Advantages of Using a Systematic Approach in Counseling and Psychotherapy - Essay Example

The systems approach to counselling is one that encourages a holistic view of the patient and their life, taking into account everything that may have contributed to the way that the patient currently feels and using this knowledge to help them work through their issues (Barker et al, 2010). This approach understands the world as a system, with many different interacting elements that influence the whole (Street & Downey, 1996); in this case the mental well-being of a patient or group. This essay is a case study, and will first detail the patient in question, giving information about their life and why they initially sought counselling. After this, the systemic issues that related to the case study will be discussed; how the patient’s life could be contributing to their problems of fear and sadness. The final section will be exploring how to use this new knowledge of the patient and their systemic issues to help them work through the problems that originally caused them to seek counselling. This means exploring how a counsellor using the systemic approach would work with the case study. Finally, the essay will conclude by briefly discussing how the systems approach to counselling is relevant in this case and how its use would benefit an individual like that in the case study, whilst pointing out any weaknesses. Case Study Katie is a 30 year old female, originally from Wales and now residing in South London. She is white and currently works as an architectural designer, but aims to become a full trained and certified architect. Katie was brought up by her father due to the loss of her mother at age 12, and has no siblings. Katie’s relationship with her father is healthy and loving. Katie sought counselling because of the intermittent but persistent depressive episodes she has been having since the move to South London. Katie moved to London ostensibly for her career, but has mentioned a close childhood friend named Ben who moved to London a few months earlier who she has recently reconnected with. Katie mentions her desire to start a romantic relationship with Ben, but fears that (despite their closeness) he will not want to undertake the burden of her depressive episodes in the context of a romantic relationship. Katie has a tendency to withdraw from Ben when she has these episodes, often making him confused and less communicative than usual. When asked about her view of relationships, Katie suggested that she would like someone to rely on and to love her, rather than mentioning any feelings of love on her part. Katie also mentioned that her depressive episodes include periods of severe under-eating and over-sleeping, meaning that she can often fall behind at work (although she is generally successful in this department, recently receiving funding to train for architect status), as well as a general feeling of hopelessness. Systemic Issues and the Case Study In the systemic approach, the aim is to find patterns that reoccur within the life history of the patient and use these to try and explain the current problem (Barker et al, 2010). In the case of Katie, the first obvious starting point is the loss of a parent. The loss of a parent can cause a ‘feeling of isolation that can make you feel so totally unsupported’ (Abrams, 1999, p1). This feeling may be compounded by the fact that Katie lost her mother at 12, a time when a female is looking for support, information and reassurance from the maternal figure as she begins her journey through puberty (Furman & Brown, 1999). It may be this feeling of being left unsupported and having to go through this period of her life alone that explains why Katie suggests that she wants someone to rely on in her love relationships, stressing the need to be loved rather than the need to love. Katie also has no siblings who could have helped her through this. Her relationship with her father is healthy and solid, but there are times when a child needs the support of more than one parent to form a healthy world view (Barker et al, 2010). This childhood has had some benefits for Katie, as she is now a thoroughly independent woman with an impressive career history. Katie is not afraid to take risks and is happy being alone, although this was truer two years ago before the depressive episodes became apparent. Another part of the system that needs to be addressed with Katie is her desire to start a romantic relationship with Ben. Ben was a close childhood friend of Katie and they both have made the transition from a rural Welsh town to a successful career in the city, meaning that they have a lot in common and many shared experiences. However, it could be this shared history that draws Katie towards Ben in her search for comfort and stability. Although Katie mentions several close friends, Ben is the one that appears most in conversation, and it sounds like Ben has been an object of stability for Katie throughout much of her life. This is interesting because although both parent-child and romantic relationships may both be ‘attachment relationships’ (Furman & Brown, 1999, p77), the roles are asymmetrical in the parent-child dynamic but should be equal in the romantic sense. It may be easy for Katie to fall into a dependency role in a relationship with Ben, something which would not be healthy for either of them (Strawbridge et al, 2009). It could also be suggested that the shared experiences Katie has with Ben are similar to those found in family situations (part of the reason why familial bereavement is so difficult, see Abrams [1999]) could suggest a sibling-style relationship with transference into romantic feelings. Finally, the other main issue in Katie’s life is the depression. It has been found that the loss of a parent prior to the age of 17 can have a significant effect on the adult psychiatric health of an individual (Harris et al, 1986). Katie’s early loss of her mother and the resulting effects it has had on her life (as described above) are probably a major contributing factor to the depressive episodes she is currently experiencing. As previously mentioned, the loss of a parent can lead to feelings of isolation and abandonment (Abrams, 1999) which are comparable to the feelings produced by episodes of clinical depression. The effects of Katie’s depression (under-eating and over-sleeping) are often found in those who have recently lost a parent and can be used as a coping mechanism (Strawbridge et al, 2009). It may be that there are some unresolved issues here that need to be discussed in the following section. Working as a Counsellor with the Case Study Having explored the issues in Katie’s life that may be leading to her depressive intervals, it is now necessary to discuss how counselling would help her to work through these issues. Using the systemic approach, I would ask Katie how she feels about her mother and try and get as much detail as possible about the