Pragmatic Approaches and Multicultural Considerations

Introduction
In Units 5 and 6, you will focus on the pragmatic theories, which include cognitive therapy, behavioral therapy, reality therapy, cognitive behavior therapy, and rational emotive behavior therapy.
Behavioral Therapy
Behavior therapy emerged in the 1950s, and as with other theories, departed from the beliefs of psychoanalytic theory. The principle theorists were Skinner (operant conditioning), Pavlov (classical conditioning), and Bandura (social learning theory). Generally speaking, the behavioral therapies were based in a scientific viewpoint and incorporated very structured means of assessment and treatment. Behavior therapies focus on objective and measurable behaviors and incorporate a systematic method of treatment. The focus is on the current behaviors rather than the historical causes of the behavior. The goals include changing undesired behaviors, promoting personal choice, and encourage new learning conditions. With the structured nature of the behavioral therapies there are many interventions such as applied behavior analysis, systematic desensitization, relaxation training, in vivo exposure, social skills training, and eye movement desensitization and reprocessing (EMDR) (Corey , 2013).

Cognitive Therapy
Cognitive therapy (CT) was created by Aaron Beck during the late 1960s and paralleled Ellis’s creation of rational emotive behavior therapy (Unit 6). Cognitive therapy shares some concepts of behavior therapy, but it adds a new dimension of focus: cognitions. In his work as a psychoanalyst, Beck became interested in a process his clients engaged in, which he eventually termed automatic thoughts. These thoughts seem to be triggered by certain stimuli and then would elicit emotional responses. This was the beginning of his eventual creation of the notion of cognitive distortions. Cognitive distortions are “logical errors” people make about their objective reality that skew that reality toward negativity. Cognitive therapy had a significant impact in the emergence of cognitive-behavioral therapy (Corey, 2013).
Reality Therapy
William Glasser developed reality therapy, which is a theoretical approach based on choice theory. Its key concepts are that all we do is behave and all of our behaviors are our choice. Reality therapy is based on the concept that human beings are motivated by five innate needs: self-preservation, love and belonging, achievement, enjoyment, and freedom. The way in which we get these needs met, or not met, affects our total behavior. Glasser’s theory is based in the present and holds the client accountable. There is also the belief that all problems are relationship problems (1984).
Counselors use various techniques when working with clients, such as teaching, confronting, and role-playing. The reality therapist believes that clients often make choices that are harmful to them and that change occurs only when the client decides to change (Glasser, 1984).
Multicultural Considerations in Counseling
Multiculturalism and diversity in the United States is evolving at a rapid pace. As a result, cultural competency is essential to being an effective counselor. As a counselor, educator, or any other type of human service worker, it is very important to be aware of personal cultural values as well as to develop and maintain a sensitivity to individuals of different cultures. In the course of counseling practice, many counselors will provide services to clients who have a wide variety of diverse backgrounds. This diversity encompasses age, culture, disability, educational level, religion, sexual orientation, race, gender, and socioeconomic status. Understanding the major characteristics of culture and diversity has significance as a general practice (Corey, 2013).
The American Counseling Association (ACA) Code of Ethics (2014) reflects the reality of a rapidly growing, diverse population by integrating multicultural practices and competencies. In addition to its code of ethics for counselors, the ACA has a division that focuses specifically on issues of multiculturalism and diversity. The Association for Multicultural Counseling and Development (AMCD) has developed a mission statement to provide “global leadership, research, training, and development of multicultural counseling professionals with a focus on racial and ethnic issues” (2009, home page). This is accomplished through:
• Enhancing the awareness of human development and counseling needs of racial and ethnically diverse groups.
• Sensitizing professionals to racial and ethnic differences.
• Advancing the knowledge base of multicultural counseling through theory development and research.
• Consulting with others to advance multicultural issues across the counseling profession.
In addition to the mission statement, multicultural counseling competencies have been developed to ensure that professionals are practicing effective diversity counseling. By taking an active role in promoting these competencies and educating each other on diversity issues, we can be more sensitive to the needs of all clients. In addition, understanding the contributions and limitations of theoretical approaches to multiculturalism will enhance one’s developing competency.
References
American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.) [DVD included]. Pacific Grove, CA: Brooks/Cole.
Glasser, W. (1984). Control theory. New York, NY: Harper & Row.
Association for Multicultural Counseling and Development. (2013). Association for Multicultural Counseling and Development. Retrieved from http://www.multiculturalcounseling.org/

• Objectives
To successfully complete this learning unit, you will be expected to:
1. Create a counseling session scenario that applies behavioral, cognitive, or reality theories.
2. Analyze the effects of social or cultural diversity on psychotherapeutic approaches.
3. Post the Theories of Counseling Chart.
• Accordion Toolbar

Learning Activities Studies
Readings
Use your Theory and Practice in Counseling and Psychotherapy text and the library to read the following:
• Chapter 9, “Behavior Therapy,” pages 244–286.
• Chapter 10, “Cognitive Behavior Therapy,” pages 287–332.
• Chapter 11, “Reality Therapy,” pages 333–359.
• Cameron’s 2009 article “Regret, Choice Theory and Reality Therapy” from the International Journal of Reality Therapy, volume 28, issue 2, pages 40–42.
Review Material
• Near the end of each chapter in the Corey text, there is a section that discusses the contributions and limitations of the theory from a multicultural perspective. Choose the three theories that you relate to the most and review their multicultural perspectives.
• Review Table 15.7, starting on page 488 in the Corey text, that lists the contributions and limitations of each theory to multicultural counseling.
Multimedia
Use The Case of Stan DVD that accompanied your Corey text to complete the following:
• Watch the video’s Behavior Therapy, Cognitive Therapy, and Reality Therapy segments. Watch the introduction to the therapy, simulated counseling session, and the commentary on the approach for all theories.
Optional Readings
The following articles are recommended but not required for this unit:
• Graham, M. A., Sauerheber, J. D., & Britzman, M. J. (2013). Choice theory and family counseling: A pragmatic, culturally sensitive approach. Family Journal, 21(1), 1–5.
• Prenzlau, S. (2006). Using reality therapy to reduce PTSD-related symptoms. International Journal of Reality Therapy, 25(2), 23–29.
• Wubbolding, R. E., & Brickell, J. (2009). Perception: The orphaned component of choice theory. International Journal of Reality Therapy, 28(2), 50–54.
• Bandura, A., & Locke, E. A. (2003). Negative self-efficacy and goal effects revisited. Journal of Applied Psychology, 88(1), 87–99.
• Dozois, D. J. A., Bieling, P. J., Patelis-Siotis, I., Hoar, L., Chudzik, S., McCabe, K., & Westra, H. A. (2009). Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(6), 1078–1088.
• Hopko, D. R., Bell, J. L., Armento, M. E. A., Hunt, M. K., & Lejuez, C. W. (2005). Behavior therapy for depressed cancer patients in primary care. Psychotherapy: Theory, Research, Practice, Training, 42(2), 236–243.

