Concepts and Principles of Patient Counseling - Assignment Example

?Choose a presenting issue from the list below and apply two different therapeutic methods. (Drug and or alcohol) -conceptualise the nature of the presenting issue - clearly describe the features of the presenting issue - describe the two different approaches in relation to the resenting issue -discuss, compare and contrast the two different approaches With the growing stress and frustrations that people are increasingly facing, the need for counselling is increasing as an intervention to help people cope with stressors and life healthily (Buddy, 2008). . Many concepts and general approaches have been developed through study, research, and analysis each of them being characterised by the method applied in delivering and resolving the problem at hand. I shall try to focus on two approaches that may be applied in resolving drug and/or alcohol related issue affecting an individual. I will attempt to resolve the presenting issues following two therapeutic approaches that have been used in this field of counselling and rendered effective - the Psychodynamic therapy and Cognitive Behavioural therapy. Psychodynamic therapy has developed on the principles of psychoanalysis that were indentified and developed through the work of Sigmund Freud, and a number of his followers. Psychoanalysis ‘takes into account personality development and philosophy of human nature. The theory focuses on behaviour motivation by unconscious factors. The events taking place in the first six years of life is taken as the determinant of personality and behaviour characteristics in an individual’ (Corey, 2005). The psychodynamic approach, on the other hand, assumes that unacceptable behaviours and patterns are a result of the individual’s inability to deal with unacceptable feelings and impulses (Seligman, 2001; p 179). Although the therapy focuses on being dynamic and uncovering of issues (Weisberg, 1999; p. 105 in Seligman, 2001, p 179); the process of therapy is often shorter, as it is problem specific and may sale between six months to a year. The second approach that I will focus on is Cognitive Behavioural Therapy that was founded by Albert Ellis amongst others. Meichenbaum (1993; p.203) has described the process of Cognitive behavioural work as helping in forming new, assumptive worlds. It focuses on the altering of cognitive and behavioural responses to situations (Corey, 2005). The paper will look at how effective these two approaches of therapeutic procedures can be effectively used to resolve drug and/ or alcohol related problems though counselling. Psychotherapy refers to verbal interactions which aim at altering or changing the emotions, thought and behaviour of the client. Counsellors that have adapted to this approach in solving problems have conclusively summarised that alcoholism and drug abuse are behavioural problems that usually are reflective of underlying conflicts (Buddy, 2008). Such conflicts may be financial, social or emotional. This means that a more open outlook needs to be taken in many of the alcoholism and drug abuse cases; the cure should more or less be focused on identifying the nature and origin of conflict and consequently resolving the conflicts rather than the behaviour itself. For instance, an individual may get into alcohol and/or drug dependency because of some recurring family conflicts. Such people will attempt to find solace and comfort in this behaviour but they may not realise it before it becomes an issue. When these people seek treatment from a counsellor, a psychotherapist will want to identify the reasons which have led to the individual’s indulgence in alcohol and/or drug related problems. They have also argued that focusing on the immediate problem will only deteriorate the client’s behaviour rather than produce a cure according to Gelso & Fretz (2001). A popular concept in producing abstinence from alcoholism and drug related issues has been popularised as the ‘12-step recovery model’ of the Alcoholics Anonymous. Although there is conflicting evidence regarding this technique, it enjoys a wide publicity and awareness due to its religious nature (Galanter and Kaskutas, 2008; p. 111). Churches have sometimes encouraged its use, and this has added to its acceptance by people. On the other hand; a number of instances of the church’s disapproval of AA has been recorded. In spite of this, people still associate AA with religion due to its spiritual nature (Galanter and Kaskutas, 2008, pp 4). It is often seen that regardless of the cause, alcohol dependency and drug abuse are likely to lead to a long term life threatening disorder if not treated ( Buddy, 2008) In the 1980s private treatment of such disorders was considered the right approach. Therapists often incorporated elements that were behavioural and cognitive – and reminded people of the 12-step model in their treatment strategies (Galanter and Kaskutas, 2008, pp 94). Generally, the nature of the AA model includes initial removal of the physiological effects of the alcohol and/or drugs followed by counselling sessions that would be delivered by a peer-counsellor who was a recovered victim of alcohol and/ or other drug disorders. This model put less stress on medical treatment and management of the client beyond correcting physiological changes and such medical conditions like hypertension and diabetes according to John Orr Crites (1981). It was meant to be seen as a more direct face-off with thinking and beliefs of the clients that lead them to engagement in alcoholism and/ or other drug abusive behaviour with adamant denial of the negativity that these behaviours impacted on their work, their families and themselves. Although 12 – step programs have seen a fair amount of success; there is concern about the lack of engagement with a trained counsellor and thus, the underlying issues may never be adequately and appropriately explored. In it necessary to evaluate and choose an adequate psychotherapeutic method in order to work through the core issues and thus provide a long term solution to the problem. A psychotherapeutic technique that is in some ways similar to the working of the 12-step program is the Cognitive Behavioural Therapy. Cognitive Behaviour