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Enhancing Your Therapy with Gestalt Approaches
Gestalt Therapy continuing education addiction counselor CEUs

Section 20
Gestalt Principles in Adventure-Based Counseling

CEU Question 20 | CEU Answer Booklet | Table of Contents | Gestalt
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

Adventure Based Counseling (ABC) is a therapeutic tool that can be adapted to almost any setting and is a mixture of experiential learning, outdoor education, group counseling (Schoel, Prouty, & Radcliffe, 1988), and intrapersonal exploration. Although obviously not a panacea, the conceptual framework of ABC is based on several counseling theories including behavioral and cognitive theories, experiential learning, an affective perspective (Priest & Gass, 1997; Schoel et al., 1988), as well as a process of events that promotes positive change. ABC involves activities in which clients are essentially learning by doing (Gass, 1993a). Galagan's (1987) adventure-based learning by doing program was positively associated with personal growth, accountability, support, trust, and a sense of personal energy. Similarly, Vester (1987) has presented a framework of leisure that focuses on adventure as a form of counseling. Descriptively, a counselor using ABC typically chooses an experiential activity that possesses strong metaphoric relationships to the goals of counseling. The counselor may then give directives for an adventure-based activity and, during the process, make references to metaphors, thereby creating a connection from the adventure activity to real life (Gass, 1995). After this experience, counselors debrief the client to reinforce positive behavior changes, reframe potentially negative interpretations of the experience, and focus on the integration of functional change into the client's lifestyle (Gass, 1995; Hinkle, 1999; Luckner & Nadler, 1992; Priest & Gass, 1997). ABC is developing into a significant area of counseling intervention. The efficacy of ABC has been minimally supported in the research literature; however, methodological flaws in research designs may actually minimize reported effectiveness rates (see Nassar-McMillan & Cashwell, 1997). Continued theory development and empirical research are obviously needed, particularly on the long-term effects of ABC.

Conceptual Framework Of ABC: Although ABC uses traditional psychosocial and educational theories involving individual, group, and family counseling, ABC differs from traditional counseling. These differences include the setting, the use of real and perceived risk, additional required skills, additional ethical considerations, an emphasis on processing and metaphor, and transfer of learning to psychological, educational, sociological, physical, and spiritual benefits. ABC can be used as a primary treatment or as an adjunct to more traditional types bf counseling. Although traditional counseling usually takes place indoors or in an office setting, ABC often takes place in the outdoors. There is also the perception of risk or real risk in ABC that is not found in typical counseling settings. ABC requires traditional counseling skills (i.e., what experiential educators refer to as “soft” skills) as well as additional physical skills (i.e., what adventure based counselors refer to as “hard” skills, such as challenge ropes course management, rock climbing, hiking, camping, and kayaking). Facilitation of activities includes programming, or selecting appropriate activities, and macroprocessing, which includes six facilitation styles. These styles, described more fully in this article, are as follows: no loading, front loading, back loading, or front- and backloading, and the use of metaphor and paradox. Finally, the adventure-based experience is transferred to real life through processing. Because ABC originated from experiential education and outdoor education, a model is needed for the counseling profession to transfer the traditional practices from outdoor and experiential education to a more therapeutic realm. To do so, counselors, counselor educators, and counselors-in-training need to develop an understanding of how the entire process works. Finally, ABC is relatively new to the counseling field, and a model helps to organize the relative information so that it is easier to comprehend, teach, and apply.

Theory Application: ABC is derived from individual, group, and family counseling models, as well as from educational theories. The primary individual counseling theories or therapies that combine to contribute to ABC are cognitive (Beck, 1963), rational emotive behavioral (Ellis, 1962), reality (Glasser, 1965), behavioral (Bandura, 1969; Skinner, 1953), gestalt (Zinker, 1977), narrative (Bruner, 1985), and constructivist (Fosnot, 1989). Cognitive theory is used in ABC to help clients understand the association between their adventure experience and their cognitive processes and how thought processes may affect relationships with others as well as with the self. Rational emotive behavioral theory can be effectively used when assessing risk or perceived risk. For example, if a person is in a low-risk situation but perceives the situation as high risk, irrational thoughts of risk can be challenged so the client is able to confront and differentiate between real and perceived risks (Priest & Gass, 1997). Of course, having a client differentiate between real and perceived risks is consistent with current behavior therapy that relies heavily on a cognitive base. Also, ABC uses reinforcement theory as a basic component of its approach. Reality theory is incorporated into ABC by the highlighting of natural consequences, taking responsibility for one's own actions, and working in the present toward the future (Clagett, 1992).

Gestalt therapy is relevant to the adventure experience in that individuals process events while they are occurring. This happens in microprocessing as new skills or insights from the experience are applied to real life. Furthermore, the “in the moment” focus of ABC is consistent with gestalt therapy. Narrative therapy, a technique used to write and rewrite a person's “story,” is similarly used in ABC. The adventure experience can be used as a metaphor to rewrite a person's past. Finally, constructivist theory is based on the individual creating his or her own reality. ABC can assist with this process by adding another dimension to a person's reality through the insight gained from the adventure experience (Luckner & Nadler, 1992).

ABC can be used intentionally to address individual needs, but many ABC activities emphasize work in groups. The application of group counseling models is important for understanding group development and group dynamics (Gazda, Ginter, & Horne, 2001). Luckner and Nadler (1992) have identified a model of group development that is specific to ABC. These stages include acquaintance, goal ambiguity, diffusing anxiety, members' search for position, focus on affect and confrontation, sharpened interactions (growth), norm crystallization, distributive leadership, decreased defensiveness and increased experimentation, group potency, and termination.

