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Enhancing Your Therapy with Gestalt Approaches Gestalt Therapy continuing education MFT CEUs

Section 21
Guidelines for Implementing Gestalt Techniques
in Adventure-Based Counseling

CEU Question 21 | CEU Answer Booklet | Table of Contents | Gestalt
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

Counseling Skills: ABC requires different types of skills. In the experiential and counseling fields these are referred to as “soft” skills and “hard” skills. Soft skills are those associated with traditional counseling and are more interpersonal. These skills include reflective listening, verbal and nonverbal communication, reflection, reframing, leadership style, problem solving, decision making, effective communication, and ethical behavior. Hard skills include the physical skills required to do an activity, such as rock climbing or kayaking. Hard skills include not only the ability to perform physical and technical tasks but also the ability to manage the activity while others engage in the task. In addition, the ability to teach the task is a cross between hard and soft skills and is typically an important aspect of the adventure based counselor's repertoire. Counselors without the appropriate hard skills will need a cocounselor or facilitator who possesses the respective competencies. Likewise, facilitators without soft skills will need the assistance of counselors.

Priest and Gass (1997) have outlined hard skills specific to ABC in three categories: metaskills, generic competencies, and specific competencies. The first category is metaskills, or the ability to use a combination of hard and soft skills. The second category, generic competencies, is the skills applicable to all adventure experiences such as physical fitness, weather interpretation, first aid, trip planning, appropriate level of performance, mental awareness associated with the activity, selecting a location, understanding the needs of the participants, and knowledge of anticipated adversity. The third category, specific competencies, includes skills unique to particular activities. Priest and Gass (1997) have listed eight adventure activities that require specific competencies; they include backcountry travel, rock climbing and rappelling, mountaineering, challenge (ropes) courses, caving or spelunking, flatwater and whitewater paddling, on-road and off-road bicycling, and cross-country skiing. Ewert (1989) also included hot air ballooning, rafting, snowshoeing, orienteering, wilderness camping, sailing, scuba diving, sky diving, and hang gliding, all of which incorporate a measure of real risk.

Many of the ethical guidelines for the American Counseling Association and the Association for Experiential Education are quite similar. However, some ethical considerations reflecting the combination of counseling and adventure therapeutics are warranted. For example, counselors of all types are concerned with the welfare of the client. In ABC, this includes the element of risk, both physical and emotional, wherein the client is challenged by choice. The client's physical and mental welfare should be taken into consideration when programming ABC activities as well as participating in them. Any Diagnostic and Statistical Manual of Mental Disorders, text revision (DSM; American Psychiatric Association) Axis III medical conditions such as allergies, heart conditions, or physical limitations should be identified and precautions taken. For example, all professionals using ABC should complete courses in first aid and CPR.

In ABC, the therapeutic relationship is different in that the amount of time spent with clients and the types of activities might make it more difficult to keep professional boundaries. This is depicted in some OB trips that may be scheduled for up to 90 days in length. Some ABC interventions include overnights with clients (e.g., camping), which can create a different type of relationship than that in an office setting. Due to the nature of the time clients spend together, a friendship, or the perceptions of friendship, can form. However, dual relationships should be guarded against.

In relation to competence and professional responsibility, ABC may include an outdoor trip for certain populations, such as adolescents with conduct disorder, survivors of breast cancer, or court-ordered perpetrators of domestic violence. To work with these populations, the counselor must be competent and knowledgeable. For example, if a survivor of sexual abuse was on a hiking trip and had a traumatic flashback, the counselor would be required to handle that situation within the wilderness setting.

Counselors using ABC will be respectful of client's rights. Clients should not be persuaded beyond the level of what might be thought of as challenging to complete a task, and counselors should adhere to the “challenge by choice” philosophy. However, clients are generally encouraged to participate in activities. Ewert (1989) has suggested that there is an optimal point of risk; however, if there is too much risk, the client could have a negative experience. Certainly, when given a choice some individuals will choose the “easier way out,” but the easy way may not be the most therapeutic. Clients avoiding the “impossible task” that could result in a “breakthrough” may not reap the full benefits of the adventure experience. Similarly, Leahy and Associates (see http://www.leahy-inc.com) of Lafayett, Colorado, discuss the phenomenon of “the learning edge,” which propels people to breakthrough, breakdown, or bailout, all of which are therapeutic depending on the task of the adventure process (P. Hazelrigg, personal communication, August 18, 1999).