Therapy may be classified as experiential or humanistic approach. Cognitive-behaviour therapy is one among the many approaches that have been in the frontline in treating many mental disorders including phobias and mental depression just to mention a few (Seligman, 2001; p 438-39). In recent times, it has also been rendered effective in treating alcoholism and/ or drug related disorders (Seligman, 2001; p 438-39). This approach has been taken as a short-term strategy that aims at using the procedures that the clients used to get into alcoholism and drug addiction to help them out of the practices. It is more or less a counteractive procedure so as to get an individual to an original state. This approach is fortified in the belief that a person’s behaviour and feelings are induced by a person’s mind and his or her thoughts as opposed to the environment surrounding them or even events. This is relevant given that an individual may not be in position to change the circumstances but he/she may be in a position to change the way he/she perceives these circumstances and therefore change the way he/she feels and behaves in relation to these circumstances (Seligman, 2001; p 441, 426). The aim of Cognitive Behaviour Therapy in treatment of alcoholism and/or drug related disorders is to help the individuals identify the circumstances under which they may be involved in alcohol or drug taking. For instance, one may have experienced a bad day and therefore suffer from some stress. In order to manage this stress, they may decide to drink a bottle of beer or some other drug they might think will help in relieving their stress. Before long, they may become dependent on these drugs and/ or alcohol and without notice. Once an individual has identified these situations, the approach aims at helping them to avoid them and deal with any other related behaviour that may be tempting to compel the individual to engage in alcoholism and drug abuse. In a more directed analysis, Cognitive-behaviour therapy has two main phases i.e. 1- functional analysis and 2- skills training. In functional analysis, the client works together with the therapist in identifying the feelings, thoughts, and situations relating to cases when the client took alcohol and/ or drugs. Together they analyse these aspects relative to time before and after the alcohol and/ or drugs were taken. This essentially helps the client to identify and pinpoint the risk factors that tolerates the problem. This also helps the individual to identify the reasons that may cause him/her to alcoholism and/ or drug abuse and probably help significantly in offering solutions to help curb or avoid these causes as illustrated by Herlich & Corey (2006). Skills training helps individuals in learning to undo their old dysfunctional habits and to develop new functional habits and behaviour as argued and illustrated by Buddy (2008) and Seligman, (2001). These skills can be referred to as coping skills and can be categorised into interpersonal or intra-personal skills. Interpersonal skills are those that involve a second party while the intra-personal skills relate to the individual alone. Just to mention a few, interpersonal skills include one’s refusal to take alcohol and/ or drugs, heightening socially supportive networks, individual perspective in handling criticism and personal description of intimacy in relationships. Intra-personal skills that this approach popularises include management of anger, making of decisions, solving of problems and negative thinking as stated by Hay & Kinnier (1998). It is evident according to this approach that self-monitoring in an individual is paramount as it can be used to identify cravings of drugs in early developments and other problems related to personal behaviour. Once such identification is made, relevant procedures to manage these high-risk phenomena can be put in place. A set of psychotherapeutic techniques has been developed into a norm called Motivational Enhancement Therapy as illustrated by Burnard (1999). This therapy is usually integrated with initial observation then a number of sessions of treatment follow. Psychoanalysis as developed by Sigmund Freud has been used in order to help individuals deal with addictions by various practitioners. Although Psychoanalysis typically takes a long time (longer than six months) to deliver significant behavioural and emotional changes, its value lies in that it delves into the past to trace and repair experiences that are at the basis of the problem faced. Psychoanalysis typically tries to find root causes for behaviours rather than trying to repair only the visible behaviours. The assumption to this work is that if the root cause that leads to a problem faced in the present can be traced and dealt with, then it can lead to changes in the present day experiences that are long term and withstanding (Corey, 2005). Psychoanalysis is practiced by specific licensed Analysts; and thus is observed less frequently. The Psychodynamic methods that have developed from Psychoanalysis are more commonly used in practice. The Psychodynamic Therapy is a shorter, more focussed process that is initiated with specific issues in mind. (Seligman, 2001; p 178-79). It often requires less than a year of therapy; and sometimes may be as less as six months. The principle that the psychodynamic therapy is based on are the same as the psychoanalytic approach; but the psychodynamic method applies more active and challenging methods to the counsellor – client interaction (Seligman, 2001; p 179). Therapists using Psychodynamic therapy believe that early experiences form pattern in the mind that are enduring and pervasive; and these patterns show up in later life through dysfunctional behaviour. Psychodynamic therapy is most suitable for clients who are introspective, have the ability to gain and use insight, are able to listen and use interpretations, and are able to understand and report their thoughts and feelings. These are people who are typically above average in intelligence; and motivated for growth. They have had positive relationships alongside the disturbances; and present a specific issue as a therapeutic goal (Seligman, 2001; p 180). When the psychodynamic model is applied to the area of