Study 2
Theories of Counseling Chart
Complete the Theories of Counseling Chart for the theories covered in this unit. Add notes about key concepts, notions of what changes and why, interventions the counselor may employ, and roles of the counselor and client. Explore the Web links for each theory to see the activities of its contemporary practitioners. Add references for your favorite scholarly resources providing evidence for its efficacy.
You will work on this chart throughout the course and post it in Unit 5 and in Unit 10 as discussion posts. You will be able to refer to this chart throughout your classes, into your fieldwork, and later as you study for licensure exams.
Refer to the Web Sites and Readings for Theories of Psychotherapy document to assist you in completing the Theories Chart.
Multimedia
Before updating the Theories of Counseling Chart, view the two Theories in Action multimedia presentations on Behavior Therapy and Reality Therapy to inform your work.
Theories in Action
Behavior Therapy
Tim Seibles
Developed during the first half of the 20th century, behavior therapy is based on three types of paradigms: operant conditioning, classical conditioning and modeling. Originally viewed as a scientific reductionistic and mostly sterile approach to counseling, today’s behavior therapist realizes the importance of having a strong therapeutic relationship.
For instance, it is now usual for the modern-day therapist to use empathy and develop a collaborative working relationship with the client. This allows the therapist to build trust and correctly identify targeted behaviors the client would like to change. After behaviors are identified, goals can be established and techniques chosen. Today’s behavior therapists usually have a wide range of techniques to choose from with some of the more popular ones being modeling, such as when clients observe behaviors usually in the clinical setting, and later practice the behaviors in the office and on their own. Assertiveness training has been particularly used in this fashion. Operant conditioning techniques such as positively reinforcing targeted behaviors and extinguishing unwanted behaviors such as the use of sticker charts for children. Relaxation exercises such as learning how to progressively relax oneself in an effort to reduce anxiety or other unwanted feelings.
Systematic Desensitization, which is often used with anxiety disorders is the deliberate pairing of collaboratively chosen hierarchical aspects of the feared object with learned relaxation techniques, thus, slowly reducing the fear of response. Flooding and implosion techniques both involve the exposure to intensive amounts of fearful stimuli with the assumption being that prolonged the exposure will extinguish the fear of response. And, self-management techniques which are used when one wants to help clients learn various behavioral techniques and have them practice on their own.
In the following role-play, Dr. Suzan Thompson works with Rayneer who is struggling with a panic disorder resulting from a recent car accident. Dr. Thompson will assist Rayneer in applying relaxation techniques to her anxiety about driving.
Dr. Suzan Thompson
Hi Rayneer, welcome back.
Rayneer
Hi Suzan, how are you?
Dr. Suzan Thompson
I am doing OK. So, how has the practicing been going with the relaxation techniques that we talked about last time?
Rayneer
Well, it was kind of hard at first. I just kept having my heart palpitations and the sweating, and then I put the hearts up around the house and every time I saw a heart, it helped to remember to do the breathing you taught me.
Dr. Suzan Thompson
(Reinforcing Client) What a great idea sort of that association. (Heart Association = Classical Conditioning)
Rayneer
I really needed it because if I did not see something outside of me, I just kept being involved in the feeling.
Dr. Suzan Thompson
Right, and so, that reminded you to bring up that relaxation that we talked about.
Rayneer
Yes.
Dr. Suzan Thompson
(Relaxation Paired with Hierarchy) Well, so, one of the things that we are going to do today is to talk about the different components of what has happened for you and use the relaxation along with sort of a hierarchy of events or situations that you might face. And eventually, what we will do is have you practice the relaxation along with each of the different pieces of it, does that make sense?
Rayneer
It does. And, that would be good because it has been really hard just getting in the passenger side of the car and somebody else had to drive me.
Dr. Suzan Thompson
(Showing Interest) I was wondering about that.
Rayneer
And, just getting in the car, it makes me very nervous and I start to sweat and tremble and feel a little shortness of breathe. And, I am really concerned that I would not be able to go back to work because I drive for a living. If I am not driving, then I cannot make do for my family.
Dr. Suzan Thompson
(Identify Short and Long-Term Goals) So, we really kind of have some short-term immediate kinds of things that you want to focus on, getting in the car even, and then maybe some longer term that would be getting you back to work. Is that—?
Rayneer
Yes.
Dr. Suzan Thompson
(Paraphrasing) OK, you said that you had some of the anxiety came up when you are even getting into the passenger side coming here.
Rayneer
Yes, I just felt like I was choking and I just had this loss of control that if I was in a car again, something else would happen. And, when this accident happen there was no—I did not have any passengers and I keep thinking if it happened again or what if there are passengers and somebody else was injured. So, it is very scary.
Dr. Suzan Thompson
(Identifying Component Parts of Anxiety) It sounds like it was. Well, if we had to kind of break things down because that is what you are telling me now of what is going on now and if we had to break things down into smaller pieces, let us look at what those pieces might be. And, I am going to write some things down so that we can kind of keep things straight.
So, one of the things that you are having a hard time with is that even getting into the passenger side, but maybe we can back up from there. So what, as you think about even getting into a car, what happens to your anxiety?
Rayneer
It goes up. Let us just say, just thinking about getting in the car, it goes up to—on a scale of one to 10—it goes to like a five. And, maybe a four, it is like it gets to a five when I get ready to get in the car, then I start the heart palpitations and I am sweating and I start to tremble a little bit and I just have that feeling of fear that I am going to lose control or something is going to happen.
Dr. Suzan Thompson
(Rating Fear Response) Even just—that is that thinking about it and I am glad that you would have them and put that scale to—we talked about that last time as an application here. So, thinking about getting into the car is about a four or five depending on—
Rayneer
I think it is probably—I just get so—to me, it is not just thinking about you getting in the car, so I guess thinking about it is a three, but actually getting in the car is probably a five.
Dr. Suzan Thompson
(Being Specific About Component Parts) OK, and, is that getting into the passenger side or the driver side?
Rayneer
Well, I am getting into the passenger side. I have been too afraid to get into the passenger side. So, the passenger side is definitely a five and I would—the driver side is higher.
Dr. Suzan Thompson
(Rating Fear Response) OK. So, where would you rate getting into the driver side?
Rayneer
It is definitely at least a seven.
Dr. Suzan Thompson
(Identifying Smaller Units) OK, and I am wondering if there is something in between there getting into the driver side or what surrounding that?
Rayneer
Opening the door, once I get into the driver side and then usually, then I kind of put my hands on the wheel and sometimes I will—then I start the car after I check the mirrors and put on my seatbelt and stuff.
Dr. Suzan Thompson
(Reinforcing Client) OK, so you are doing a great job of starting to break things down, that is exactly where we are headed with this. (Summarizing Component Parts) So, just so that I have it straight with just thinking about getting into the car even before you go anywhere, even before you leave the house is about a three, so that brings up some of the anxiety. And then, getting into the passenger side is a little bit higher, opening the door to the driver side is a little bit higher than that. But, not as high as to say getting into the driver side, and then putting your hands on the wheel kind of brings it up a little bit more, and then starting the car is a little bit more too.
Rayneer
Yes, it feels like it would be. I have not tried it yet because I have been too anxious about it.
Dr. Suzan Thompson
(Identifying Component Parts) And that makes sense. OK, so, starting the car and then if we take it one-step further, what would be another step from there?
Rayneer
I guess, maybe driving the car like a short distance or maybe in the driveway or something.
Dr. Suzan Thompson
Yes really short distance, a really short distance, so in the driveway, OK. (Identifying Component Parts) And then, what would be a next step from there that we could aim for?
Rayneer
I guess going around the block.
Dr. Suzan Thompson
(Rating Response) All right, and if you even thinking about that right now?
Rayneer
That feels like it is a nine. I start sweating all over again just thinking about driving and going around the block because I know there would be other cars out there and that really is scary for me.
Dr. Suzan Thompson
(Validating Client’s Feelings) And I see that in your face. So then, we have sort of a hierarchy of different pieces of getting back to driving that we can then apply the relaxation techniques. So, let us just do one right now just for practice and see how that goes, that first one that you have on the list just thinking about getting into a vehicle.
Rayneer
OK.
Dr. Suzan Thompson
(Applying Relaxation to Hierarchy) So, right now as you are thinking about getting into a vehicle, I see that you are kind of shaking. Remember the relaxation, talk me through the relaxation that you are aware of what we—
Rayneer
Trying to take a deep breath and holding it for the count of five and then breathing out again.
Dr. Suzan Thompson
OK, to do that—just independently, just be in that relaxed place. (Practicing in Session) Great, and now, as you are in that relaxed placed, just think about leaving your house and getting into a vehicle—passenger side—and go back to that relaxed—take a deep breath—and go back to that relaxed placed. And how was that? (Asking Client for Feedback)
Rayneer
The thinking that might getting in the car is kind of scary, but I know I could put a heart in the car, I have hearts on the car seat, so I know to breathe when I see them, like I have them in the house.
Dr. Suzan Thompson
(Validating Client) Great idea, as even right now as you think about getting into a car, you can kind of—where would that heart be?
Rayneer
Right now, I need to put it on the door or the window.
Dr. Suzan Thompson
I almost thought of putting a slap, a big huge heart on the car, but it is your image.
Rayneer
I feel better with a little one, just a little one.
Dr. Suzan Thompson
(Practicing in Session) So, let us go back to the deep breath, get to a relaxed place and as you are in that relaxed placed, think about just going out to the car, the heart is right on the car exactly where you put it. (Reinforcing Visual Image of Heart) Go keep relaxing. That is it. Go back to your relaxed place.
Rayneer
I feel more like I have to do it than I am relaxed about it.
Dr. Suzan Thompson
What do you mean?
Rayneer
Well, if I cannot drive again, then I would not be able to work again.
Dr. Suzan Thompson
(Encouraging Small Steps) We are just going to take it a little bit at a time. So right now, just it is that one piece of thinking about going out there, the rest of it will fade away from right now.
Rayneer
Neat trick. OK, that does feel a little better.
Dr. Suzan Thompson
(Rating Response) Before, when we first started talking about that, you rated it as a three, where is it right now?
Rayneer
It is probably a 2.5.
Dr. Suzan Thompson
(Reinforcing Results) So, we brought it down a little bit. (Encouraging More Practice) What I am going to ask you to do then is to keep practicing that because the more you practice it just like you did at home, then the more you practice the relaxation and with the heart you are able to get to that place. (Encouraging Small Steps) It is the same thing with each one of these, so we are going to take it a little bit at a time and we will build from there.
Rayneer
Thank you. I appreciate your help.
Dr. Ed Neukrug
Suzan, that was great and I really appreciate your work with Rayneer. I particularly noticed how encouraging and how empathic and how warm you were with her.
Dr. Suzan Thompson
I know that for behavioral counseling, people have this impression that it is called and it is sterile, but any counseling, really, you have to work on the relationship and that rapport building and empathy and encouragement is a big part of any kind of counseling and it is particularly applicable to the behavioral.
Dr. Ed Neukrug
Right, it seems like when I have been doing with my post interviews with the different therapists during the role-plays that I think all of them have been saying that, that how important the relationship is with the client. Why did you choose the particular techniques that you chose with this client?
Dr. Suzan Thompson
Well, she came in with some problems with anxiety and there was a clear incident, something that was very specific that happened and that has led itself very readily to behavioral approach.
Dr. Ed Neukrug
And then, the idea of using relaxation techniques and systematic desensitization.
Dr. Suzan Thompson
It is very clear I think in terms of working with anxiety that is—it is just as so helpful to break down the different pieces because people seemed to tend to take the whole situation and the systematic desensitization really breaks things down into little parts that are much more manageable for people.
Dr. Ed Neukrug
I noticed that you really worked collaboratively with her and that you were really letting her take the lead in some cases, what are your thoughts on that?
Dr. Suzan Thompson
That has the investment of the client in the process. So, that again, it is like building the rapport, it is having a collaborative relationship I think that makes a big difference and the behavioral approach working.
Dr. Ed Neukrug
As you were building the hierarchy with her, I was thinking about the fact that many of these things on the hierarchy, she can only do outside of the office. And, I was wondering if you were going to physically go outside of the office with her or do you tend to stay in your office and have her do it?
Dr. Suzan Thompson
It really depends. It depends on a lot of different things. I start on the office and we start with thinking about the different situations, and it depends on what she might run into as a problem and then if she runs into it as a problem, then we figure out ways that either she can get help with it or she might need my help with it.
Dr. Ed Neukrug
So, let me see if I am hearing this right, if you are thinking that if she can maybe do this on her own that she can, but you are willing and able to go out there and be with her if she needs it.
Dr. Suzan Thompson
Yes, I am. Brain research these days says that we make no distinction between what we imagine and what we actually do, so to me that is an exciting piece to making this behavioral therapy work.
Dr. Ed Neukrug
Right, that is very interesting. I want to thank you so much for your expert work with Rayneer and I appreciate you being willing to share that with us today.
Dr. Suzan Thompson
Thanks.

