Psychodynamic and Cognitive Theoretical Approaches to Counseling - Essay Example

?PSYCHODYNAMIC AND COGNITIVE THEORETICAL APPROACHES TO COUNSELLING Introduction Psychodynamic Approach to Counselling Psychodynamic counselling has its origin from psychoanalysis of the renowned Sigmund Freud. Psychological disorders and physical sickness can be traced to sickness of the mind, and not of the brain. Counselling can be applied to people with problems or psychological disorder in the form of sessions where the counsellor and the counselee make a talk and recall the source and effects of the past or the problem of the individual. Freud developed the thesis of the conscious and the unconscious mind where much of mental activity occurs but the unconscious mind is aware of it while the conscious mind is not. Traumatic memories of childhood are recorded in the unconscious mind and these are reminded in the individual until it becomes a cause of sickness and emotional disorders in adulthood. The belief that psychological factors can cause some sickness or malfunctioning became a popular concept during the time of Freud. Freud became phenomenal when he first announced the science of psychoanalysis. It was new then but his patients were healed and freed of their illnesses because of his precise diagnosis. Although his theory focused more on the sexual libido and the oedipal complex, they were at first unopposed and became the basis for treatment of many illnesses. Stress or anxiety, according to Freud, was a primary cause of sickness in man. Riley says that these unconscious events of the pasts were discovered through “techniques such as free association, the interpretation of dreams, thoughts and feelings emerging through reveries on the couch and nothing slips of the tongue (known as ‘Freudian slips’), misreadings and the forgetting of names” (Riley, p. 5). Once the recorded memories in the unconscious are revealed – according to Freud’s theory – they can be reconciled with the individual’s conscious life, and the person becomes healed of the malady. Freud was able to prove his theory through experiments of actual events of a patient’s life and treatment, and so he became popular and his theories were later developed into further ideas by his followers and practitioners of psychodynamics. Let us take an example of stress. Stress can mean anxiety, arousal, fear, or burnout. This particular phenomenon causes maladies like mental illness, cancer, cardiovascular disease, but also common cold. There is a relational link between arousal and stress to metabolic rate. When we are active, or involved in sports, our metabolic rate rises, along with gross measures of the heart and respiratory rates. When stress is experienced, metabolic rate also rises. Ways to determine if an organism is activated or aroused include physiological measure, where the “organism’s overt behaviour may be used as basis for evaluation” (Pargman, 2006, p. 3). We can measure or observe the physiological component. We have the nervous system which is composed of the central nervous system and the autonomic nervous system. The central nervous system is comprised of the brain, spinal cord and its branches. The automatic nervous system is composed of the head, pelvic, and sympathetic divisions. The three divisions of the autonomic nervous system are in counterbalancing act. They have some control on the vital functions of the body. The central nervous system on the other hand interferes in cases of emergency – it sends impulses to the autonomic system as soon as it perceives danger. The perception of fear in particular situations can provide thoughts. For example, a musician may think that he/she will not be able to perform well; she becomes afraid. This will send impulses to the brain. Anxiety may come in and the performance will be greatly affected. There are theoretical perspectives in determining stress causality, these are: psychoanalytic orientations, learning orientations, sociological orientations, and personological orientations (Pargman, 2006, p. 30). Freud called traumatic anxiety the excess libido or drive that is inside, which requires release. This is related to unpleasant experiences during infancy that when remembered by the person becomes anxiety. The remembering is caused by a stimulus or stimuli, and this happens in man’s everyday activities. It is sort of awakening the inside feeling; it is there kept ‘inside’ the individual, to come out later in life. It is being kept in one’s memory and can be aroused anytime. Freud suggested that anxiety is a signal of a danger from the outside environment, which he termed as signal anxiety. This theory has been critically analysed by other psychoanalytic theories, some have disagreed, modified and clarified Freud’s interpretations. Freud focused on sexuality. His critics commented that his emphasis on sexuality is excessive. Freud also based his theory on long past experiences, tracing back even to infancy and then childhood, but other theorists said that what should be given emphasis is the recent past events that involve harmful or threatening life events. Relating to pleasure, Freud stresses that the basic objective of all human behavior is to achieve pleasure. This is known as the ‘pleasure principle’, which is to achieve pleasure and avoid unpleasure or pain. The primary goal of human pleasure is realized by means of drive reduction, and the goal of the instincts is to restore the body to a previous state of equilibrium. (Ewen, 1998, p. 33) From the studies of Freud and other psychoanalysts, many of whom were critical of Freud, one theme has remained in the studies