UNIT 4

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BEHAVIOURAL COUNSELLING

Behavioral theories of Counseling focus on a broad range of client behaviors. Often, a

person has difficulties because of a deficit or an excess of behavior.

Counselors who take a behavioral approach seek to help clients learn new, appropriate
ways of acting, or help them modify or eliminate excessive actions.

In such cases, adaptive behaviors replace those that were maladaptive, and the counselor
functions as a learning specialist for the client.

Also, “behavioral change opens doors to perceptual change”.

Behavioral counseling approaches are especially popular in institutional settings, such as

mental hospitals or sheltered workshops.

They are the approaches of choice in working with clients who have specific problems
such as eating disorders, substance abuse, and psychosexual dysfunction.

Behavioral approaches are also useful in addressing difficulties associated with anxiety,
stress, assertiveness, parenting, and social interaction.

FOUNDERS/DEVELOPERS

B. F. (Burrhus Frederick) Skinner (1904–1990) is the person most responsible for the
popularization of behavioral treatment methods.

Applied behavior analysis is a direct extension of Skinner’s (1953) radical behaviorism

(Antony, 2014), which is based on operant conditioning.

Other notables in the behavioral therapy camp are historical figures, such as Ivan Pavlov,
John B. Watson, and Mary Cover Jones.

Contemporary figures, such as Albert Bandura, John Krumboltz, Neil Jacobson, Steven
Hayes, and Marsha Linehan, have also greatly added to this way of working with clients
View of Human Nature

Seven key characteristics of behavior therapy are described below:

Behavior therapy is based on scientific methods, applying learning principles to change

maladaptive behaviors with empirical evaluation.

Includes both observable actions and internal processes like thoughts, emotions, and
beliefs, which can be operationally defined.

Emphasizes current problems and environmental factors maintaining them, using

functional assessment to facilitate change.

Clients engage in specific actions, monitor behaviors, practice coping skills, and complete
homework assignments to implement change.

Behavioral change can occur without deep insight into past issues, with action-oriented
approaches leading to self-understanding.

Continuous evaluation of behavior, social environment, and interventions ensures

effective treatment.

Therapy techniques are customized to the client’s specific problems, focusing on the most
effective approach for each individual.

Behaviorists, as a group, share the following ideas about human nature:

A concentration on behavioral processes—that is, processes closely associated with overt

behavior (except for cognitive–behaviorists)

A focus on the here and now as opposed to the then and there of behavior

An assumption that all behavior is learned, whether it be adaptive or maladaptive

A belief that learning can be effective in changing maladaptive behavior

A focus on setting up well-defined therapy goals with their clients

A rejection of the idea that the human personality is composed of traits

ROLE OF THE COUNSELOR

A counselor may take one of several roles, depending on his or her behavioral orientation
and the client’s goal(s).

Generally, however, a behaviorally based counselor is active in counseling sessions.

As a result, the client learns, unlearns, or relearns specific ways of behaving. In the
process, the counselor functions as a consultant, teacher, adviser, reinforcer, and
facilitator.

He or she may even instruct or supervise support people in the client’s environment who
are assisting in the change process.

An effective behavioral counselor operates from a broad perspective and involves the
client in every phase of the counseling.

GOALS

The goals of behaviorists are similar to those of many other counselors.

Basically, behavioral counselors want to help clients make good adjustments to life
circumstances and achieve personal and professional objectives.

Thus, the focus is on modifying or eliminating the maladaptive behaviors that clients
display, while helping them acquire healthy, constructive ways of acting.

Just to eliminate a behavior is not enough; unproductive actions must be replaced with
productive ways of responding.

A major step in the behavioral approach is for counselors and clients to reach mutually
agreed-on goals.

TECHNIQUES

• General Behavioral Techniques- General techniques are applicable in all behavioral

theories, although a given technique may be more applicable to a particular
approach at a given time or in a specific circumstance.
• Use of Reinforcers- Reinforcers are those events that, when they follow a behavior,
increase the probability of the behavior repeating. A reinforcer may be either
positive or negative.
• Schedules of Reinforcement. When a behavior is first being learned, it should be
reinforced every time it occurs—in other words, by continuous reinforcement. After
 a behavior is established, however, it should be reinforced less frequently—in other
words, by intermittent reinforcement. Schedules of reinforcement operate
according to either the number of responses (ratio) or the length of time (interval)
between reinforcers. Both ratio and interval schedules may be either fixed or
variable.
• Shaping- Behavior learned gradually in steps through successive approximation is
known as shaping. When clients are learning new skills, counselors may help break
down behavior into manageable units.
• Generalization- Generalization involves the display of behaviors in environments
outside where they were originally learned (e.g., at home, at work). It indicates that
transference into another setting has occurred.
• Maintenance- Maintenance is defined as being consistent in performing the actions
desired without depending on anyone else for support. In maintenance, an
emphasis is placed on increasing a client’s self-control and self-management. One
way this may be done is through self-monitoring, when clients learn to modify their
own behaviors. It involves two processes related to self-monitoring: self-
observation and self-recording. Self-observation requires that a person notice
particular behaviors he or she does; self-recording focuses on recording these
behaviors.
• Extinction- Extinction is the elimination of a behavior because of a withdrawal of its
reinforcement. Few individuals will continue doing something that is not rewarding.

