Humanistic Person-Centered Psychotherapist Work - Essay Example

An Exploration into the impact of working with a dying client on the Humanistic Person-Centered Psychotherapist LITERATURE REVIEW This discussion and review critically evaluates the theoretical approaches used in a client centered humanistic therapeutic or related approach of treatment, and the conclusions reached in published studies. The review also addresses similarities and differences in theoretical methods and perspectives adopted by different researchers and provides an evaluative analysis on the effects of working with a dying client and the impact this could have on the therapist. This review explores the impact of working with a dying client and the effects of the dying individual's condition on the humanistic and person-centered psychotherapist. The humanistic person centered psychotherapist is empathetic of the needs of a client who has gone through a difficult condition in life and possibly faces the possibility of terminal illness, fatal disease and even death. The death or dying condition of the client has a profound impact on the therapist who not only witnesses the gradual demise of a person he knew closely but also the dissociation of a relationship that may have developed over years in which the client and the therapist were part of deeper thought processes and the therapist became aware of the inner mental processes of the client. Considering that the therapist may well have been the closest person to the client, and the client revealed many secrets to the therapist, the bond may have been especially strong between the client and the therapist. Clients in many cases are closest to their therapists than even to their family members and the client therapist relationship is defined by trust as the client reveals many personal facets to the therapist which the world may not even know. The therapist and client thus develop a mutual attachment and that is why being attached to a dying client and witnessing a close person's death could have a significant impact on the psychotherapist. It is difficult to gauge what sort of impact this could be and whether this would be positive or negative for the therapist but it is expected that the therapist would learn from the experience so it would be positive in an experiential sense although the emotional impact being significant, the whole experience could be negative and disturbing for the psychotherapist. The case placed here is that of a terminally ill cancer patient, 60 year old John P who joined a clinical centre and therapeutic group initially to overcome his emotional problems following the discovery of his life threatening illness. John P was then recommended to a psychotherapist who practiced person centered humanistic approaches and therapeutic sessions began after a first introductory visit by John p to the therapist's chamber. The client therapist mutual relationship soon developed as a bond and an attachment as John P revealed his inner fears, his emotional strengths and weaknesses and his general attitude towards life and death and reflected on his illness. The therapy continued to help John greatly as he found a confidante and a friend in the therapist and their mutual relationship strengthened as the therapist focused more on the humanistic approach and showed concerns about John's emotional and personal needs, his aspirations, and goals and what he wanted in life. The opportunity to share his thoughts and feelings with the therapist infused confidence in John P and the therapeutic sessions turn out to be advantageous for John especially during his end of life stage when he faces the prospect of rapid health deterioration due to his terminal illness. The focus however is the impact of the professional relationship which can even border on the personal, on the therapist who will live with the memories of the client and having developed an attachment or bond with the client may find it difficult to cope with the loss of daily interaction with the patient when John P dies or becomes incapable of attending sessions any further. These issues are raised in the next parts of the discussion which along with a background analysis of research papers in the field, uses evaluative and critical arguments to focus on theories and practices of humanistic psychotherapy. The similarities and differences in the theoretical approaches in client centered therapy are also studied. Carlozzi et al (2002) suggested in a study that psychotherapists who follow the humanistic perspective are more empathetic about their clients than all other psychotherapists with different inclinations. In the study, psychologists and counselors completed a questionnaire and explored relationships and empathy definitions and also their own orientations on the theories of psychotherapy. At least 565 respondents identified humanistic and psychodynamic theories as associated with empathy and some consistency has been reported between identification, definition and views on empathy. Elliott and Greenberg (2007) suggested that the Process-Experiential/Emotion-Focused Therapy (PE-EFT) is "an empirically-supported, neo-humanistic approach that integrates and updates person-centered, Gestalt, and existential therapies". Thus this sort of therapeutic approach integrates the philosophies related to humanistic approaches, the gestalt or holistic approach and the existential psychotherapeutic approach. The neo humanistic values, process experiential and process guiding relational stance, marker task strategies and therapist exploratory response styles are some of the essential features of process experiential therapies. The treatment principles in therapeutic relationships have been identified as follows - achieving empathic attunement or a mutual empathy (in therapist-client relationship), fostering an empathic, caring therapeutic bond (developing attachment) facilitating task collaboration (client and therapist work together in mutual cooperation) helping the client process experience appropriately to the task (the client is helped by the therapist to understand his own experiences and how to use them in his tasks) supporting completion of key client tasks (the therapist supports the client in task completion and achieving specific goals, in fact the therapist's support is necessary for this) fostering client development and empowerment (the client overall growth and empowerment in matters related to his emotional and physical health is important to the therapist and the mutual relationship focuses on how far the therapist can help the client to overcome problems and work towards better social adjustments). The contradictions and difficulties faced by a client are dealt with by the therapist and the therapist acts as the support and lifeline for the client. This consistent support from the therapist develops mutual empathy and provides a strong bond between the client and the therapist. The empathic humanistic approach provides a new level of