Adjunct and Primary Treatment: The aforementioned theories have been identified to provide a better understanding of how ABC is grounded and supported. ABC can be used as an adjunct to treatment or as the primary treatment (Gass, 1995). In counseling, it will most likely be used as an adjunctive treatment intervention (Bandaroff & Parrish, 1997). For example, a day hike may be used adjunctively with breast cancer survivors to help them relax, engage in a peaceful environment, and have success with something that requires healthy, physical exertion. In contrast, an adolescent residential treatment facility may use longer trips using an outdoor setting with ABC as the primary treatment, and clients are expected to make behavioral changes as a result.
- Fletcher, Teresa B.; Hinkle, J. Scott; Adventure Based Counseling: An Innovation in Counseling; Journal of Counseling & Development, Summer2002, Vol. 80 Issue 3
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #6
The preceding section contained information about Gestalt principles in Adventure-Based Counseling.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 20
What are two ways in which Gestalt therapy is relevant to Adventure-Based Counseling? Record the letter of the correct answer the CEU Answer Booklet.

 
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Enhancing psychotherapy process with common factors feedback: A randomized, clinical trial.
In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergraduates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU + CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU + CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU + CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Can reflecting on personal values online increase positive beliefs about counseling?
This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation—a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Depression symptoms moderate the association between emotion and communal behavior.
Depression is associated with emotion regulation deficits which manifest as elevated negative affect and greater continuation of negative affect over time. The present study examined a possible emotion regulatory deficit, whether depression symptoms attenuate the association between communal (i.e., agreeable, quarrelsome) behavior and affect. A community sample reported on depression and anxiety symptoms before recording their affect and behavior following naturally occurring interpersonal interactions over 21 days. Participants’ behaviors were measured using items selected to represent the Interpersonal Circumplex Model of behavior. Results indicated an association between affect and communal behavior, which was stronger for negative than positive affect. Depression symptoms moderated this association; elevated depression symptoms were associated with decreased association of affect and interpersonal behavior. Comorbid anxiety symptoms did not moderate this association. Results suggest that elevated depression symptoms are associated with a diminished ability to adapt communal behavior to emotion cues. Given prior evidence of elevated overall quarrelsome behavior among individuals with elevated depression symptoms, this may demonstrate an interpersonal mechanism by which emotion regulation deficits impact the generation of interpersonal problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Thwarted belongingness, perceived burdensomeness, and depression among asian americans: A longitudinal study of interpersonal shame as a mediator and perfectionistic family discrepancy as a moderator.
This short-term longitudinal study applied Joiner’s (2005) Interpersonal-Psychological Theory of Suicide to Asian Americans’ experiences with depression. Interpersonal shame (i.e., the experience of inadequacy arising from interpersonal concerns) was hypothesized to mediate the effects of (a) thwarted belongingness and (b) perceived burdensomeness on future depression. Furthermore, the positive associations between (a) thwarted belongingness and (b) perceived burdensomeness on future depression were hypothesized to vary depending on students’ experiences with perfectionistic family discrepancy (PFD; their perceived gap between their actual performance and what their parents expect of them). A total of 605 Asian Americans attending predominantly White, Midwestern universities completed 3 online surveys. Conditional process modeling via Hayes’s (2013) PROCESS was used to analyze the data. Results demonstrated that (a) thwarted belongingness and (b) perceived burdensomeness contributed to higher interpersonal shame, which influenced students’ future depression. Furthermore, the effect of thwarted belongingness on future depression was significantly positive for those with PFD levels greater than the 12th percentile, after taking into account students’ initial level of depression. The effect of perceived burdensomeness on future depression was not significant for those with PFD levels greater than the 3.5th percentile. This study identified that students with perfectionistic family discrepancy may be at higher risk for depression while experiencing thwarted belongingness. Overall, findings supported using Joiner’s (2005) theory to understand Asian American students’ risk for future depression. Future studies may gather data across Asian American students’ years in college. Counselors can apply these findings to increase students’ awareness about possible risk factors for depression. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Distress disclosure and psychological functioning among Taiwanese nationals and European Americans: The moderating roles of mindfulness and nationality.
Research using Western samples shows that talking about unpleasant emotions—distress disclosure—is associated with fewer psychological symptoms and higher well-being. These benefits of distress disclosure may or may not be observed in East Asia where emotional control is valued. Instead, mindfulness may be more relevant to emotion regulation in East Asia (e.g., Taiwan). In the present study, cultural context (Taiwanese nationals vs. European Americans) and mindfulness were examined as moderators of the relation between distress disclosure and both depression symptoms and life satisfaction. A sample of 256 Taiwanese college students and a sample of 209 European American college students completed self-report measures in their native language. Moderated multiple regression analyses revealed significant interaction effects of mindfulness and distress disclosure on both depression symptoms and life satisfaction for Taiwanese participants but not for European Americans. Specifically, distress disclosure was negatively associated with depression symptoms and positively associated with life satisfaction for Taiwanese low in mindfulness but not for Taiwanese high in mindfulness. For European Americans, distress disclosure was not associated with depression symptoms but was associated with higher life satisfaction, regardless of one’s level of mindfulness. These findings suggest that the potential benefits of disclosing distress are a function of one’s cultural context as well as, for those from Taiwan, one’s mindfulness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

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