Counselling Theories Essay, Research Paper
This essay will critique the efficacy of Psychodynamic and Cognitive-Behavioural counselling approaches, in particular as they apply to a specific case scenario. Both approaches will be defined and explained, and a brief expose of their relative antecedents will clarify the respective locations of each in the broad spectrum of counselling theories. Conceptual elements and therapeutic strengths pertinent to the scenario will be identified, and the limitations of each approach will be highlighted, along with the need for racial, cultural, religious and gender sensitivity on the part of the counsellor. Examples of practical techniques will be explored to illustrate the therapeutic effectiveness and expected outcomes of each model. Finally, it will be demonstrated that both the psychodynamic and cognitive-behavioural counselling theories, in the hands of trained, professional helpers, occupy important roles in the spectrum of counselling philosophies.
An irrefutable element in contemporary psychological and counselling practices is the seminal work of Sigmund Freud, who originally conceptualised the notion of the unconscious and its effect on human behaviour (Kovel 1987: 96-98). A core principle in Freud s theories espoused that unpleasant or traumatic childhood experiences – if suppressed in the unconscious and denied by means of defence mechanisms – could subsequently surface as inexplicable thoughts or behaviours in adult life (Geldard 1998: 12-13). Corey (1991: 96-99) succinctly describes the three systems that make up the structure of personality as the biological (id), psychological (ego), and social (super-ego), and that ego defence mechanisms whilst having the potential to warp reality, are normal processes operating on an unconscious level to protect the ego from being overwhelmed .
Psychodynamic therapy, whilst firmly established in Freud s original concepts of psychoanalysis, explores the dynamic nature of the anxiety caused by conflict between the id, ego and superego (McLeod 1998: 32-33). Specific techniques include free association and resistance interpretation – encouraging the client to say whatever freely comes to mind and analysing areas of defensiveness; dream analysis – dreams seen as uncensored thoughts from the unconscious; and transference – allowing the client to project feelings onto the therapist.
Burgeoning from the classical psychoanalytical school are two philosophies conceived in the latter part of the twentieth century known as Object Relations and Attachment Theories. Corey (1991: 111-114) explains that Freud applied the word object to define any person or thing embraced, usually by a child, as the target of feelings or drives . Melanie Klein developed the Object Relations Theory as an extension of this original hypothesis. The theory describes the enigma precipitated by the child s need to direct all emotions at one object usually the mother or primary caregiver and its inability to integrate the simultaneous concepts of love and hate. Klein suggests that this inability to tolerate ambivalent feelings for the one object person may bring about underdeveloped personalities in adulthood (Avery 1996:26-27). D.W. Winnicott added another dimension by introducing the notion of good enough mothering whereby a good enough mother will gradually let her child down to encourage independence, understanding of individuality and healthy object relations. If the process is hurried or degraded the child can create a false self to protect its true self from further distress (Avery: 27-28).
Attachment Theory (or self-psychology), espoused by John Bowlby to oppose those of Melanie Klein, demonstrates that in order for adults to maintain acceptable social and personal attachments they must first have forged secure attachments with their primary caregivers in childhood (Ivey, Ivey & Simek-Morgan 1993: 172-173). This innate need for positive attachments and a secure base , if unsatisfied, will result in lack of trust and the inability to eventually form sound, intimate relationships (McLeod: 51-52). Bowlby s work was corroborated by empirical studies conducted with and by Mary Ainsworth in which it was shown that infants demonstrate varying degrees of anxiety when deprived of the company of their parent (Ivey & al: 174; Howe 1995:68-69). In summary, the psychodynamic approach is a broadly based perspective, which extrapolates Freud s original hypotheses and seeks to facilitate client insight by understanding the impact of childhood experiences and defence constructs suppressed in the unconscious.
