Counseling Psychology Model Training Program draft V. 6 Introduction

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Counseling Psychology Model Training Program


The Model Training Program (MTP) in Counseling Psychology is intended to provide future and current Counseling Psychologists with a frame of reference for clarifying (a) the ways in which Counseling Psychologists are different from those psychologists trained in other specialties, and (b) the ways in which Counseling Psychologists are similar to psychologists trained in other specialties. As a result of understanding this document, individuals will know what it means to be a Counseling Psychologist. This meaning is rooted in our shared values and identity, and is manifest across our education, training, curriculum, and daily practice as professional psychologists.
The Model Training Program is not a mandatory standard, nor does it carry any mechanism for enforcement. It is rather framed as a set of principles that suggest aspirational or exemplary facets of a Counseling Psychology doctoral program. The principles are meant to facilitate the systematic maintenance and development of Counseling Psychology programs, while allowing for flexibility in implementation to reflect a variety of program dimensions. The MTP is thus descriptive, not prescriptive.
The document below provides statements of background, need, values, compatibility and development that form the foundation of the principles developed for the MTP. The 20 specific principles, grouped in six clusters, then follow with further explanation and elaboration of each.
Two previous versions of the Model Training Program have been written. Murdock, Alcorn, Heesacker, and Stoltenberg (1998) formed the first MTP writing group, jointly appointed by CCPTP and Division 17. Its purpose was to serve as a modal or normative standard for Counseling Psychology. Murdock et al. wrote the MTP in response to the American Psychological Association Commission on Accreditation’s (COA) revision of its Guidelines and Principles (G&P) of Accreditation in which programs were allowed to designate a model of training on which to be evaluated. At the same time, the Commission for the Recognition of Specialties in Professional Psychology (CRSPP) asked for clarification concerning the shared definition of Counseling Psychology. Concern also existed within CCPTP and Division 17 that the G&P did not provide opportunities to Counseling Psychology programs to include training specific to the specialty. Thus, the MTP in 1998 was intended to serve as a guide to Counseling Psychology programs in specifying the common training components of our field so that COA site visitors would have criteria to judge our programs. Additionally, Murdock et al. (1998) stressed that Counseling Psychology programs should have the freedom to go beyond the MTP to add individual program specialties and embellishments.
The second MTP writing group of Epperson, Fouad, Stoltenberg, and Murdock (2005) was also jointly appointed by CCPTP and the Society of Counseling Psychology (SCP). It was written in response to the creation of three new sets of guidelines, the Multicultural Guidelines for Psychologists in Education, Training, Research, Practice, and Organizational Change (APA, 2003), the Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients (APA, 1998), and the Guidelines for Psychological Practice with Older Adults (APA, 2004). The structure of the COA Guidelines and Principles (G&P) was used to organize the 2005 MTP. The G&P consisted of Domain A (Eligibility), Domain B (Program Philosophy, Objectives and Curriculum Plan), Domain C (Program Resources), Domain D (Cultural and Individual Differences and Diversity), Domain E (Student-Faculty Relations), Domain F (Program Self-Assessment and Quality Enhancement, Domain G (Public Disclosure) and Domain H (Relationship with Accrediting Body).
The third writing of the MTP occurs 12 years after its latest predecessor. Many important developments have occurred affecting training in our specialty, prompting the need for the current revision.
The need for a new MTP is driven by several powerful currents in the river of change, to which Counseling Psychology, professional psychology, national policies/legislation, as well as global trends are all tributaries. Much has happened since 2005 when the prior MTP was created.

Globally, we are increasingly interconnected, both through our economies and via our web-based, social-media embedded, and technologically advancing societies. At the same time, persistent and resistant problems of intergroup violence, poverty and inequality, environmental degradation and depletion remain. Counseling Psychologists are called to contribute to understanding the issues and solving the problems. In both science and practice, global forces impact us. The critique of Western-based psychological research demands that we attend to training our students in emic as well as etic approaches. Practicing internationally is hampered by credentialing complexities which few have the resources to navigate.