Theories in Action
Reality Therapy and Choice Theory
Tim Seibles
Reality therapy postulates that there are five inborn needs: love and belonging, power, freedom, fun and survival; and proposes that every behavior we exhibit is an attempt to have these needs met. However, reality theory also suggest that we sometimes develop dysfunctional behaviors to meet our needs and those behaviors become the basis for how we perceive reality.
Reality therapy states that we continue to exhibit these behaviors in order to obtain what clients would consider to be their quality world. Throughout the counseling process, reality therapists believe that clients can be shown how they create their reality through the behaviors they choose, thus, the term choice theory.
For instance, a CEO who has not been much of his or her life striving for power at work may become depressed because he or she has developed a repertoire of behaviors to meet the need for power, but has neglected his or her need for love and belonging. Reality therapists often use the WDEP model to describe the counseling process.
W represents asking the client what he or she wants in an effort to create a quality world or a success identity. D stands for doing and is the point where the counselor asks the client what choices and behaviors he or she is currently making to obtain a quality world. E stands for helping the client evaluate what he or she has been doing to meet his or her needs into identifying new behaviors that would be more effective in obtaining a quality life for success identity. P stands for developing a plan for change. The therapeutic process involves creating a trusting environment, working collaboratively with the client as equal partners, and being committed to the client as they explore the change process.
In the following role-play, we will see Dr. Sylinda Gilchrist work with Todd, a 42-year-old male, who has been struggling with mild depression related to work and life transitions.
Dr. Sylinda Gilchrist
Hi Todd. What brings you here today?
Todd
Well, I have been feeling pretty stressed lately, maybe a little down, just noticed I am not pretty much not the same as I used to be. I just feel overwhelmed at times. I am not really motivated and that is pretty much it. I retire probably about two years ago and just do not have the same kind of level of go that I did before.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, you are feeling kind of down because you retired?
Todd
I do not think it is so much because I am retired. I do not know. I just think I do not feel motivated and it might be because I am not as focused as I was in the military, I always had something to do, I knew where I stood, I had responsibility, people depended on me, and those things have changed, that might have something to do with it. I do not know.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) OK, so you feel a little down because you retired recently from the military and you had more responsibilities and that your life has kind of transitioned to a change.
Todd
Yes, that is pretty much it. I mean, it might also be because I am really focused on being a single parent right now and school, and I noticed that if I am not doing that, I am really not doing anything else. But, when I was in the military, I had friends and I had a big support group and I always had something going on and it is just not that way anymore.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, it sounds like since you have retired, you lost a lot of your friends and that support system that you had and while you were in the military is now gone.
Todd
Yes ma’am I would think that that would have a lot to do with it. I am pretty much at cave dweller now. I do not much go out or anything like that. So, I do not have the—I had a good support group when I was in the military because I was always working, but since I got out, they are all transient. I really do not talk to or see anybody that I used to work with, so it is just pretty much me and my 11-year-old.
Dr. Sylinda Gilchrist
OK, so what would make you happy or feel connected again?
Todd
I do not know. I guess getting out and getting involved with other people, talking to them maybe. I just really do not know how to do that, I am not sure how to just go out. I know when my son was playing soccer, I did not feel as bad as I do now, and just because I was talking to the adults on the sidelines while he was out there playing. I had a pretty good group of friends then, but he has not played the last two season sort of drifted apart with me doing school and stuff like that.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, it sounds like you felt better when you were involved in activities around adults or activities that involved your son that allowed you to communicate with other adults.
Todd
Yes, I mean, that was a benefit of going to the soccer. I mean, it does not really have to be with my son. I mean, that is always great, but I mean, just the adult interaction would be probably better than nothing. I am not really talking to anybody.
Dr. Sylinda Gilchrist
(Clarifying “Wants”) So, it sounds like that what you would like to have is more interactions with adults and develop more support mechanisms or support from other adults that you had when you were in the military.
Todd
Yes, that sounds like that would benefit me. I think it all started occurring to me when I like throughout my back and I realize that I do not have the option to be off or have a sick day. I am a full time parent now and I have to go to school, I cannot miss classes or exams or anything and it occurred to me. I do not have anybody in call to step in.
Dr. Sylinda Gilchrist
(Encouraging Client to Focus on Wants) OK, so what would you want? What would make you happy? What would support look like outside of the military?
Todd
Probably some kind of camaraderie, but I am really apprehensive about being obligated. I do not want to be in a position. I think that is what holds me back. I do not want to be in a position that I have to do anything. I want to be able to cancel out if I am going to meet people on a Thursday night if something comes up because I end up feeling really guilty if I do not meet my obligations and I just do not want to be pulled into anything. In the military, I had to do what everybody else said and I guess that maybe I am shying away from that, so I guess I want the best of both worlds, being a group but not to be stuck with it all the time.
Dr. Sylinda Gilchrist
(Reflecting “Wants”) So, you want some interaction or interaction with adults, but you do not want a required obligation.
Todd
Right, because for a time there, I was getting involved with the church and they were calling like twice a week and it was like this—it would stress me out because I felt obligated and I just do not want to take any time away from school or my son, and that is the most important to me.
Dr. Sylinda Gilchrist
(Clarifying “Wants”) OK, so we are going to look for maybe activities or look for something that will allow you to interact with other adults and increase your social circle, but no time restraint, no time obligation.
Todd
Yes, that would be the ultimate because like I said that I end up just severing ties if it becomes too overwhelming and I do not want to have that stress either. So, I would like to have some kind of an adult interaction that I am not—I do not feel required to attend.
Dr. Sylinda Gilchrist
(Asking Client to Evaluate Current Choices) So, what are you doing to get that adult interaction?
Todd
Well, I am busy in school right now and my son has a lot of school projects.
Dr. Sylinda Gilchrist
Outside of school?
Todd
Well, I guess if I am outside the school, I am pretty much focused on my son and doing stuff with him right now.
Dr. Sylinda Gilchrist
(Pushing Client to Evaluate) You kind of mentioned before that you are a cave dweller. What does that mean?
Todd
I guess I really do not go out unless I have to go to somewhere like to the store, the school or anything like that. I guess I am either inside unless I am going to the gym or something like that. I do not really much get out.
Dr. Sylinda Gilchrist
(Stressing Client’s Current Choices) So, you are kind of choosing to kind of stay in your cave?
Todd
Well, it is not a choice. I do not have anything else to do. I am not making that choice. It is just there is nothing else out there.
Dr. Sylinda Gilchrist
(Challenging Client to Evaluate Choices) But, if standing in your cave is that getting you what you want with increasing your friends?
Todd
No, I guess not. I guess I am really not creating opportunities to meet people.
Dr. Sylinda Gilchrist
(Focus on New Choices—”Doing”) So we really have to kind of possibly look at other ways to develop more of a support circle for you.
Todd
Yes, that would be good as long as—like I said, I am very—I guess paranoid about getting pulled into something and being stuck. I just do not—I have to go to school three nights a week and I do not want to have the other four nights of the week—
Dr. Sylinda Gilchrist
(Encouraging Finding New Ways of Doing) Obligated to something—so what is some ways you think you could go and meet people or some activities you could try, some groups, military groups, single-parent activities, church groups, are there some activities out there or places you could investigate?
Todd
I guess I could probably do a web search for local kind of things. I know you could probably just type in Virginia Beach activities or something and I could probably find all kinds of stuff. I could look into that. I mean, there might be some single-parent type groups or something like that. I do not know. I never thought of that before.
Dr. Sylinda Gilchrist
(Reflecting/Reinforcing Choices) OK, so you can go on the Internet and search for some activities in this area. Would it have to be an activity involving your son?
Todd
No, I mean, we do things together, but—the adults—does not have to involve him.
Dr. Sylinda Gilchrist
(Reflecting/Reinforcing Possible Choices) OK, so one plan we can do: We can actually go or you could go search the internet and look for activities that—or clubs that you may be interested in that will help you increase your social circle and introduce you to other people. (Challenging To Find More Choices) Are there other things that you could possibly do?
Todd
Well, there is a recreation center down the street that my son and I used to go to in the summer, and I remember there is all kind of fliers and pamphlets and all kinds of stuff there with activities. And, I never thought of that before I have seen them. I mean, they are everywhere and there is a lot of interesting activities that I did not even consider before. That might be an avenue to take and that is a great idea.
Dr. Sylinda Gilchrist
(Reinforcing New Choices) And so, now we have two activities that we can really do to kind of increase your social circle. We can actually search the internet as well as go to the community center and see what fliers and activities are available for people living in your area.
Todd
Yes ma’am, that sounds like a great idea.
Dr. Sylinda Gilchrist
(Reinforcing Getting Needs Met) OK, and so hopefully, we can move you out and actually allow you to be happy and content again.
Todd
Not living in the cave anymore.
Dr. Sylinda Gilchrist
Not live in the cave anymore.
Todd
Yes ma’am, it sounds good.
Dr. Sylinda Gilchrist
Well, thank you for coming in.
Todd
Thank you Doctor, I appreciate your help.
Dr. Sylinda Gilchrist
You are welcome.
Dr. Ed Neukrug
Well, that was excellent. I was really impressed with how you worked with Todd. As I was watching your work with Todd, I was noticing that how important it was for you to build a relationship with him and that you were using a lot of empathy and good listening skills. I guess I was thinking in a way that is kind of similar to Vassar’s notion of commitment to your client. You really want to connect with your client and feel a sense of commitment to him. Was that something your thoughts about what was going on?
Dr. Sylinda Gilchrist
Yes, and I think it is important for you to connect and have the client understand that there is really a partnership, it is a collaborative process that we are working together to help him solve his own issues and really take control over his life so that he can get what he wants out of life and really develop that world that he is seeking to obtain.
Dr. Ed Neukrug
In reality therapy, and as now called on choice theory, one other things that they talk about is, is he getting his needs in that, and I think specifically to talk about needs and love and belonging, power, freedom, fun and survival. And, I guess I was thinking that that is what you were thinking as you were working with him, is that true?
Dr. Sylinda Gilchrist
Yes, and I think in the military provided a way for him to get all his needs met. He had the power with the job and his friends and social system in the military allowed his loving belonging to all of those needs to get met, and then, once he retired and was placed back into the civilian world, he had to find another way to get those needs to meet. And so, for 20 years, the military kind of provided a end-all, it was a very tight system that he really did not have to do much because everything was already there for him. And so, now he is transitioning into the civilian world where he has to find a way to meet his needs of power as well as belonging with and finding new friends and connecting to the community. So, I think that is really the struggle that he is having, how do you get the needs met in a new environment.
Dr. Ed Neukrug
Right, so then I saw you working with the WDEP system and it has to do with what does he want to get in terms of getting his needs met. What is he doing and how does he evaluate what he is doing and then developing a plan, is that right?
Dr. Sylinda Gilchrist
And that is pretty much what we did, and you know, I asked him what does he want, and he really wanted to connect and be happy and I think the end to that happiness was having social interactions with adults and friends and feel like connected again to the community. And then, we kind of went what are you doing, and he said he was a cave dweller, so he really was not doing what he needed to do to get that need met. And we kind of evaluated this, so being a cave dweller is that actually giving you, meeting you, and helping you meet your needs. And then, we developed a plan and that plan was to go on to the Internet and begin to look for social activities that will allow him to kind of increase his social interaction. So, that is kind of how you take a client through that process and help them to figure out what they want, evaluate, and see what they are doing, evaluate it and then develop a plan.
Dr. Ed Neukrug
And you did a wonderful job at that and I guess I am wondering what happens next? Next time he comes to see you, what does this leads to?
Dr. Sylinda Gilchrist
Well, we come back and we really evaluate the plan. Did he find activities on the internet, did he find activities going to the community center, and then we begin to go to the next steps. So, we completed the first part, what would be the next step of the plan. So, it is constantly evaluating the plan to hopefully get him to his end-goal. So, once we have activities selected, then the next step maybe participating some of those activities, and then hopefully, he will begin to increase his social network and begin to get his needs met.
Dr. Ed Neukrug
What would happen if he came back the next time and did not follow through on some of those suggestions that were made?
Dr. Sylinda Gilchrist
And then, you have to evaluate your behavior again. Why did you not, so do you really want to increase your social circle, maybe that is not really what you want.
Dr. Ed Neukrug
So, is that the process of showing that you are committed to him. You are going to stick with him and re-evaluate maybe what he wants.
Dr. Sylinda Gilchrist
Yes and choosing, this is a choice. Are you really committed to the change? You are choosing. You have the ability to choose your behavior. So by not following the plan, are you choosing to stay isolated, and that is a choice, so, really deciding; you choose and determine your destiny.
Dr. Ed Neukrug
I see, so really helping him see that he is making those choices.
Dr. Sylinda Gilchrist
Right, and he is in charge and control of his own behavior.
Dr. Ed Neukrug
It was excellent work. Thank you so much.
Dr. Sylinda Gilchrist
Thank you.

