Theory and Practice of Counseling and Psychotherapy - Essay Example

Theory and Practice of Counseling and Psychotherapy The Psychoanalytic theory is premised on the belief that human nature is greatly affected by a person’s early childhood experiences and conflicts between impulses and prohibitions. The complicated theories developed by Sigmund Freud became highly controversial especially in the era they were presented due to the fact that it involved psychosexual issues considered “taboo” at the time. Still, because it attracted much interest and debate, it gained a prestigious distinction in the field of Psychology to merit a great deal of influence, intensive study, modification and application. Freud’s views human behavior as determined by irrational forces, unconscious motivations and biological and instinctual drives evolving in the first six years of life. His idea of the three systems of personality, the id, ego and superego being in constant battle is likened to a person’s continual debate of what is right and wrong, and then behaves according to his moral decisions. Such decisions are affected by what society dictates as well as what the person truly desires for himself. To survive living with negative experiences that may have marred a person’s personality or life views, he develops “defense mechanisms” that aim to keep those traumatic experiences repressed in the unconscious. These defense mechanisms are usually practiced by everyone in their daily life not knowing that they are applications of Freudian thought. An example of a defense mechanism commonly used is ‘rationalization’. If a person has strived hard to reach a goal like applying for a certain job position and does not get it, he would rationalize to his family that he was not so interested in it after all. It is much like the fabled fox “sour-graping”. This is an attempt to mask his utter disappointment and maintain an “unaffected” façade to the people around him. The goals of Psychoanalytic therapy are settling unresolved conflicts in a person’s past that deeply affect his current patterns of behavior and personality. It may involve bringing repressed painful memories to resurface to be dealt with consciously through the techniques of free association, dream analysis, hypnosis, transference, and analysis of resistance handled by a skilled psychoanalyst. This tedious process intends for the client to reach a level of self-understanding for him to be able to move on with his life without the heavy emotional baggage he has been carrying all his life. This understanding is necessary for an eventual change in character. The psychoanalytic therapist should be adept and very patient in coaxing the client to unearth his repressions. The ability to listen and be alert and sensitive to what the client tries to communicate (verbally or non-verbally) is crucial to her valid interpretations about the client. She must also possess maturity and maintain her professional objectivity especially when the client undergoes “transference” of remembered feelings towards a significant person in his life to the therapist. A deep level of trust must have been established between the therapist and the client to be able to achieve this feat. In order for the therapy to be successful, the client must be committed to being cooperative and ready to discover truths about himself, no matter how ugly it may be. In the course of the therapy, the client is expected not to make any drastic life changes that may affect the analysis of the clients’ problems. Psychoanalytic therapy ends when both client and therapist mutually agree that they have reached the goals of therapy, that of the client reaching self-understanding, and being able to use uncovered information in confronting present conflicts and future possibilities of repetition of patterns of unwanted behavior. Adlerian Theory Adlerian theory offers much encouragement to disheartened individuals. It embraces inherent feelings of inferiority as positive signs of a person’s realization that he needs to strive to be better than what he is now. Adlerian theory focuses more on an individual’s concern for social interest. A person’s capacity to identify and empathize with other people’s life circumstances builds up his own self-esteem and relevant purpose of existence. Alfred Adler advocates that we must successfully master three universal life tasks: building friendships, establishing intimacy and contributing to society. Being able to do all three makes life worth living. A person’s quality of relationship with his family members while growing up greatly influences the development of his personality. Individuals acquire a certain style of relating to others in childhood that carries over to their adult interactions. For instance, if his birth order reflects strong sibling rivalry, the patterns of behaviors with the rival sibling may be repeated to an adult counterpart in the person of a colleague at work who constantly competes with him in terms of work performance or social popularity within the office. Adlerian therapy begins with establishing a mutually respectful relationship between the therapist and the client who both collaborate in identifying, exploring and disclosing mistaken goals and faulty assumptions in a client’s life. The client is then reeducated towards the useful side of life which acknowledges his existence to be significant in his social