life Katie has led without her mother. I would also ask Katie what she wishes she could have spoken to her mother about during those early teenage years and what she feels she missed out on from not having her mother, encouraging her to feel selfishly about her mother, as recommended by McLeod (1991). By exploring her own feelings on the matter rather than always trying to reassure her father that she feels fine, Katie might be able to readjust to the situation and perhaps remove some of the guilt that is sometimes felt by children who lose parents young (Harris et al, 1986). I would also encourage Katie to talk to her father and Ben about the loss of her mother, and see how they understand the situation. This links in well with the systemic approach, as it encourages a holistic approach to relationships, bringing in all the important people within Katie’s life to tackle the problem (Barker et al, 2010). By doing this, Katie may again be absolved of some of the guilt that is often felt (Harris et al, 1986) as her father and Ben may encourage her not to feel this. It would be interesting to conduct a few counselling sessions with Ben and her father on a one-to-one basis (if Katie will allow this) as well as conducting some sessions with them in their pairs. This will allow me as a counsellor to see the relationships in person and not just rely on what the patient says. Again, this is useful because systemic counselling encourages exploring the unit as a whole rather than picking apart individual traits (Brazier, 2009) and this holistic approach may reveal more about Katie and her depressive episodes. Bearing this in mind, it would be interesting to see how the joint counselling benefits Katie, because systemic counselling holds that exploring the whole (as it occurs in life) is more useful than exploring the parts in isolation (Barker et al, 2010). Additionally, I would encourage Katie not to pursue the romantic relationship with Ben at this stage, as it seems like she could be operating on dependency rather than actual love and attachment. Although it is clear she has strong feelings for her childhood friend, it could be suggested that these are displaced feelings (Strawbridge et al, 2009) for something else that is missing in her life; in Katie’s case this could be her mother or a sibling. In this case, her depression could be adding to the feelings of need and fear of rejection (Barker et al, 2010) and thus this scenario may be best avoided at present. It would also be interesting to move away from the systemic counselling and perhaps try narrative therapy in this context. Narrative therapy holds that most of the elements of our character are held within our life stories or narratives (Barker et al, 2010). The main benefit of narrative therapy is that it shows the patient how the problem has affected their lives and allows a sense of distance to occur between the patient and the event. In this case, we could use narrative therapy to explore the event of Katie’s mother’s death, as well as for the current episodes of depression. We could incorporate this into the wider systemic approach to counselling by showing how these experiences fit into her current relationships (Barker et al, 2010). As a counsellor, then, my overall aim would be to help Katie to understand what some of the reasons behind her depressive episodes may be, and by doing this perhaps help ease her psychological need for someone to depend on (either a maternal or sibling figure). By doing this, I would hope that Katie’s depressive episodes become less severe and less frequent, and with the aid of medication these may disappear altogether. I believe that as a counsellor, the ultimate aim should be to make the patient feel better by allowing them to understand their situation and exploring the issues together, and so this applies also in this case. Conclusion To conclude, then, as a counsellor I would encourage Katie to think about many of the main issues that seem to have come up within the course of this essay. I would question her about her relationships with her father, mother, and Ben, as well as encourage introspection about how she feels living life without a sibling. I would encourage her, using the holistic systems approach, to see these relationships as a whole web rather than seeing them all as separate areas of her life, which may help her to see patterns. As mentioned, I would encourage discussion in group sessions with her father and with Ben so she can explore some of her dependency issues as a whole. These topics and relationships were chosen because they seem to be the most influential in Katie’s life, and this is important when using the systemic approach (Dallos & Vetere, 2009). The systemic approach to counselling has several benefits, most of which have been covered in this essay. The main one is that it allows the counsellor to see the social fabric of the client’s life and how this affects them and why they may have sought counselling originally. Often, conducting sessions exclusively on a one-to-one basis can be quite limiting, but with this approach group sessions and discussions are encouraged, although these do not have to take place in the therapist’s office. Overall, this exploration of the systemic approach to counselling has been informative and seems to be appropriate for use in this context of Katie’s fear and sadness. Self-Reflection I found it interesting how easily some of the approaches discussed could be applied to a situation like that of the case study, and how some connections could be made that weren’t immediately apparent. However, it was quite difficult not to talk too much about some of the other counselling approaches that have been covered. References Abrams, R., 1999. When parents die: learning to live with the loss of a parent, Routledge. Barker, M., Vossler, A. & Langdridge, D., 2010. Understanding Counselling and Psychotherapy, Sage Publications Ltd. Bateman, A., Brown, D. & Pedder, J., 2010. Introduction to Psychotherapy: An Outline of Psychodynamic Principles and Practice, Taylor & Francis. Brazier, C., 2009. Listening to the Other: A New Approach to Counselling and Listening Skills, O Books. Dallos, R. & Vetere, A., 2009. Systemic therapy and attachment narratives: applications in a range of clinical settings, Taylor & Francis. Furman, W. & Brown, B.B., 1999. The development of romantic relationships in adolescence, Cambridge University Press. Harris, T., Brown, G.W. & Bifulco, A., 1986. Loss of Parent in Childhood and Adult Psychiatric Disorder: The Role of Lack of Adequate Parental Care. Psychological Medicine, 16(03), pp.641-659. McLeod, J.D., 1991. Childhood Parental Loss and Adult Depression. Journal of Health and Social Behavior, 32(3), pp.205-220. Strawbridge, S., Woolfe, R. & Dryden, W., 2009. Handbook of Counselling Psychology, SAGE Publications Ltd. Street, E. & Downey, J., 1996. Brief therapeutic consultations: an approach to systemic counselling, Wiley. Read More