Specific behavioral techniques are refined behavioral methods that combine general
techniques in precise ways.

• Behavioral Rehearsal- Behavioral rehearsal consists of practicing a desired

behavior until it is performed the way a client wishes.
• Environmental Planning- Environmental planning involves a client’s setting up part
of the environment to promote or limit certain behaviors.
• Systematic Desensitization- Systematic desensitization is designed to help clients
overcome anxiety in particular situations. A client is asked to describe the situation
that causes anxiety and then to rank this situation and related events on a
hierarchical scale, from aspects that cause no concern (0) to those that are most
troublesome (100). To help the client avoid anxiety and face the situation, the
counselor teaches him or her to relax physically or mentally. The hierarchy is then
reviewed, starting with low-anxiety items. When the client’s anxiety begins to
mount, the client is helped to relax again, and the procedures then start anew until
 the client is able to be calm even when thinking about or imagining the event that
used to create the most anxiety
• Assertiveness Training- The major tenet of assertiveness training is that a person
should be free to express thoughts and feelings appropriately without feeling undue
anxiety. The technique consists of counterconditioning anxiety and reinforcing
assertiveness. A client is taught that everyone has the right (not the obligation) of
self-expression. The client then learns the differences among aggressive, passive,
and assertive actions.
• Contingency Contracts- Contingency contracts spell out the behaviors to be
performed, changed, or discontinued; the rewards associated with the
achievement of these goals; and the conditions under which rewards are to be
received.
• Implosion and Flooding- Implosive therapy is an advanced technique that involves
desensitizing a client to a situation by having him or her imagine an anxiety-
producing situation that may have dire consequences. The client is not taught to
relax first (as in systematic desensitization). Flooding is less traumatic, as the
imagined anxiety-producing scene does not have dire consequences.

• Time-Out- Time-out is a mild aversive technique in which a client is separated from

the opportunity to receive positive reinforcement. It is most effective when
employed for short periods of time, such as 5 minutes.
• Covert Sensitization- Covert sensitization is a technique in which undesired
behavior is eliminated by associating it with unpleasantness

Cognitive Therapy

Basic Concepts

• Cognitions are thoughts, beliefs, and internal images people have about events in
their lives.
• Cognitive counseling theories focus on mental processes and their influence on
mental health.
• A common premise of all cognitive approaches is: how people think largely
determines how they feel and behave.
 • As Burns (1980) points out, “Every bad feeling you have is the result of your
distorted negative thinking”.
• Cognitive theorists and clinicians believe that if individuals change their ways of
thinking, their feelings and behaviors will be modified.

Clients that work best with cognitive therapy:

• They are average to above-average in intelligence.

• They have moderate to high levels of functional distress.
• They are able to identify thoughts and feelings.
• They are not psychotic or disabled by present problems.
• They are willing and able to complete systematic homework assignments.
• They possess a repertoire of behavioral skills and responses.
• They frequently have inhibited mental functioning, such as depression.

View of Human Nature

Individuals who suffer from dysfunctional automatic thoughts specific to an event.

These thoughts are known as schemata, which are general rules about oneself or the world
associated with an event, such as how a person should think or behave.

These individuals often engage in self-statements that affect their behaviors in much the
same way as statements made by another person.

Cognitive distortions – ways to mentally assess a situation.

View of Human Nature

• All-or-nothing thinking (also known as dichotomous thinking) occurs when people

think they must do something a certain way or else they are failures. For example, in
giving a speech, if all-or-nothing thinkers do not say every word written, they believe
they will be seen as incompetent.
• In selective abstraction, individuals pick out an idea or fact to support their negative
thinking. For instance, if a person who usually makes straight As in school suddenly
makes a B, that person might use the B to conclude, “I’m not really very smart.”
 • Personalization occurs when an event unrelated to a person is distorted and made
to appear related. For example, a woman may begin to think that the elevators in
her office complex are slow even though she uses them only at peak times.
• Mind reading refers to the tendency of some people to guess what others are
thinking about them. An older adult may believe that others who see him think,
“There is an incompetent old fool who is good for nothing.” Therefore he fails to
interact with people in his environment and becomes a recluse.

