behavioral* Defensive & Avoidant, Excessive Use of Alcohol, Poor Sleep Patter	*Imagery* Negative parental messages, Poor Body Image Poor, Self Image, Suicidal, Fantasizes being shunned
*Affect* Anxiety, Panic, Depression, Fear of Criticism, Worthlessness, Stupid, isolated	*Cognition* Worrying, Self-defeating, "Should," values, comparisons, fatalistic
Sensation Dizziness, palpitations, impotence, headaches	Interpersonal Issues Unassertive, few friends, Parent issues, fear of women

Questions Used by Therapist

“What are some situations in which you feel that way?”
“What do you actually do that leads to you feeling that way?”
“What behaviors do you want to change?”
“What would you like your life to look like after you complete this course of therapy”

Specific Goals of Stan in Therapy

Get rid of his inferiority complex
Function without drugs & alcohol
Not to be apologetic about his existence
Reduced anxiety around women
Overcome his fear of failing
Reduce his feelings of guilt & anxiety

Techniques Used

Inferiority: modeling, rehearsal, role play
Alcohol: recording when drinks & events that lead to this drinking
Apologetic: Assertiveness training with boss & coworkers
Women: behavioral rehearsal dates
Fear of Failure: Desensitization
Guilt & Anxiety: modeling, rehearsal, role play

Emphasis in Behavior Therapy

Need to modify faulty learning-no emphasis on insight about past
Work directly with present behaviors-no exploring of early childhood issues
Learning more appropriate coping behaviors and acquiring more adaptive responses-not focus on need for insight nor need to re-experience old feelings

?’s to Ponder on Stan’s Therapy

What areas might you consider pursuing with Stan based on his assessment?
How would you work collaboratively with Stan to identify his behavioral goals?
How would you handle Stan’s continuous bringing up past & his childhood?
What other behavioral techniques not already used with Stan would you suggest?

Cognitive Behavioral Therapy with Stan

Stan’s Cognitive Behavioral Therapy Goals

Minimizing Stan’s self–defeating attitudes
Helping him acquire a more realistic outlook on life
From beginning ask Stan to identify problems & formulate goals
Remain goal-oriented & problem focused
Help Stan reconceptualize his problems so as to increase chance of finding solutions

Structure in Stan’s Cognitive Behavioral Therapy

Provide Stan with cognitive rationale for treatment & demystify treatment
Encourage Stan to monitor thoughts that accompany his distress
Implement behavioral & cognitive techniques
Assist Stan to identify & challenge basic beliefs & ideas
Teach Stan ways to examine and reality test his beliefs & assumptions
Teach Stan basic coping skills to enable him to avoid relapsing into old patterns

Structure in Stan’s Sessions

Stan give brief review of the week
Stan gives feedback from previous session
Joint review of his homework
Collaboratively create agenda for session
Set new homework for the week
Encouragement for Stan to perform personal experiments & practice new coping skill in vivo
Encourage Stan to apply his new found learning into his everyday life

Three Levels of Awareness for Stan in Cognitive Behavior Work

Level 1: Awareness of antecedent cause of Stan’s fear of women
Level 2: Recognition that Stan is still threatened by women-based on believing and repeating faulty beliefs he once has accepted as true
Level 3: Stan’s acceptance to improve he must change self-defeating beliefs & engaging in behaviors that allow him to confront his beliefs which result in his fear of women

Identification of Stan’s Self-Talk

Identify the “shoulds, musts, oughts” which have been accepted unquestioningly
“I always have to be strong, tough, & perfect”
“I’m not a man if I show any signs of weakness.”
“If everyone didn’t love me & approve of me, things would be catastrophic.”
“If I fail, I am then a failure as a person.”
“I’m apologetic for my existence, because I don’t feel equal to others.”

Confrontation in Cognitive Behavior Work with Stan

Therapist challenges core of his faulty thinking:
You’re not your father…
Do you need to continuing accepting without question your parents’ value judgments about your self worth?
Where is evidence they were right in their judgment?
Do your current behaviors support calling yourself a failure & that you are inferior?
If you weren’t so hard on self how would your life be different?
Having been scapegoat in your family mean you need to continue to be so now?

Through Use of Behavioral Cognitive Techniques with Stan

Stan more fully understands his cognitive distortions and self-defeating beliefs
Stan gets to make the changes he is interested in making
Stan learns to identify, evaluate, & respond to his dysfunctional beliefs
Through didactic & Socratic technique therapist helps Stan to examine the evidence he holds on to which support his unhealthy beliefs
Stan then unfreezes his beliefs about himself & world
Stan views his beliefs & automatic thinking as hypotheses needing to be tested
Stan becomes scientist testing validity of these hypotheses which contribute to his problems so he can test validity and functionality of these beliefs

Stan’s Homework Targets Beliefs

To deal with his fears
Explore his fear of powerful women – why he tells himself
“They can castrate me.’
“They expect me to be strong & perfect.’
“If I’m not careful, they’ll dominate me.”

