Download Week 14 Lecture - PSY 310-1

Using a Psychological Model
and Counseling Skills in Sport
Injury Rehabilitation
WEEK 14: 4/06/15 – 4/10/15
PSYCHOLOGY 310:
SPORT & INJURY PSYCHOLOGY
UNIVERSITY OF MARY
INSTRUCTOR:
DR. THERESA MAGELKY
Introduction
 Chapter 12 in the Arvinen-Barrow text –
demonstrates the usefulness of using a
psychological model and counseling skills in sport
injury rehabilitation
 Working alliance/therapeutic relationship
 The concept of “relationship” refers to the
therapeutic element in counseling or therapy in
which there is an unconditional, non-judgemental
and congruently empathic respect for the athlete and
these process that occurs in the space in between the
content of what is being verbally articulated and
what is being experienced by the athlete internally
Introduction
 “Counseling” is an activity that takes place when
someone who is troubled invites and allows another
person to enter into a particular kind of relationship
with them (a therapeutic relationship)
 Counseling/therapy involves gaining a depth of
understanding of issues such as personality
characteristics, emotional reactions, coping
mechanisms, past behaviors impacting current
behaviors, and thinking patterns
 Recognizing clinical features within an athlete
presentation including anxiety, depression, and
posttraumatic stress disorder (PTSD)
Introduction
 3 Primary Models within counseling 
Psychodynamic, cognitive behavioral, humanistic
 A counselor’s work will often be underpinned by one
of these three approaches
 However, many counselors use an integrative
approach in which several models are integrated to
form one theory (e.g., combining psychodynamic and
cognitive behavioral approaches)
Primary Theoretical Approaches
 Psychoanalytic/psychodynamic approach
 Cognitive behavioral approach
 Humanistic approach
 Integrative approach
Psychoanalytic/Psychodynamic Approach
 Psychodynamic Model / Psychoanalysis –
developmental stage approach examining unconscious
processes and bringing to light past experiences that
impact the present; theory of the mind or personality
that investigates unconscious processes; a method of
treatment
 Developed by Sigmund Freud – focus on
development of personality and of consequences of
what Freud regarded as abnormal development
 Emphasis on the unconscious – the notion that
unconscious motivations and needs have a role in
determining behavior
Psychoanalytic/Psychodynamic Approach (cont.)
 Freud’s theory is divided into 3 main parts:
1.
Description of the mind or psyche
2.
Description of the development of the psyche
3.
Description of the way in which the psyche defends itself
 3 Levels of Unconsciousness:
1.
Conscious – everything we are aware of
2. Pre-conscious – the area of the mind containing thoughts
and ideas which are available to recall but are currently ‘at the
back of one’s mind’
3. Unconscious – Freud saw the unconscious as holding all the
early thoughts and feelings that might cause anxiety, conflict,
or pain, and which are the motivating factors that drive
behavior
Psychoanalytic/Psychodynamic Approach (cont.)
 Freud’s 3 Aspects of Self:
 Id – functions at an unconscious level, driving primitive needs
 Ego – controls the Id
 Superego – brings a moral sense to behavior
 Freud’s complex view of the ‘inner self’ describes the
ego as battling against the id and the superego
Psychoanalytic/Psychodynamic Approach (cont.)
 In Freud’s stages of psychosexual development, various
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crises are resolved at each stage, leading to a healthy or
unhealthy personality
If these crises get “stuck” at a specific stage, they will be
apparent and manifest in adult behavior
The concept of anxiety is central to Freud’s theory – when
anxiety cannot be dealt with by realistic methods that are
socially acceptable, the ego calls on various defense
mechanisms to release the resultant build-up of tensions
Defense mechanisms – e.g., denial, repression, projection,
regression – used to deal with conflicts between the expression
and inhibition of desires and needs
Defense mechanisms defy, alter, or falsify reality; work
unconsciously; are not immediately obvious to ourselves or
other people
Psychoanalytic/Psychodynamic Approach (cont.)
