The cognitive theory approach - Essay Example

The Cognitive Theory Approach The focus of the Cognitive Therapy approach is directed towards the manner in which a person’s thoughts and attitudes may affect his/her behavior. The theory is grounded on the premise that people develop negative perceptions about themselves, which in turn impacts negatively upon their behavior. The most important symptom is depression, couple with a tendency to procrastinate and display signs of attention deficiency as well as hyperactivity. Symptoms of depression, hyperactivity and attention deficiency indicate neurobiological roots to the problem and therefore this approach would focus upon treatment directed towards helping patients to closely examine their inner belief systems. Negative self esteem, an inferiority complex and the development of defeatist attitudes due to deep rooted, inner belief systems are the blocks that are the causal factors and have to be dealt with. Once those inhibiting factors are identified, the patient can then be taught strategies to cope with those symptoms. The patient reports (a) depression (b) feelings of inadequacy and low self esteem (c) acute self consciousness in crowds (d) learning disability and an inability to stay focused and maintain concentration (e) hyperactivity as a child (f) difficulty in communicating effectively with others (g) procrastination in applying for a job. Most of these symptoms are closely aligned to the patient’s learning disability with is a neurobiological condition . This is also coupled with attention deficiency disorder, since she is unable to concentrate and also procrastinates in finding a job. Most of her problems arise from the negative attitudes and beliefs that the patient has been carrying around since her childhood, sparked off by the learning disability, which has also created in her an inferiority complex that she is not on par with her peers. The goal in the patient’s treatment from a cognitive standpoint would therefore be to deal with the patient’s negative attitudes and tackle the attention deficiency disorder. By helping the patient to learn to cope with day to day issues, a feeling of confidence and competence can be generated which will be helpful. Therefore counseling could first of all set out some cognitive tasks which could be divided into components. For example, a memory exercise or a simple task such as preparing a daily schedule. Patient could be asked to estimate the time she will take to complete the task which can be matched with her actual performance, with periodic reviews so that the memory and procrastination problems are addressed. Later, the tasks of writing interview letters and practice interview sessions can be tackled on a stage by stage basis so that the patient is able to overcome her feelings of inadequacy and the procrastination that has kept her from seeking a job. Although the patient history shows learning disability, I would like to examine where and when the patient first went to school and what her experience was, so that any traumatic event or incident can be identified. If there was any specific trauma associated with her first experience at school, it may help if she is able to identify the trauma and face it so that she can deal with it and move on with her life. Some deeply buried trauma could be related to the subsequent hyperactivity and learning disabilities, closely associated with her emotional problems in communicating effectively with other people. As a Counselor, I would adopt an impersonal friendly approach. My primary effort would be geared towards helping the patient feel comfortable enough to reveal any inadequacies in completing her tasks without trying to be defensive about it, as she seems to be. I would play the role of a catalyst, merely encouraging her to face up to her mental problems , acknowledge them and overcome them. The Trait theory The Trait theory is based upon the principle of the individuality of human nature. This theory seeks the answer to mental and emotional problems from the point of view of the aptitude or potential performance that each person demonstrates depending upon the qualities he or she may have inherited from his or her parents. Therefore, this theory advocates the testing of these individual traits through performance and aptitude tests designed to test the individual capacity of the patient. This patient has approached the counselor with the primary worry about not being able to find a job. During the course of preliminary examination, she has revealed the following aspects which are useful: (a) Her GPA has hovered around 2.5 (b) she has been diagnosed with learning disability disorder (c) Her social quotient ranking is not high (d) Her personality is like her mother’s but she does not understand her. Based upon an assessment made upon what the individual abilities and aptitude of this patient are, it is possible to identify that she has a problem relating to people and perceives herself in a negative light. Her problems with communication could be the result of too close identification with her mother, with whom she does not vibe well. She also drinks as a defensive measure, something she may have inherited from her father. She finds it difficult to demonstrate her ability because she ranks herself low on the personality scale. She rocks herself to sleep, which is yet another measure of the defensive attitude of a child who could have experienced a lack of love and affection in childhood which manifests in the outward measure of rocking. This is corroborated by her statement expressing her fear that no one will love her. The fact that she experienced feelings of dissatisfaction in her intimate relationship could indicate that she is searching for a level of intimacy and closeness that was satisfactory at first but could not be maintained on a long term basis. To counsel this person, the main objective would be help her realize what her personal attributes are. The Trait theory also states that there are individual differences between people and the major thrust of treatment would be to make the patient understand that differences exist but each person is of value. Therefore the first step would be to allow the patient to talk about why she feels that her differences make her inferior, so that any childhood blocks could be overcome. I would then administer several different types of quantitative and qualitative tests in order to assess other traits that this patient may possess, possibly some talents which could be used to bolster her self confidence. I would like to know more about the peers of this patient, in order to analyze the effect of the hereditary element in the problems that the patient is facing. Do either of her other peers have the same problems of adjustment? If so, parenting lack would show up. Otherwise, the possibility that exists is that some deep rooted childhood trauma has caused the negative perception. I would also find out the patient’s drug history and try to treat her with some anti depressants, so that any hereditary neurobiological disorder can be remedied through medicines. While employing this theory, I would work with this patient as a close friend and sympathizer. The role I would assume would be one of confessor, the person to whom she could talk and express all of her inadequacies. My efforts would be geared towards creating an understanding that differences do not indicate inferiority and the discovery of additional talents would reinforce this claim. I would focus on making her list all her positive traits, then make her memorize them and use flash cards so she can keep it fresh in her memory all the time. Multimodal Theory The underlying principle in the multimodal theory is that therapist-client similarity is likely to elicit the best response to treatment. This