Counseling Practices and Treatment Methods for Psychological Disorders - Assignment Example

?Running Head: ADDICTIONCOUNSELING Addiction Counseling: Establishing a Theoretical Foundation and Practice Strategy The following paper is intended to discuss theories that can be formulated into an overriding set of ideas about how to construct counseling practices. The idea of human nature is explored before looking at the ideas that have been at the foundation of behavioral modification. Once the theories that define human nature and behavioral modification have been discussed, more focused attention is put on the methods through which practice can reflect these beliefs. In bringing in the theories that range from Aristotle to Bandara and Rogers, the approach that is suggested looks at addiction therapies in order to establish a course of action that will be most beneficial in this field. In constructing a multi-disciplined approach to treating addiction, the theories that were presented towards understanding human nature and modification of behavior are expanded towards the use of client centered therapies with motivational interviewing techniques in order to establish reinforcement for changed behavior. Addiction Counseling: Establishing a Theoretical Foundation and Practice Strategy Introduction Addiction is a human condition in which the body or the mind has placed importance upon habits and consumption that satisfies some aspect of their existence. Mental addictions use these addictive behaviors in order to supplement experiences so that they feel normalized. Physical addiction comes when a substance has created a need that must be fed in order to feel right. Both types of addictions interrupt life and interfere with the individual as they try to function as an acceptable member of society. Addictions can alter the mind, interfere with purpose and production, and isolate people from their community. Worse still, some people function as if there is no interference, living a secret life where their obsession with their addictive focus is hidden and in the way of real happiness. In order to create good counseling practices, a therapist should determine what they think about human nature, how theory affects their approach to client intervention, and what strategies they will use as they interact with their clients. Creating a basis on which to form therapeutic practice is essential in order to be effective. Human nature and changing behavior are linked because it is essential to work with basic human nature to end behaviors created through the adoption of behavior. The following paper creates an overview human nature and how it can be considered in relationship to behavior. Behavioral change will be addressed and intervention strategies and counseling practices that are based on the theoretical foundation of human nature is discussed. The methods and theories in which counseling practices that will be developed are be examined in order to create a personal statement of theory so that the practices that are adopted in private practice are in context with the beliefs of the practitioner. The theories that have been developed in previous research form a hybrid from which practice is adopted. Human Nature The idea of human nature is abstract in many ways. There is no real definitive way in which to express the idea of human nature and trying to find a definition has been a struggle for theorists in many disciplines. It is easy to define what is considered human nature, but to define the substance of human nature is far more complex. Fink (2010) defines human nature by writing that “human nature is the set of determinants of behavior that generate within the human organism and ultimately within the genes” (p. 3). However, this definition seems largely incomplete and seems to allow for everything and nothing at the same time. Human nature is biologically driven, individually driven, and socially driven. It comes from the complex relationship that develops between the individual and the world and creates what could be considered a gooey, sticky mess of thought which translates into action and connects the individual to their situations. There are two biological factors to human nature. The first is through genetically predetermined patterns of genes that can be stimulated or lie dormant which influence behavior and help to create traits. The second biological factor comes from prenatal exposure to various chemicals that are transmitted from the mother. A very distinct example of this would be the mother who is addicted to heroin exposes her fetus to heroin that becomes a heroin user later in life because they have been influenced by the presence of the drug during the pregnancy. Drug use is not the only type of substance that can influence the behavior of the child later in life. These traits are considered second nature traits but are not considered innate (Fink, 2010). There are a number of theories that can be considered in relationship to the study of human nature. Defining how one views human nature, however, requires looking at the theories and critically evaluating those concepts that when combined make the most sense towards understanding the behaviors and patterns that can emerge in life. The first theory that does not make sense is the feminist theory on human nature. Feminist theory is highly valuable in understanding the social experience of women in the context of patriarchy and the dominance/subordination patterns that have been applied to social experience. However, as a way of looking at a broad concept of human nature, the theories of feminism apply only in very tight and concentrated ways to an understanding of human nature. Loptson (2006) discusses feminist theories of human nature as defining dividing lines between the genders with empowering and disempowering tones which are viewed through a specific lens. Human nature comes from biological and mental processes which are affected by social construction, but are the primary resources from which human behavior produces society. The reason that feminist theories are not involved in a comprehensive theory on human nature is because they are too narrow. Essentialism is the belief that there is an essential human nature which defines the multiple directions that society takes by a core set of human principles. Loptson (2006) writes that “everyone will agree that there is such a thing as what human beings for the most part currently seem to be like, and that there is no reason to believe either that much