Critical Analysis of Patient Centered and Cognitive Behavioral Approaches in Psychotherapy - Essay Example

? PERSON FOCUSED VERSUS CBT PSYCHOTHERAPY Introduction The patient focused approaches in psychotherapy such as the psychodynamic and the person-centered methods are based of a sound relationship between the patient and the therapist and usually their sessions take a long time. On the other hand the cognitive-behavioral methods of psychotherapy are less patient centered and thus the systems they apply are structured and the sessions limited. The cognitive-behavioral approach has been applied widely in the treatment of mental disorders because the therapists who support this method belief that it is more effective in behavioral change as compared to the patient focused methods which rely on the patient resources for success of the therapy. This paper gives a critical analysis of the two approaches in psychotherapy with illustrative discussion of their differences and similarities. The approaches used aims and the roles of the patient and the therapist in both methods of psychotherapy have also been described in this paper. Cognitive-behavioral therapy (CBT) is a goal oriented approach to psychotherapy which aims at treating dysfunctional behaviors, cognitions and emotions. CBT is sometimes referred to as a talking therapy which follows systematic procedures in psychotherapy. CBT represents psychological treatment which is based on both cognitive and behavioral research. According to Tursi & Cochran, (2006, p. 391) empirical proof demonstrates that CBT is very effective in the treatment of anxiety, mood, personality, psychotic, substance abuse and eating disorders. This approach of therapy applies direct, technique driven and time limited therapy for disorders of the mind. The approach is applicable for both group and individual therapies. Moreover, the techniques used in the CBT therapy are usually applications which are adapted for self help. According to Dryden (2007) the cognitive and behavioral approaches have different origins and thus some researchers and clinicians are either behaviorally oriented or cognitive oriented. Cognitive restructuring is an example of cognitive specific psychotherapy while in vivo exposure treatment is an application of the behaviorally oriented treatment. However it is important to note that some therapists and researchers combine both the cognitive and behavioral therapy applications such as the imaginal exposure treatment. McLeod (2009) illustrates that the development of CBT was a result of the integration of the cognitive and behavioral approaches even though they are rooted in divergent theories. Hart (2010) asserts that the common ground which led to the combination of the cognitive and behavioral approaches is the need to focus on ‘here’ and ‘now’ as a way of alleviating the symptoms related to the disorders of the mind. CBT has been evaluated for efficacy in the treatment of various mental disorders. As a result, the CBT programs for psychotherapy have been recommended for treatment of mental disorders because they are considered to be symptom and evidence based treatments. Cooper, (2007, p. 35) illustrates that in the UK, CBT is recommended by the National Institute for Health and Clinical Excellence for treatment of disorders such as bulimia nervosa, clinical depression and Post traumatic stress disorder (PTSD). Psychodynamic therapy is an approach to the treatment of mental conditions which uses deep psychology with an aim of disclosing the unconscious thoughts within the psyche of the patient. The treatment approach uses the deep thoughts of the patient to ease the psychic tension which is experience by the patient as explained by Mountford, (2011, p. 18). The psychodynamic psychotherapy is similar to psychoanalysis in many ways. Moreover, this approach of psychotherapy is based on interpersonal interaction or relationship between the patient and the therapist. Furthermore, psychodynamic therapy is more free or eclectic as compared to other forms of psychotherapy. As a result the applications and techniques of the psychodynamic therapy do not rely on one source and instead their interventions depend of a variety of systems. The psychodynamic approach has been applied in individual, family and group therapy. In addition, this approach has been used as a way of understanding the behavior of individuals based on organizational and institutional perspectives. According to Osatuke, Glick, Stiles, Greenberg, Shapiro & Barkham, (2005, p. 97), the person centered approach is a type of psychotherapy which solves the problems of the patients through the application of the patient’s own resources. This approach believes that the patient has latent resources within himself or herself which would be used to help solve a specific dysfunction. This kind of treatment is also called non-directive or client centered therapy. It was begun by Carl Rogers as an approach of psychotherapy and counseling which enables the patient take responsibility in the treatment process while the therapist plays a non-directive function during therapy. The psychodynamic and person