Unit 5 Discussion 1
Behavioral, Cognitive, or Reality Theory Counseling
For this discussion, you will create a scenario in which you are counseling a client using one of the theories from this unit. The details of the counseling session scenario are up to you; however, note that your client must come from a diverse social or cultural background. Write the script of your hypothetical counseling session. The script must have at least 20 responses—10 from the client and 10 from you as the counselor. Your responses should align with the philosophy and goals of your chosen theory and with the multicultural contributions or strengths of that theory. Use your Theories of Counseling Chart to be sure that your interventions align with your theory’s key concepts, theory of change, interventions, and its vision of client and counselor roles. You will present the following:
• A brief introduction to the client scenario.
• Your script, which illustrates your chosen theory.
• A discussion of how concepts you applied in the script related to the theory’s key concepts, theory of change, interventions, and vision of client and counselor roles.
• A discussion of how your client’s social or cultural background affected your application of your chosen approach.
Upload your Theories of Counseling Chart as an attachment to your post. It should be complete through Reality Therapy.
This discussion response should be a minimum of 500 words and maximum of 700 words.

Notes for the writer: Please make part one of the assignment 500 words and the rest pages will be for completing the attachment charts from Psychoanalytic to Reality Therapy. 6 pages needed. Add references as needed. Thanks.