Freud’s Stages of Psychosexual Development
1. Oral Stage (birth to 12-18 months) – child is focused
on oral pleasures (sucking)
2. Anal Stage (12-18 months to 3 years) – pleasure is on
eliminating and retaining feces, learning control and
stimulation
3. Phallic Stage (3 to 6 years) – pleasure zone becomes
the genitals; Oedipus complex develops (boys develop
unconscious desires for their mother)
4. Latency Stage (7 to 12 years) – sexual urges remain
repressed; children interact mostly with same-sex peers
5. Genital Stage (12 to 18 years) – primary focus of
pleasure is genitals and sexual urges are awakened
Psychoanalytic/Psychodynamic Approach (cont.)
 Working from a psychoanalytic approach involves
working with unconscious drives through free
association and dream work, when the analyst
interprets what is being said to make sense of it to the
athlete
 Transference – refers to the way athletes relate to us
based on experiences with those who cared for them in
their formative years
 Countertransference – can be useful in learning
about how athletes relate to others but the practitioner
must be sufficiently skilled and self-aware to, sometimes
painfully, recognize some feelings within a therapeutic
alliance do not belong to the athlete but to the
practitioner’s own unresolved difficulties
Cognitive Behavioral Approach
 Cognitive behavioral therapy – concentrates on
the way that thoughts and schemas impact emotion
and behavior
 Cognitive behavioral approach consists of both
behavior (learning) and cognition
 Within behavioral approach, the focus is placed
directly on the athlete’s inappropriate behavior and
the associated contingencies reinforcing this
behavior
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Behavioral change is central within behavioral therapy, with an
emphasis on targeting undesirable behavior, adapting the
athlete to promote appropriate behavioral change
Cognitive Behavioral Approach (cont.)
 Ivan Pavlov – most well-known behavioral
psychologist
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Known for the concept of classical conditioning
Conditioned response – Pavlov conditioned dogs to salivate at
the sound of a bell they had learned to associate with food
 Watson – contended that conditioning could also be
reversed through unconditioning
 Thorndike – Law of Effect – if a response to a
specific stimulus is followed by a reward the bond
between the stimulus and response will be strengthened
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If the response is followed by a negative outcome, the bond will be
weakened
Behavior, therefore, is dependent upon its consequences, which may
either reward or punish
Cognitive Behavioral Approach (cont.)
 Skinner – further developed Thorndike’s law of effect to suggest
that operant conditioning reinforces reward or punishment and
the principle of reinforcement is important to both behavioral change
and maintenance of appropriate behavior
 Ellis & Beck – proposed that cognitions (thoughts, attitudes,
beliefs) played an important role in emotional and behavioral
consequences or outcomes
 Ellis – rational emotive behavior therapy – uses the A-B-C model
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A – Activating event
B – Belief
C – Emotional & behavioral consequences
 Emotional difficulties are consequence of distorted thinking and
problems occur when people’s interpretation of situations and events
around them is excessively biased from the reality of those situations
or evens
 More rational (realistic) belief statements allow a person to cope with
relationship difficulties in a more constructive and balanced fashion
Cognitive Behavioral Approach (cont.)
 According to Beck, the cognitive behavioral approach
concentrates on the stimulus, the cognitions and
emotions, and behavioral outcome
 Key feature of cognitive behavioral approach according
to Beck – its problem-solving delivery style, with
change in focus from interpretive in the psychoanalytic
model to working collaboratively with clients, a respect
for scientific values, and close attention to the cognitive
processes through which people monitor, control, and
mediate their behavior
Cognitive Behavioral Approach (cont.)
 Working with athletes using a cognitive behavioral
therapeutic approach often involves establishing
rapport and building the therapeutic alliance,
explaining rationale for treatment, assessing the
problem, setting goals and targets primarily for
cognitive and behavioral change and monitoring
progress
 Methods for executing cognitive behavioral approach
– challenging irrational belief, reframing issues using
cognitive restructuring techniques, scaling feelings, in
vivo exposure, homework assignments
Humanistic Approach
 Humanistic Approach – highlights phenomenological
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issues and self-actualizing
Carl Rogers – proposed that behavior is typically an attempt
by humans to meet their own needs as they perceive them
Emphasis of humanistic approach to counseling is on the
athlete’s perceptions as determinants of their actions
Rogers viewed individuals as functioning as an organized
whole
People who are self-actualizing are fully functioning
individuals who are open to new experiences and trust their
feelings rather than being threatened by them
Self-actualization is seen as the fundamental motivation
and underpins the notion that athletes have the necessary
resources for dealing with their own problems effectively
Humanistic Approach (cont.)
