The Process of Counseling and Therapy

by Moursund, Janet; Kenny, Maureen

• ISBN13: 9780130409621
• ISBN10: 0130409626
• Edition: 4th
• Format: Paperback
• Copyright: 2019-10-26
• Publisher: Pearson

Summary

Taking a verypractical"how to be a psychotherapist" approach, this overview of the process of counseling provides information that isfundamentalto counseling, butnotrepresentative of any one theoretical orientation. Concise, yet thorough--and accessible to novice and seasoned professional alike--it explores counseling basics (e.g., skills, relationship building) as well as specific populations (e.g., groups, clients in crisis, couples and diverse populations).Foundation skills. The initial interview. The early phase. The middle phase. The final phase. The client in crisis. Groups and group therapy. Couple therapy. Dealing with diversity. Care and feeding of therapists.For new and seasoned professionals in counsel and psychotherapy.

Table of Contents

Preface	xi
First Things First	1	(12)
Therapy Then and Now	3	(2)
The Therapy Depot	5	(1)
Evaluating Outcomes	6	(3)
Theory, Assumptions, Values	9	(4)
Foundation Skills	13	(24)
Listening	15	(7)
Minimal Encouragers	16	(1)
Paraphrasing	16	(3)
Perception Checks	19	(1)
Summaries	20	(1)
I-Statements	21	(1)
Problem Solving	22	(8)
Goal Setting	22	(3)
Using Questions	25	(2)
Feedback	27	(2)
Advice	29	(1)
Dealing with Feelings	30	(7)
Timing	33	(1)
Therapist Feelings	34	(1)
Sharing Your Feelings	35	(2)
The Initial Interview	37	(20)
Preparation	38	(1)
Getting Started	39	(4)
Centering	40	(1)
Following the Client's Lead	41	(1)
Being Yourself	42	(1)
Gathering Information	43	(5)
Diagnosis and Assessment	46	(2)
Answers	48	(6)
Will You Continue?	49	(2)
How Will You Work Together?	51	(2)
How Often, How Long, How Much?	53	(1)
Ending the Session	54	(3)
The Early Phase	57	(18)
Rapport	58	(3)
The Therapist As Teacher	61	(5)
How to Talk	61	(2)
A Common Vocabulary	63	(1)
Skill Building	64	(1)
How To Be a Client	65	(1)
Contracting for Change	66	(6)
What Is a Therapeutic Contract?	66	(1)
Phases of the Contracting Process	67	(1)
The SAFE Contract	68	(2)
Building a Contract	70	(1)
A Few Last Words about Contracts	71	(1)
Limits	72	(2)
Conclusions	74	(1)
The Middle Phase	75	(24)
The Relationship As a Change Agent	77	(2)
Emotional Work	79	(7)
Emotion and Discomfort	81	(2)
Permission and Protection	83	(2)
To Touch or Not to Touch	85	(1)
Plunging into the Process	86	(8)
Agreement and Disagreement	87	(1)
Silence	88	(2)
Resistance	90	(3)
Getting Unstuck	93	(1)
Timing	94	(3)
Closing a Session	96	(1)
Middle-Phase Retrospective	97	(2)
The Final Phase	99	(23)
Planning for Termination	100	(6)
When to Terminate	102	(4)
The Work of the Final Phase	106	(3)
Repeating Old Themes	107	(1)
Hanging On	107	(2)