NOTE: For the writer how to read my text book online
Sign-in to Chegg.com with my email address which is ebassey55@yahoo.com
Password will be capital Kilio@2449. Note that only the K is capital and the rest are low key. If you have any problem please give me a call at 972-803-3455 (Home Phone number).Thanks.
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Description

Pragmatic Approaches and Multicultural Considerations

Pragmatic Approaches and Multicultural Considerations

ANSWER


Introduction
In Units 5 and 6, you will focus on the pragmatic theories, which include cognitive therapy, behavioral therapy, reality therapy, cognitive behavior therapy, and rational emotive behavior therapy.
Behavioral Therapy
Behavior therapy emerged in the 1950s, and as with other theories, departed from the beliefs of psychoanalytic theory. The principle theorists were Skinner (operant conditioning), Pavlov (classical conditioning), and Bandura (social learning theory). Generally speaking, the behavioral therapies were based in a scientific viewpoint and incorporated very structured means of assessment and treatment. Behavior therapies focus on objective and measurable behaviors and incorporate a systematic method of treatment. The focus is on the current behaviors rather than the historical causes of the behavior. The goals include changing undesired behaviors, promoting personal choice, and encourage new learning conditions. With the structured nature of the behavioral therapies there are many interventions such as applied behavior analysis, systematic desensitization, relaxation training, in vivo exposure, social skills training, and eye movement desensitization and reprocessing (EMDR) (Corey , 2013).

Cognitive Therapy
Cognitive therapy (CT) was created by Aaron Beck during the late 1960s and paralleled Ellis’s creation of rational emotive behavior therapy (Unit 6). Cognitive therapy shares some concepts of behavior therapy, but it adds a new dimension of focus: cognitions. In his work as a psychoanalyst, Beck became interested in a process his clients engaged in, which he eventually termed automatic thoughts. These thoughts seem to be triggered by certain stimuli and then would elicit emotional responses. This was the beginning of his eventual creation of the notion of cognitive distortions. Cognitive distortions are “logical errors” people make about their objective reality that skew that reality toward negativity. Cognitive therapy had a significant impact in the emergence of cognitive-behavioral therapy (Corey, 2013).
Reality Therapy
William Glasser developed reality therapy, which is a theoretical approach based on choice theory. Its key concepts are that all we do is behave and all of our behaviors are our choice. Reality therapy is based on the concept that human beings are motivated by five innate needs: self-preservation, love and belonging, achievement, enjoyment, and freedom. The way in which we get these needs met, or not met, affects our total behavior. Glasser’s theory is based in the present and holds the client accountable. There is also the belief that all problems are relationship problems (1984).
Counselors use various techniques when working with clients, such as teaching, confronting, and role-playing. The reality therapist believes that clients often make choices that are harmful to them and that change occurs only when the client decides to change (Glasser, 1984).
Multicultural Considerations in Counseling
Multiculturalism and diversity in the United States is evolving at a rapid pace. As a result, cultural competency is essential to being an effective counselor. As a counselor, educator, or any other type of human service worker, it is very important to be aware of personal cultural values as well as to develop and maintain a sensitivity to individuals of different cultures. In the course of counseling practice, many counselors will provide services to clients who have a wide variety of diverse backgrounds. This diversity encompasses age, culture, disability, educational level, religion, sexual orientation, race, gender, and socioeconomic status. Understanding the major characteristics of culture and diversity has significance as a general practice (Corey, 2013).
The American Counseling Association (ACA) Code of Ethics (2014) reflects the reality of a rapidly growing, diverse population by integrating multicultural practices and competencies. In addition to its code of ethics for counselors, the ACA has a division that focuses specifically on issues of multiculturalism and diversity. The Association for Multicultural Counseling and Development (AMCD) has developed a mission statement to provide “global leadership, research, training, and development of multicultural counseling professionals with a focus on racial and ethnic issues” (2009, home page). This is accomplished through:
• Enhancing the awareness of human development and counseling needs of racial and ethnically diverse groups.
• Sensitizing professionals to racial and ethnic differences.
• Advancing the knowledge base of multicultural counseling through theory development and research.
• Consulting with others to advance multicultural issues across the counseling profession.
In addition to the mission statement, multicultural counseling competencies have been developed to ensure that professionals are practicing effective diversity counseling. By taking an active role in promoting these competencies and educating each other on diversity issues, we can be more sensitive to the needs of all clients. In addition, understanding the contributions and limitations of theoretical approaches to multiculturalism will enhance one’s developing competency.
References
American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.) [DVD included]. Pacific Grove, CA: Brooks/Cole.
Glasser, W. (1984). Control theory. New York, NY: Harper & Row.
Association for Multicultural Counseling and Development. (2013). Association for Multicultural Counseling and Development. 

Pragmatic Approaches and Multicultural Considerations

• Objectives
To successfully complete this learning unit, you will be expected to:
1. Create a counseling session scenario that applies behavioral, cognitive, or reality theories.
2. Analyze the effects of social or cultural diversity on psychotherapeutic approaches.
3. Post the Theories of Counseling Chart.
• Accordion Toolbar

Learning Activities Studies
Readings
Use your Theory and Practice in Counseling and Psychotherapy text and the library to read the following:
• Chapter 9, “Behavior Therapy,” pages 244–286.
• Chapter 10, “Cognitive Behavior Therapy,” pages 287–332.
• Chapter 11, “Reality Therapy,” pages 333–359.
• Cameron’s 2009 article “Regret, Choice Theory and Reality Therapy” from the International Journal of Reality Therapy, volume 28, issue 2, pages 40–42.
Review Material
• Near the end of each chapter in the Corey text, there is a section that discusses the contributions and limitations of the theory from a multicultural perspective. Choose the three theories that you relate to the most and review their multicultural perspectives.
• Review Table 15.7, starting on page 488 in the Corey text, that lists the contributions and limitations of each theory to multicultural counseling.
Multimedia
Use The Case of Stan DVD that accompanied your Corey text to complete the following:
• Watch the video’s Behavior Therapy, Cognitive Therapy, and Reality Therapy segments. Watch the introduction to the therapy, simulated counseling session, and the commentary on the approach for all theories.
Optional Readings
The following articles are recommended but not required for this unit:
• Graham, M. A., Sauerheber, J. D., & Britzman, M. J. (2013). Choice theory and family counseling: A pragmatic, culturally sensitive approach. Family Journal, 21(1), 1–5.
• Prenzlau, S. (2006). Using reality therapy to reduce PTSD-related symptoms. International Journal of Reality Therapy, 25(2), 23–29.
• Wubbolding, R. E., & Brickell, J. (2009). Perception: The orphaned component of choice theory. International Journal of Reality Therapy, 28(2), 50–54.
• Bandura, A., & Locke, E. A. (2003). Negative self-efficacy and goal effects revisited. Journal of Applied Psychology, 88(1), 87–99.
• Dozois, D. J. A., Bieling, P. J., Patelis-Siotis, I., Hoar, L., Chudzik, S., McCabe, K., & Westra, H. A. (2009). Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(6), 1078–1088.
• Hopko, D. R., Bell, J. L., Armento, M. E. A., Hunt, M. K., & Lejuez, C. W. (2005). Behavior therapy for depressed cancer patients in primary care. Psychotherapy: Theory, Research, Practice, Training, 42(2), 236–243.

Study 2
Theories of Counseling Chart
Complete the Theories of Counseling Chart for the theories covered in this unit. Add notes about key concepts, notions of what changes and why, interventions the counselor may employ, and roles of the counselor and client. Explore the Web links for each theory to see the activities of its contemporary practitioners. Add references for your favorite scholarly resources providing evidence for its efficacy.
You will work on this chart throughout the course and post it in Unit 5 and in Unit 10 as discussion posts. You will be able to refer to this chart throughout your classes, into your fieldwork, and later as you study for licensure exams.
Refer to the Web Sites and Readings for Theories of Psychotherapy document to assist you in completing the Theories Chart.
Multimedia
Before updating the Theories of Counseling Chart, view the two Theories in Action multimedia presentations on Behavior Therapy and Reality Therapy to inform your work.
Theories in Action
Behavior Therapy
Tim Seibles
Developed during the first half of the 20th century, behavior therapy is based on three types of paradigms: operant conditioning, classical conditioning and modeling. Originally viewed as a scientific reductionistic and mostly sterile approach to counseling, today’s behavior therapist realizes the importance of having a strong therapeutic relationship.
For instance, it is now usual for the modern-day therapist to use empathy and develop a collaborative working relationship with the client. This allows the therapist to build trust and correctly identify targeted behaviors the client would like to change. After behaviors are identified, goals can be established and techniques chosen. Today’s behavior therapists usually have a wide range of techniques to choose from with some of the more popular ones being modeling, such as when clients observe behaviors usually in the clinical setting, and later practice the behaviors in the office and on their own. Assertiveness training has been particularly used in this fashion. Operant conditioning techniques such as positively reinforcing targeted behaviors and extinguishing unwanted behaviors such as the use of sticker charts for children. Relaxation exercises such as learning how to progressively relax oneself in an effort to reduce anxiety or other unwanted feelings.
Systematic Desensitization, which is often used with anxiety disorders is the deliberate pairing of collaboratively chosen hierarchical aspects of the feared object with learned relaxation techniques, thus, slowly reducing the fear of response. Flooding and implosion techniques both involve the exposure to intensive amounts of fearful stimuli with the assumption being that prolonged the exposure will extinguish the fear of response. And, self-management techniques which are used when one wants to help clients learn various behavioral techniques and have them practice on their own.