 Working with athletes using a humanistic approach
involves the ‘core conditions’ of empathy,
unconditional positive regard, and congruence
 The core conditions allow a therapeutic relationship
of trust and non-judgment to develop, within which
the process of work between athlete and practitioner
allows the space for self-actualization to be realized
Integrative Approach
 Integrative Approach – examines the way that past
and present collide in thought, emotion, and behavior
 Integrating the 3 primary models (psychoanalytic,
cognitive behavioral, & humanistic) is suggested by some
and is appealing because it allows work with both
presenting issues and past experiences which
impact current mechanisms of coping and behavior, and
to do so within a relationship or ‘working alliance’ that is
conducive to positive change
 Research indicates that, no matter what the theoretical
approach, the usefulness of therapeutic interventions
comes from the quality of the relationship between client
and practitioner
Key Skills in Counseling/Therapy
 Attending skills
 Observing
 Active Listening
 Reflective skills
 Probing skills
 Immediacy
Attending Skills
 Attending skills – refers to the set of skills the
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practitioner adopts to ensure an effective professional
relationship
Attending acts as a basis for listening to and observing
athletes
The means by which the practitioner communicates “nonverbally” that they are with the athlete and interested in
them
Attending communicates acceptance and congruence
Attending to athletes allows verbal and non-verbal
messages
Involves an open, upright and relaxed posture, and good
eye contact
Observing
 Observing – the set of skills the practitioner uses to
better understand the athlete’s non-verbal behavior
and how this behavior correlates, or not, with the
athlete’s verbal expression
 Athletes communicate non-verbally through their
dress, their tone of voice, facial expressions, gestures,
postures, etc, which inform practitioner of
inconsistencies between what athletes verbalize and
their behavior
 Observations offer opportunities for the practitioner
and athlete to further explore inconsistencies for
better understanding of presenting issues
Active Listening
 Active listening – listening with explicit purpose, using
silence appropriately and communicating that you have
listened and understood
 About listening to, receiving, and understanding messages
while clarifying and organizing information that is heard,
checking what to respond to and asking for clarity on what
is unclear
 Enables the practitioner to gain empathic understanding
of the athlete’s situation from their perspective
 Provides useful insight into both what the athlete thinks
and feels and the process of how these thoughts and
feelings arise
Reflective Skills
 Reflective skills – include restating, paraphrasing, and
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summarizing
Reflective skills offer a way for the practitioner to construct
how they communicate their empathic understanding
Help in building trust and empathy; helps athletes feel they
have been listened to, appreciated, and understood
Restating – involves repeating single key words or phrases
back to the athlete to emphasize a point or an emotion
Paraphrasing – lets athlete know that the practitioner
understands what they are saying by communicating back to
them, in the practitioner’s own words, the main message
expressed by the athlete
Summarizing – organizes the athlete’s content by bringing
together the important aspects of their story
Probing Skills
 Probing skills – questioning skills – sometimes
required to question or gently challenge what
athletes express
 Probing offers opportunities for the client to explore
issues that the practitioner thinks are important
 Most helpful type of probing questions begin with
“what, how, when, where, and who” because they
offer opportunity for open dialogue from the client
rather than providing one-word responses
Immediacy
 Immediacy – a skill that involves listening to your own
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reactions as the practitioner, and using this to invite the
athlete to look at what is happening between you and them
Invites immediate exploration of the athlete’s feelings,
thoughts, and somatic responses
A coming together of the practitioner’s feelings in the
moment, and the athlete’s behavior in the moment, to make
sense of what is going on in the relationship in that moment
Offers a way of interpreting what is going on in the
therapeutic relationship
Focuses on the “here and now” between the practitioner and
the athlete
Using constructs to address patterns of relating between
practitioner and athlete
References
 Arvinen-Barrow, M., & Walker, N. (2013). The
Psychology of Sport Injury and Rehabilitation (1st
ed.). Routledege.