Counselling and Virtual Care

Week 8 Tutorial

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Counselling and Virtual Care

Unit Overview
• Week 1 Basic counselling skills part 1 – Intro to Counselling, Psychology and Virtual care
• Week 2 Basic counselling skills part 2 – Active listening
• Week 3 Basic counselling skills part 3 – Reflection of content/feeling and paraphrasing
• Week 4 Basic counselling skills part 4 – Use of questions, summarizing and clinical interview
• Week 5 Basic counselling skills part 5 – Closure, note-taking and reflective practice
• Week 6 Ethical practice 1 – Morality, ethical frameworks and the APS Code of Ethics
• Week 7 Ethical practice 2 – Ethical issues and ethical decision making
• Week 8 Counselling approaches 1 – Person-centered Approach and Cognitive Behavioral Therapy
• Week 9 Counselling approaches 2 - Psychoanalysis
• Week 10 Virtual care
• Week 11 Psychology in professional contexts
• Week 12 Culturally sensitive practice

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Counselling approaches recap

Rogers Insoo Kim Berg Hayes

(1940s) (1970s) (1980s)

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Counselling approaches recap

Person Centered Approach (PCT)

Emphasis on the client‘s experiential reality (internal frame of reference), rather than the
therapist’s views of or theories about the client.
Client’s freedom to choose how to be and what meanings to live by – no ‘unconscious’ constraints
on one’s freedom.
Concerned with the person, not the person’s presenting problem – anti-diagnostic stance.

Emphasises immediate awareness of self in the present rather than experience in the past;

The therapist avoids being the expert and interpreter of the client’s experience

Focused on the healing qualities of the client-therapist relationship (egalitarian) as a catalyst for
change.

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Person centered therapy – Class discussion

Now that you have been introduced to Rogers’ person-centered therapy, reflect on the following questions. Take a
few minutes to write down some of your thoughts and share them with the rest of the class.

a) Why do you believe the person-centered therapy approach is widely adopted by psychologists?

b) Imagine you are a psychologist who is adopting the approach. How would you feel using these techniques?

c) What are some benefits for a client when working with a PCT counsellor?

d) Can I use ‘techniques’ with clients in counselling sessions and still be a PCT counsellor?

e) To what degree do you believe clients have the ability to understand and resolve their own problems without a
great deal of advice or suggestions from a therapist?

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Let’s watch Carl Rogers in action…

Let’s watch the following video from 1965(!!!), in which Carl Rogers is in session with a client (6 min). Then, let’s
answer the questions in the next slide…

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Carl Rogers in action… (cont.)

What are your thoughts after watching this video?

How does Carl Rogers use the basic counselling we’ve learned so far?
How does the client react?
How many questions does Carl Rogers ask?
How does Carl Rogers react to the client’s demands?
How easy is it to allow clients to find their way in sessions?

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Extensions of PCT - Motivational interviewing…

Surprisingly, not all clients are ready to take the steps that are necessary to address their presenting difficulty when they first see
a psychologist. The main aim of MI is to draw out a client’s motivations and reasons for behavior change. Let’s watch this short
video (7 min) to learn more about MI and answer the questions in the next slide.

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Motivational interviewing… (cont.)

In which instances would you say that MI is applicable?

How do you feel about using MI?
How is MI an extension of PCT?

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Let’s watch motivational interviewing in action…

Let’s watch the following video (3 min) where a practitioner is using MI. Is this being correctly used? Let’s answer
the questions in the next slide…

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Let’s watch motivational interviewing in action… (cont.)

In fact, the video in the previous slide was an example of MI being used poorly.

What did the counsellor do wrong?

What did you notice in the client’s behavior/demeanor/responses?

How did you feel while watching the video?

Would you like to be in therapy with this counsellor?

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Let’s watch motivational interviewing in action… (cont.)

Let’s watch this second clip (9 min), which shows an example of MI being used skillfully. Then, let’s answer the
questions in the next slide…

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Let’s watch motivational interviewing in action… (cont.)

What are your thoughts after watching this video?

What is different in this example?

What is the counsellor doing right (or wrong)?

What do you think about the use of questions?

Did you recognize any type of questions used by the counsellor?

Did your perception of MI change?