On the domestic front, new federal policies affecting health care continue to fluctuate, though integrated health care initiatives and the need for mental health assistance for veterans and military families are prominent. Psychologists are now considered to be Health Service Providers, and are engaged in ongoing efforts to work collaboratively with those in other health care professions. Accountability concerns in health care, including in professional psychology, have manifest in the competency movement, which has resulted in significant changes to how training is conceptualized, moving from a curricular focus to an emphasis on behavioral outcomes. The competency movement has altered the ways in which programs formulate their goals and evaluate their students. In tandem with the competency movement, the APA Commission on Accreditation has phased out the old Guidelines and Principles (G&P), replacing them with the new Standards of Accreditation (SoA).

Within our own specialty, Counseling Psychology’s emphasis on diversity and social justice has emerged with a level of clarity and vigor unsurpassed in its history, providing rich opportunities to address many of the issues of national and global concern noted. Another stream of influence is the growth in Psy.D. programs in Counseling Psychology, with several new programs developing and being accredited. Of further consequence, Counseling Psychology struggles to remain afloat as our unique history of largely being situated in Colleges of Education brings on a confluence of conflicting interests in which we must learn to swim if we are to survive.
The current MTP is intended to serve as a strong yet flexible vessel which can carry Counseling Psychology forward, be the waters calm or turbulent. We will continue to set sail buoyed by our values, maintaining an even keel through our joint efforts and collective wisdom.

Counseling Psychology Values
Counseling Psychology has deeply-rooted and long-standing values which underlie our training. Values give meaning and direction to our work. While Counseling Psychologists attend to professional competencies as articulated by the HSP blueprint, the SoA, and the APA Benchmark competencies, as do our colleagues in Clinical Psychology and in School Psychology, it is in how we implement those competencies and the lens through which we view our work that most clearly manifests our values and identity. Four interlocking core values are described here.
Growth towards full potential. From the earliest statements of Counseling Psychology definition, we have valued the humanistic ideal of self-actualization; we believe in peoples’ abilities for growth and the realization of their potential. In 1956, we wrote, “The Counseling Psychologist wants to help individuals toward overcoming obstacles to their personal growth, wherever these may be encountered, and toward achieving optimal development of their personal resources.” (Division of Counseling Psychology Committee on Definition, p. 283). Sixty years later, these words still ring true and underscore the optimism embraced by Counseling Psychology. In fact, our vision of actualized potential has expanded to embrace possibilities for positive change in our communities, organizations and social structures, and we recognize that Counseling Psychologists can have a role in that growth, as well as in the prevention of distress. All growth occurs nested in multiple systems. This leads to our second core value, being holisitic and contextual.
Holistic and contextual. Counseling psychologists value a broad perspective in understanding people. From our early days in vocational work, we have long recognized that context matters. We speak of it as “person by environment interaction,” by referencing the importance of connecting clients to concrete resources, by “…being willing to follow the client out of the office into work with other persons and grips with whom the client has to deal” (Division of Counseling Psychology Committee on Definition, 1965, p. 284), and by recognizing structural aspects of power, privilege and oppression that routinely impact our development. As Cooper (2009) eloquently states, “Human beings, as human, supersede the sum of their parts. They cannot be reduced to components.” (p. 120). The contextual perspective is intimately interwoven into our third core value, diversity and social justice.
Diversity and social justice. As the Counseling Psychology Model Training Values Statement Addressing Diversity (CCPTP, ACCTA, & SCP, 2009) unequivocally asserts, “Respect for diversity and for values different from one’s own is a central value of Counseling Psychology training programs” (p.641). We encourage our training programs to promote respect for diversity and inclusiveness in all that we do. We are encouraged to promote training environments representing safety, trust, and respect to all members of the training community. Furthermore, trainers and trainees should acknowledge the presence of bias and prejudice in themselves as well as society, and work to guard against its oppressive effects through self-examination and critical thinking about personal values and beliefs. Assumptions should be evaluated on the basis of scientific data, standards of professional practice, and the promotion of mutual respect and cooperation. Goals of training programs should include inclusiveness and respect for intersecting identities. Programs are directed to advocate and work for social justice to prevent societal oppression. Embracing diversity and social justice can only happen when we work together with sensitivity and openness. These qualities comprise our fourth core value: a communitarian perspective.