circles. He is likewise assisted in the adoption of appropriate behaviors and practices characterized feelings of belongingness and social interest. In doing so, the client gains confidence and positive self-esteem empowering him to modify his faulty beliefs of his weaknesses and uselessness in society. The therapist culls information about a client’s lifestyle using subjective information provided by the client himself as he volunteers information about himself and objective information likewise provided by the client, but structured by the therapist. Mostly, they discuss recollections of early family memories. From this point, a client may be aware of some personality quirks he possesses because of a significant past familial experience. Throughout the therapy, the therapist takes on the client’s frame of reference in understanding his subjective life views. Again, this fosters a sense of belongingness, and encourages the client to move towards positive change because of a motivating partner. Developing insight about oneself comes from exploring different interpretations of disclosed and realized goals and purposes, directions in life, one’s private logic and how it works, and one’s current behavior. The final stage of therapy translates these insights to action in achieving the goals of developing the client’s positive self-concept and empowerment to be a contributing member of society The success of Adlerian theories is palpable in its application in a wide variety of fields – from education to parenting, marriage and family counseling, group therapy, etc. Encouragement is the key in Adlerian theory, and it is something this world needs a lot of. With devastation consuming a lot of people because of stress, family conflicts, imbedded hurts from failed relationships, and moral transgressions, Adlerian therapy would be very much welcome, as it aims to heal broken and strengthen healthy relationships. Person-Centered Therapy Person-centered therapy stems from the theories of Carl Rogers, a noted psychologist who espoused humanistic views in therapy. His non-directive approaches to the therapeutic process raised a lot of eyebrows when it was introduced because it seemed to have thrown scientific techniques out the window and instead focused on the inherent needs of the client as a human being instead of a mere subject of therapy. This approach has great respect for a client’s subjective views and potential for self-actualization. It offers a fresh and hopeful perspective on its views on human nature. The main ingredient to successful therapy is a warm and caring therapist imbued with attributes such as congruence, unconditional positive regard and accurate empathic understanding. Such qualities are hard to come by in therapists nowadays. Rogers believe that possession of such qualities in addition to a high level of maturity qualifies a person to practice as a person-centered therapist, as it does not require a specialized training. Being a sensitive and tactful listener who exudes total acceptance of the client can compensate for the lack of formal counseling techniques. Being congruent means being real and authentic – no discrepancy between one’s perceptions and one’s being. A therapist needs to be congruent himself before he can decipher incongruence in his clients. His wisdom enables him to spot clients whose ideal self-concept is far from the truth, (i.e. the mistaken perception of one’s greatness in a skill when in reality, he is very poor at it). His goals include helping his clients have an openness to experience, a trust in themselves, an internal source of evaluation and a willingness to continue growing. The ability of a therapist to accurately empathize with a client’s subjective experiences on an interpersonal, cognitive and affective level is essential in fully unlocking the client’s perceptions, feelings and motivations for his behavior. The therapist’s enormous capacity to understand and accept the client no matter what communicates to the client that he is a worthy person. However, the therapist must caution against being swayed by emotions of his clients to justify excuses for wrong decisions, as he must always have a firm grasp of what is right and wrong. As the saying goes, “Love the sinner but not the sin”. This is not to say that the therapist holds the moral compass in the therapy sessions, but he is in a position to influence the “awakened” client to come up with his own appropriate decisions from the therapy point forward. A client comes to a counselor with a feeling of helplessness, powerlessness and an inability to make decisions or effectively direct his own life. He finds refuge in therapy with a warm, trustworthy and accepting friend who is there for him in his seemingly lowest point. He feels safe enough to shed his mask and just be. He finds freedom to express his innermost feelings, be they positive or negative, and is assured that he will remain acceptable. In this kind of relationship, the client finds opportunity to grow and overcome his feelings of failure – and commences his healing by deciding on a positive action towards self-actualization. Assessment procedures are not given emphasis in the Person-centered approach. Diagnostic screening, identification of clients’ strengths and weaknesses and several other tests at the outset of therapy may even impede the progress of therapy as the therapist-client