Pragmatic Approaches and Multicultural Considerations

In the following role-play, Dr. Suzan Thompson works with Rayneer who is struggling with a panic disorder resulting from a recent car accident. Dr. Thompson will assist Rayneer in applying relaxation techniques to her anxiety about driving.
Dr. Suzan Thompson
Hi Rayneer, welcome back.
Rayneer
Hi Suzan, how are you?
Dr. Suzan Thompson
I am doing OK. So, how has the practicing been going with the relaxation techniques that we talked about last time?
Rayneer
Well, it was kind of hard at first. I just kept having my heart palpitations and the sweating, and then I put the hearts up around the house and every time I saw a heart, it helped to remember to do the breathing you taught me.
Dr. Suzan Thompson
(Reinforcing Client) What a great idea sort of that association. (Heart Association = Classical Conditioning)
Rayneer
I really needed it because if I did not see something outside of me, I just kept being involved in the feeling.
Dr. Suzan Thompson
Right, and so, that reminded you to bring up that relaxation that we talked about.
Rayneer
Yes.
Dr. Suzan Thompson
(Relaxation Paired with Hierarchy) Well, so, one of the things that we are going to do today is to talk about the different components of what has happened for you and use the relaxation along with sort of a hierarchy of events or situations that you might face. And eventually, what we will do is have you practice the relaxation along with each of the different pieces of it, does that make sense?
Rayneer
It does. And, that would be good because it has been really hard just getting in the passenger side of the car and somebody else had to drive me.
Dr. Suzan Thompson
(Showing Interest) I was wondering about that.
Rayneer
And, just getting in the car, it makes me very nervous and I start to sweat and tremble and feel a little shortness of breathe. And, I am really concerned that I would not be able to go back to work because I drive for a living. If I am not driving, then I cannot make do for my family.
Dr. Suzan Thompson
(Identify Short and Long-Term Goals) So, we really kind of have some short-term immediate kinds of things that you want to focus on, getting in the car even, and then maybe some longer term that would be getting you back to work. Is that—?
Rayneer
Yes.
Dr. Suzan Thompson
(Paraphrasing) OK, you said that you had some of the anxiety came up when you are even getting into the passenger side coming here.
Rayneer
Yes, I just felt like I was choking and I just had this loss of control that if I was in a car again, something else would happen. And, when this accident happen there was no—I did not have any passengers and I keep thinking if it happened again or what if there are passengers and somebody else was injured. So, it is very scary.
Dr. Suzan Thompson
(Identifying Component Parts of Anxiety) It sounds like it was. Well, if we had to kind of break things down because that is what you are telling me now of what is going on now and if we had to break things down into smaller pieces, let us look at what those pieces might be. And, I am going to write some things down so that we can kind of keep things straight.
So, one of the things that you are having a hard time with is that even getting into the passenger side, but maybe we can back up from there. So what, as you think about even getting into a car, what happens to your anxiety?
Rayneer
It goes up. Let us just say, just thinking about getting in the car, it goes up to—on a scale of one to 10—it goes to like a five. And, maybe a four, it is like it gets to a five when I get ready to get in the car, then I start the heart palpitations and I am sweating and I start to tremble a little bit and I just have that feeling of fear that I am going to lose control or something is going to happen.
Dr. Suzan Thompson
(Rating Fear Response) Even just—that is that thinking about it and I am glad that you would have them and put that scale to—we talked about that last time as an application here. So, thinking about getting into the car is about a four or five depending on—
Rayneer
I think it is probably—I just get so—to me, it is not just thinking about you getting in the car, so I guess thinking about it is a three, but actually getting in the car is probably a five.
Dr. Suzan Thompson
(Being Specific About Component Parts) OK, and, is that getting into the passenger side or the driver side?
Rayneer
Well, I am getting into the passenger side. I have been too afraid to get into the passenger side. So, the passenger side is definitely a five and I would—the driver side is higher.
Dr. Suzan Thompson
(Rating Fear Response) OK. So, where would you rate getting into the driver side?
Rayneer
It is definitely at least a seven.
Dr. Suzan Thompson
(Identifying Smaller Units) OK, and I am wondering if there is something in between there getting into the driver side or what surrounding that?
Rayneer
Opening the door, once I get into the driver side and then usually, then I kind of put my hands on the wheel and sometimes I will—then I start the car after I check the mirrors and put on my seatbelt and stuff.
Dr. Suzan Thompson
(Reinforcing Client) OK, so you are doing a great job of starting to break things down, that is exactly where we are headed with this. (Summarizing Component Parts) So, just so that I have it straight with just thinking about getting into the car even before you go anywhere, even before you leave the house is about a three, so that brings up some of the anxiety. And then, getting into the passenger side is a little bit higher, opening the door to the driver side is a little bit higher than that. But, not as high as to say getting into the driver side, and then putting your hands on the wheel kind of brings it up a little bit more, and then starting the car is a little bit more too.
Rayneer
Yes, it feels like it would be. I have not tried it yet because I have been too anxious about it.
Dr. Suzan Thompson
(Identifying Component Parts) And that makes sense. OK, so, starting the car and then if we take it one-step further, what would be another step from there?
Rayneer
I guess, maybe driving the car like a short distance or maybe in the driveway or something.
Dr. Suzan Thompson
Yes really short distance, a really short distance, so in the driveway, OK. (Identifying Component Parts) And then, what would be a next step from there that we could aim for?
Rayneer
I guess going around the block.
Dr. Suzan Thompson
(Rating Response) All right, and if you even thinking about that right now?
Rayneer
That feels like it is a nine. I start sweating all over again just thinking about driving and going around the block because I know there would be other cars out there and that really is scary for me.
Dr. Suzan Thompson
(Validating Client’s Feelings) And I see that in your face. So then, we have sort of a hierarchy of different pieces of getting back to driving that we can then apply the relaxation techniques. So, let us just do one right now just for practice and see how that goes, that first one that you have on the list just thinking about getting into a vehicle.
Rayneer
OK.
Dr. Suzan Thompson
(Applying Relaxation to Hierarchy) So, right now as you are thinking about getting into a vehicle, I see that you are kind of shaking. Remember the relaxation, talk me through the relaxation that you are aware of what we—
Rayneer
Trying to take a deep breath and holding it for the count of five and then breathing out again.
Dr. Suzan Thompson
OK, to do that—just independently, just be in that relaxed place. (Practicing in Session) Great, and now, as you are in that relaxed placed, just think about leaving your house and getting into a vehicle—passenger side—and go back to that relaxed—take a deep breath—and go back to that relaxed placed. And how was that? (Asking Client for Feedback)
Rayneer
The thinking that might getting in the car is kind of scary, but I know I could put a heart in the car, I have hearts on the car seat, so I know to breathe when I see them, like I have them in the house.
Dr. Suzan Thompson
(Validating Client) Great idea, as even right now as you think about getting into a car, you can kind of—where would that heart be?
Rayneer
Right now, I need to put it on the door or the window.
Dr. Suzan Thompson
I almost thought of putting a slap, a big huge heart on the car, but it is your image.
Rayneer
I feel better with a little one, just a little one.
Dr. Suzan Thompson
(Practicing in Session) So, let us go back to the deep breath, get to a relaxed place and as you are in that relaxed placed, think about just going out to the car, the heart is right on the car exactly where you put it. (Reinforcing Visual Image of Heart) Go keep relaxing. That is it. Go back to your relaxed place.
Rayneer
I feel more like I have to do it than I am relaxed about it.
Dr. Suzan Thompson
What do you mean?
Rayneer
Well, if I cannot drive again, then I would not be able to work again.
Dr. Suzan Thompson
(Encouraging Small Steps) We are just going to take it a little bit at a time. So right now, just it is that one piece of thinking about going out there, the rest of it will fade away from right now.
Rayneer
Neat trick. OK, that does feel a little better.
Dr. Suzan Thompson
(Rating Response) Before, when we first started talking about that, you rated it as a three, where is it right now?
Rayneer