of psychoanalysis, and this is that ‘anxiety is a fear of experiencing some kind of traumatic state’ (Pargman, 2006, p. 31). Because of fear, an individual experiences a number of psychological responses. Stress-initiating stimuli enable our mind and body to react, but we react with coping mechanisms. We react to environmental threats. Examples of coping mechanisms are: Displacement – The mechanism is to shift responsibility and use scapegoat. Repression allows the individual to forget some anxiety-provoking stimuli; it may result to amnesia, an anxiety-coping strategy. Denial is rejection of reality or denying some instances that carry threats to emotional well-being. Rationalization is a defense mechanism that employs excuses for avoiding stress-causing situations. (Pargman, 2006, pp. 31-32) These are defense mechanisms that are very important for the individuals. Projection is another kind of mechanism wherein we project unpleasant personal characteristics onto other people. Horney (1945, 1950, cited in Ewen, 1998) termed it externalization. People who are neurotics seek to dominate others and are likely to behave sadistically toward those who are weak and helpless. Defense mechanisms have a role in our lives when we encounter so many stressful situations. We can have reaction formation, rationalization, regression, fantasy, and repression. Theories on psychoanalysis emphasize events that have occurred in the distant past, but learning theorists counter this. Learning theorists emphasize the immediate experiences to be of paramount importance. Stress reactions are learned like any other kind of behavior or response. Physiological responses on the other hand are more susceptible to conditioning in some individuals. There is what we call avoidance behavior where an individual evades or abandons an environment because of the presence of danger or pain; learning theorists say this too can be learned. The linkages to learning have a Darwinian basis, according to Pargman (2006:35), because they might be directed toward preserving the species, though this may be speculative in a sense. Learning reactions to stressors are influenced by an individual’s cognitive functions. Cognitive approach to Counselling Freud’s theory is more on ‘digging’ up the records of the unconscious mind as it connects to the conscious mind, but the cognitive approach which is centred on the behavioural habits of the patient, “behaviour is determined not by the decisions of an inner self but learnt through stimulus response associations” (Riley, 2001, p. 7). The concept here is that behaviour is learnt and the bad habits are learnt from experiences; that becomes bat habit. But bad habits that have been learnt can be unlearnt and this becomes good behaviour. “Responses can be positively reinforced by pleasurable consequences and negatively reinforced by unpleasant outcomes.” (Riley, 2001, p. 8) Counselling sometimes utilizes hypnosis which, of course, cannot be performed without proper training. Counselling using Freud’s behaviour should not be done without proper training. Rational Emotive Behavior Therapy (REBT) The precursor of REBT is the Adlerian psychotherapy and some ideas of Jung. However, it is not the same as the other non-cognitive approaches which depend on the therapist’s warmth or positive attitude in order to effect change on the patient. The therapist is direct to the point. REBT is the anti-psychoanalytic approach which originated from Albert Ellis. Ellis says that REBT came from ancient Asian and Greek philosophers and twentieth-century psychotherapists, one of the most popular is Alfred Adler. REBT simply states that what a person thinks, that is how he/she feels. “A person’s cognitive interpretation of events will determine his or her attitude and emotions.” (Eisner, 2000, p. 27) REBT is against the unconscious, and not about dreams. It’s all about what one sees and perceives. It is not concerned with the ‘records’ of the unconscious. The REBT therapist will simply look at the issue and investigate what is happening. The therapist doesn’t mind the history, the experiences of childhood, and dreams are not for real. REBT deals with the basic concept of neurosis. “This is happening to you because you should not do this.” That is the main thrust of a REBT therapist. Ellis (2003) explains that REBT is more depth-centred than psychoanalysis. The explanation here is that psychoanalysis is more on psychology and Freud’s theory on the id, ego, and superego, while REBT looks at the disturbing assumptions and the facts behind the person’s problems. Psychoanalysis looks at higher-order abstractions and ignores the “depth-centered semantic problems”. (Ellis, 2003, p. 217) The REBT therapist is straightforward in his dealing with change on the patient. The therapist deals with activating events, for example if the patient doesn’t get good grades. The psychoanalyst says that the student doesn’t get good grades because he thinks so. But the REBT therapist deals with the belief of the activating events. This portrays an irrational behaviour. And the next step should be to deal with emotional consequences. The therapist would soon intervene. The view of REBT is that emotional upsets come from irrational beliefs. A person believes that something should happen, and if it does not happen, something bigger will soon happen. The emotion of that person bursts. There is an ambiguous mediator in the REBT; meaning irrational beliefs are ambiguous in this sense. Numerous researches conducted on REBT have been inconclusive and inadequate, although this has been countered and argued by Ellis himself that those