relationship is believed to evolve from the clients’ subjective sharing of his life experiences instead of a record of information created before establishing a relationship with the therapist. The best assessment for this form of therapy is self-assessment by the client. Reality Therapy Reality therapy is the kind of therapy that makes clients accountable for whatever state of life he is presently in. It is a product of the choices he has made, and so, makes him in control of his own thinking, feeling and behavior. It is premised on Choice theory that advocates that we are born with five genetically encoded needs – survival, love and belonging, power or achievement, freedom or independence, and fun. If one need is not satisfied, it becomes a source of instability, and reality therapists teach clients to identify and satisfy that need. Total behavior is made up of four inseparable but distinct components – acting, thinking, feeling and physiology. Clients are asked to evaluate each component and the quality of each as it functions in their practical lives. This self-assessment will eventually help the client make effective choices. The most important component in our quality life is the important people in our lives that we want to connect with. Clients who come to therapy are usually those who have unsatisfactory relationships in their perceived quality world and hope to repair these dysfunctional relationships. It is the goal of therapy to help clients make the right choices through intensive reflection and introspection guided by realistic questions. Such questions are like bitter pills to swallow, as they force the clients to confront reality and deal with it. Reality therapists are direct, frank and open about their opinions without being intimidating to their clients. The art of balancing confrontation and unconditional acceptance is to be mastered to ensure success. Taking the basic points of Reality therapy into consideration, let us try to apply it to a fictitious depressed client whom we shall call Marla, who is experiencing a falling out with her best friend and business partner. Marla has shared a very close friendship with Bessie. Both ladies put up a flower shop which became hugely successful. After three years, Bessie had to take a leave from the business because of her problematic family issues, which left Marla in charge. Marla run the shop very well and established happy relationships with satisfied customers. When Bessie came back after three months, she felt slighted that customers seemed to prefer Marla over her, and resented Marla for it. She became sarcastic and self-righteous, making her very difficult to live with. Marla tried her best to understand Bessie, as she is aware that she is still reeling from her family problems. She felt guilty at being so successful in her management of the business to the “detriment” of her friend’s self-esteem. To save their friendship, Marla kept on apologizing about little things, and allowed to be manipulated by Bessie. During therapy, Marla has identified that her needs for love, achievement and freedom were affected in her relationship with Bessie. She desperately wanted to keep her love; her achievement at her successful business management was questioned; and she has lost her freedom to decide on business matters by herself because she kept on considering her business partner’s feelings. Her self-assessment of her behavior components are as follows: she acts very subservient towards Bessie in an effort to win back the quality of friendship they shared; she thinks Bessie is insecure, over-reactive and irrational and needs to realize that she is being hurtful herself; she feels inauthentic in the way she deals with Linda as she is overly cautious with her words and actions to avoid being misjudged; and when she is with Bessie, her body is tensed, she finds her throat dry all the time and she feels “butterflies in her stomach”, and all these physiological responses disappear the moment they part ways. The hard questions that she confronts are: “Would you choose to stick to her friendship or prefer to lose it?”, “What do you get from maintaining this friendship?” , “How is this affecting your business, your sense of achievement?”, “What is is you want that you don’t seem to be getting from this friendship?”, “What do you think stops you from making the changes you would like?” In confronting these hard questions, she realizes that she indeed wants to keep Bessie’s friendship, but accepts that it may not be possible to regain the closeness unless Linda herself chooses it to be that way. However, she realizes that she needs to take the business aspect of their relationship out of the way, as it is the source of friction between them. She decides that once and for all she needs to express her real feelings to Linda about their sticky situation, and announce her decision either to leave the business and start a new one on her own, or to go on to a totally different career path and leave the business to Besie. Whichever she decides, she will assure Bessie of her friendship, and if Bessie rejects it, Maila just needs to accept it and move on with her life. If everything turns out well, Marla satisfies her need for love (either Bessie’s or her own love for self), achievement (by choosing her own career path) and freedom (to make her own choices for her own life without considering a “partner”). Cognitive