Pragmatic Approaches and Multicultural Considerations

It is probably a 2.5.
Dr. Suzan Thompson
(Reinforcing Results) So, we brought it down a little bit. (Encouraging More Practice) What I am going to ask you to do then is to keep practicing that because the more you practice it just like you did at home, then the more you practice the relaxation and with the heart you are able to get to that place. (Encouraging Small Steps) It is the same thing with each one of these, so we are going to take it a little bit at a time and we will build from there.
Rayneer
Thank you. I appreciate your help.
Dr. Ed Neukrug
Suzan, that was great and I really appreciate your work with Rayneer. I particularly noticed how encouraging and how empathic and how warm you were with her.
Dr. Suzan Thompson
I know that for behavioral counseling, people have this impression that it is called and it is sterile, but any counseling, really, you have to work on the relationship and that rapport building and empathy and encouragement is a big part of any kind of counseling and it is particularly applicable to the behavioral.
Dr. Ed Neukrug
Right, it seems like when I have been doing with my post interviews with the different therapists during the role-plays that I think all of them have been saying that, that how important the relationship is with the client. Why did you choose the particular techniques that you chose with this client?
Dr. Suzan Thompson
Well, she came in with some problems with anxiety and there was a clear incident, something that was very specific that happened and that has led itself very readily to behavioral approach.
Dr. Ed Neukrug
And then, the idea of using relaxation techniques and systematic desensitization.
Dr. Suzan Thompson
It is very clear I think in terms of working with anxiety that is—it is just as so helpful to break down the different pieces because people seemed to tend to take the whole situation and the systematic desensitization really breaks things down into little parts that are much more manageable for people.
Dr. Ed Neukrug
I noticed that you really worked collaboratively with her and that you were really letting her take the lead in some cases, what are your thoughts on that?
Dr. Suzan Thompson
That has the investment of the client in the process. So, that again, it is like building the rapport, it is having a collaborative relationship I think that makes a big difference and the behavioral approach working.
Dr. Ed Neukrug
As you were building the hierarchy with her, I was thinking about the fact that many of these things on the hierarchy, she can only do outside of the office. And, I was wondering if you were going to physically go outside of the office with her or do you tend to stay in your office and have her do it?
Dr. Suzan Thompson
It really depends. It depends on a lot of different things. I start on the office and we start with thinking about the different situations, and it depends on what she might run into as a problem and then if she runs into it as a problem, then we figure out ways that either she can get help with it or she might need my help with it.
Dr. Ed Neukrug
So, let me see if I am hearing this right, if you are thinking that if she can maybe do this on her own that she can, but you are willing and able to go out there and be with her if she needs it.
Dr. Suzan Thompson
Yes, I am. Brain research these days says that we make no distinction between what we imagine and what we actually do, so to me that is an exciting piece to making this behavioral therapy work.
Dr. Ed Neukrug
Right, that is very interesting. I want to thank you so much for your expert work with Rayneer and I appreciate you being willing to share that with us today.
Dr. Suzan Thompson
Thanks.