earlier human beings were exactly like that or humans of remote futures will be” (p. 22). However, there are essential human frameworks that have a consistent overriding influence on how society is created. Therefore, essentialism is highly influential at a core level on how human beings approach life. Percy believed that there is a fixed way in which a person should live. It is in striving to figure that nature of human existence out that people end up failing. LaRocca (2011) writes that “Percy thinks…it is our failure to grasp it that leads to our inability to navigate the world successfully” (p. 236). Sartre disagrees with this idea completely. The basis for this idea is on the belief that there is no God. Without God, he believes, there can be no essential nature of human life because there is not a primary driving force. Aristotelian perspectives can be divided into three basic concepts that are at the core of essentialist perspectives. The first is that the way in which a functioning person lives is the model for how a human nature is intended to be enacted. The second is the theist perspective in which the “intention a God who creates that fixes what it means to be a person” (LaRocca, 2011, p. 236). The third concept has to do with a substance through which human nature is created. The first Aristotelian perspective has some value in that the way in which human nature manifests in what is the best possible and functional ways would be an indicator of the core of human nature. The most appropriate way to look at human nature in its essential form would be from two perspectives, one creative and one destructive. The creative drive in human nature is that which is based on procreation. Human beings, just like all animals in the world, have drives towards reproduction and the reproduction drive includes the consequences of the drive to raise children. The destructive drive comes from the need to survive. In survival, the requirement of consuming, destroying the life of plants, animals, and the fight with each other for resources is all found in the destructive drive. The happy individual has balanced creation and destruction. They can create survival for themselves and they have found a way to fulfill their need to create, even if it is not in procreative terms. Creating a balanced life is the way in which to create the best possible health. Models for happy, functional people are those who have a high capacity for the social environment in which they live. Happy families work well within the social world of their choosing. Although people do not necessarily choose the mainstream social world, they do choose a world and learn to function within it in order to create balance. Those who are within a world but not functional within it are unhappy, which means that individuals and families have not found out how to be a model of functional capacity. Therefore, the basic theory upon which counseling practice will be based is the essentialist theory for human nature which features the need to create and the need to destroy. In order to evaluate the drives that are at the core of human nature in relationship to social construction, those who succeed and are considered the most functional in addressing those needs and fitting into the world as it has been constructed are the models for human nature as it is manifested. Combining this with the theory that Percy puts forward, it is clear that the basic struggle is for human beings to connect to their basic natural drives and relate them successfully within the social construct. Change in Human Behavior It has long been held that certain types of behaviors in the animal kingdom have been shown to be gene driven. Genes direct them to seek water, hide during the daylight, and flight in the face of danger so that they can survive in isolated but still species similar situations. This encourages survival of the species. Peterson (2010) uses the example of the cockroach which has a genetically programmed reaction for fleeing from light. The same kind of science that has found ways to test that theory is not available for use in humans. It is not possible to change a gene and then see how it affects the development of a trait in a human being. It is likely that it would not work because humans are far more complex, their environment having a large influence on how their reactions to the world are developed. The genetic theories on responses to the world are contradictory at times. Evidence can be found to support any number of theories that are in opposition. As an example, if a researcher decides that babies most often cry at night, then it might be concluded that this is because they are competing with other forces to get what they need. Another research could see that babies cry less at night and come to the conclusion that this is a response to the need to hide infants from predators. In other words, trying to find specific responses to the world that have meaning on a level of the basic drives comes with as many theories as there are possibilities (Peterson, 2010). Although there is evidence that genes exist to drive people towards certain behaviors, there is also evidence that behaviors caused by genes are activated through different environmental factors. As an example, having seizures has been shown to activate genes which respond to injury in the brain (Peterson, 2010). The experiences that people have will activate different genes that are coded for certain responses, thus affecting human behavior. Someone with PTSD may have had certain hyper vigilant genes activated that affect their level of anxiety. Behavior, then, is far more complicated than just adjusting what is defined as behavior. Behavior can be seen as conscious, unconscious, and as well directed by drives that come from genetic predispositions. In looking at what influences behavior, one can look at the way in which Albert Bandura considered human nature. Bandura put past and present experiences as equal in influencing current behavior, with the same equal balance between free will and determinism. Nurture has more influence than nature, with uniqueness having more influence than universality and growth measuring more than equilibrium. Additionally, optimism has more influence than does pessimism. Therefore, creating present experiences that are reinforced with optimism and nature, and are based on uniqueness and growth will have a better chance of enacting change (Schultz & Schultz, 2005). Reinforcement that comes from connecting with these internal