Role of the Counsellor

• To collaborate with clients, sharing the responsibility to select goals and bring
about change.
• Counselors function as educators and as experts on cognitions, behaviors, and
emotions.
• Clients collaborate by participating in assignments.
• Initially, cognitively oriented counselors do not try to disprove beliefs but let clients
examine the functionality of their beliefs.
• Exploratory in working with clients and Socratic in letting them assess what is
correct and incorrect in their belief systems.
• Cognitive therapy is ever evolving so that as new data come in, the counselor-client
team can make new strategies.
• Requires empirical testing on the part of clients to understand how functional or
dysfunctional their beliefs are. Counselors, especially cognitive-behavioral
counselors, may use diagnoses, such as those in the Diagnostic and Statistical
Manual, in working with clients.
• However, diagnoses are employed only as a way of working with clients to
overcome a disorder, such as posttraumatic stress.

Goals of Counselling

• Employ specific learning experiences to teach clients ways to monitor their negative
or automatic thoughts.
• Taught to recognize the relationship between these thoughts and their emotions
and behaviors.
• Help clients compile evidence for and against their distorted automatic thoughts.
 • Ideally, clients are freed to alter their distorted beliefs and to substitute reality-
based interpretations for unrealistic thoughts.
• Goals are constantly reexamined and modified to fit clients; cognitive approaches
• are tailored to individual situations.

Process and Techniques

Cognitive and cognitive-behavioral therapy are specific and goal directed (Sharf, 2016),
emphasizing the modification of thoughts to bring about therapeutic change.

One way to organize thoughts is in three categories: cold, warm, and hot cognitions.

A cold cognition is descriptive and nonevaluative, such as “I lost my job.”

A warm cognition emphasizes preferences and non-preferences, such as “I lost my job and
I really don’t want to have to start looking for another one.”

Hot cognitions “are heavily laden emotional-demand statements” (James C Gilliland,

2003, p. 238) that may reveal varied distortions, such as overgeneralizing, catastrophizing,
magnification, and all-or-nothing thinking—for example, “I must get a job just like the one I
lost.” Hot cognitions usually lead to dysfunctional behaviors because they are filled with
both demands and distortions.

• First establish a relationship between client and counselor and then implement
• cognitive strategies in a basic four-step procedure (Burns, 1989; Schuyler, 2003).
• These four steps and the premises behind them are at the heart of change.
• Use standardized guidelines for understanding in a concrete manner the events in
clients’ lives—that is, what is happening in their environments.
• Set up a way of recording or reflecting clients’ thoughts about these events to
understand their cognitions in a clear, precise way. Often thoughts are written down
so that they can be seen in as concrete a manner as possible.
• Work to find a means to identify and challenge distorted thoughts. For instance, if a
client believes that no one likes her, an empirical test might be set up whereby she
records all positive as well as negative interactions.
• To implement new ways of thinking that are realistic and productive. Thus the client
might change her thinking from “Nobody likes me” to “Some people like me and
some do not.”
Cognitive Techniques

• Specifying automatic thoughts. Automatic thoughts are cognitions that occur

without effort. They are usually distorted and lead to unhealthy emotional
responses. Therefore, a major focus of cognitive therapy is to identify—that is,
specify—and then correct such thoughts.
• Homework. Much change that occurs in cognitive therapy happens outside actual
counseling sessions. Clients may practice giving themselves different thoughts at
home, on the job, or in particular settings. Such practice makes it easier for clients
to achieve the desired changes in their thinking.
• Cognitive interventions. Several cognitive processes focused on bringing cognitive
distortions into greater awareness—for example, challenging absolutes and all-or-
nothing thinking, reattribution, labeling of distortions.
• Cognitive rehearsals. Clients to consistently rehearse healthy thoughts. They may
do so covertly or overtly, privately through mental rehearsal, or publicly, as in a
gathering of friends.
• Scriptotherapy. In the process of writing, which is scriptotherapy, individuals
improve their thoughts by expressing them concretely. Pennebaker and Smyth
(2016).

Cognitive-Behavioral Techniques

Overall, focuses on what lies ahead, grouping stressful events into manageable doses,
thinking of ways to handle small stressful events, and practicing coping skills.

The major drawback to this procedure is that its initial results sometimes do not generalize
into permanent behavior changes. Therefore, follow-up and booster sessions are often
necessary.

Thought stopping-Helps clients who ruminate about the past or who have irrational
thoughts to stop such self-defeating behavior and live more productively.

