Management of performance anxiety in new therapist
- First, new therapists are encouraged to question the unrealistic performance expectations they often place on themselves, accepting that it is OK to make mistakes.
- Since the anxiety comes from fear of failing, tp need to focus more on what they are learning than how they are performing.
- Focus on what ct saying rather than performance. Goal: Participant observer stance = focus on ct & the tp & ct relationship
- Focusing on performance = self consciousness, unbalanced unawareness, all bad
- Goal: More important to focus on what the client is saying rather than our performance
- Third, to help with these normative and expectable performance anxieties, new therapists need active support from their supervisors and instructors
define process dimension
an interpersonal process that is taking place with their clients. Client plays out their problems in their other relations in the ct & tp relationship. Mirroring (interventions such as: process comments, working in the moment, etc)
define corrective emotional experience
- Tp provides new & satisfying response to ct’s old relationship patterns & alter the pattern .
- Tp works w/ ct to alter old pattern, change expectations, & change unwanted interaction.
- The therapist helps clients identify maladaptive relational patterns or themes that commonly occur with others, and works with clients to alter this problematic pattern, disconfirm the faulty expectations or schema, or change this familiar but unwanted interpersonal scenario in their real-life relationship or therapeutic interaction.
define client response specify
the tp’s response must fit specific need of each individual ct. (mutual exploration & flexibility). Therapists need to tailor their responses to fit the specific needs of the client. Therapists need to have the flexibility to listen to cues, assess clients’ responses, and search for the best way to respond to a particular client.
What is the interpersonal approach? What is the primary goal of this approach?
- The interpersonal approach: It combines cognitive domain, which speaks to object relations, attachment theory, & CBT. Then goes into depth to familial contextual domain. There are familial unspoken rules, homeostasis mechanisms and cultural variations.
- An integrative model that highlights relational components from differing theories and synthesizes a common focus on the therapeutic relationship—which has emerged in the empirical literature as the most consistent predictor of successful treatment outcome
- Emphasis on providing clients reparative experiences with the therapist that will allow them to create self-narratives that are more coherent, affirming and flexible.
- The guiding principle in the interpersonal process approach is to provide clients with an experience of change- to use the interpersonal process they are enacting with their clients to promote change
what is the change process and effective interventions that facilitate change.
- Process of Change:
- 1. Examine their habitual response patterns in problematic situations (e.g., am I withdrawing and avoiding this situation)
- 2. Evaluate the patterns’ usefulness in their current lives (e.g., am I becoming quiet and walking out of the room without addressing the problem) when there is conflict with someone
- 3. Begin trying out new and more adaptive ways of responding (e.g., trying to dialogue with my mother about the problem we are having)
- Effective Interventions:
- Successful outcomes are facilitated by therapists who promote rapport, instill hope, encourage “change talk” are more active (not directive), and engage in a collaborative, focused relationship (p. 49)
- Internal Focus: Therapist helps clients begin to look within, and assist the client in assuming more responsibility for change
- Expand clients’ focus beyond the other person and include themselves as well.
- Help clients be compassionate as they explore their internal working model.
Define resistance and know the different forms it may take.
- Ct’s may feel: shame w/ prob can’t solve on their own, revealing fam issues outside may seen as disloyal, anxiety w/ expecting tp to act same as other relationships,
- Also ct’s resistance is a coping strategy from their past to prevent abandonment, ridicule or hurt.
- The client’s reluctance to enter treatment or explore a problem, usually based on fears that once were reality based of receiving the same type of unwanted responses they have experienced with significant others in the past when they have asked for help, shared their distress or vulnerability, or risked trust and genuine involvement in a relationship
Know the three-step (it’s actually a two-step) sequence to follow in approaching resistance.
- Affirm/validate the reality-based constraints they perceive Ex. Respond flexibly by doing whatever is reasonable to accommodate or to help resolve the problem (scheduling conflicts, etc.)
- Inquire about other conflicted feelings that entering treatment may hold Ex. What’s the biggest fear or concern that coming here and talking to me brings up for you?
List some common behaviors clients exhibit during resistance
Missing multiple apt, frequently late/cancels/reschedules, a dodging the problem/?’s, reluctant to speak freely, door knob statements at end of session, during productivity ct stops,
What is the importance of developing a “working hypothesis”?
- It’s important to remember that hypothesis is ongoing, should anticipate ct’s responses to be able to work with them rather than avoiding the resistance.
- If you don’t understand the working hypothesis, then don’t understand what’s going on with ct. Must understand ct’s relational schemas, how responded in past, & fear & shame that motivates them in order to apply intervent appropriately.
Explain the construct, “holding environment”
A safe haven of empathic understanding and attuned responsiveness that therapists provide to help modulate or contain the client’s distress or disruptive feelings.
Yalom’s eleven therapeutic factors.
- Instillation of hope.
- Imparting of information.
- The corrective recapitulation of the primary family group.
- Development of socializing techniques.
- Imitative behavior.
- Interpersonal learning.
- Group cohesiveness.
- Existential factors.