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Counselling approaches recap

Cognitive Behavioral Therapy (CBT)

Judith Beck
Donald Michenbaum
Albert Ellis

John B Watson
Joseph Wolpe
Edward Thorndike

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Counselling approaches recap

Cognitive Behavioral Therapy (CBT)

CBT integrates both cognitive and behavioral principles and methods in a short-term approach
CBT is based on the premise that psychological distress is largely a function of disturbances in
cognitive processes
There is an emphasis on changing cognitions to produce desired changes in affect and behavior
CBT has generated more empirical research than any other psychotherapeutic model

CBT is based on a psychoeducational model

Focused on the present

The client assumes an active role in the therapeutic process and there is an emphasis on homework

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Basic cognitive behavioral model

Cognitive Behavioral Therapy (CBT)

Avoidance

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Basic cognitive behavioral model (cont.)

Now that you have been introduced to the basic cognitive behavioral model let’s put it into practice.

1) Think about a recent event where things didn’t go your way.

2) Identify an antecedent (event), an unhelpful cognitive appraisal, which emotions you felt as a result of these
unhelpful thoughts, and the outcome behavior.
3) Hopefully, you are comfortable sharing your experience with a classmate. If you are, pair up with someone and
take them through your experience. Together, try to identify how you could reframe the unhelpful thoughts to
elicit different emotions and behaviors.
4) Without mentioning specific details, share your experience with the rest of the class.

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Recognizing automatic thoughts…

Automatic thoughts are cognitions that stream rapidly to our minds in the middle of a situation. These are often unspoken or
private and fire rapidly. They can generate painful emotional reactions and dysfunctional behavior. Here are a few examples:

Event Automatic Thoughts Emotions

My mother calls and asks why I forgot “I messed up again”; “There’s no way I will ever Sadness, anger
my sister’s birthday please her”; “I can’t do anything right”; “What’s
the use?”
My husband complains that I’m “I’m failing as a wife”; “I don’t enjoy anything”; Sadness, anxiety
irritable all the time “why would anyone want me?”

Thinking about a big project that is due “It’s too much for me”; “I’ll never get it done in Anxiety
at work time”; “I’ll lose the job and everything else in my
life”

1) Draw three columns on a sheet of paper and label them “Event”, “Automatic Thoughts” and “Emotions”.
2) Now think back to a recent situation that seemed to stir up emotions such as anxiety, anger, sadness or physical tension.
3) Close your eyes and imagine being back in the situation, just as it happened.
4) What automatic thoughts were occurring in this situation? Write down the event, the automatic thoughts and the emotions on
the three-column thought record.

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Breathing training

Breathing training is often used in the treatment of panic disorder because irregular breathing and hyperventilation
are frequent symptoms of panic attacks. A frequently used strategy for breathing training begins with simulating the
experience of hyperventilation and panic. The therapist may demonstrate over-breathing to replicate the respiration
experience of a panic attack. Let’s watch the following video, in which breathing training is explained.

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Systematic desensitization

This is a process that combines relaxation techniques with gradual exposure to help clients gradually overcome their
phobias. The relaxation aspect involves directing one’s attention to different parts of the body (e.g., body scan) to notice
potential tension and learn how to relax. The gradual exposure intends to help clients gradually become more accustomed to
the anxiety-provoking stimuli.

Let’s try body scanning.

1) Try to find a comfortable position.

2) For the next 3 minutes, focus on your breath, breathing deeply and intentionally. Let your breath slow down and notice
the air flowing in and out of your lungs, chest and belly.
3) Begin bringing awareness to your forehead. Notice any tension in your forehead… and let it go. Spend a few seconds
visualising your forehead. Repeat this step with your eyelids, neck, shoulders, chest, arms, elbows and belly.

Let’s now try a fear-provoking hierarchy.

1) Think of something that paralyses you with fear, for example, a poisonous snake.
2) Create a ladder with 5 rungs. In the bottom rung place something not too scary (e.g., a bad drawing of a snake).
3) Progressively increase the scariness of each rung (e.g., in rung 2, you can place a picture of a scary snake; in rung 3, put
a video of a snake, and so on…)
4) Switch back and forth between the ladder rungs and the body scanning. After each body scan, move up the ladder.
Ideally, you will be quite relaxed when reaching rung 5 (e.g., holding a snake in your hand).

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 Assignment 3

What is required: Complete an Online quiz

Due: Friday 11.59 of Week 11

Weighting: 20%

How many questions? 20 multiple choice questions

How much time do I have? 20 minutes

What is included? Only weeks 8 and 9

Is it only the material covered in the slides? No, it also includes

the prescribed readings (i.e., Corey Chapters 4, 7, 9 and 10)

Is it open book? Yes, you can have access to your notes

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