Counselors initially ask their clients to think in a self-defeating manner and then, in the
midst of such thoughts, suddenly yell, “Stop!” The shout interrupts the thought process
and makes it impossible to continue. Process comprises several components (Cormier et
al., 2017); it teaches clients to progress from outer to inner control of negative thought
patterns. It also helps clients replace self-defeating thoughts with assertive, positive, or
neutral ones.
Cognitive restructuring- Among the most effective cognitive-behavioral techniques is
cognitive restructuring, which includes stress inoculation and thought stopping. In
cognitive restructuring clients are taught to identify, evaluate, and change self-defeating or
irrational thoughts that negatively influence their behavior. Process accomplished by
getting them to vocalize their self-talk and then change it, when necessary, from negative
to neutral or positive.

Rational Emotive Behavioural Therapy

Rational emotive behavior therapy (REBT) originally was known as rational therapy (RT).
Albert Ellis changed its name to rational-emotive therapy (RET) in 1961 and then changed
its name again in 1993 to rational emotive behavior therapy to better reflect what the
theory actually did— focus on behaviors as well as cognitions.

Rational emotive behavior therapy was primarily a cognitive theory in the beginning. Its
main tenets were first published in Ellis’s Reason and Emotion in Psychotherapy (1962).
REBT has since broadened its base considerably and now includes behavioral and
emotional concepts.

View of Human Nature

REBT assumes that people are both “inherently rational and irrational, sensible and crazy”
(Weinrach, 1980, p. 154). According to Ellis (1995), this duality in people is biologically
inherent and is perpetuated unless a new way of thinking is learned (Dryden,1994).

Irrational thinking, or as Ellis defines it, irrational Beliefs (iBs), may include the invention of
upsetting and disturbing thoughts regarding self, others, and life. Examples of such beliefs
are: “I’m a product of my past. I cannot change anything. I’ve always been this way” and
“It’s easier to avoid than to face this problem; hopefully, it will just go away.”

These fallacies and others like them have been used in formulating various tests, which
have been correlated “with various kinds of emotional disturbance”

Ellis organizes irrational beliefs under three main headings:

 • “I absolutely must perform important tasks well and be approved by significant
others, or else I am an inadequate, pretty worthless person!” Result: severe feelings
of anxiety, depression, and demoralization, often leading to severe inhibition.
• “Other people, especially my friends and relatives, truly must treat me kindly and
fairly, or else they are rotten, damnable people!” Result: severe feelings of anger,
rage, fury, often leading to fights, child abuse, assault, rape, murder, and genocide.
• “The condition under which I live absolutely must be comfortable, unhassled, and
enjoyable, or else it’s awful, I can’t stand it, and my life is hardly worth living!”
Result: severe feelings of low frustration tolerance, often leading to compulsion,
addiction, avoidance, inhibition, and public reaction.

He believed that human beings are by nature gullible, highly suggestible, and easily
disturbed. Overall, people have within themselves the means to control their thoughts,
feelings, and actions, but they must first realize what they are telling themselves (i.e., self-
talk) to gain command of their lives (Ellis, 1962). This matter is one of personal, conscious
awareness; the unconscious mind is not involved.

Role of the Counsellor

• In the REBT approach counselors are active, direct, provocative, and

confrontational. They are instructors who teach and correct clients’ cognitions.
• Countering a deeply ingrained belief requires more than logic; it requires consistent
attention and repetition. Therefore, REBT therapists listen carefully for illogical or
faulty statements from their clients and challenge them.
• In the process, they show concern and care for their clients by “attending to their
behavior, by frequently asking questions for clarification, by recalling personal
details about the client and his or her problems, by the use of gentle humor, and by
active attempts to help the client solve difficult issues” (Vernon, 1996, p. 122).
• Ellis (1980) and Walen et al. (1992) have identified several characteristics desirable
for REBT counselors. They should be bright, knowledgeable, empathetic, respectful,
genuine, concrete, persistent, scientific, interested in helping others, and involved
in using REBT themselves.
• They should also adopt the humanistic core REBT philosophies of unconditional
self-acceptance, unconditional other- acceptance, and unconditional life-
acceptance (Ellis C Ellis, 2019).
 • A counselor’s main assessment instrument is the evaluation of a client’s thinking.
Some formal tests may be employed to measure rational and irrational thinking, but
the evaluation process is primarily accomplished in counselor-client sessions. As a
rule, REBT practitioners do not rely heavily on the diagnostic categories in the DSM.