Explain the “working alliance”
a balance of the ct’s need for understanding & guidance & ct’s own initiative & responsibility. Client needs to share ownership in the change process.
The therapist creates strong working alliance for a partnership working together. This interpersonal process helps clients resolve their presenting problems and achieve greater self-efficacy
telling clients what to do resulting in view as therapist as sole agent responsible for change; confrontation increases resistance
Taking a laid back/solely active listening approach results in lack of change
Understand the importance of empathic understanding.
Enter into the client’s subjective experience with a genuine feeling of warmth and concern for the client, that their distress matters to the therapist (respectful, nonjudgmental concern for the client)
Identify effective and ineffective interventions facilitating change.
- Effective: Refrain from anxiously filling silences, allow for the client to check in with themselves
- Ineffective: Shifting the impetus from the client onto the therapist, possibly triggering a hierarchical teacher/student process. Client’s must remain actively engaged in therapy.
What deepens the process of therapy?
When the client focuses inward
Tracking client’s anxiety: signs, triggers, addressing client’s anxiety.
- Anxiety is a sign that real threat or danger is present → tp identify themes & signs causing problem. Pay attention to prob they talking about & notice behavior.
- Behavior is a sign ( hair pulling, nail biting, hand gestures, speech blockage etc. ) & always repetitive
- Another sign is coping strategies ct using (pleasing other, criticism, controlling, acting helpless, & withdrawing)
Four step sequence to track anxiety and understand what is really wrong
- Step 1: identify signs of a client’s anxiety
- Step 2: Approach the client’s anxiety directly
- Step 3: Observe what precipitates the client’s anxiety
- Step 4: Focusing clients inward to explore their anxiety
Working with client’s ambivalence and addressing most salient feelings.
Affirm both sides of fence to ambivalence & point out current presenting emotional states in the room between tp & ct. Point out transference in the room.
How do therapist provide a holding environment for client’s distress? Developmental perspective? Intervention guidelines?
Development perspective: Parent & child must have be mutually attuned, parent must sustain the holding environment responding to child distress, then engage & repair when needed, & provide a safe haven & secure base for secure attachment. (if parent provides all of this child can regulate their emotions)
Intervention Guidelines: Attachment informed tp respond to ct’s distress by providing a hold environment of empathetic understanding & attuned responsiveness to contain the ct’s affect (maintain steady presence during ct’s distress)
The impact of therapist’s countertransference.
- Personal factors can interfere w/ tp appropriately providing interventions
- Must be accurately empathetic & communicate respect & compassion for emotional conflicts ct’s are struggling with, w/o the tp’s own developmental histories & current life stressors in the counseling session.
What is the coping-collapse continuum in group psychotherapy?
Coping collapse continuum: everyone may be on different point of continuum (low hope<--->high hope). Patients have continual contact with group members who have improved in the group and often encounter patients who have had problems very similar to their own and have coped with them more effectively.
The concept of altruism in group psychotherapy.
The act of giving without expecting anything in return. If a client is given to by others, they can understand that people find them to be of value and importance.
Identify the conditions necessary for a corrective emotional experience.
The members must experience the group as sufficiently safe and supportive 2. There must be sufficient engagement and honest feedback to permit effective reality testing
What are the four levels of insight?
- Learn how they're seen by others
- Learn what they are eliciting in others
- Learn their motivations behind interpersonal interactions
- Learn how they got to be the way they are.
The importance of group cohesiveness. How does it influence outcome?
Having cohesion makes it easier to take risks, engage in more substantial disclosure, and begin the working process. Highly cohesive groups are more stable groups with better attendance and less turnover.
Self-reinforcing loop generated in therapy groups.
Trust - Self-disclosure - Empathy - Acceptance - Trust
Two steps involved in the effective use of the here-and-now.
- The group lives in the here-and-now, and it also doubles back on itself.
- It performs a self-reflective loop and examines the here-and-now behavior that has just occurred. Process illumination.
Explain the difference between process and content.
The process is the nature of the relationship between interacting individuals/members and therapists. The content of a discussion consists of the explicit words spoken, the substantive issues, the arguments advanced.
The therapist basic tasks in group psychotherapy.
- Activating phase: move the group into the here and now.
- The group must be helped to understand the process of the here-and-now experience: that is, what the interaction conveys about the nature of the members’ relationships with one another.
- Process illumination: history, repetitive cycles, observer and historian
Differences between the techniques of Activation and Illumination.
Activation: This is the technique of actively thinking in the here and now, or steering the group into the here and now. This involves relating shared group experience to the group’s primary task. Asking question such as how can I make it come to life in the here-and-now? Typically, this is started during the first session.
Illumination: identifying and sharing experiences of the group as they happen in the group. This involves clients recognizing how they impact other members of the group, group members appreciating how their behavior impacts group members opinions of the group, exercising the will of members to change how they are impacting other group members (intent → decision → action), and solidifying change in the group and transfer that change from the group to their personal lives. This is basically the process of the here and now experience, that is, what the interaction conveys about the nature of the members’ relationships with one another.