centered approaches to psychotherapy are categorized as the patient focused systems as compared to the cognitive and behavioral therapy which is based on the thoughts and actions of the patient during the treatment process. According to McLeod (2009, p. 327) cognitive behavioral therapy is a popular area of research and application in psychotherapy because it seeks to bring change to the observable behavior and conscious thoughts of patients by making them aware that such behavior and thoughts exist within themselves. Even though there are research which support the psychodynamic and patient-centered approaches to psychotherapy, the CBT is described by Paley, Cahill, Barkham, Shapiro, Jones, Patrick & Reid (2008, p. 157) as the most effective way of treating mental disorders. On the other hand, psychodynamic therapy which is based in psychoanalysis of patients is the most effective approach of therapy especially for a long term cure of mental illnesses as demonstrated by Tursi & Cochran, (2006, p. 389) Mountford (2011, p. 20) says that the therapeutic change brought about by psychodynamic psychotherapy is based on the fact that what happens in the early life of an individual affects the adult life. Coleman, Cole & Wuest, (2010) illustrates that a studies done on patients with long term depression show that their present condition is a result of their past experiences. Moreover, the patient centered psychoanalysis helps patients suffering from depression to have complete recovery as opposed to the time limited cognitive-behavioral approaches which lead to recurrence of the depression soon after the therapy. The person-centered therapy also gives the patient an opportunity to illustrate the circumstances and the relationships in the early life so that the therapist is able to evaluate their impact on the adult life. The information which the patient gives to the therapist during a psychotherapy session is used by the therapist as a resource in giving an accurate evaluation of the circumstances which have led to the current mental condition of the patient. This demonstrates that the person centered therapies are focused on the insight of the patient during the treatment process. Leichsenring, Hiller, Weissberg & Leibing (2006, p. 239) explain that cognitive and behavioral therapy does not focus on the causes of the patient’s distress in the past but rather evaluates the symptoms of the patient and finds ways of improving the state of the patient’s mind in the present moment. The CBT focuses on the present condition of the patient because it aims at changing the way the patient thinks and does hence the cognition and behavior of the patient. It is notable however that both the patient focused and the CBT approaches are aimed at effectively in changing the thoughts of the patient and the related behavior. Psychodynamic and client focused approaches helps the patient to use his own information resources to enable decision making on the need for change of thoughts and actions so that a given desired outcome is reached. On the other hand the cognitive-behavioral approach uses predefined applications to enable change of behavior as demonstrated by Osatuke, Glick, Stiles, Greenberg, Shapiro & Barkham (2005, p. 107). The reason for the application of predefined applications in the CBT is due to the objective nature of the CBT systems which aim at helping the patient change his behavior in the shortest time possible. This is different from the patient focused approaches which are subject to the patient resources in determining the direction and the duration of the therapy. As demonstrated by Serralta, Pole, Tiellet, Eizirik & Olsen, (2010, p. 565), the therapeutic alliance between the patient and the therapist is relied upon by both the psychodynamic and person centered approaches to psychotherapy. The aim of this alliance is to enable a personal connection between the patient and the therapist so that the patient is enabled to provide sufficient information about the likely reasons for the current behavior or thoughts. The role of the patient is thus to provide information resources while the therapist acts to analyze the disorder of the patient in relation to the present condition. Moreover, the therapist acts as the facilitator of the patient involvement in the therapy by provision of guiding questions through which the patient is enabled to explain his past experiences and thus relate it to what happens in the resent time. This approach enhances the understanding of the patient on the cause of his or her condition. Additionally, the patient appreciates his contribution to the therapy as explained by Leichsenring, Hiller, Weissberg & Leibing (2006, p. 252) According to Hart (2010, p. 244), the patient who is under a CBT program of treatment plays the role of presenting feelings and thoughts to the therapist. On the other hand, the role of the therapist in the CBT is to help the patient breakdown his problems into small parts. The therapist then plays the role of determining how the current behavior and thoughts of the patient affect him. Tursi & Cochran, (2006, p. 392) says that this is possible through