Goals

• The primary goals of REBT focus on helping people realize that they can live more
rational and productive lives.
• In general, rational emotive behavior therapy constitutes “an attempt to correct
mistakes in a client’s reasoning as a way of eliminating undesirable emotions”.
• Ellis points out that when people use words such as “must,” “ought to,” “have to,”
and “need,” they make demands of wishes and think irrationally. For individuals
who think that wishes must or should occur, a wish unfulfilled results in a
catastrophe. REBT helps clients stop catastrophizing and making such demands.
Clients in REBT may express some negative feelings, but a major goal is to help
them avoid a more emotional response than is warranted by the event.
• Another goal of REBT is to help people change self-defeating habits of thought or
behavior. One way this goal is accomplished is through the ABCs of REBT: A
signifies an activating experience, B represents how the person thinks about the
experience, and C is the emotional reaction to B.
• Thoughts about experiences may be characterized in four ways: positive, negative,
neutral, or mixed. A positive thought leads to positive feelings.
• REBT encourages clients to be more tolerant of themselves and others, for everyone
is a fallible human being.
• People are encouraged through REBT to achieve personal goals, rather than dwell
on mistakes or miscues. Such goals are accomplished when individuals learn to
think rationally, to change self-defeating behavior, and to unconditionally accept
themselves.

Process s Techniques

The two primary emphases of REBT are teaching and disputing. Before any changes can be
made, clients must learn the basic ideas of REBT and understand how thoughts are linked
to emotions and behaviors.
REBT is highly didactic and very directive. In the first few sessions, counselors teach their
clients the anatomy of an emotion—that is, feelings are a result of thoughts, not events,
and self-talk influences emotions. This process, generally known as rational emotive
education (REE), has had a high success rate with children, adolescents, and adults with a
wide variety of problems and from a wide range of backgrounds.

It is also critical in the REBT process that clients be able to dispute irrational thoughts.

Disputing thoughts and beliefs takes one of three forms—cognitive, imaginal, or

behavioral— and is most effective when all three forms are used (Walen et al., 1992).

Cognitive disputation involves the use of direct questions, logical reasoning, and
persuasion.

Direct questions challenge clients to prove that their responses are logical. Sometimes
these inquiries use the word “why,” which is seldom employed in other counseling
approaches because it puts many people on the defensive and closes off exploration.

However, why questions help REBT clinicians cut through defenses and educate clients to
new ways of thinking, feeling, and behaving. For example, counselors might ask, “Why
must you?” or “Why must that be so?”

These inquiries help clients learn to distinguish between rational and irrational thoughts
and appreciate the superiority of rational thoughts.

Another form of cognitive disputation involves the use of syllogisms, “a deductive form of
reasoning consisting of two premises and a conclusion”.

Syllogisms help clients and counselors more thoroughly understand inductive and
deductive fallacies that underlie emotions. For example, in irrational can’t-stand-it-ism the
process might go as follows:

Major premise: “Nobody can stand to be lied to.”

Minor premise: “I was lied to.”

Conclusion: “I can’t stand it.”

Certainly being lied to is not pleasant, but it is often a part of life, and concluding “I can’t
stand it” is silly, false, and illogical.
Imaginal disputation depends on a client’s ability to imagine and employs a technique
known as rational emotive imagery (REI) (Maultsby, 1984).

REI may be used in one of two ways. First, a client may be asked to imagine a situation in
which she is likely to become upset and to examine her self-talk during that imagined
situation. Then she is asked to envision the same situation but to be more moderate in her
self-talk this time.

Second, a counselor may ask a client to imagine a situation in which he feels or behaves in
a different way from that of a real occurrence. The client is then instructed to examine the
self-talk he used in this imagined situation. REI takes practice.

The emotional control card (ECC) is a device that helps clients reinforce and expand the
practice of REI. Wallet-sized ECCs list four emotionally debilitating categories— anger,
self-criticism, anxiety, and depression (Ellis, 1986).

Under each category is a list of inappropriate or self-destructive feelings and a parallel list
of appropriate or non-defeating feelings. In potentially troubling situations, clients can
refer to the cards and change the quality of their feelings about the situations. At their next
counseling sessions, clients can discuss the use of the cards in cognitively restructuring
their thoughts from irrational to rational.

Behavioral disputation involves behaving in a way that is the opposite of the client’s usual
way of acting. Sometimes behavioral disputation takes the form of bibliotherapy, in which
clients read a self-help book such as those distributed by the Albert Ellis Institute. At other
times, behavioral disputation includes roleplaying and completing a homework
assignment in which clients do activities they previously considered impossible. In both
cases, clients bring their completed assignments to their scheduled counseling sessions
and evaluate them with their counselors.

If disputation of irrational beliefs (iBs) is successful, a new and effective philosophy will
emerge. This philosophy will include a new cognitive Effect (cE), which is a restatement of
original rational Beliefs (rBs). For example, “It is not awful, merely inconvenient, that I was
rejected by a particular person.”

Ellis has devised a number of homework assignments, such as shame attack exercises, to
help clients learn to behave differently. These exercises usually include an activity that is
harmless but dreaded, such as introducing oneself to a stranger or asking for a glass of
water in a restaurant without ordering anything else. By participating in such exercises,
clients learn the ABCs of REBT on a personal level and come to realize more fully that the
world does not stop if a mistake is made or if a want remains unfulfilled (Ellis C Ellis, 2019).
Clients also learn that others are fallible human beings and need not be perfect. Finally,
clients learn that goals can be achieved without “awfulizing” or “terriblizing” personal
situations.