awareness with regard to patient needs and concerns. The patient surroundings and the settings where therapy is provided could be calm, homelike and friendly to visitors and in a study by Harris (1997) caregivers and therapists have reiterated their commitment towards a humanistic approach to patient care where not only holistic perspectives are considered but also perspectives related directly to patient needs are emphasized. It is the patient who is at the centre of the therapy and it is the patient's physical and emotional well being that is the prime concern of the therapist. The patient centered therapy is humanistic as it is more emotion based and based on empathy where the patient being the centre of the therapy is considered unique and his or her needs are also unique that trigger an approach specifically designed to meet the unique needs of the individual. The therapy is thus human centered or humanistic, emotion based and based on an approach of care and concern for the patient where the therapist pays special attention to what the client thinks or how he approaches his life and problems. The background research papers that have focused on humanistic psychologies, humanistic perspectives, patient centered therapies and particularly on the empathy factor between client and therapist are very similar although the nuances of theoretical approaches may be different as some are based on humanism and empathy whereas some others on emotional needs of the patient and specific client problems and issues. The doctor patient as a client therapist relationship is a social relationship and the final objective is to help patients attain any specific treatment goal (Loh and Sivalingam, 2008). The positive therapeutic relationship could be related to active participation of a patient in a treatment plan so that the treatment goals are successful. The humanistic patient centered approach is about understanding the patient's needs for love, belongingness, self esteem and self expression and the therapeutic exercise helps the patient to attain the stage of self actualization and the drive and desire to realize full potential. According to Loh and Sivalingam, the person centered approach to therapeutic relationship would include fundamental elements of genuineness, positive regard and empathy as seem between clients and therapists. Application of these elements would promote success in any therapeutic process. When considering specific cases of the dying patients, Miller et al (2005) have emphasized on the need to focus on the psycho-social-spiritual needs of patients, especially if they have a life threatening illness or are elderly or dying. Such patients require palliative care interventions with a spiritual dimension. However the effects of any innovative care program could also be effectively evaluated. Miller and his colleagues evaluated a group intervention entitled Life-Threatening Illness Supportive-Affective Group Experience (LTI-SAGE) that was developed to reduce patient spiritual, emotional, and death-related distress for dying patients. 69 African American and Caucasian patients from two hospitals with life-threatening medical conditions such as cancer; human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]; geriatric frailty; liver, kidney, pulmonary, or cardiovascular diseases were assigned to intervention or control groups. Control group patients received standard care whereas intervention group patients participated in a program - Life-Threatening Illness Supportive-Affective Group Experience -(LTI-SAGE model) for 12 months. Depression symptoms, anxiety, spiritual well-being, and death-related emotional distress were the measures studied in both the groups. Among the 73.9% patients who completed the trial, the results indicated that the experimental clinical program (the LTI-SAGE model) could enhance quality of life and emotional conditions for dying patients. Albert Ellis established rational emotive behavior therapy or REBT and suggested 11 dysfunctional beliefs, considering these beliefs could be important in understanding patient therapist relationships in humanistic therapies. Ellis suggested that these beliefs may be that all adult humans have the need for love and compassion, and everyone requires a sense of adequacy and achievement in important aspects. It is also believed that people have an inherent need to act in a proper righteous manner and want things to work systematically. All emotional disturbances are caused by external factors and dangerous possibilities need concern. It is also one of the beliefs that life's responsibilities could be easy if avoidable and others' disturbances are difficult and perfect solutions are possible for life's problems (Ellis, 1994). These are however irrational beliefs according to Ellis and could define any therapeutic relationship as therapist could even treat their patients to dissuade any such beliefs that the patient may hold. End of life therapy or therapy for terminally ill patients could be understood on the basis of such beliefs although this would require some agreement with Ellis' viewpoint as well. Ellis theory may be criticized as being too extreme as it is true that many of the beliefs which Ellis has branded as irrational could be natural among humans. End of life therapy may become reflective and the client would tend to dwell on life's past achievements, as well as show extreme emotional dependence on others. These factors could well be studied with Ellis' theory or other theories that could suggest how end of life beliefs, whether rational or irrational could be treated or understood by the therapist. According to a study by Lacy and Higgins (2005), understanding psychodynamic principles is necessary when treating patients with co morbid or fatal medical and psychiatric illnesses and patients with psychiatric illness could be treated with the help of a combined family practice-psychiatry resident who would care for the patient until the time of her death from cancer. School specific psychotherapies may not always be applicable in this case and this would require integrated approach as different kinds of psychotherapeutic strategies and a combination of various methods will be necessary to treat a patient with multiple complications, and physical and emotional needs. Integrated approaches to psychotherapy and practice have become increasingly popular in recent times. The next stage of review would be an evaluation of the therapeutic methods used in any session and the advantages of these approaches, the weaknesses of such theoretical or practical approaches and the use of integrated approach in psychotherapy and how or when this can be used. This can be done by considering the published papers highlighting different models. Brubacher (2006) has provided a critical approach to Satir's model suggesting that the humanistic family systems approach by Satir lacks theoretical strength and structure. The approach could however be integrated with a model