Communitarian perspective. Communitarianism in professional training means instilling, promoting, and modeling a process of “collegial engagement, caring, and compassion…essential for the well-functioning of any community of professionals” (Johnson, Barnett, Elman, Forrest, & Kaslow, 2014, p. 212). Johnson, Barnett, Elman, Forrest, Shwartz-Mette, and Kaslow (2014) note that competence is not static, but “embedded in the interpersonal fabric of one’s professional life.” (p. 212). Communitarian values are demonstrated by staying interconnected with others in order to honestly model work-life balance, provide checks on our own often inaccurate self-appraisals, and to further our professional development. Communitarian training environments require collegiality, vulnerability, humility, and transparency. Communitarianism complements notions of individual responsibility by acknowledging that collective support and mutual, reciprocal accountability matter.
The principles of the model training program in Counseling Psychology are built upon and are fully compatible with (1) the vision and recommendations of the blueprint for Health Service Psychologists (HSP; Health Service Psychology Education Collaborative, 2013), (2) the APA Commission on Accreditation’s Standards of Accreditation (SoA; 2016;, (3) the Society for Counseling Psychology/Division 17 and the Council for Counseling Psychology Training Programs’ Counseling Psychology Competencies (Covey, Fouad, Jackson, Juntunen, Sauer, Stabb, Varghese, & Voelkel, 2013), (4) APA’s Benchmark Competencies (Fouad et al., 2009), and (5) the Counseling Psychology Petition for the Recognition of Specialty in Professional Psychology (
The issues noted in the “Background” and “Need” sections of this document prompted Jim Lichtenberg, President of SCP/Div. 17 from August, 2015 to August, 2016 to create a Special Task Group (STG) charged with drafting a new MTP. These efforts began early in the winter of 2016 with the appointment of a five-person STG. The STG members who authored this document represent different types of programs (Ph.D., Psy.D.), different program training models (scientist-practitioner, practitioner-scholar, practitioner-scientist), and different stages of professional career development (early career professional,, mid-career, later career).
In preparation for writing the current document, several sources were used to assist in capturing the current zeitgeist of our field. Among the documents utilized and cited are the most recent petition from Counseling Psychology to the Council on the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP); the Benchmark Competencies in Professional Psychology (Fouad et al., 2009); the Murdock, Alcorn, Heesacker, Stoltenberg (1998) Model Training Program in Counseling Psychology, the 2005 Model Training Program in Counseling Psychology (Epperson, Fouad, Murdock, & Stoltenberg, 2005); the Counseling Psychology Core Competencies (Covey, Fouad, Jackson, Juntunen, Sauer, Stabb, Varghese, & Voelkel, 2013); the Counseling Psychology Model Training Values addressing Diversity (Bieschke, Abels, Adams, Miville, & Schreier, 2006); the Standards of Accreditation for Health Service Psychology (2015); the APA Prevention Guidelines (Romano, Bogat, Conyne, Kenney, Mathews, Hage, Horne, Schwartz, Singh, Waldo, & Wong, 2014); the Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients (2012), and the Competencies in Professional Counseling and Related Human Services (Scheel, Lichtenberg, Fouad, & Jackson, 2011). A number of additional background articles and APA Guidelines were also consulted.
The STG met via several conference calls as well as a face-to-face meeting over the July 4th weekend in 2016 in Dallas, TX. The STG presented their initial ideas to interested constituencies during a 2-hour open meeting at APA in August of 2016. Following input gained through the meeting, the present MTP was revised, then reviewed by both SCP (month, year) and CCPTP (March, 2017), revised again, and vetted by both organizations [future date here]. The present MTP was adopted on [future date here].

What follows are 20 Model Training Program (MTP) principles organized into six clusters. Principles of Cluster 1 describe training that fosters a Counseling Psychology identity as holistic, anchored in science, concerned with the common factors across all forms of therapy, vocationally oriented, and developed through self-reflective processes that foster awareness. Multiculturalism, diversity, and social justice are organized as cohesive and interrelated components of Cluster 2. Ethical, legal, and professional standards, psychological assessment, and supervision and consultation are found in Cluster 3, identifying components of Counseling Psychology training that correspond to the Health Service Psychology (HSP) framework. Developmental and preventive interventions and emphasizing human strengths are elements of Counseling Psychology training in Cluster 4. These principles highlight Counseling Psychology’s broad perspective beyond remedial services to clients. Scientific mindedness, research self-efficacy, and the reciprocal nature of practice and research are emphasized in Cluster 5 as elements of science-practice integration training. Lastly, Cluster 6 is concerned with relationships across professional communities and covers Counseling Psychology’s role in master’s level counseling training, leadership development, and collaborative and transdisciplinary partnerships.
A Counseling Psychology doctoral program:
Cluster 1: Counseling Psychology Identity

  1. Fosters a strong Counseling Psychology identity among its students and the program that encompasses core Counseling Psychology values and a scientific mindset.