In addition, Ellis frequently used puns and other humorous devices to help his clients see
how irrational thinking develops and how silly the consequences of such thinking are. He
cautioned clients not to “should on themselves” (a demand using the word “should,” e.g.,
the world should be perfect), not to “awfulize” (characterizing an event as “awful,” not just
inconvenient), and advises people to avoid “musterbation” (an illogical mandate that a
situation must be a certain way).

Solution Focused Brief Therapy

View of Human Nature

• Built on the philosophy of social constructionism, which is the social or cultural

context of people or families.
• Foundational Belief: Dysfunctional people are often stuck in dealing with their
problems. They use unsatisfactory methods to solve their difficulties, relying on
patterns that do not work.
• Solution-focused therapy is aimed at breaking such repetitive, nonproductive
behavioral patterns by enabling individuals and families to take a more positive view
of troublesome situations and actively participate in doing something different.
• “Not necessary to know the cause of the complaint or even very much about the
complaint itself in order to resolve it”.
• Another premise of solution-focused therapy is that individuals really want to
• change.
• To underscore this idea, deShazer considered resistance no longer a valid concept.
• When clients do not follow therapists’ directions, they are actually cooperating by
teaching therapists the best way to help them.
• A related concept is that only a small amount of change is necessary.
• An analogy used to illustrate this point notes that a 1-degree error in a plane’s path
across the
• United States results in a destination that is considerably off course (deShazer,
1985).
• Small amounts of change can also encourage people to realize that they can make
progress.
• Even minute change boosts confidence and optimism and creates a ripple effect.
Role of The Counsellor

• Solution-focused therapists construct solutions in collaboration with clients (Kiser

et al., 1993).
• However, one of the therapists’ first roles is to determine how active clients will be
in the process of change.
• Clients usually fall into one of three categories: visitors, complainants, or
customers.
• Visitors are not involved in the problem and are not part of the solution.
• Complainants complain about situations but can be observant and describe
problems even if they are not invested in solving them.
• Customers are not only able to describe a problem and their involvement in it but
are also willing to work to solve it.
• If therapists are working with customers or can help visitors and complainants
evolve into customers, appropriate intervention strategies can be developed.
• Therapist is a “facilitator of change, one who helps clients access the resources
and strengths they already have but are not aware of or are not utilizing”.
• Work with clients to change their perspective on a problem, paying special attention
to language.
• Positive assumptions about change are constantly conveyed. For example,
therapists might ask a presuppositional question such as “What good thing
happened since our last session?”
• In addition, “by selecting a specific verb tense, or implying the occurrence of a
particular event … individuals are … led to believe that a solution will be achieved”
(Gale, 1991, p. 43).
• Likewise, when an improvement occurs, therapists use positive blame and
recognition of competence through such questions as “How did you make that
happen?”.
• Solution-focused therapists believe that it is important to fit therapeutic
interventions into the context of individual or family behavior.
• A solution does not have to be as complex as the presenting problem. E.g. Lock and
Key. Skeleton keys (i.e., standardized therapeutic techniques) can be helpful in
dealing with most locks, regardless of complexity.
• To obtain a good solution fit, deShazer used a team whenever possible to begin
mapping or sketching out a course of successful intervention.
• However, it is up to clients to define what they wish to achieve; therapists then help
them define clear, specific goals that can be conceptualized concretely.
 • In this process, clients and therapists begin to identify solutions—that is, desired
behaviors.
• “Therapy is over when the agreed upon outcome has been reached”.
• To increase motivation and expectation, solution-focused therapy, like strategic
therapy, emphasizes short-term treatment, between 5 and 10 sessions.

Goals

• Believe that all individuals and families have resources and strengths with which to
resolve complaints.
• The task is simply to get them to use the abilities they already have.
• Encourages, challenges, and sets up expectations for change in clients.
• Help clients unlock their set views, be creative, and generate novel approaches with
broad applicability.
• The concept of pathology, as defined in the DSM/ICD, does not play a part in the
treatment process.
• Identifying what is a problem and what is not a problem is a key component in the
solution-focused process.

Process and Techniques

• Processes and techniques are geared to solutions, not problems.