Behavior Therapy Cognitive Behavior Therapy views human nature as full of innate potentials and flaws. Clients suffering from psychological problems are assumed to focus more on their flaws that pull them down than on their potentials that may spur them up to success. The basic premise of Cognitive Behavior Therapy is the clients’ erratic or exaggerated beliefs that it is their fault why they came to such a dreadful state. The goal of therapy is to help the client realize that reorganizing the way they view situations will call for a corresponding reorganization in behavior – sort of marrying the concepts of “mind over matter” and “self-fulfilling prophecy”. As an example, a recovering alcoholic will think that he has mustered enough discipline over alcohol. (mind over matter), hence, he strives to be strong and sober enough to resist a drink offered to him at a party (self-fulfilling prophecy). The focus of Cognitive Behavior Therapy is more on thinking and acting more than just expressing feelings, which was more of the concentration of other kinds of therapies. It deals with the client’s present and not his past, although it acknowledges that his irrational thinking might have come from past negative experiences. The duration of the therapy process is usually short, as it immediately cuts to the core and does away with useless preliminaries. The therapist uses a variety of therapeutic strategies depending on what he decides will work on his particular client. He also delegates responsibility to his client by expecting him to do homework outside the therapy sessions. Homework is aimed at positive behavior that brings about emotional and attitudinal change. Ellis’ Rational Emotive Behavior Therapy (REBT) is considered to be the forerunner of Cognitive Behavior therapies. Its basic hypothesis is that our emotions stem mainly from our beliefs, evaluations, interpretations and reactions to life situations. Ellis believes that we have an inborn tendency towards growth and actualization but we often sabotage our movement toward growth due to self-defeating patterns we have learned. Through therapeutic processes, the client learns skills to isolate and dispute their irrational views which were mostly self-constructed and maintained by self-indoctrination. REBT helps clients replace such irrational views with rational and constructive ones, thus resulting in more productive change in behavior and reactions to situations. Although Ellis believes that therapists maintain unconditional regard for the client, he also warns against giving too much warmth to the point of coddling, as it encourages clients’ dependence for approval from the therapist. Maturity is expected of the client as great faith is placed on him that he can change his irrational ways of thinking. Another proponent of Cognitive therapy is Aaron Beck who agrees that much of our psychological problems are caused by “cognitive distortions” due to our acknowledged human fallibility. Therapists engage in Socratic dialogues with the clients, throwing questions that encourage introspection with the goal of the client arriving at his own conclusions. Still another alternative to REBT is Donald Meichenbaum’s Cognitive Behavior Modification. It features client’s self-verbalizations that involve a heightened sensitivity to his thoughts, feelings, actions, physiological reactions and ways of reacting to others. Clients are also taught more effective coping skills practiced in real-life situations. He may be considered his own coach because his self-talk reminds him of how he should restructure his thinking and behavior. Meichenbaum also puts emphasis on stress management which can be very helpful to clients when faced with stressful situations not unlike those that caused their flawed thinking. Counseling as a Way To Deal With Life’s Challenges In this increasingly complicated world, more and more people are turning to therapy in dealing with their everyday troubles. From traditional psychotherapies such as Psychoanalysis which are known to thoroughly scrutinize every detail of a person’s past, and would usually last for such a long time, the alternative of brief therapies are turning out to be a more attractive option, especially for those whose problems are not as deeply-seated as those needing long-term, intensive therapies. From the name itself, Solution-Focused Brief Therapy (SFBT) would easily attract prospective clients who seek solutions to their woes in abbreviated time. It was developed by Steve de Shazar, Insoo Kim Berg and colleagues at the Brief Family Therapy Centre in Milwaukee in the 1980s. These proponents’ work with their counselees and their interest in brevity in therapy made them realize that people were most often inherently capable and resourceful in ‘doing more of what works’ and discussing how they cope with challenges and exceptions to the problem help them go on with their daily lives (Freeman, 2007). Freeman (2007) defines SFBT’s core principles as “a shift of expertise toward the client (who must be recognised as the expert not only in themselves but also in their resources and ambitions)” and “exploring ways in which the client can do more of what works and stop or reduce doing things which do not.” (p. 32). This humanistic view offers much respect to the client and empowers him to recognize his capabilities, which he might seem to have forgotten due to his immersion