division of the behavior of the patient into emotions, thoughts, actions and physical feelings. Each of these parts of the patient’s behavior can influence other parts and therefore they enable the therapist to determine how the patient reacts to various situations. As a result of this evaluation, the reason why the patient reacts in a specific manner is determined by the therapist. It is however important to note that both the person focused therapies and the CBT apply different approaches but aim at determining the reasons for the current behavior of the patient so that it provide the basis for treatment. The patient focused approaches to psychotherapy attempt to enable the patient to gain sufficient insight on the past experiences which would be difficult to think or talk about. Additionally, the therapist attempts to help the patient to understand himself as much as possible so that they would be mindful of the reasons for their current thoughts, feelings, actions, experiences and perceptions. Corsini & Wedding (2008) describes the psychotherapy in the patient focused approach as being more open-minded as compared to the cognitive-behavioral approach. Greer, Park, Prigerson & Safren (2010, p. 294) emphasize that there are five major areas of focus in cognitive-behavioral psychotherapy: situation, thoughts, actions and feelings. The therapist in the CBT session plays the role of analyzing the feelings of the patient in relation to how they influence and how they are influenced by the present situation and thoughts. This is done to determine the reason for the actions of the patient. According to Serralta, Pole, Tiellet, Eizirik & Olsen, (2010, p. 567), the patient focused approaches such as psychodynamic and person-centered approaches also recognize the emotion and feelings of the patient. In the patient focused approaches to psychotherapy, the therapist plays the role of encouraging the patient to talk and explore his emotions and feelings. This is aimed at enabling the patient to talk about emotions which are threatening, contradictory and even those feelings which are apparent. Therefore the CTB and the patient focused approaches both aim at using the emotions and feelings of the patient to gain intellectual and emotional insight on the current behavior of the patient. As a result, the psychotherapy enables the patient to identify new options and choices which would replace the behavior patterns which once seemed uncontrollable or inevitable. As described by Osatuke, Glick, Stiles, Greenberg, Shapiro & Barkham (2005, p. 105), the patient focused psychotherapy helps the patient to understand and learn avoidance. This is made possible through the interaction between the patient and the therapist. For example, a psychodynamic therapist may nurture the behavior of the patient to be more flexible and adaptive in cases when the patient avoids sessions or arrives late. This is possible if the therapist demonstrates to the patient the need to compromise between the need for therapy and the fear which results from what is likely to emerge during the session. As a result the patient is likely to be able to learn why some actions are avoided so that he is enabled to compromise between situations and therefore make the right choice. The role of therapist in this scenario is to enable the patient to understand his own behavior through determination of what leads to it. The aim of patient focused therapies is therefore to let the patient discover by himself how compulsive behaviors are caused by avoidance and the ways in which they can be overcome by compromising between one or more situations. In terms of time, the CBT method of psychotherapy is briefer than the patient focused psychotherapy. According to Corsini & Wedding (2008), CBT is the most rapid method of psychotherapy because results are obtained in an average of only 16 sessions. On the other hand, psychodynamic and person centered therapy sessions may take years. CBT uses homework assignments for patients demonstrating that it is a highly instructive and brief approach of psychotherapy. Moreover, unlike the patient focused methods, CBT is not open-ended because the patient is made to understand that the session will end at some point. Leichsenring, Hiller, Weissberg & Leibing (2006, p. 253) say that the duration of the therapy in CBT is decided by both the client and the therapist. The limited time in CBT helps the therapist to schedule the assignments and the tasks given to the patient to ensure that they are covered during the duration of the therapy. The psychodynamic approach on the other hand is described by Cooper, (2007) as a never-ending psychotherapy. The patient is given the freedom of deciding when the sessions would be terminated depending on the evaluation of his progress. Psychodynamic psychotherapy lasts at least for a year and involves more than 50 therapy sessions. Salzer, Winkelbach, Leweke, Leibing & Leichsenring (2011, p. 504) justifies the long duration of the psychodynamic therapy saying that a real life meta-analysis conducted on patients with anxiety and mood disorders show that the long term treatment helps the patients