Homework Assignment include:

Approaching a woman for a date
If he gets a date, to challenge his catastrophic expectations of what might happen.
“What would be so terrible if she did not like him or if she refused the date?”
“Why does he have to get all his confirmation from one woman?”
To stop telling himself that he must be approved by women & if women rebuff him he could not bear the consequences of that
Start telling himself Although he prefers to be accepted over rejected it is no end of the world if he does not get what he wants
Learn to substitute preferences & desires for should & musts

Other Behavioral Techniques Used with Stan

Role Playing
Humor
Modeling
Behavior rehearsal
Desensitization
Bibliotherapy: read cognitive behavioral self-help books

Functioning of Therapist with Stan

Active manner of working
Focused on cognitive & behavioral dimensions
Pays little attention to Stan’s past
Highlights Stan’s present functioning
Points out his faulty thinking
Teaches him to rethink & reverbalize in a more constructive way

New Messages for Stan

“I can be loveable.”
“I’m able to succeed as well as fail at times.”
“I need not make all women into my mother.”
“I don’t have to punish myself by making myself feel guilty over past failures, because it is not essential to always be perfect.

Step One of Cognitive Restructuring with Stan

Learn ways to observe own behavior
Take particular problematic situations & pay attention to automatic thoughts & internal dialogue – what he tells himself as he approaches the situation
How he sets himself up for failure by his self-talk

Step Two of Cognitive Restructuring with Stan

See how what he tells himself has as powerful impact on him as what others say about him
Sees connection between his thinking & his behavioral problems
He learns new, more functional internal dialogue

Step Three of Cognitive Restructuring with Stan

He learns new coping skills he needs to apply in various daily situations
He experiences success with his assignments
He handles increasingly more demanding assignments as he gets stronger and healthier

?’s to Ponder on Stan’s Therapy

What techniques from Ellis, Beck, & Meichenbaum would you borrow to use with Stan?
Identify Stan’s obvious faulty beliefs and say what techniques would you use with him to identify and then examine them?
Come up with some homework assignments you would give Stan which would be most helpful to help him overcome his self-defeating beliefs?

Feminist Therapy with Stan

Qualities of Feminist Therapy with Stan

Egalitarian relationship with Stan
Strong female therapist who empowers Stan
Therapist respects him and does not demean him

Stan’s Strengths built upon in Feminist Therapy

Able to identify positive attributes
Ability to feel his feelings
Gift for working with children
Stan knows what he wants to get out of therapy:
- Stop Drinking
- Feel better about himself
- Relate to women on an equal basis
- Learn to love & trust himself & others

How Therapist Makes Process of Therapy Egalitarian

Therapist stresses it is important that therapeutic relationship does not replicate his relationships with other strong women
Therapist demystifies therapeutic process
Works at equalizing relationship
Let’s Stan see he is in charge of the direction which therapy will take as well as the duration it will take
Reassures Stan that she will not abandon him

Assessment Process in Feminist Therapy

Gender-role analysis
Help Stan see influence of gender-role expectations in the development of his problem
Identify gender-role messages gotten while growing up
- Father: you are dumb
- Mother: grow up and be a man
Identify self-statements of today based on early messages received
- Sees self as “not much of a man”
- Sees self as “letting other people down a lot”

Gender Role Intervention

Recognize that many of his valuable traits – feeling feelings, doing well in helping kids - are labeled by society as “feminine”
Identify models in his life who did not fit the stereotyped images of woman or man
Gender – role socialization has hindered him to this point and he can now let go of it
He now can combine his masculine and feminine traits and be happy with it

Identification of Deeply Held Feelings

Therapist gets Stan to recognize that he has held in his anger and fear
Use of empty chair give him a chance to vent his anger at parents and to overcome his fear of them – encouraged to be a MAN not Mouse
- Confronts Mom: about call him a mistake
- Confronts Dad: why did he not teach him to be a man
- To both: it was not fair!
Process helps him grow in tolerance, healing & forgiveness of his parents

?’s to Ponder on Stan’s Therapy

What value is there in working with Stan from a feminist perspective than from the others studied?
What other self-statements about himself as a man would you encourage?
What therapeutic modes would you include in this perspective: client centered, gestalt, cognitive behavioral, Adlerian etc.?
How valuable do you think Bibliotherapy is for Stan?

Stan’s Family Therapy

Stan's Family Therapy

Begins with assessment of the systems in which Stan is and has been involved
Relationship with parents, grandparents & siblings
Relationships at school, place of work, church & any friendship networks
Problems seen as symptoms of power struggles & dysfunctional communication patterns within family of origin
See Stan as part of ongoing, living unit
Do Genogram

Stan’s Genogram Tells Therapist

Mom married Dad after he stopped drinking and went to AA but they had contentious life
Mom’s Dad drank and went to AA’
Mom’s Mom drank but denied problem
Matt, Stan’s sisters husband drinks as does Stan and Stan’s Mom has problem with them both
Karl the younger brother is close to Stan
Stan is distant or disengaged from Dad & older brother

Process of Stan’s Therapy

Therapist encourages Stan to invite his family in
He still lives much of his life in relation to his family of origin
His alcohol has become the problem of his primary focus & is negative part of his life
Systemic problem: How does Stan’s drinking affect the family?

Work with Stan’s Family

Early: joining the family members
Reframing Stan’s problems into a family problem in which everyone has a stake
Look at multigenerational context of problem
Identify family processes that support this problem
Track interactions of family members to transform communication patterns
Alliances and resources in family are explored

Goals for Stan in Family Therapy

To individuate from his parents
Help everyone establish clearer boundaries & more useful interactions
Reduce resentment to mother
Reduce emotional distance from father
Stop comparisons with older siblings

?’s to Ponder on Stan’s Therapy

What unique value is there in working from a systemic approach with Stan?

If he resisted idea of bringing in family what would you do?

How would you get his entire family involved in these family therapy sessions?

How would you maintain a systemic focus if you were only able to meet with Stan alone?