who claimed that the results of their experiments were inadequate were really not knowledgeable enough about RET. There is an unreal RET, or a copy of the original. Experimenters should be guided by manuals when they do their therapy, according the Ellis. And the experimenters did not record and provide publications for the results of their experiments. What should experimenters do with new therapy on REBT? First, Lyons and Woods conducted a meta-analysis. This study consisted of 70 studies on REBT. They used a baseline in which to compare with, and a control group for a psychotherapy session. (Eisner, 2000, p. 129) In their meta-analysis some studies on REBT were not included because of inadequate information on critical elements of the study. Nevertheless, they found that REBT was effective form of therapy. The study also conducted investigation on the use of terms such as RET, Cognitive Therapy and Behavior Therapy. They concluded that there were no differences on the use of these terms. Lyons and Woods (cited in Eisner, 2000, p. 127) further said that “there is no guarantee that the therapy being used was actually RET as practiced and taught by the Institute of Rational-Emotive Therapy”. The studies however on REBT have little information on long-term effectiveness, which meant there was no follow-up data of the experiments. The effectiveness of REBT has not been shown to therapists, and therapists have been reluctant to show an effective REBT. There have been reports that REBT has shown some improvement in the therapy sessions, but scientific results have not been shown. There was a study conducted of REBT along with the pill Prozac. There was improvement on the part of the patient, but again it was inconclusive since the experimenter could not tell whether the ingredients of Prozac or the psychotherapy was responsible for the behavioural or physiological change. (Eiszer, 2000, p. 1130) Integrative Knowledge Base Corey (2009) defines an integrative approach to counselling as based on theory, with techniques adapted from the different approaches but designed to the client’s unique needs. Anyone can develop his/her own integrative style according to one’s personality and the kind of clients that a counsellor meets. Anyone can have this model, but to have it without training may be conceived as dangerous. Mere knowledge of theories without adequate training is dangerous. This is true with many other disciplines. To conduct therapy with knowledge of the theories alone could endanger therapy, the facts surrounding the case and the patient’s health and wellbeing. It is important that one should look at his own life, whether he/she is willing to do what he/she wants of the clients to do. It is difficult to tell others what to do if you yourself are reluctant to do it. Corey states that one can start with practicing the different approaches to therapeutic practice. By mastering one theory and studying it in depth, the counsellor can search for an integrative style. The best wise move for a student of therapeutic practice is to master a particular theory about what he/she thinks of the world, or something that is near to his/her worldview. This theory can be used as a foundation for developing a knowledge base of the therapeutic practice that one would like to expound and improve further. A therapist should have an explicit theoretical rational before practicing therapy. This is the same as building a house; a strong foundation is needed before it can be further improved and added with floors and features. One must have a theoretical base, but training is also needed. In the field of counselling, one can meet clients with different and unique problems. Corey says that there is no permanent and constant approach to therapy that applies to all clients; each client and situation are unique, and therefore the therapy to be applied must also be unique. To understand clients, the therapist “must be able to appreciate them from a multitude of perspectives” (Corey, 2009, p. 3). A unique approach for a client should revolve around the questions that need to be answered by the therapist: What is wrong with this person at the moment? What are the problems and situations that led to the client’s present state? What counselling is effective on this client, and what does the client need for the moment in order to restore him/her into the formal state of life? Corey states that with the basic knowledge of the client, the therapist can draw from the concepts and techniques in counselling and then adapt from the contemporary counselling models to suit to the client. Moreover, the therapist should also take into account the universal behaviour that can be seen as common to all humans in terms of thinking, feeling, and behaving. The client can be led to examine himself/herself about such ideas and questions that the client can answer, for example: How do the problems reflect about what the client thinks of the world in general? How are problems created according to one’s beliefs? How can you free yourself by evaluating the problems and beliefs and the statements that have been said? The questions can help the client assess the problems and the facts that have brought him/her into the present situation and malady. Clients can have an in-depth thinking of themselves, interpret the events that have transpired, and cognitively change their belief systems. Corey explains that once clients think of their problems, they get stuck because of the unexpressed feelings and emotions. Clients should be encouraged to experience their feelings and talk about the experience that has affected them that led to the