Psychodynamic STT
When someone isn’t making eye contact, is tapping, etc: “I get the feeling that you’re uncomfortable being here talking to me/talking about it”
*You actively address activity/affect you observe RIGHT AWAY “I notice you’re tapping/playing with your hair, etc, is there something about being here that makes you anxious?" “what’s going on right now that makes you want to shut me out?”
Don’t psychoeducate or norm the bx (IE: DON’T SAY “most ppl would be nervous, often people feel anxious in counseling” etc)
*Norming will make them feel comfortable: we want to amplify the anxiety
*The increased anxiety and your targeting the affect and defenses forces underlying issues out faster: you are …show more content…
trying the bx to an anxiety that’s serving the defensive function
Interpretation is the change agent *even if someone doesn’t like who they’re working with, if the clinician says something on target, change can occur
*Interpretation provokes a person’s acting out which activates a person’s historical experiences & engages the person’s emotions/affect
you interpret: Someone withholding, lateness, avoiding their emotions, etc- if you talk about what they are doing in the room with you, you are recreating what the do in general/outside of the office with others
O-------(T-------(P our insight helps the change
BE aware: lower functioning Pts can’t necessarily articulate bx they repeat: they usually SHOW you through action, reaction, bc
*The best way to make change is to acknowledge their patterns and draw out their affects *If you can activate a feeling in relation to you, you can start to make a change
Keep in mind: Just BC someone has worked through something on an intellectual level does not mean they’ve worked through their emotions
Qts of Age, experience, etc:
“it seems like you’re nervous I can’t handle your feelings or emotions. Have you felt this way before?”
*you’re looking at their anxiety etc to bring their past into the here and now & the room
“what’s your concern? Are you worried that I can’t help you or I don’t have enough life experience?”
*”Do you feel I can’t understand you?”
*Do you feel you can be helped?”
*”are you concerned about my life experience?”
When they ask a question about you:
*”help me understand why it’s important that you know”
*Curiosity isn’t good enough, I’m curious about your curiosity”
ANY ANSWER CAN CREATE COMPLICATIONS
If Social Work Student asks about your experience, it can be their way of telling you about their anxiety about being a provider!
“Does your insecurity about ability to provide come up for YOU with clients?”
We don’t have to tell them any info, but:
The younger the client, the more concrete we must be
If someone asks us something and we bristle and have anxiety they will sense it and clam up so we must be prepared for the questions
When someone asks if we have experienced something ourselves, even if it is something seemingly benign, we don’t have to answer
IE: someone going abroad and asking us what we did/how we handled it
“ It sounds like you’re curious to see if I’ve ever experienced that and how I handled it”
Questions speak to fears for themselves
Our Qts can address their transference and be corrective
“How did you experience my question/response?” “I’m sorry you heard it that way, my intention was to understand your question”
SEE HANDOUT 10.11.12
In short term tx, we must link session to session: it shows you’re paying attention and provides structure for change
9.27.2012
Please review p.
4 of 9.20.12 handout
C.I cont’d
The work we do in C.I differs with the population: with college students the work is around transitions and developmental issues. Work with older adults will depend on the context
With adults commonly: long-term relationships, life trajectory
We need to explore:
What brings someone to counseling NOW
This is usually something that is symbolic to them: something occurs that has meaning to them
Partner Abuse:
Interventions:
1. set out a safety plan 2. psychoeducation about what’s normal and what constitutes abuse 3. Ask them what they need and establish your legal obligations 4. Ask what’s safest/most helpful for their kids 5. You want to help sell your help to the client 6. When they talk about their partner and their partner’s hx, you must empathize with their partner’s stress &/or abuse hx: the client will see that you understand their partner’s plight & WE MUST SEE that their sense of self is connected to their partner- people will not move unless they feel understood! 7. Get the victim resources for their partner
We must consider that the abusive partner is insecurely attached: we can see this is when they abuse: it generally occurs when they feel insecure about
commitment
Our empathic response to the woman: “it sounds like you have a lot on your plate, it’s sounds like you’re taking responsibility for his stresses too”
Suicide:
See handout p. 4 9.20.12
Risk factors: Powerlessness, feeling like the world is in control rather than self, no sense of agency
A sense of isolation is about relation: how do they relate to others or feel alone
People CHOOSE suicide, it’s a rational act for them
Factors to take into account: ➢ What’s the purpose of the suicidal behavior? ➢ Is it meant to teach a lesson? ➢ Will it put an end to pain? ➢ Is it about joining someone who died?
Ask the QT: “how would you say goodbye?”
When you hear a struggle, you can engage them in a conversation about it
When they’ve made the decision and are certain, it’s hard to change their minds
STT 9.20.2012
The bulk of this lecture comes from the handout: Comparison of crisis intervention and brief psychotherapy
IN C.I:
Before crisis there is homeostasis: we use this to measure normal functioning
Crisis Occurs: it can be accidental, developmental, maturational (see page 3 of 9/20 handout)
Holms-Rah Inventory Scale will dictate your reactions to different life stressors: positive change affects us too!
“It’s easier to stay wedding to negative relationships/patters than it is to have new experiences”: We’re working to bring people to a different level
Goals in C.I • Bring client to equilibrium • If someone is coming from working at a deficit IE: drugs, late-stage alcoholism, we need to bring them to a higher level of functioning than their current state o We want them to learn this higher functioning
Crisis is the intersection of danger and opportunity
In crisis we always regress
WE ALSO: • Ask for help • Are susceptible to change • Regress to a needier place • Are stripped of defenses
Goals/Counselor Role in Crisis: • We support them and build them up • We act as their Ego • Reduce PT. stress • Support their coping and give them tools • Return them to homeostasis
In Brief Therapy: We modify their functioning and help them resolve their conflict
IN BOTH: The relationship is essential
|Brief Tx: |Crisis Intervention: |
|Explores issues and the Pt’s views |Provide coping skills and social supports |
|Therapists engages in Qts but not supports |Present-oriented |
|Therapist is active but not directive |Doesn’t open up dynamic work: we don’t ask WHY |
|Therapist increases anxiety to further the work |Therapist reduces anxiety |
|Length of Tx is set |The client sets the length of Tx |
Always bring the focus back to what you’re working on: just bec they’re talking doesn’t mean it’s effective Only brief comments to let them know we’re present to what they’re saying and that we’re listening: think about how much you’re talking.