The psychodynamic technique of free association would be particularly useful in counselling the case study client. As she presents with anxiety apparently brought about by conflict, feeling free to say whatever is on her mind may allow a previous unpleasant experience that has been repressed to be recalled and dealt with in the conscious mind (Corey 1991: 120-121). For example, it is probable that as a child the client was witness to or even a victim of atrocities in her war-torn homeland. If so, it is possible that these horrific confrontations have been suppressed and that as a result, interpersonal conflict of any kind now causes extraordinary levels of anxiety. Similarly, if these traumatising acts were perpetrated by military or other authoritative men, she would possibly be projecting or transferring the images of her childhood onto the personas of all males, particularly those in a position of authority. Assuming this scenario to be true, the stages of free association would have the client focus on a current concern (the conflict at her work); to describe and physically locate the emotions and feelings surrounding that problem (anger, frustration, helplessness, abuse, fear); to recall a time early in life when similar feelings and emotions were experienced (childhood memories of abuse, pain and oppression in her country of origin); to connect or associate the two occurrences and deliberate on the validity of the association (Ivey et al :185). Hence, candid free association in an environment of trust and discretion would encourage the client to make unconscious material conscious (Nelson-Jones 1995:204) and to locate the root cause of her anxiety in its appropriate context. This in turn would allow her to objectively re-examine her workplace problems and deal with them on their own merits, free of any emotional confusion caused by misplaced or repressed fears of authority or conflict.
The analysis and interpretation of resistance presents as a logical follow on and complementary technique to that of free association. Counsellors may discern during free association that clients are avoiding or distorting certain issues, and the interpretation of this defensiveness can direct the client to the actual causes of these unconscious constructs (McLeod 1998: 37). Laplanche & Pontalis (in Ivey et al 1993: 197) describe resistance as everything in the words and actions of the [client] that obstructs his gaining access to his unconscious . Applying this technique to the case scenario would involve listening intently to the clients free association comments and detecting any blocks, slips or anomalies in the narrative. For example, using the situation discussed in free association above, the client may feel that the gross acts perpetrated by the authorities were in some way her fault or that she could or should have done something to prevent them. As this level of guilt is impossible for a child to deal with, then the feelings may have been repressed to allow the conscious mind to continue functioning. The counsellor would need to exercise caution as this particular type of resistance is regarded as the one analysts most dread (Nelson-Jones: 205), by virtue of its potentially harmful nature. Although the analysis and interpretation of resistance can be a valuable tool in helping the client, counsellors need to be mindful that resistance serves a purpose for the client by keeping suppressed those memories that would otherwise cause onerous levels of anxiety. Forcing the issue could cause more harm than good (Corey: 122-123).
Notwithstanding the potential illustrated, the Psychodynamic approach is limited in that it is expensive, time-consuming, and requires a degree of intellectual agility on the part of the client that cannot be presumed (Corey: 128-129). Only highly skilled, professional therapists should be using the technique to avoid wild analysis and the ignorance of the fact that some repression is a normal homeostatic mechanism (Ivey et al: 212-213; Stafford-Clark & Bridges 1990: 44-45). Also, there is the risk of developing fostered dependency by creating an environment from which the client is unable, unwilling, or convinced not to, cease therapy (Abramson, Cloud, Keese & Keese 1994).
Cognitive-behaviour therapy (CBT) is described as incorporating behaviour interventions to address inappropriate emotions by altering behaviours, and cognitive interventions to address inappropriate emotions by addressing thought processes (Brewin 1996). The five main therapies involved in CBT are behaviourial – Ivan Pavlov, B.F. Skinner; rational emotive behaviour – Albert Ellis; cognitive – Aaron Beck; reality – William Glasser; and cognitive behaviour modification – Donald Meichenbaum (Corey: 7-9). Through empirical research, behavioural theorists conclude that maladaptive behaviours are learned, and as such, are capable of being unlearned . Further, that the way behaviours are learned is through classical conditioning repetitive stimulus and response; and operant conditioning rewarding or discouraging behaviours by increasing or decreasing stimuli (George & Cristiani 1995:87-91). Rational emotive behaviour therapy is founded on the proposition that thoughts cause feelings and that it is not events that produce anxiety but rather the client s perceptions, irrational beliefs , and continual re-indoctrinating surrounding those events (Cormier & Hackney 1993: 180-188). Cognitive counselling, founded by Beck and refined by Carl Rogers, is generally short term, structured, and aimed at teaching clients to adjust their thinking and acquire more adaptive thought processes (Nelson-Jones: 345-346). Reality therapy is commonly used in the short term with difficult clients who do not respond to the more subtle approaches, and involves directing clients to take control of their lives and to accept responsibility for their actions (Ivey et al: 275). Cognitive behavioural modification connects the other approaches and encourages modification in the behavioural, emotional and cognitive aspects of the clients lives (Ivey et al: 228).