in his negativity. The therapist’s role is to help him find alternative ways that work for him based on his capabilities, resources and ambitions. SFBT has been gaining popularity in the past decade in its application in a variety of fields. Solution-focused principles have been applied to management coaching, supervision and education. It has been integrated in systems such as Child Protection. It has been mentioned in key documents and is recognized by the National Institute for Mental Health in England. SFBT has been known for a number of strategies that has been adopted by other brief therapists. These are succinctly described as follows: The Miracle Question: The Miracle question is a hypothetical scenario posted by the therapist to the client to imagine what he thinks will happen if a miracle happened to wipe away his problem as he sleeps at night. What does he expect to notice in the morning when he wakes up? “This introduction is followed by an exercise in 'respectful curiosity' where as much detail as possible is gained about the day after the miracle.” (Freeman, 2007, p. 34) It would help the client focus on a preferred situation and consider what parts of the miracle are already happening. Scaling Question: Scaling questions are asked of the client to rate himself as to where he is on a scale of 1 to 10 in terms of his problem situation and what steps can he take in order to bring himself up to the next levels. This helps the client set his own achievable goals which may not be perfect or ideal, but acceptable at that particular point in time. Problem-free Talk: This is part of the session where time is spent discussing about issues other than the client’s problem. This helps both therapist and client identify client’s resources, strengths and interests that may be useful in helping him overcome his problem (Smith, 2005) Preferred Future: This is how a client describes a future free of his problem at hand, or at least, more manageable to allow him to enjoy life. It focuses on the positive outcomes instead of the absence of a negative situation. Videotalk Description: Client’s preferred future is described in concrete (visual and auditory) details to help both client and therapist focus their attention on observable behavior and other factors that could be changed as part of a solution strategy. (Smith, 2005) Exception Seeking: Both therapist and client work together to investigate occasions in the client’s past when the problem was still non-existent. This exercise helps “identify the factors that impact upon the presence or severity of the problem including pre-existing client-strategies for dealing with the problem, so that these can be employed as part of the intervention” (Smith, 2005, p. 103) SFBT theory does not emphasize the need to understand the original cause of the problem in order to solve it. More time is spent in focusing on the present and future circumstances rather than the past, and on the client’s strengths and resources rather than the problem. It is what makes it stand out from other therapeutic approaches. Such discussions provide the advantage of helping the therapist form better rapport with the client which otherwise may be difficult to establish considering the problematic situation. (Smith, 2005). Giving the client control as to the brevity of the treatment is likewise effective, as most clients aim to get better sooner than later so they are motivated to be cooperative with the therapists’ strategies. Solution-Focused Brief Therapy may be applied in a wide variety of situations, even in helping children cope with their own challenges. Nims (2007) has explained how integrating play therapy techniques in SFBT may be effective in children’s expression of their innermost feelings. “In a study by DeJong and Berg (1998), it was reported that 78% of children 12 years old and younger and 89% of children 13–18 years of age made progress toward achieving their goals through this process.” (Nims, 2007, p. 54). When language is adjusted to be age-appropriate, it has proven to be effective, however, due to the cognitive requirements of this approach, it may not be recommendable to children younger than kindergarten level. All the elements of SFBT mentioned above are applied to the children in therapy, with concrete experiences with art, sand tray and puppets. Such materials encourage free expression in children without being threatening to them. Combined with the SFBT strategies, children are helped to envision a preferred future and come up with realistic goals. “The solution message is the final step in the SFBT process. This is a concrete written summary of the session that the child can take home as a visual representation of the child’s efforts toward finding a solution.” (Nims, 2005, p. 63). The sessions are punctuated with a positive atmosphere that aim to elicit positive feelings for the child. Froeschle, Smith & Ricard (2007) used SFBT techniques in developing a program for female adolescents who are substance abusers. The program, named SAM, short for solution, action, mentorship, is “designed to reduce substance abuse, increase negative attitudes toward drug use, and reduce negative behaviors while increasing positive behaviors, knowledge of the physical symptoms of drug use, student achievement, and self-esteem. Group sessions were based on solution-focused brief therapy and action learning theory and were