Because ABC is often used as an adjunct to treatment, it is important to be respectful of the integrity of other therapeutic relationships. Confidentiality in a group setting in ABC needs to be addressed appropriately. ABC may appear less formal compared with traditional counseling, and this aspect of confidentiality should be clearly addressed. Finally, counselors-in-training and counselors in the role of teaching and supervising should be properly trained in counseling and experiential/adventure education or at least be knowledgeable enough to know when consultation is necessary.

Client Disequilibrium: Putting clients in a state of dissonance is crucial for client change (e.g., Bandura, 1986; Minuchin & Fishman, 1981; Perls, 1969). In ABC, Gass (1993a) has referred to this as a state of disequilibrium. This concept involves taking individuals out of their respective comfort zones, such as taking athletes off the athletic field and into a setting that will increase or enhance anxiety, frustration, or dissonance, thereby creating a state of disequilibrium. For example, in collegiate volleyball, players have already established patterns of functioning based on leadership skills and ability. An ABC treatment would take players out of a comfortable environment, which is often uneven in terms of roles and abilities, and place them in a setting that is uncomfortable (e.g., a low-element challenge course or climbing wall). This is called “leveling the playing field” (Gass, 1993a). In doing so, it might be easier to detect personal and team dynamics and address issues that might otherwise be masked on the volleyball court.

When clients are in a state of disequilibrium, oftentimes their established coping mechanisms are not sufficient to address the anxiety. Therefore, counselors are required to intervene in order to teach a new coping skill, execute crisis intervention, and process the state of discomfort. As the challenge increases, the client grows, thereby enhancing the outcome of the experience (Csikszentmihalyi & Csikszentmihalyi, 1988). Similarly, during the adventure activity, counselors need to be supportive but also challenging (Ewert, 1989).

Macroprocessing: The facilitation of the adventure process is necessary to enhance the experience for clients. Gass (1995) has outlined six facilitation styles. The first three styles are the following. First, letting the experience speak for itself (no loading) is essentially letting clients figure out the meaning of the activity for themselves. Second, speaking for the experience (front loading) occurs when the facilitator or counselor sets up the experience. Directly front loading the experience requires counselors to brief clients before the experience regarding how the activity should work. Third, speaking after the experience (back loading) is learning by reflecting and by guiding clients to discover their own meanings.

The last three styles—front and back loading, metaphor, and paradox—are more proactive in nature, reflecting a philosophical shift among adventure based counselors and facilitators to create a more powerful experience. Front and back loading consists of setting up the activity and processing the activity after it is completed.

Metaphors are a common phenomenon in counseling; however, the use of metaphor in ABC is intentional and somewhat unique. In ABC, metaphors are emphasized and intentional in the process of transferring the adventure activity to real life. When designing adventure programs, it is important to keep in mind the metaphor that provides an effective transfer back to personal life or the workplace. Gass (1995) has outlined steps to assist in achieving a successful experience: stating and ranking goals; selecting metaphoric adventure experiences; identifying successful resolution to the therapeutic issue; strengthening an isomorphic framework or personalizing it so the metaphor is more apparent to the participant; reviewing client motivations; and debriefing, or processing experiences. Often, clients can create their own metaphors during the activity or debriefing process.

Although used less often in ABC, paradox can be an effective processing procedure. According to Gass (1995), this style is often used when clients' problematic issues are more significant. This includes double binds, symptom prescriptions, symptom displacements, and proactive refraining.

Transferring the Experience and Benefits: It is important that adventure-based experiential therapeutics be designed in a manner that provides for effective implementation to ensure transference back to personal social life and the workplace. Debriefing is an important aspect of facilitation and is critical to the ABC process. For example, a debriefing session may include a lack of emphasis on winning, reducing competition, exerting or not exerting personal power, or simply letting the activity speak for itself (see Crone, 1999). Benefits include the enhancement of psychological, educational, sociological, physical, and spiritual domains. Psychological benefits can include new confidence in oneself, increased willingness to take risks, improved self-concept, enhanced leadership skills, increased logical reasoning skills, and greater reflective thinking skills (Priest & Gass, 1997). Educational benefits include a greater knowledge of the environment and nature (Ewert, 1989). Enhanced cooperation, more effective communication skills, greater trust in others, increased sharing of decision making, new ways to resolve conflicts, improved problem-solving skills, and enhanced leadership skills are manifested as sociological benefits (Priest & Gass, 1997). Adventure activities require both muscular and cardiovascular exertion, therefore providing clients with physical benefits (Ewert, 1989). Spiritual benefits include connection with the greater environment and the feeling that one is part of a force that embraces other people as well as nature (Hinkle, 1999).
- 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 #7
The preceding section contained information about guidelines for implementing Gestalt techniques 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 21
What are Gass's six facilitation styles? 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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