present problems. Healing then can be experienced on hand by using techniques that allow the client to express his/her feelings, express them out, and let the client feel that someone is listening and has the will to understand. Thinking and feeling are important in the healing process. The client should be able to express his/her emotions and feelings in the acting dimension. There has to be an open discussion between the client and the counsellor, with the client in the acting part, expressing himself and gaining insights. Clients should also be able to accept change, and change for the better. Feelings and thoughts should be applied to real-life situations. Integrative counselling means there is an interaction between the client and the therapist. Real-life situations include what the client is experiencing at the moment, his affairs and relations, his activities in school or in the office. All this affects the present life situation and has brought problems to the client. The counsellor can help the client to recap what he/she learned from the sessions and apply new behaviour to forthcoming experiences in everyday life. Some of the activities that need changing behaviour are contracts at work, homework assignments, activities in the community, self-enhancing techniques, work with organizations, and programs for personal change or civic work by helping others. The client has to commit to work for change, practice new behaviours, or to follow a certain plan in a new direction in life. One of the recommendations that I can make in therapy with clients, from the experiences and the theories I have learned, is to ‘experience’ what my client has experienced. This is not to mean literally experience the present situation of the client. What I mean by experience is to put myself in the shoes of the client. With my beliefs, my experience, and knowledge, I can understand the client. What would I do if I were on the client’s side? Corey says that you can do this by ‘becoming’ the client. From there, the therapist can reflect on the theories we have discussed on integrative counselling. Sample session with a client I should like to put this in a make-believe scenario. If I have the client now sitting on a coach beside me, the first session is critical. The client has to speak out what has been inside that allows all the negative feelings to remain there inside. As he speaks out, these negative feelings would start to come out and not remain there forever. Since the first session is critical, I have to open “the gates of secrecy”. My understanding and listening to the client can set the tone for an open discussion, although at first really, this may not be so. I can begin to set a friendly atmosphere by explaining that the session is a friendly talk and it is just between the two of us. My first statements should be to let the client feel at ease and to talk freely about his/her situation. The sense of safety on the part of the client must be established. To establish rapport, I should let him feel to talk about the situation, and what to expect of the day. The client can get focused, relaxed and talk out his heart out, slowly and with trust. My first questions would be: What inspired you to come to my office? What is presently happening in your life to let you come to my office? What do you expect me to help you? What are your hopes, disappointments, and fears? What do you aim to do with this therapy? Is this therapy to you? Can you please describe the events that recently transpired in your life? Who are the people in your life? What struggles have you just me? Were you successful with these struggles? Conclusion/Recommendation A comparison of Freud’s psychoanalytic therapy and the REBT may be too difficult to conceive. What the therapist should do is to find an integrative approach, where a combination of Freud’s psychoanalysis and REBT is possible. The therapist has to master the theories, and apply this to real life. The life of the client should be known – his problems, his ups and downs, and eventually his life is laid open for possible recommendations and successful session. Every therapy session with a client should be unique from the others. To practice the art of therapy, one should have adequate training and experience. This is for professional practice. But in terms of a friendly ‘healing’ with a friend or a relative, we can actually do it, as in sharing and interaction. When a friend comes to consult his/her problems, you would not be too selfish not to share your time and provide him/her the listening pleasure. Listening and giving a few advices can heal. This is called informal therapy – without formal training. But of course, we cannot do it all the time. Professional therapy should be accompanied with training and mastering of the theories of psychoanalysis, REBT and other theories. References Corey, G., 2009. The art of integrative counseling (second edition). Belmont, CA: The Thomson Corporation. Ellis, A., 2003. General semantics and rational-emotive-behavior-therapy. In: I. Caro and C. Read, Eds., General semantics in psychotherapy. Brooklyn, NY: Institute of General Semantics. Eisner, D., 2000. The death of psychotherapy: from Freud to alien abductions. Westport CT: Greenwood Publishing Group, Inc. Ewin, R. B., 1998. Personality, a topic approach: theories, research, major controversies, and emerging findings. New Jersey: Lawrence Erlbaum Associates, Inc. Pargman, D., 2006. Managing Performance Stress: models and methods. Oxon, Great Britain: Taylor and Francis Group. Riley, J., 2001. Getting into counselling. Great Britain: Trotman and Company Ltd. Read More