theory explains human behavior and functioning in terms of seven independent dimensions which may be categorized as Behaviors, affects, sensory, imagery, interpersonal, cognition and biological factors. The multimodal theory considers all these factors in one composite approach that does not individually isolate a particular trait or ability but assesses the patient’s diseased state as a function of the composite individual. While the factors may also be considered singly in terms of relative importance yet the overall composite dimension assumes importance in implementation of this theory. Applying this approach, a patient would be tested according to the modality of each one of the seven dimensions. For example, high scores on the behavior modality indicate an energetic person while high sensory modality would indicate a person attuned to physical sensations. People scoring high on the Asffects modal are emotional and likely to be guided by their emotion while people scoring high on the cognitive modal may be logical, rational and contemplative. People with high scores on interpersonal modalities derive the source of their strength from their interpersonal relationships. Therefore applying the multimodal approach to this patient, it may be noted that she scores low on the behavioral modality, cognitive and interpersonal modalities while she may score high on the affects and imagery modality indicating that the patient is an emotional person. The patient shows several signs of being an emotional person, her anxiety in a crowd, her depression and desire for intimacy and intensity are only some of the outward manifestations. Therefore the first step in treatment of this patient would be to test her out thoroughly on all of the seven dimensions. Once the tests have been completed, dominant modalities can be identified so that the patient’s personality and characteristics will become clear and the treatment can be tailored accordingly. Once the patient’s “type” has been determined, the next stage would be to put her in touch with the right therapist. Since patient-client similarity is a very important factor that affects the degree of success that the treatment will have, therefore, it will be necessary to first identify her type and then decide who would be the right counselor for this patient. The right counselor will understand this patient best and be able to bring about the best results. Through the use of the multimodal approach, it is likely that all aspects of the patient’s personality will be tested and therefore I would rely solely upon the effects of the tests in order to treat the person, since all aspects would be revealed. This will also reveal the patient’s stress points, irrespective of whatever the patient may have said in her interviews. For example, the manner in which she categorizes her relationship with her boyfriend as being emotional and intense at first and then sort of blah may provide an indication that the affects modal may predominate in her case and she may be an emotional kind of person who will have to be treated accordingly and is likely to establish the greatest degree of rapport with a therapist of similar disposition.I would like to also meet the mother of the patient separately if possible, to ascertain the kind of person she is, in order that a more accurate assessment may be made of the kind of factors that may have gone into shaping the patient’s composite personality. My role as a counselor would be to encourage the patient to explore through therapy and counseling sessions, the underlying reasons for her problems. The focus of my effort would be investigative, in order to first ascertain the causes for the inner anxiety and depression that this patient feels in order to determine what treatment will be most helpful. By providing the patient the opportunity to understand herself, she may be helped. The Family Systems Theory The Family Systems Theory advocated by Bowen is distinct from other theories in that it is a natural systems theory that places importance upon the value of the family as an emotional framework that guides the behavior and motivations of individuals. This theory also proposes eight variables that are interconnected and make up the emotional framework within which an individual grows. These variables are (a) level of differentiation of self, the response and reactivity mechanisms within the nuclear family, the existences of family triangles, sibling positions and sibling rivalry, anxiety associated with the family unit and relationships both chronic and acute and emotional cut off or deprivation. All of these concepts were interconnected and none of them could be isolated from the group or used individually to explain the individual variations that exist. This theory states that all the variables interact in a certain way to affect the manner in which the human being functions. All symptoms that the patient feels or complains of are all expressed within the theoretical framework of the family and all imbalance sin individual functioning are explained on the basis of the emotional framework that has been provided to the patient. This patient’s history shows definite symptoms of emotional imbalances in childhood and a great impact of family on her life. She reports that her closest playmates were her siblings and that she has a good relationship with them until she started going to college. There are also indications of repressed anger and an inability to vent feelings within the family environment. She reports special disagreement with her mother yet reports that she is alike in terms of her personality. She also states that she feels “abandoned” by her family since she has started going to college. All these provide indications of a need for family closeness and attachment which was perhaps repressed in some instances by the closed atmosphere in the family where raising voices was frowned upon. There may be pent up anger and resentment in this patient which would need to be vented. There have also been behavior problems at home which again provides an indication of the need for attention. Therefore, this theory appears to be the most relevant for consideration in treatment of this patient. Her own interviews appear to suggest that she does not have many close relationships outside the family and that the source of most of her problems may lie within the family unit, including her need for intensity in relationships. In treating this patient using this theory approach, the important thing is to conduct interactive therapy sessions where the patient can first be counseled on an individual basis followed by whichever members of her family are willing to attend the sessions, also on an individual basis. However, at some point, it will be necessary to bring the members of the family together so that the patient’s interaction with them can be examined within a clinical framework. Alternatively, it may be necessary to seek additional information from the patient about her family background and to pay attention to all the details she has revealed. Additional information I would like to collect in assessing this case is whether there was nay possibility that this patient was exposed to abuse as a child or if there is any trauma resulting from abuse that has created emotional problems for her. My role as a counselor in this case would not be on a very deeply involved level. I would function merely as a facilitator, to help the patient explore her relations with her family and her growing years from a more objective framework so that any hidden blocks that are causing the diseased condition can be revealed. I would have to be very careful in this case to refrain from becoming personally involved, since the probing into family background may unearth the patient’s painful past experiences. Read More