Counseling Psychology training programs assist students in developing a Counseling Psychology identity. Such an identity is influenced by training and education oriented to (a) work role preparation, (b) values supporting diversity and social justice, (c) five unifying themes of the Counseling Psychology specialty, (d) a strength orientation promoting health, well-being, and flourishing, and (d) a scientific mindset in which students are encouraged to integrate science with practice.

Work role preparation in Counseling Psychology programs involves students in performing remedial, preventive, and educative-developmental activities. Training experiences in these three areas allow students to work as generalists across the entire spectrum of applied psychology practice in work settings that include university counseling centers, independent practice, community mental health centers, and hospitals.

Values supporting diversity and social justice advocacy are encouraged in Counseling Psychology training programs. Inclusion, appreciation and celebration of diversity, and willingness to advocate for those less privileged, disempowered, and marginalized importantly define what it means to be a Counseling Psychologist. Counseling Psychologists recognize the importance of social justice work with individual clients, and they advocate for systems-level social change. Social justice advocacy work is a common dimension of Counseling Psychology practicum experiences. Training materials in handbooks and on websites of Counseling Psychology programs often include Counseling Psychology Model Training Values addressing Diversity (Bieschke, Abels, Adams, Miville, & Schreier, 2009).

Gelso, Williams, and Fretz (2014) describe five themes of Counseling Psychology (p. 7). These are (a) the incorporation of human strengths and optimal functioning; (b) a focus on the whole person that includes lifespan development and vocational growth; (c) a contextually derived commitment to advocacy and social justice; (d) the use of brief, educational, and preventive counseling interventions; and (e) dedication to the scientific foundations of practice.
An orientation toward human strengths and assets is woven throughout all Counseling Psychology training activities. Research training encourages scientific inquiries of strength-oriented constructs such as well-being, healthy lifestyles and methods of coping, and the improvement of life conditions and experiences of individuals and groups. Practice training prioritizes a psychological metaphor for human change (in contrast to a physical science metaphor) involving development of meaningful life experiences; supportive, caring relationships; beliefs in efficacy and agency; formation of approach goals (in contrast to avoidance goals); and frequent experiences of positive emotions (Scheel & Conoley, 2015). Counseling Psychology students are encouraged to use and promote contextually driven psychological change efforts in integrated healthcare settings.
Counseling Psychology students are encouraged to adopt a scientific mindset as central to being a Counseling Psychologist. Programs rely on graduate training in scientific methods as the most effective means of instilling such a mindset. Without an emphasis on research and its resulting production of knowledge, our specialty would risk diminishment of its professional status. Gelso and Lent (2000) suggest that students may gain experiences as scientists at each of three levels. At level one, students gain the ability to review and make use of research findings. At level two, scientific findings guide students’ professional practice. At level three, Counseling Psychology students actually conduct research and produce new knowledge to inform practice and policy. A goal of Counseling Psychology programs is to increase students’ efficacy, interest, and value placed on research scientific endeavors.

  1. Prepares our students as generalists in the practice of psychology; emphasizes theoretically- and empirically-informed methods that flexibly fit with individual client contexts and benefit clients through the healing power of the common/non-specific factors of therapy.

Students in Counseling Psychology are not directed to adopt a specific theoretical orientation for use in conducting therapy. Instead, they are encouraged to form an integrated theoretical model that fits best for the student, corresponds to evidence-supported therapy methods, and allows them flexibility to work in a variety of clinical settings and with many different types of clients. Their training prepares them to work with clients identified with a variety of problems and representing developmental stages across the lifespan. Students learn that common factors (e.g., the working alliance; therapist use of empathy; goal consensus and collaboration) present in all forms of effective therapy, are essential to positive therapeutic outcomes (Wampold, 2001). Counseling Psychology students gain competence in making therapeutic adjustments to treatment approaches to realize contextual fit with their clients in contrast to using a prescriptive method of matching a specific treatment to a diagnosis or problem label. Client culture is a primary consideration and students learn that collaborating with clients in forming treatment plans is preferable over a hierarchical relationship in which therapists are in charge and dictate treatment directions to clients.