• Focus on a detailed personal or family history of problems is believed to be
unhelpful because there are many problems for which causal understanding is not
clear and therefore unnecessary.
• Co-create a problem: Agreement made initially on problem is to be solved. E.g. Both
therapist and family must agree that a family’s failure to discipline a child properly
is the difficulty that needs to be addressed.
• Ask clients for a hypothetical solution to their situation - miracle question (Isoo Kim
Berg).
• For example, “If a miracle happened tonight and you woke up tomorrow and the
problem was solved, what would you do differently?”.
• Such a question invites clients to suspend their present frame of reference and
enter the reality they wish to achieve.
• Focus on exceptions— that is, to look for times when clients’ goals may be
happening.
 • “In a practical sense, exceptions do not exist in the real world of clients; they must
be cooperatively invented or constructed by both the client and the therapist while
exploring what happens when the problem does not occur”.
• For example, a couple that is quarreling a lot might find that they are peaceful
whenever they sit down to eat.
• By examining the dynamics of situations or at various times, clients may learn
something about who they are and how they interact.
• Moreover, in the process they may become different. “Inventing exceptions to
problems deconstructs the client’s frame: I am this way, or it always happens that
way”.
• Second-order or qualitative change. The goal is to change clients’ patterns by
intervening in the order of events in clients’ lives or altering the frequency and
duration of a dysfunction.

For example, a couple who has been having long fights at dinner might agree to finish their
meal before arguing and then limit their discussion of the difficult topic to 15 minutes. This
type of change in the structure and duration of events is likely to alter family dynamics.

• Use procedures that have worked before and that have a universal application.
These skeleton keys help clients unlock a variety of problems.
• Between now and next time we meet, we (I) want you to observe, so that you can tell
us (me) next time, what happens in your (life, marriage, family, or relationship) that
you want to continue to happen”. Encourages clients to look at the stability or
steadiness of the problems on which they wish to work.
• Do something different. This type of request encourages individuals to explore their
range of possibilities, rather than to continue to do what they believe is correct.
• Pay attention to what you do when you overcome the temptation or urge to …
perform the symptom or some behavior associated with the complaint”. This
instruction helps clients realize that symptom behaviors are under their control.
• A lot of people in your situation would have … ”. This type of statement helps clients
realize that they may have options other than those they are exercising. With such
awareness, they can begin to make needed changes.
• Write, read, and burn your thoughts”. This experience consists of writing about past
times and then reading and burning the writings the next day in an attempt to move
on.
Acceptance and Commitment Therapy

Basic Concepts

• Known as ACT – a mindfulness based behavioral therapy.

• Created by Steven Hayes in 1986 –Eclectic mix of metaphor, paradox and
mindfulness skills with a wide range of experiential exercises and value-guided
behavioral interventions.
• Based on research on human language and cognition - Relational Frame Theory
(RFT)
• RFT explains how we relate to things, thoughts and experiences and how these
relationships influence our behavior.
• Does not have symptom reduction as a goal.

View of Human Nature

• View that the ongoing attempt to get rid of ‘symptoms’ actually creates a clinical
disorder in the first place.
• How? As soon as a private experience is labeled a ‘symptom’, it immediately sets
up a struggle with it because a ‘symptom’ is by definition something ‘pathological’;
something we should try to get rid of.
• In ACT, the aim is to transform our relationship with our difficult thoughts and
feelings, so that we no longer perceive them as ‘symptoms’.
• Instead, we learn to perceive them as harmless, even if uncomfortable, transient
psychological events.
• Ironically, through this process ACT actually achieves symptom reduction—but as a
byproduct and not the goal.
• Doesn’t rest on the assumption of ‘healthy normality’.
• Western psychology: That by their nature, humans are psychologically healthy, and
given a healthy environment, lifestyle, and social context (with opportunities for
‘self actualisation’), humans will naturally be happy and content.
• From this perspective, psychological suffering is seen as abnormal; a disease or
syndrome driven by unusual pathological processes.
• Even though our standard of living is higher than ever before in recorded history,
psychological suffering is all around us.
 • Destructive Normality

ACT assumes that the psychological processes of a normal human mind are often
destructive, and create psychological suffering for us all, sooner or later. Root of this
suffering is human language itself – language used in two domains – public and private.

The public use of language includes speaking, talking, miming, gesturing, writing, painting,
singing, dancing and so on.

The private use of language includes thinking, imagining, daydreaming, planning,

visualising and so on. A more technical term for the private use of language is ‘cognition’.

Human language is a double-edged sword.

• Experiential Avoidance

ACT assumes that human language naturally creates psychological suffering for us all.
One way it does this is through setting us up for a struggle with our own thoughts and
feelings, through a process called experiential avoidance.

Problem = something we don’t want. Solution = figure out how to get rid of it, or avoid it.

Problem solving strategies - highly adaptive for us as humans (and indeed, teaching such
skills has proven to be effective in the treatment of depression).

Problem solving approach works well in the outside world.

Only natural that we would tend to apply it to our interior world; the psychological world of
thoughts, feelings, memories, sensations, and urges.