aspects of the individual and create motion that will move towards change. Reinforcement sounds like the ultimate way in which to encourage good behavior but as any parent will tell you, reinforcement no matter what its form is not nearly enough to create desired behavior. Change in behavior is very difficult to achieve and requires self-awareness and a belief that reinforcement will be the result of the change. Reinforcement comes from both internal and external forces. Reinforcement from an internal perspective comes from the awareness of the benefits of change. Self-awareness allows the person who wants to change the permission to change because it is understood that the benefit outweighs the cost of the continued behavior. External factors such as reinforcements that come from the environment will influence the actor who will have some choice in how they allow those influences to take hold. Albert Bandura discussed the idea of external and internal forces in terms of choices that the individual has about their environment. Bandura believed that by using behavior modification techniques, abnormal behaviors, which he felt were only really bad habits, could be changed (Schultz & Schultz, 2005). Bandura was firmly in the belief that nurture was the primary cause of behavior. Self-efficacy was founded on the way in which the environment influenced the individual. Interestingly, Bandura discovered that physical appearance was effective in how others responded and gave positive reinforcement to others and it had more effect on the ability to function than did high self-esteem or good health. Therefore, the search for improving one’s looks is not necessarily vain, but a part of creating a healthy and supportive environment (Shultz & Schultz, 2005). Human nature might explain the need for physical attractiveness if it is based in the create side of human nature development When a client is behaving in ways that are countering his or her ability to successfully interact in society, behavior can be changed towards creating healthier choices and inspiring fundamental change by understanding how to connect with basic human drives and inspire them towards responding to positive actions. Intervention strategies are essential to creating reinforcement for behaviors that will fill the gap that Percy discussed, establishing how well-being can be achieved through understanding how behaviors are reflective of the balance needed to exist within the fixed human nature that is at the core of human existence. Counseling is a way in which to address the gap between the drives in human nature and enacting them successfully in the social construct. The theories that Carl Roger put forward in relationship to counseling practice was that the counseling session should be focused on and directed by the client. Greene (2011) writes that “Helping professionals grounded in existential humanism (including Rogers) turned their attention to understand the person in the present and exploring how a client makes decisions in his or her own world” (p. 115). This is the basis of client-centered therapy. Intervention Strategies One of the biggest problems about addiction recovery is that there has been a rift torn between mental health services and addiction recovery services. Often addiction recovery fails to address the mental health issues through ignoring psychiatric symptoms and attributing them only to the addiction, failing to give medications when indicated because of the adherence to the idea that all drugs are drugs, and through triggering episodes of decomposition through confronting issues without the appropriate work before hand. The mental health field fails by prescribing medications that contribute to the addiction cycles rather than working with addiction recovery to medicate, discharging patients because they are addicted and harboring biases against 12-step programs. Both sides of the recovery process are failing to recognize that it is all the same field of practice and a combined effort may be necessary (Sanders, 2011). Any lay homelessness advocate will tell you that many of the alcoholics and drug users they encounter clearly are self-medicating for some other mental health issue. In creating client-centered therapy that is directed and focused on the direction that the client intends, motivational interviewing is a method that can have a great effect on creating meaningful change (Jensen et al, 2011). There are three styles of interactions with motivational interviewing. One is directing in which information is provided to the client in order to help them in creating a knowledge base from which to create change. The second is in following which means the practitioner is a good listener and is hearing the story that is being told, showing the client that their narrative is at the center, at least in the beginning, of the work that they will do. The position in the middle is guiding in which the guide does not tell where to go or when the client has arrived, but acts as a conduit to those places that the client desires to get to in their lives (Miller and Rollnick, 2013). Counseling Process Mental health comes from combining the knowledge of human behavior and knowledge about the influence of the environment in order to address how the individual can find the way in which to enact the ‘fixed’ human nature towards being happier and healthier. The ideas of Percy in relationship to the search for finding the appropriate essence of human nature provides for the idea that there is an ideal that can be reached, but the path to that ideal is unknown by the client. Addiction recovery should be found through a combined system of both recovery methods and client-centered therapy so that change in behaviors come from modification as well as addressing the environmental factors both internal and external that have supported the addiction process. While Bandura thought that recovery from abnormal behaviors was solely based upon behavior modification, it is clear that both biological factors and environmental factors contribute to addiction. A combined method that uses knowledge and medicine to treat mental illness, client centered therapy to treat personality disorders, and recovery processes to help modify behavior is the best approach to practice. Through methods that direct, follow, and guide the client, the therapist can achieve a well-rounded system through which to reach mental health goals. Without the desire and motivation of the client, the process is unlikely to be