addiction; it is often used after medical treatment of symptoms brings the client to a more stable state. The therapy begins with an analysis of the course of the individual’s addiction; and then proceeds to draw inferences about the roots of the problem. The counsellor helps the client understand and interpret significant experiences, and helps that client apply the information to their present life (Corey, 2005). The process of using psychodynamic work with addiction attempts to discover the root of the person’s need to use alcohol; and tries to understand what need it is trying to fill. The therapist helps the client re-interpret the experiences such that the client is able to achieve closure with the said past experiences, and move forward with an understanding of the base needs that trigger the need to consume alcohol. This understanding is then applied to discuss and practice new behaviours that are healthy and functional. Cognitive-behaviour therapy, in contrast to psychodynamic approaches is relatively short term as it is more goal-oriented focusing on the problems at hand. While it may take a few months to help the client using the Psychodynamic approach, this approach requires an average of only 14 sessions where the client requires the attention of the therapist. It has been documented that cognitive-behaviour therapy works best when the client gets involved in supportive groups as stated by Buddy (2008). It may be noted that the speed of the therapeutic process of CBT is due to the lack of in-depth exploration of causes and underlying reasons that lead to addictions in the first place. The process does not address these issues, and they stay in the background despite surface behavioural changes. It is clear that these two approaches are focused on trying to curb or eliminate distress and symptoms that come hand in hand with addictions. However, there are particularities that distinguish these two approaches. As discussed earlier, the psychodynamic approach identifies the basis of why a client thinks the way he/she does or feels. This is not seen in Cognitive-behaviour therapy. Rather, it tries to go back to times when the individual was free from the alcohol and/ or drug dependency disorder. This is done by training the mind to delete impaired thoughts, behaviour and perceptions with more valuable and ethical thought patterns and behaviour in an attempt to change problem behaviour. Therapists who prefer psychodynamic approaches argue that this approach is more effective by identifying the underlying causes of alcoholic and/ or drug dependence disorders. Cognitive-behavioural therapist indicate that their approach is equally effective through its immediate counteractive strategies to curb the problems as stated by Norcross & Goldfried (2005) Just to mention a few features that exemplify each of these two approaches, Cognitive-behaviour therapy is seen to be time fixed and short taking an average period of less than six months. The psychodynamic process takes much longer i.e. more than six months (Corey, 2005) (Also, the psychodynamic approach is less instructional entailing fewer home assignments. The Cognitive-behaviour therapy involves much more instructions and home assignments, is highly structured, and depends on mutually set targets between the client and the therapist. As seen earlier, psychodynamic therapy concentrates on correcting the client’s behaviour but his/ her history is equally important. Cognitive-behaviour therapy focus on treating the current behaviour and the client’s history is less significant. It’s also important to understand that with psychoanalytic therapy, the relationship of the client with the therapist is a part and parcel of the treatment strategy, and forms a basis for the speed and efficacy of the treatment process. Although the relationship shared by the client and counsellor is extremely important in CBT work as well; the focus is on the activities and tasks as being the most important, and the relationship shared by the client and counsellor as being facilitative of this work. (Corey 2005). Conclusion Studies have shown that the different therapeutic approaches have varying effectiveness relative to the problem being taken care of (Corey, 2005). It therefore is the responsibility of the therapist to ultimately choose the most effective approach to be used in an individual depending on the nature of the issue and the individual. He/she should also realise that integrating his/her expertise with mutual responsibility of the client would work best. In addition, taking care of any physiological challenges that the client may have been subject to due to alcoholism and/ or other drugs is equally as important as part of the therapy bearing in mind the client should be in good physical health before their thoughts, feeling and perceptions are changed. References Buddy, T (2008), Cognitive behaviour therapy for addiction, viewed on 9th July, 2011, http://www.alcoholism.about.com/od/relapse/a/cbt.htm Burnard, P. (1999, pp.76 & 132) Practical counselling and helping. Routledge, London. Corey, G (2005) Theory and practice of counselling & psychotherapy, 8th edn, Thomson. Brooks/Cole, New York Gelso, C., & Fretz, B (2001, p.89) Counselling psychology, 2nd edn, Harcourt College Publishers, Fort Worth. Galanter, M. and Kaskutas, L.A. (Eds.) (2008) Recent developments in alcoholism, Vol. 18. Research on alcoholics anonymous and spirituality in addiction recovery. Springer, New York. Hay, C.E. & Kinnier, R (1998, p.122-132) Homework in counselling, Journal of mental health counselling, vol.20, no. 2. Herlich, B. & Corey, G (2006, p.231) ACA ethical standards casebook, 6th edn, American Counselling Association, Alexandria. John Orr Crites, (1981, p.56) Career counselling: models methods and materials, McGraw-Hill College, New York. Meichenbaum, D. (1993, p.203) changing conceptions of cognitive behaviour modification: retrospect and prospect. Journal of consulting and clinical psychology, 61(2), 202-204. Norcross, J. C. & Goldfried, M. R (2005, p.85) Handbook of psychotherapy integration, 2nd edn, Oxford University Press, New York. Seligman, L. (2001) Systems, strategies and skills of counselling and psychotherapy, Merrill Prentice hall, New Jersey. Read More