Counseling Psychology students are also trained to conduct therapy based on client feedback using systems to gather client perspectives about how treatment is progressing such as the Partners for Change Outcome Management System (PCOMS; Miller, Duncan, & Hubble, 2005) and the Outcome Questionnaire Psychotherapy Quality Management System (Lambert & Vermeersch, 2008). Such approaches fit well within a contextual model of psychotherapy in which treatment is adjusted to fit the client’s context (Scheel & Conoley, 2012).

Therapeutic practices are prioritized in Counseling Psychology programs to foster healing contexts in which clients are offered new learning in the form of culturally fitting and appropriate interventions. Students strive to implement a contextual model of therapy that relies on the interaction between therapist and client resulting in the subjective construction of meaning about how therapeutic change will occur. Therapy training in Counseling Psychology emphasizes the importance of forming a strong therapeutic relationship comprised of the working alliance (Bordin, 1979) and the real relationship (Gelso & Carter, 1985). The real relationship involves genuineness and realism (Gelso, 2002). The Alliance involves the therapist and client achieving agreement on goals and tasks, and forming an emotional bond.
Finally, Counseling Psychology students diligently attend to client factors that impact therapy progress such as client readiness for change, client hope and involvement, and client expectations and preferences (Scheel & Conoley, 2012). By integrating client factors into treatment, attention is given to promoting client commitment and motivation for the treatment approach that is used.

  1. Educates our students to contribute to the research and practice of vocational psychology by understanding, investigating, and addressing work-related issues that impact the lives of individuals in a changing global economy.

Counseling Psychology students understand that work is inextricably linked to psychological health. Training and education include examination of the critical roles of work and career development in helping people to gain healthy, happy, satisfying, and meaningful lives. An appreciation of vocational psychology is fostered within Counseling Psychology training. Students gain a broad and deep understanding of multiple perspectives concerning career development, career choice, and the role of work in individual lives. Perspectives toward work and career are represented through a number of theories developed by Counseling Psychologists. These include but are not limited to Super’s (1990) developmental life-span life-space theory; Holland’s theory (1997) of vocational personality and the RIASEC configuration of occupations; Dawis and Lofquist’s (1984) Theory of Work Adjustment (TWA) that informs students about the process of career counseling; Gottfredson’s (2005) theory of circumscription and compromise that considers the roles of gender, prestige, and interest in career choice; Krumboltz’ (1979) social learning theory of career decision-making; Lent, Brown, and Hackett’s (1994) Social Cognitive Career Theory (SCCT) emphasizing the interaction of individuals with their environmental and social contexts; and perspectives on the relational nature of work (Blustein, Schultheiss, & Flum, 2004) that highlight the “meaning and mattering” of work in individuals’ lives (p. 191; Schultheiss, 2007).
In parallel with vocational theory development, a number of assessment tools have been created by Counseling Psychologists to assist in working with clients who have career concerns and may need guidance in identity development and goal formation. Career assessments provide means to work with the whole person in counseling and psychotherapy. Counseling Psychology students typically gain knowledge, competence, and skill in the use of a variety of vocational assessments alone or in combination with other psychological assessments.
Training and education in Counseling Psychology includes the examination of the critical roles of work and career development in peoples’ lives. Students learn that career and work are indicators of social justice. Counseling Psychology programs teach students that the practice of vocational psychology includes helping individuals who are marginalized and disadvantaged due to gender, race, and class to live healthy and productive lives (Walsh & Savickas, 2005). Juntunen and Even (2012) explain that a task of vocational psychology is to emphasize the central role of work and career in healthy human functioning. If this is a task for vocational psychology, it also is one for Counseling Psychology. Vocational psychology is an integral identifying component of Counseling Psychology. Students learn that vocational psychologists are Counseling Psychologists. Thus, Counseling Psychology training emphasizes the role of vocational psychology in both assisting the disadvantaged and as a means of facilitating social justice efforts.

  1. Encourages students to conceptualize self and others holistically, as situated in multiple relational, socio-cultural, and structural contexts interacting with intrapersonal experiences.

