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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 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 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 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 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 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 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 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 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 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.