achieved. Addiction centers often have high recidivism rates, thus suggesting that the right combination of motivation has yet to be reached. Some of this is clearly because mental illness issues may not be addressed or medicated in order to place the client in a state in which they can feel normal without the influence of a non-prescribed drug. The motivational interview technique will not work well with someone who is not cognitively aware of their mental illness or how is not competent to work with the therapist towards goals. Until the patient has been stabilized for any mental illness that exists, they must be treated through medical therapies such as a drug therapy in order to reach relative mental health before the client centered approach and motivational interviewing can be used. Addiction Recovery Center Addiction recovery is a complex process in which the body and the mind must come together to cooperate towards the desire to end addiction behaviors that are placing constraints on the success a person may experience in their life. The addict will have an effect on the entire family and may or may not be able to function within that environment without falling back into addiction. The family, however, is most often going to be seen as a constant so the idea is to have sessions that include the entire family so that the goals of the patient can be understood and supported or rejected by the family that is affected. Finding a way in which to cope with either success or failures in communicating and getting approval of goals is one of the primary functions towards creating meaningful reinforcement for recovery. One of the things that must be recognized is that dysfunctional people tend to be in environments that promote dysfunction. Imagining the right circumstances through which change could be created is one way in which motivational interviewing can be useful towards creating this environment for the patient. One of the ways in which to seek out the right environmental mix for the patient is to create lists of what supports their creative needs and what supports their destructive needs. While initially the idea of a destructive need sounds negative, this should be embraced because this means finding ways in which to focus the aggressive drives for survival. Survival is an aggressive, almost violent act where food, shelter, and other material needs are gained. This should not be denied but embraced as a part of human nature. In order to find recovery, human nature must be accepted and embraced rather than wrapped up in idealistic concepts that no one can live up to in their lives. One of the biggest ways in which recovery fails at times is that it brings some clients into too humble of a state and maintaining that humility is contradictive to the aggression that comes with ambition, thus they equate success with their addiction. An addiction recovery center that focuses on physical, mental, and emotional health with future goals as a focus for motivation would be the ideal environment for practicing under these theories. Addiction recovery would begin with addressing the physical and mental addiction, but also with addressing mental health issues that may be contributing to the illness of addiction. The addiction recovery process could have either in-patient or out-patient services because this method is comprehensive and would allow people at all levels of need to benefit. The focus in the process would be on the future and not on the past unless there were issues that the client felt needed to be addressed. While allowing clients to work on their recovery in their own way is not traditional, it might lead to more effective reinforcement for positive behaviors if the client is put in a position of creating control over their lives. Conclusion Human nature is an elusive concept that must be developed through looking at a number of broad theories in order to define a concept from which to establish theories for human intervention. Human nature is the development of capacities along two lines of need, creative and destructive, in order to create a balance in which life can be lived. Theories of behavior modification when laced with client centered approaches for therapy provide for directing, following, and guiding patients so that they can find their balanced place in society. As Percy suggests, there is a fixed model for human nature which can be found through observing those who are the models within society (Loptson, 2006). Choosing societies to live in means choosing which model suits one’s goals in life. Through therapy that is designed for focus on the future, addiction recovery can be constructed through focusing on managing mental issues, working with behavior modification for personality disorders that are anti-social and contradictory to the goals of the client, and through looking at motivational interviewing as a method of determining what balance would create the most harmonious life for the patient. In finding out where their balance exists, the therapist and the patient can work towards achieving goals they have mutually determined to be important. Without the cooperation of the patient, modifying behavior is likely not going to happen. Motivational interviewing provides for a means of honing in on just what the patient really wants so that they can be shown how their addiction is preventing that from happening. Through cooperative therapy, the patient has a hope of reaching real goals. Resources Fink, G. (2010). Stress of war, conflict and disaster. Amsterdam: Elsevier/Academic Press. Greene, R. R. (2011). Human behavior theory and social work practice. New Brunswick, NJ: Transaction Publishers. Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig, J. T., Sorell, D. M., & Steele, R. G. (2011). Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review. Journal of consulting and clinical psychology, 79(4), 433. LaRocca, D. (2011). The philosophy of Charlie Kaufman. Lexington, Ky: University Press of Kentucky. Loptson, P. (2006). Theories of human nature. Peterborough, Ont: Broadview Press. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press. Peterson, J. C. (2010). Changing human nature: Ecology, ethics, genes, and God. Grand Rapids, MI: W.B. Eerdmans Pub. Co. Sanders, M. (2011). Slipping through the cracks: Intervention strategies for clients with multiple addictions and disorders. Deerfield Beach, Fla: Health Communications. Schultz, D. P., & Schultz, S. E. (2005). Theories of personality. Belmont, Calif. [u.a.: Wadsworth. Read More