Counseling Psychology has long been aware of the person x environment interaction ((Division of Counseling Psychology Committee on Definition, 1956). Over time, this simple statement has been articulated and expanded in substantially more depth. Persons are recognized as holistic entities who cannot be reduced to the sum of their parts (Cooper, 2009). Reductionistic thinking is discouraged in Counseling Psychology, in how both psychotherapy and research are approached (Shean, 2015; Zeldow, 2009). Environments are now understood to encompass multiple, dynamic interacting components, whether conceptualized through the lens of systems theory (Capra, 1997; Gelo & Salvatore, 2016), social-ecological theory (Bronfenbrenner, 1979), or other relevant models. The indivisible interaction between individuals and their contexts – interpersonal, social, economic, political, educational, legal, medical, national, global - has been acknowledged and elaborated from a variety of perspectives. These perspectives include biopsychosocial models (Suls & Rothman, 2004), feminist perspectives (Sumi, Crenshaw, & McCall, 2013), multicultural theories (Leong, 2014), critical/liberation psychologies (Prilleltensky, 2008; Watkins & Shulman, 2008) and more if we access models from other disciplines. Greatly expanded knowledge in the foundational sciences of psychology allow us to consider how intricate physiological, cognitive, and affective processes impact each other and how such processes both influence and are influenced by, our social world.

Model training programs may assist students in understanding this complexity in self and others by encouraging self-reflection on personal development in coursework, research, and clinical domains. Communication regarding the Counseling Psychology value of a holistic approach can be modeled throughout training, from seminar classes on professional issues to feedback about case conceptualization in practicum supervision. Many programs use comprehensive/qualifying exams for doctoral candidacy as an opportunity for students to demonstrate how they synthesize theory, practice, and research in a holistic manner. Integrative theoretical perspectives can be brought to bear across the curriculum, with clear application to many domains such as ethics, psychotherapy, or in the production of sophisticated research designs. APA’s Standards of Accreditation ( ), which now mandate integrative knowledge, are likely to propel further movement in this direction.

  1. Encourages ongoing self-reflection to assist students in attaining self-awareness and impact of self on others.

Reflective practice has become a key competency in the training of Health Service Psychologists in general (Health Service Psychology Education Collaborative, 2013) and for Counseling Psychology in particular (Counseling Psychology Competencies, 2013). The ability to accurately assess one’s strengths and areas for growth, as well to be open to feedback and change regarding those areas, is considered a critical component in Counseling Psychology training. Gaining awareness of how we may be actually impacting others – past our good intentions and personal needs to see ourselves in a positive light – is valued.

Within Counseling Psychology training programs, engaging in sometimes difficult dialogues regarding how we see others and how they see us are encouraged, whether students engage in those dialogues with each other, between themselves and faculty members, as therapists-in-training with their clients, or in supervisory contexts on-site at practica and internship.Guidelines for such dialogues have been articulated (e.g. Jacobs et al, 2011; Sue, Lin, Torino, Capodilupo, & Rivera, 2009). Program faculty encourage students and each other to consider what we communicate to the general public about our profession, and the impact that our personal demeanor, social networking, public behavior, and language conveys when we have contact with entities external to our programs (broader university, community, media, friends and family).
In coursework, students may be encouraged to write reflection papers which tie their personal history, attitudes, or experiences to course content. Assignments that directly engage self-examination are potentially useful. Some illustrations might be cultural self-portraits, writing about perceptions of strengths and weaknesses, and experiential exercises that surface aspects of identity that may not be well-articulated (for example, regarding social class, see; APA CSES, 2017). In the research domain, students may be asked to examine their motivations and biases for certain topics (“research is me-search”). Borrowing from the tradition of qualitative methods, students may be asked to specifically articulate bias, expectations, and hopes about the outcomes of their studies prior to designing, conducting, executing, and analyzing them (Patton, 2015). These more personal components of research work can then be revisited in writing discussion sections (e.g. limitations). Such reflexive research writing can be used in quantitative, qualitative, or mixed-methods work. In training for practice, self-reflection is often enhanced through individual and group supervisory experiences, including self-reflection in case conceptualization. See McGillivray, Gurtman, Boganin, and Sheen (2015) for a review of the effectiveness of self-reflection in psychotherapy training.

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