to improve significantly even after the therapy is ended. The CBT therapists are convinced that a good relationship between the patient and the therapist is not enough for therapy to be effective. According to Serralta, Pole, Tiellet, Eizirik & Olsen, (2010, p. 568), patients change behavior because they are taught on how to think differently. As a result the CBT therapists aim at teaching patients to have self counseling skills so that they can have different thoughts which enhance change of behavior. On the other hand, a person focused therapist belief that a sound relationship between the therapist and the client plays the major role in ensuring the success of therapy. Therefore psychodynamic therapists engage patients in active communications and interaction with the aim of enabling the patients to talk freely about their circumstances and experiences. According to Dryden (2007, p. 297) the similarity between the CBT and the person focused approaches in that both recognize the need for a good relationship between the client and the therapist in facilitating the treatment. Corsini & Wedding (2008, p. 187) assert that both the patient focused and the cognitive-behavioral psychotherapy approaches involve collaborative efforts between clients and therapists. The roles of the CBT and the person centered therapists are similar in collaborative therapy. The therapists act to listen, encourage and teach the patients while the patient plays the role of learning, expressing feelings and concerns and implementing what is learned during the therapy sessions. Despite the similarity between these approaches Cooper, (2007, p. 34) says that the agenda of the sessions are usually structured differently. CBT sessions are directive and structured. As a result the CBT therapists aim at teaching their patients how to behave. On the other hand the person centered approaches are less directed and are not structured. The patient is only encouraged by the therapist in psychodynamic therapy and not directed towards a specified outcome. In CBT therapy, the therapists therefore play the role of specifying the agenda of each therapy session. Specified and directed concepts are taught to the clients during each session of the CBT therapy unlike the patient focused approaches which are open-ended. Conclusion The patient focused and the cognitive-behavioral methods of psychotherapy have various differences in the approaches used, duration, systems, roles of the patient and the therapist and their application in the treatment of various mental disorders. The CBT therapists thus support the application of this method because they belief that it is more effective in psychotherapy but the personal focused methods have also been used to help many patients to change behavior. References Cooper, M 2007, 'Person-centered therapy: the growing edge', Therapy Today, 18, 6, pp. 33-36 Coleman, D, Cole, D, & Wuest, L 2010, 'Cognitive and psychodynamic mechanisms of change in treated and untreated depression', Journal of Clinical Psychology, 66, 3, pp. 215-228 Corsini, R.J., & Wedding, D., 2008, “Current psychotherapies”, Belmont, CA: Wadsworth, pp. 187–222 Dryden, W., 2007, “Dryden’s Handbook of Individual Therapy”, Sage, London, pp. 297-326 Greer, J, Park, E, Prigerson, H, & Safren, S 2010, 'Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid With Advanced Cancer', Journal of Cognitive Psychotherapy, 24, 4, pp. 294-313 Hart, TA 2010, 'The Role of Cognitive-Behavioral Therapy in Behavioral Medicine: Introduction to the Special Issue', Journal Of Cognitive Psychotherapy, 24, 4, pp. 243-245 Leichsenring, F, Hiller, W, Weissberg, M, & Leibing, E 2006, 'Cognitive-Behavioral Therapy and Psychodynamic Psychotherapy: Techniques, Efficacy, and Indications', American Journal Of Psychotherapy, 60, 3, pp. 233-259 Mountford, C 2011, 'Focusing and the person-centered way', Therapy Today, 22, 1, pp. 18-20 McLeod, J. 2009, “An Introduction to Counseling”, Open University Press, Buckingham, pp 324-415 Osatuke, K, Glick, M, Stiles, W, Greenberg, L, Shapiro, D, & Barkham, M 2005, 'Temporal patterns of improvement in client-centered therapy and cognitive-behavior therapy', Counseling Psychology Quarterly, 18, 2, pp. 95-108 Paley, G, Cahill, J, Barkham, M, Shapiro, D, Jones, J, Patrick, S, & Reid, E 2008, 'The effectiveness of psychodynamic-interpersonal therapy (PIT) in routine clinical practice: A benchmarking comparison', Psychology & Psychotherapy: Theory, Research & Practice, 81, 2, pp. 157-175 Salzer, S, Winkelbach, C, Leweke, F, Leibing, E, & Leichsenring, F 2011, 'Long-Term Effects of Short-Term Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy in Generalized Anxiety Disorder: 12-Month Follow-Up', Canadian Journal Of Psychiatry, 56, 8, pp. 503-508 Serralta, F, Pole, N, Tiellet Nunes, M, Eizirik, C, & Olsen, C 2010, 'The process of change in brief psychotherapy: Effects of psychodynamic and cognitive-behavioral prototypes', Psychotherapy Research, 20, 5, pp. 564-575 Tursi, M, & Cochran, J 2006, 'Cognitive-Behavioral Tasks Accomplished in a Person-Centered Relational Framework', Journal Of Counseling & Development, 84, 4, pp. 387-396 Read More