Feeling Reactions to Termination	109	(5)
Sadness	109	(1)
Anger	110	(1)
Fear	111	(1)
Guilt	112	(1)
Pleasant Affect	113	(1)
Therapist Feelings	114	(2)
Unplanned Terminations	116	(4)
The ``No-Show''	116	(2)
The ``Abrupt Stopper''	118	(2)
Therapist-Initiated Terminations	120	(1)
And, to Terminate This Chapter ...	120	(2)
The Client in Crisis	122	(26)
Basic Principles	123	(3)
First Steps with a Client in Crisis	126	(11)
Gathering Information	126	(1)
Resources	127	(1)
Confidentiality	128	(1)
The Crisis Contract	129	(1)
Moving In	130	(1)
Cognitive Work	131	(2)
Affective Work	133	(2)
Some Guidelines	135	(2)
Suicide	137	(9)
Recognizing the Suicidal Client	138	(1)
Assessment of Suicide Danger	139	(2)
The Meaning of Suicide	141	(2)
What to Do	143	(3)
Conclusions	146	(2)
Groups and Group Therapy	148	(23)
Curative Elements of the Group	148	(7)
Imparting Information	149	(1)
Socializing Techniques	150	(1)
Instilling Hope	150	(1)
Universality	151	(1)
Altruism	151	(1)
Cohesiveness	152	(1)
Transference	153	(1)
Imitation	154	(1)
Catharsis	154	(1)
Building and Maintaining the Group	155	(5)
Initial Information	155	(3)
Setting the Stage	158	(2)
Therapeutic Guidelines	160	(5)
Noticing Process	161	(1)
Interventions	162	(1)
Confrontations	163	(2)
Problems	165	(4)
Air Time	165	(1)
Monopolizing	166	(1)
Rescuers and Victims	167	(1)
Disrupting and Scapegoating	168	(1)
A Few Last Thoughts	169	(2)
Couple Therapy	171	(23)
The First Steps	172	(4)
Assessment and History Taking	174	(1)
Treatment Planning	175	(1)
The Art of Couple Therapy	176	(4)
General Guidelines	176	(4)
Problem Solving	180	(3)
Identifying the Problem	180	(2)
Finding Antecedents	182	(1)
Vulnerability	183	(1)
Common Patterns	183	(4)
Blaming and Complaining	184	(1)
Hurting Each Other	185	(1)
Double Binding	185	(1)
Fusion	186	(1)
Responsibility	187	(1)
Some Special Situations	187	(6)
Sexual Dysfunction	187	(1)
Gay and Lesbian Couples	188	(2)
The Extramarital Affair	190	(2)
Separation Therapy	192	(1)
A Final Word	193	(1)
Dealing with Diversity	194	(20)
Therapist Assumptions	196	(1)
Client Needs	197	(1)
General Guidelines	198	(7)
Explaining Your Role	201	(1)
Referral	202	(1)
Getting Started	203	(2)
Specific Cultural Groups	205	(7)
African Americans	205	(1)
Hispanics	206	(1)
Asians	207	(1)
Gay and Lesbian Clients	208	(2)
The Elderly	210	(1)
Religion	211	(1)
In Conclusion	212	(2)
Care and Feeding of Therapists	214	(24)
Professionalism	215	(6)
The Setting	216	(2)
The Exchange	218	(2)
The Attitude of a Professional	220	(1)
Legal and Ethical Issues	221	(10)
Responsibilities to the Client	224	(2)
Confidentiality	226	(4)
Extra-Therapeutic Relationships	230	(1)
Therapist Self-Care	231	(7)
Physical Well-Being	231	(1)
Emotional Well-Being	232	(2)
Special Concerns	234	(2)
Growth and Development	236	(2)
References	238	(9)
Index	247