grounded in explicit theory, relationship principles, therapeutic skills and processes (Brubacher 2006). Emotion focused therapy or EFT could be effective in bringing about change in the individual and in the therapeutic approach that would also involve family systems. Bringing about change in the individual for positive end of life care through family involvement as well could be an effective therapeutic approach and could be followed by therapists who may want a more integrated approach rather than any strict methodological principle in therapeutic practice. Goldberg (2000) has argued that psychology has not lived up to its expectations of providing the right kind of support or direction for the establishment of a mentally stable and well functioning society. However psychology should be based on humanistic values and approaches that could help not just the development of the subject but help in development of society and understanding if emotional needs of individuals in various scenarios. The roles of healthcare, rehabilitation and professional practice seem to change as suggested by MacLeod and McPherson (2007). Although care is important in healthcare service, the concept of care may still be controversial within rehabilitation services. The ethical, humanistic and political aspects of caring have been examined along with risks of caring and the value placed in caring and particularly in rehabilitation. However the difference between rehabilitation and care could be studied further. The integrative approach to psychotherapy is one of the more popular methods of psychotherapeutic research and this have been studied using instances of history, the reasons of integrative approaches, and the approaches to integration is psychotherapy. The three approaches to integration in psychotherapy include - theoretical integration, theoretical eclecticism, and common factors in different psychotherapeutic trends (Kozari-Kovaci D, 2008).Integrative psycho-therapeutic methods are holistic and draw upon phenomenology and field theory along with humanistic approaches. However the similarities and differences of different therapeutic approaches being not sorted out, the definition or proper practice of integrative approach in psychotherapy remain elusive. The applied models based on different epistemological and theoretical presumptions suggest that integrative psychotherapy could well be a synthesis of object relations, humanistic therapy, field theory and psychoanalysis. The focus is on human relationships rather than just the feelings or emotions of the client, the focus is also on the holistic development and environment and the context within which the client interacts with the therapist and the world at large. Integrative psychotherapy could also focus on a developmental-relational model as well as creation of a psychotherapeutic relationship as an interactive event although in any integrative approach the betterment of the client would depend on the relationship between the patient and the client. The relationship of the therapist and the client highlights the need for a relationship which is basic in all humans and the situation is about close interpersonal contact between two people. The therapist client relationship is in that way unique and extremely meaningful for both although along with the relationship, there are many expectations and demands on both sides which when not met could lead to hard feelings and disagreement. This situation is best avoided if the patient and therapist are clear of their therapeutic goals and it is up to the therapist to determine what the sessions should achieve in terms of client wellbeing and expectations. The client establishes a sensitive and attuned relationship with the therapist although this relationship and the therapeutic approach is strengthened when the integrative approaches from neurosciences, holistic perspectives, sociology and developmental relational models are also used. The therapeutic relationship is primarily a healing process and in order to understand the differences in practices as taken up by different psychotherapists of different schools we have to understand that there are certain basic similarities in that all therapeutic processes could be seen as healing process or treatments striving towards a betterment and strengthening of relationship goals between client and therapist. Whether it's the neurosciences or gestalt or object relations or simply humanistic perspectives the different approaches could be added to integrative psychotherapy although the implementation would depend on the specific needs of the client and how the client would respond to such therapies. The client's own preference for different approaches or methods of therapy could also be considered along with discussions with family members (Wanigaratne and Barker, 1995). In conclusion the case of John P could well be understood on the basis of the integrative or simply humanistic approach to psychotherapy as therapies with John P could be done suing holistic perspectives and his life goals or developmental approaches as in life span development. John P is a patient who has reached his end of life through terminal illness and his life span development though not stopped has been seriously affected with the discovery of cancer. To overcome feelings of worthlessness or inadequacy, the support of the therapist could become significant at the end of his life. With the advanced stages of cancer the therapeutic relationship could even become stronger as with deteriorating physical health, John P's emotional needs could increase significantly and this could lead to stronger bonds with the therapist. The sessions may well be advantageous for the patient as previously noted although for the therapist, this is a difficult experience as with a dying patient, the attachment could become even stronger as the therapist almost participates in the process of death with the client by developing empathy at every stage. It is almost as if the therapist lives through death and sees death closely with his client and as the client dies and leaves the therapist behind who had a close encounter of death with his client, the experience could be in a way disturbing to the therapist although this can lead to positive changes within the therapist who can also develop as a person and grow further as a therapist. Treatment of a terminally ill patient could be difficult and challenging and providing support and empathy to a client during his last days are even disturbing for any therapist however with an integrative approach and less emphasis on emotions and more on the process of therapy could be more effective more a therapeutic relationship in this case. Bibliography: Alliex S, Irurita VF. (2004) Caring in a technological environment: how is this possible Contemp Nurse. Jul-Aug;17(1-2):32-43. Barker P. (1998) The humanistic therapies Nurs Times. Feb 11-17;94(6):52-3. Brookes CE. 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