Often when we try to avoid or get rid of unwanted private experiences, we simply create
extra suffering for ourselves. For example, addiction results from feelings such as
boredom, loneliness, anxiety, depression and so on. The addictive behaviour then
becomes self-sustaining, because it provides a quick and easy way to get rid of cravings or
withdrawal symptoms.

Role of The Counsellor

• ACT training helps therapists to develop the essential qualities of compassion,

acceptance, empathy, respect, and the ability to stay psychologically present even
in the midst of strong emotions.
 • ACT teaches therapists that, thanks to human language, they are in the same boat
as their clients—so they don’t need to be enlightened beings or to ‘have it all
together’.
• In fact, they might say to their clients something like: ‘I don’t want you to think I’ve
got my life completely in order. It’s more as if you’re climbing your mountain over
there and I’m climbing my mountain over here. It’s not as if I’ve reached the top and
I’m having a rest. It’s just that from where I am on my mountain, I can see obstacles
on your mountain that you can’t see. So I can point those out to you, and maybe
show you some alternative routes around them.’

Goals

• To create a rich and meaningful life, while accepting the pain that inevitably goes
with it.
• Taking effective actions guided by our deepest values and in which we are fully
present and engaged.
• Mindful action leads to a meaningful life.
• Private experiences (thoughts, images, feelings, sensations, urges and
• memories) interfere with a meaningful life.
• Mindfulness skills help to handle private experiences.
• Mindfulness – Consciously bringing awareness to the here and now experience with
openness, interest and receptiveness.

• Clients come to therapy with an agenda of emotional control. They want to get rid of
their depression, anxiety, urges to drink, traumatic memories, low self-esteem, fear
of rejection, anger, grief and so on.
• In ACT, there is no attempt to try to reduce, change, avoid, suppress, or control
these private experiences.
• Clients learn to reduce the impact and influence of unwanted thoughts and
feelings, through the effective use of mindfulness.
• Clients learn to stop fighting with their private experiences—to open up to them,
make room for them, and allow them to come and go without a struggle.

Techniques
ACT interventions focus around two main processes: developing acceptance of unwanted
private experiences which are out of personal control, commitment and action towards
living a valued life.

• Confronting the Agenda- Client’s agenda of emotional control is gently and

respectfully undermined. Clients identify the ways they have tried to get rid of or
avoid unwanted private experiences.

Control is the problem, not the solution

In this phase, we increase clients’ awareness that emotional control strategies are largely
responsible for their problems;

As long as they’re fixated on trying to control how they feel, they’re trapped in a vicious
cycle of increasing suffering.

Useful metaphors here include ‘quicksand’, ‘the struggle switch’, and the concepts of
‘clean discomfort’ and ‘dirty discomfort’.

• Quicksand – E.g. Anxiety state.

• Struggle switch – switching on leads to secondary emotions.
• Switching off – anxiety rises and falls as the situation dictates.
• Clean discomfort and Dirty discomfort.

Six core principles to develop psychological flexibility

Defusion

Acceptance

Contact with the present moment

The Observing Self

Values

Committed action

Cognitive defusion (watch your thinking)

Learning to perceive thoughts, images, memories and other cognitions as what they are—
nothing more than bits of language, words and pictures—as opposed to what they can
appear to be—threatening events, rules that must be obeyed, objective truths and facts.

Exercise:

Step 1: Bring to mind an upsetting and recurring negative self-judgment that takes

the form ‘I am X’ such as ‘I am incompetent’, or ‘I’m stupid.’ Hold that thought in your mind
for several seconds and believe it as much as you can. Now notice how it affects you?

Step 2: Now take the thought ‘I am X’ and insert this phrase in front of it: ‘I’m having the
thought that . . .’ Now run that thought again, this time with the new phrase. Notice what
happens.

Acceptance (Open Up)

Making room for unpleasant feelings, sensations, urges, and other private experiences;

Allowing them to come and go without struggling with them, running from

them, or giving them undue attention.

Contact with the present moment (Be here now)

Bringing full awareness to you’re here-and-now experience, with openness, interest, and
receptiveness;

Focusing on and engaging fully in whatever you are doing.

The Observing Self (Pure Awareness)

Accessing a transcendent sense of self; a continuity of consciousness that is unchanging,

ever-present, and impervious to harm.

Possible to experience directly that you are not your thoughts, feelings, memories, urges,
sensations, images, roles, or physical body.

These phenomena change constantly and are peripheral aspects of you, but they are not
the essence of who you are.

Values (Know what matters)

Clarifying what is most important, deep in your heart; what sort of person you want to be;
what is significant and meaningful to you; and what you want to stand for in this life.

Committed Action (Do what it takes)

Setting goals, guided by your values, and taking effective action to achieve them.