Excerpts

Nine years later, and time for another edition. The first question a reader/student may well ask is "why?" Is it just to make all those used copies obsolete, so as to make more money selling new ones? (That''s what I firmly believed when I was a student.) Or, do the authors get more glory--and better chance of promotion--by churning out new editions of their books? Well, dear readers, I''m glad to be able to tell you that neither of these answers is correct. The real reason for putting out a new edition is&3151;it''s needed. A lot has happened in seven years; lots of research has been done, new aspects of therapy have been discovered or rediscovered, the social climate in which therapy and counseling take place has changed enormously. I''m also glad to be able to say that the basic premises upon which this book was originally written, back in 1985, have not changed. Indeed, it has been gratifying to go back to the first edition (and the second, and the third) and find nothing significant with which I now disagree. In the main, what I believed about therapy then is what I still believe today, and those ideas still form the core of the book you now hold in your hands. Given that basic similarity, it makes sense to share with you part of the preface of the original edition. It''s about writing a book that . . . tells, as honestly as I can, how to be a psychotherapist. It also tells a lot about me, about the kinds of things that are important to me as a therapist, and the kinds of things that are difficult for me, and the kinds of things that work for me. I hope some of them will work for you too. And I also hope that some of them won''t be right for you, because every therapist needs to build a unique style, taking and rejecting bits and pieces from all sorts of teachers and models. What you decide not to use from these pages will be as important for you as what you decide to keep, for in the very process of deciding you will be shaping your own personal way of doing therapy, your own way of being in the work. There are a few things that may be helpful for you to understand before we actually get started. One has to do with pronouns--the bane of every modem American writer, forced to deal with a language that has no unisex words for her or him, he or she, hers or his. My solution has been to refer to the therapists consistently as "she" or "her" and to the client as "he" or "him." I have two reasons for this choice. First, switching back and forth between masculine and feminine pronouns, in order to balance everything out, is something that I as a reader find distracting. Second, I have frequently been surprised at my own inertial sexist bias, my own unconscious tendency to assume that the "authority" in an ambiguous situation is probably male. If 1, a professional woman, well aware of the issues of sexism in our society, still fall victim to this kind of thinking, then it seems likely that many others do too; referring to the therapist (who is usually regarded as a high-status person) as "she" helps to jolt both myself and you, the reader, into a different level of awareness. Another shortcut I have taken the liberty of using is to omit the words counselorand counselingfrom most of the book, in favor of therapist, therapy,or psychotherapy.Using both ("Counselors and psychotherapists . . ."; "in the counseling or therapy session. . . ") is cumbersome and unwieldy; switching back and forth seems confusing. While a very good case can be made for differences between counseling and psychotherapy, the exact nature of the differences depends on who happens to be arguing about it. Moreover, it is increasingly true that many psychotherapists do a lot of counseling, and that many counselors do a lot of therapy, and that the dividing line between the two is pretty blurred. This is a book about what I would call "therapy"; it''s also a book about what occupies much of the professional life of competent counselors. What I didn''twrite in that first preface, perhaps because I wasn''t as certain about it as I am now, seventeen years later, is that this thing we call either psychotherapy or counseling or both--when it is done properly--is, first and foremost, a matter of relationship. It is the relationship between client and therapist that makes therapy work. The real process of therapy, the real excitement, happens in a kind of in-between that is forged through the therapeutic interaction. It grows out of mutual respect, out of the client''s genuine desire to change and grow and out of the therapist''s regard for the client''s own wisdom. Certainly, the skill of the therapist is another major ingredient. But without a solid therapeutic relationship, skill can do little to help a client. So, as you read about active listening and diagnosis and contract-building and all of the other technical things that therapists do, remember that they all depend on something else, something elusive and hard to put into words: an authentic relationship between two individuals who are willing to be real with each other. Authenticity, being real, is at the heart of the kind of therapy that this book attempts to describe. Because my professional life has taken a number of twists and turns over the last few years (my academic title now has the word "Emerita" tacked onto the end of it), I decided not to tackle a new edition of The Process of Counseling and Therapyon my own. The good folks at Prentice Hall were kind enough to find another professor/author/therapist interested in working with me, and this book is the product of our joint efforts. -- Jan Moursund Although this book has been around for some time, it is this fourth edition that I lend my name to. Simply put: the book needed revisions, and Jan needed help! Over the last year, we have worked together, Jan in Oregon and I in Florida. Thank goodness for e-mail and overnight packages; they have kept this bicoastal project alive. The writing has been an incredible experience for me. It has helped me to define what it is that I do in therapy and to understand why it is so important. I found that I agreed with most of what Jan had to say, which helped make our writing together easier and also validated me as a clinician. I have used this text in my classrooms for years, so I was familiar with its strengths and its weaknesses. When I began to work on the new edition, I used both comments from reviewers and my own ideas. Many of the references in the book have been updated to include the most current work in the field of counseling, but we have not forgotten those "legends" whose words are always timeless. The most obvious addition is the inclusion of a new chapter, "Dealing with Diversity." Given the changing demographics of the United States, it seemed compelling to include such a chapter. Certainly, from my perspective in south Florida, a multicultural society is a reality and not just a scholarly notion. In this new chapter we have tried to provide a sense of how generally to work with individuals who differ from oneself, whether it be in terms of age, ethnicity, or sexual orientation. My thanks go to those who have helped me on my journey to write this book:. my colleague Adriana McEachern, who lent me many sources of information and is a great sounding board; my assistant Salima Patel, who spent endless hours working on the computer and who has suffered through editing each chapter and reference; my "legal mind" in Jim Koenig, handy with legal advice and know-how; my dearest friend Joanna Pera, whose enthusiasm is unsurpassed--she must have been a cheerleader in another life; my partner in practice Irene Marshal--thanks for your support both in practice and friendship