supplemented by mentorship from community members and peers.” (Froeschle, Smith & Ricard, 2007, p. 498). The SFBT strategies incorporated in this program greatly help the girls in the realization that dropping the drug habit will be very beneficial to them, and this eventually becomes a goal they intend to meet. Newsome (2005) reports how schools are using SFBT in addressing the problems of at-risk youths with emphasis on collaborative goal formulation that focuses on client strengths. Problematic youths are taught to shift their focus from despair and deficiency to hope and potential. This is achieved in a nonjudgmental environment that allows for open dialogue using solution-oriented language emphasizing exceptions and potential solutions. (Newsome, 2005). The miracle question allows at-risk youth to imagine a life without the problem and create goals toward such ideal. The therapist’s kind attitude towards the young client and his direct and indirect compliments help the youth focus on his inherent strengths and resources that would assist him in the fulfillment of his goals. With SFBT techniques, at risk youths may begin to co-construct with the therapist or school social workers a reality that focuses on their future success in school in all aspects – academic, social, extra-curricular, etc. SFBT is likewise used in group settings, as it enables the youths to realize that they are not alone in coping with difficult challenges faced by adolescents. It helps if they listen to other members of the group relate what they are dealing with as well as sharing their own experiences in failure. The group realizes that an individual remains to be valuable and worthwhile despite the challenges they face every single day. Group therapy allows group members to form connections to others and increase their commitment to action. People with learning disabilities also benefit from SFBT. The case studied by Smith (2005) proved that a learning-disabled person may learn to cope with his disability by focusing on his ability. Managing their disability is one great feat that is usually desired by such a population. “Further outcome research examining the efficacy of SFBT with people with learning disabilities is needed to provide empirical support for these clinical observations. As many solution-focused techniques need to be adapted for use with people with learning disabilities, research to help identify what elements of the therapy (if any) work well would also be beneficial.” (Smith, 2005). Solution Focused Brief Therapy strategies, proven to elicit responses contributory to the client’s realizations of his own realistic preferences are filled with pearls of wisdom in human thinking and behavior. Each strategy was well-thought through, and creates in the client a sense of ownership and accountability. The therapist’s role is to shake the client to introspect and come up with his own solutions to his problem. However, once the client is discharged from therapy, he is not totally let go, as he is free to consult his therapist for follow-up or plain reporting of how he is progressing so far. SFBT may be likened to Cognitive Behavioral therapy in the sense that a client’s thinking and behavior is modified from negative to positive. Goal-setting is essential to the therapeutic process, and the client is assisted by an understanding therapist who keeps him grounded on his own reality. The fact that SFBT is results-oriented and time-limited makes it attractive to weary souls who need a boost. The therapist upholds a “get right to the core” and “cut to the chase” attitude and balances it with understanding and consideration. More sensitive and fragile clients may take a longer while to adjust to the no-nonsense techniques, but they will appreciate the processes aimed by the SFBT strategies for clients to undergo. No matter how many counseling approaches are developed, it is always refreshing to see anew one sprout up, offering much possibilities for populations which do not find the more established approaches suitable to them and their personalities. SFBT is one new counseling approach that offers practical methods within a reasonable time frame, which works for many busy people today. SFBT has all the makings of an effective brief therapy. It is bound to help more and more people see the light in their darkened perceptions and bleak future. In doing so, SFBT may contribute much to a better and brighter world ahead. References Corey, G. (2005) Theory and Practice of Counseling and Psychotherapy, 7th ed. Brooks/Cole, a division of Thomson Learning Inc. DeJong, P., & Berg, I. K. (1998). Interviewing for solutions. Pacific Grove: Brooks/Cole. Freeman, S. (2007) “A focused solution to therapy” Primary Heath Care, Vol. 17, No 7 Froeschle, J.G., Smith, R.L. & Ricard, R. (2007) “The Efficacy of a Systematic Substance Abuse Program for Adolescent Females.”, Professional School Counseling;, Vol. 10 Issue 5, p498-505, 8p Newsome, W.S. (2005) “The Impact of Solution-Focused Brief Therapy with At-Risk Junior High School Students”, Children & School, Vol. 27, No. 2 Nims, D.R. (2007) “Integrating Play Therapy Techniques Into Solution- Focused Brief Therapy”, International Journal of Play Therapy, Vol. 16, No. 1, 54–68 Smith, I.C.(2005) “Solution-focused brief therapy with people with learning disabilities: a case study” British Journal of Learning Disabilities, 33, 102–105 Read More