Theories in Action
Reality Therapy and Choice Theory
Tim Seibles
Reality therapy postulates that there are five inborn needs: love and belonging, power, freedom, fun and survival; and proposes that every behavior we exhibit is an attempt to have these needs met. However, reality theory also suggest that we sometimes develop dysfunctional behaviors to meet our needs and those behaviors become the basis for how we perceive reality.
Reality therapy states that we continue to exhibit these behaviors in order to obtain what clients would consider to be their quality world. Throughout the counseling process, reality therapists believe that clients can be shown how they create their reality through the behaviors they choose, thus, the term choice theory.
For instance, a CEO who has not been much of his or her life striving for power at work may become depressed because he or she has developed a repertoire of behaviors to meet the need for power, but has neglected his or her need for love and belonging. Reality therapists often use the WDEP model to describe the counseling process.
W represents asking the client what he or she wants in an effort to create a quality world or a success identity. D stands for doing and is the point where the counselor asks the client what choices and behaviors he or she is currently making to obtain a quality world. E stands for helping the client evaluate what he or she has been doing to meet his or her needs into identifying new behaviors that would be more effective in obtaining a quality life for success identity. P stands for developing a plan for change. The therapeutic process involves creating a trusting environment, working collaboratively with the client as equal partners, and being committed to the client as they explore the change process.
In the following role-play, we will see Dr. Sylinda Gilchrist work with Todd, a 42-year-old male, who has been struggling with mild depression related to work and life transitions.
Dr. Sylinda Gilchrist
Hi Todd. What brings you here today?
Todd
Well, I have been feeling pretty stressed lately, maybe a little down, just noticed I am not pretty much not the same as I used to be. I just feel overwhelmed at times. I am not really motivated and that is pretty much it. I retire probably about two years ago and just do not have the same kind of level of go that I did before.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, you are feeling kind of down because you retired?
Todd
I do not think it is so much because I am retired. I do not know. I just think I do not feel motivated and it might be because I am not as focused as I was in the military, I always had something to do, I knew where I stood, I had responsibility, people depended on me, and those things have changed, that might have something to do with it. I do not know.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) OK, so you feel a little down because you retired recently from the military and you had more responsibilities and that your life has kind of transitioned to a change.
Todd
Yes, that is pretty much it. I mean, it might also be because I am really focused on being a single parent right now and school, and I noticed that if I am not doing that, I am really not doing anything else. But, when I was in the military, I had friends and I had a big support group and I always had something going on and it is just not that way anymore.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, it sounds like since you have retired, you lost a lot of your friends and that support system that you had and while you were in the military is now gone.
Todd
Yes ma’am I would think that that would have a lot to do with it. I am pretty much at cave dweller now. I do not much go out or anything like that. So, I do not have the—I had a good support group when I was in the military because I was always working, but since I got out, they are all transient. I really do not talk to or see anybody that I used to work with, so it is just pretty much me and my 11-year-old.
Dr. Sylinda Gilchrist
OK, so what would make you happy or feel connected again?
Todd
I do not know. I guess getting out and getting involved with other people, talking to them maybe. I just really do not know how to do that, I am not sure how to just go out. I know when my son was playing soccer, I did not feel as bad as I do now, and just because I was talking to the adults on the sidelines while he was out there playing. I had a pretty good group of friends then, but he has not played the last two season sort of drifted apart with me doing school and stuff like that.
Dr. Sylinda Gilchrist
(Reflection/Understanding Problem) So, it sounds like you felt better when you were involved in activities around adults or activities that involved your son that allowed you to communicate with other adults.
Todd
Yes, I mean, that was a benefit of going to the soccer. I mean, it does not really have to be with my son. I mean, that is always great, but I mean, just the adult interaction would be probably better than nothing. I am not really talking to anybody.
Dr. Sylinda Gilchrist
(Clarifying “Wants”) So, it sounds like that what you would like to have is more interactions with adults and develop more support mechanisms or support from other adults that you had when you were in the military.
Todd
Yes, that sounds like that would benefit me. I think it all started occurring to me when I like throughout my back and I realize that I do not have the option to be off or have a sick day. I am a full time parent now and I have to go to school, I cannot miss classes or exams or anything and it occurred to me. I do not have anybody in call to step in.
Dr. Sylinda Gilchrist
(Encouraging Client to Focus on Wants) OK, so what would you want? What would make you happy? What would support look like outside of the military?
Todd
Probably some kind of camaraderie, but I am really apprehensive about being obligated. I do not want to be in a position. I think that is what holds me back. I do not want to be in a position that I have to do anything. I want to be able to cancel out if I am going to meet people on a Thursday night if something comes up because I end up feeling really guilty if I do not meet my obligations and I just do not want to be pulled into anything. In the military, I had to do what everybody else said and I guess that maybe I am shying away from that, so I guess I want the best of both worlds, being a group but not to be stuck with it all the time.
Dr. Sylinda Gilchrist
(Reflecting “Wants”) So, you want some interaction or interaction with adults, but you do not want a required obligation.
Todd
Right, because for a time there, I was getting involved with the church and they were calling like twice a week and it was like this—it would stress me out because I felt obligated and I just do not want to take any time away from school or my son, and that is the most important to me.
Dr. Sylinda Gilchrist
(Clarifying “Wants”) OK, so we are going to look for maybe activities or look for something that will allow you to interact with other adults and increase your social circle, but no time restraint, no time obligation.
Todd
Yes, that would be the ultimate because like I said that I end up just severing ties if it becomes too overwhelming and I do not want to have that stress either. So, I would like to have some kind of an adult interaction that I am not—I do not feel required to attend.
Dr. Sylinda Gilchrist
(Asking Client to Evaluate Current Choices) So, what are you doing to get that adult interaction?
Todd
Well, I am busy in school right now and my son has a lot of school projects.
Dr. Sylinda Gilchrist
Outside of school?
Todd
Well, I guess if I am outside the school, I am pretty much focused on my son and doing stuff with him right now.
Dr. Sylinda Gilchrist
(Pushing Client to Evaluate) You kind of mentioned before that you are a cave dweller. What does that mean?
Todd
I guess I really do not go out unless I have to go to somewhere like to the store, the school or anything like that. I guess I am either inside unless I am going to the gym or something like that. I do not really much get out.
Dr. Sylinda Gilchrist
(Stressing Client’s Current Choices) So, you are kind of choosing to kind of stay in your cave?
Todd
Well, it is not a choice. I do not have anything else to do. I am not making that choice. It is just there is nothing else out there.
Dr. Sylinda Gilchrist
(Challenging Client to Evaluate Choices) But, if standing in your cave is that getting you what you want with increasing your friends?
Todd
No, I guess not. I guess I am really not creating opportunities to meet people.
Dr. Sylinda Gilchrist
(Focus on New Choices—”Doing”) So we really have to kind of possibly look at other ways to develop more of a support circle for you.
Todd
Yes, that would be good as long as—like I said, I am very—I guess paranoid about getting pulled into something and being stuck. I just do not—I have to go to school three nights a week and I do not want to have the other four nights of the week—
Dr. Sylinda Gilchrist
(Encouraging Finding New Ways of Doing) Obligated to something—so what is some ways you think you could go and meet people or some activities you could try, some groups, military groups, single-parent activities, church groups, are there some activities out there or places you could investigate?
Todd
I guess I could probably do a web search for local kind of things. I know you could probably just type in Virginia Beach activities or something and I could probably find all kinds of stuff. I could look into that. I mean, there might be some single-parent type groups or something like that. I do not know. I never thought of that before.
Dr. Sylinda Gilchrist
(Reflecting/Reinforcing Choices) OK, so you can go on the Internet and search for some activities in this area. Would it have to be an activity involving your son?
Todd
No, I mean, we do things together, but—the adults—does not have to involve him.
Dr. Sylinda Gilchrist
(Reflecting/Reinforcing Possible Choices) OK, so one plan we can do: We can actually go or you could go search the internet and look for activities that—or clubs that you may be interested in that will help you increase your social circle and introduce you to other people. (Challenging To Find More Choices) Are there other things that you could possibly do?
Todd
Well, there is a recreation center down the street that my son and I used to go to in the summer, and I remember there is all kind of fliers and pamphlets and all kinds of stuff there with activities. And, I never thought of that before I have seen them. I mean, they are everywhere and there is a lot of interesting activities that I did not even consider before. That might be an avenue to take and that is a great idea.
Dr. Sylinda Gilchrist
(Reinforcing New Choices) And so, now we have two activities that we can really do to kind of increase your social circle. We can actually search the internet as well as go to the community center and see what fliers and activities are available for people living in your area.
Todd
Yes ma’am, that sounds like a great idea.
Dr. Sylinda Gilchrist
(Reinforcing Getting Needs Met) OK, and so hopefully, we can move you out and actually allow you to be happy and content again.
Todd
Not living in the cave anymore.
Dr. Sylinda Gilchrist
Not live in the cave anymore.
Todd
Yes ma’am, it sounds good.
Dr. Sylinda Gilchrist
Well, thank you for coming in.
Todd
Thank you Doctor, I appreciate your help.
Dr. Sylinda Gilchrist
You are welcome.
Dr. Ed Neukrug
Well, that was excellent. I was really impressed with how you worked with Todd. As I was watching your work with Todd, I was noticing that how important it was for you to build a relationship with him and that you were using a lot of empathy and good listening skills. I guess I was thinking in a way that is kind of similar to Vassar’s notion of commitment to your client. You really want to connect with your client and feel a sense of commitment to him. Was that something your thoughts about what was going on?
Dr. Sylinda Gilchrist
Yes, and I think it is important for you to connect and have the client understand that there is really a partnership, it is a collaborative process that we are working together to help him solve his own issues and really take control over his life so that he can get what he wants out of life and really develop that world that he is seeking to obtain.
Dr. Ed Neukrug
In reality therapy, and as now called on choice theory, one other things that they talk about is, is he getting his needs in that, and I think specifically to talk about needs and love and belonging, power, freedom, fun and survival. And, I guess I was thinking that that is what you were thinking as you were working with him, is that true?
Dr. Sylinda Gilchrist
Yes, and I think in the military provided a way for him to get all his needs met. He had the power with the job and his friends and social system in the military allowed his loving belonging to all of those needs to get met, and then, once he retired and was placed back into the civilian world, he had to find another way to get those needs to meet. And so, for 20 years, the military kind of provided a end-all, it was a very tight system that he really did not have to do much because everything was already there for him. And so, now he is transitioning into the civilian world where he has to find a way to meet his needs of power as well as belonging with and finding new friends and connecting to the community. So, I think that is really the struggle that he is having, how do you get the needs met in a new environment.
Dr. Ed Neukrug
Right, so then I saw you working with the WDEP system and it has to do with what does he want to get in terms of getting his needs met. What is he doing and how does he evaluate what he is doing and then developing a plan, is that right?
Dr. Sylinda Gilchrist
And that is pretty much what we did, and you know, I asked him what does he want, and he really wanted to connect and be happy and I think the end to that happiness was having social interactions with adults and friends and feel like connected again to the community. And then, we kind of went what are you doing, and he said he was a cave dweller, so he really was not doing what he needed to do to get that need met. And we kind of evaluated this, so being a cave dweller is that actually giving you, meeting you, and helping you meet your needs. And then, we developed a plan and that plan was to go on to the Internet and begin to look for social activities that will allow him to kind of increase his social interaction. So, that is kind of how you take a client through that process and help them to figure out what they want, evaluate, and see what they are doing, evaluate it and then develop a plan.
Dr. Ed Neukrug
And you did a wonderful job at that and I guess I am wondering what happens next? Next time he comes to see you, what does this leads to?
Dr. Sylinda Gilchrist
Well, we come back and we really evaluate the plan. Did he find activities on the internet, did he find activities going to the community center, and then we begin to go to the next steps. So, we completed the first part, what would be the next step of the plan. So, it is constantly evaluating the plan to hopefully get him to his end-goal. So, once we have activities selected, then the next step maybe participating some of those activities, and then hopefully, he will begin to increase his social network and begin to get his needs met.
Dr. Ed Neukrug
What would happen if he came back the next time and did not follow through on some of those suggestions that were made?
Dr. Sylinda Gilchrist
And then, you have to evaluate your behavior again. Why did you not, so do you really want to increase your social circle, maybe that is not really what you want.
Dr. Ed Neukrug
So, is that the process of showing that you are committed to him. You are going to stick with him and re-evaluate maybe what he wants.
Dr. Sylinda Gilchrist
Yes and choosing, this is a choice. Are you really committed to the change? You are choosing. You have the ability to choose your behavior. So by not following the plan, are you choosing to stay isolated, and that is a choice, so, really deciding; you choose and determine your destiny.
Dr. Ed Neukrug
I see, so really helping him see that he is making those choices.
Dr. Sylinda Gilchrist
Right, and he is in charge and control of his own behavior.
Dr. Ed Neukrug
It was excellent work. Thank you so much.
Dr. Sylinda Gilchrist
Thank you.

Unit 5 Discussion 1
Behavioral, Cognitive, or Reality Theory Counseling
For this discussion, you will create a scenario in which you are counseling a client using one of the theories from this unit. The details of the counseling session scenario are up to you; however, note that your client must come from a diverse social or cultural background. Write the script of your hypothetical counseling session. The script must have at least 20 responses—10 from the client and 10 from you as the counselor. Your responses should align with the philosophy and goals of your chosen theory and with the multicultural contributions or strengths of that theory. Use your Theories of Counseling Chart to be sure that your interventions align with your theory’s key concepts, theory of change, interventions, and its vision of client and counselor roles. You will present the following:
• A brief introduction to the client scenario.
• Your script, which illustrates your chosen theory.
• A discussion of how concepts you applied in the script related to the theory’s key concepts, theory of change, interventions, and vision of client and counselor roles.
• A discussion of how your client’s social or cultural background affected your application of your chosen approach.
Upload your Theories of Counseling Chart as an attachment to your post. It should be complete through Reality Therapy.
This discussion response should be a minimum of 500 words and maximum of 700 words.

Notes for the writer: Please make part one of the assignment 500 words and the rest pages will be for completing the attachment charts from Psychoanalytic to Reality Therapy. 6 pages needed. Add references as needed. Thanks.

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