Maintaining the scenario themes previously discussed and considering the client s symptoms (anxiety and lack of sleep) and the potential for these symptoms to cause more serious physiological conditions, a regime of relaxation and stress management techniques is indicated. Whilst (often protracted) psychodynamic counselling addresses the unconscious root causes of anxiety and sleeplessness, behaviour therapy is directed at the symptom (or behaviour) itself. Relaxation training incorporates progressive muscle relaxation (Jacobson in Cormier & Hackney 1993: 232) and/or having the client visualise a particularly comfortable and stress-free image from the past. Relaxation techniques have been shown to reduce oxygen consumption, decrease heart and respiratory rates as well as lowering blood pressure (American Medical Association 1996). Mastering these techniques, the case scenario client would not only realise that previously overwhelming stress could be overcome, but she could extend this ability to be in control into other difficult areas of her life (Ivey et al: 235-238). Professor Robert Priest catalogues a series of relaxation and stress management techniques that include biofeedback, quieting techniques, meditation, and controlled breathing, all of which are considered valuable and therapeutic tools (Priest 1983: 34-42). The scenario client suffers no medically explained condition, and research has shown that significant numbers of similar patients have been cured by the use of cognitive-behavioural conselling (Speckens, van Hemert et al 1995). Hence, the client would benefit from these relaxation techniques by being empowered to control the actual symptoms, thus enabling her to better control issues at work in a rational and objective manner.
A second technique utilised in cognitive-behavioural counselling is that of keeping a daily record of automatic thoughts . This process, proposed by Aaron Beck, involves the client actually writing down each negative or self-deprecating thought that comes to mind. By doing so the client not only has a diarised record to discuss with the counsellor but the process of recording those thoughts in itself reinforces and promotes change by allowing the client to see just how often he/she is unconsciously defeating his/her endeavours to change (Ivey et al: 270). By recording such thoughts and reviewing them whilst in a relaxed state of mind, the scenario client would be able to see that the disproportionate emotional response she was exhibiting to minor or impersonal issues at work were inappropriate and even exacerbating the issues further. Also, by discerning a pattern of activating events the client and counsellor would have an insight into the best subsequent technologies to employ (Nelson-Jones: 331-332). As it has been established that the client possibly suffers from feelings of guilt and low self worth, exposing her irrational and reproachful beliefs would allow her to accept that she can change; that her problems are not caused by actual events; that she can incorporate rational alternative thoughts; and that she can achieve desired change through commitment and practice of the techniques (Corey: 335). Overall, the suggested counselling techniques of relaxation training and monitoring automatic thoughts would encourage the client to step out of her present self-devaluing thought patterns and view her problems as situations that have been misinterpreted rather than personality shortcomings that diminish her self-worth.
Limitations to cognitive-behavioural conselling include the complete denial of the effect of past experiences which may have been repressed as well as the potential to intimidate clients with the rapid pace of the processes (Corey: 359-360). Also, by locating the problem on the client and ignoring his/her history, the impact of oppressive family and cultural histories as in the case scenario is disregarded (Ivey et al: 280-281). Finally, the outcomes depend heavily upon the client being candid and committed to the homework factor of the therapy; the process requires the client to conceptualise and understand the theory; and the notion of change in thinking can result in change in behaviour and feelings does not have universal professional acceptance (McLeod: 80-81).
Regardless of the particular type of therapy to be employed, it is essential that counsellors in the first instance conduct an intake and history interview to glean details regarding the client and his/her problem (McLeod 1998:222-226). These details would include the gathering of information on current presenting problems degree of anxiety, thoughts, feelings, physical manifestations, patterns; life setting religious, social, work activities; and family and personal history parents, siblings, stability, medical, relationship issues (Cormier & Hackney 1993:80-82). From this interview the counsellor would be alerted to the potential friction surrounding cultural, racial, language, religious and gender factors that could be exacerbating or even causing the anxiety (pp. 318-322). Corey (1991:5) warns of the need for counsellors to be aware of, and sensitive to, the possible influence of cultural and religious norms which may inhibit the client s willingness to share feelings and display emotions. Therefore, employing specific counselling micro-skills when dealing with racially, culturally and ethnically diverse clients is necessary to the establishment of a therapeutic relationship, as is the use of a gender-appropriate communication style (Fook 1993: 150-152). Knowing the case scenario client s background, and with the real potential of there being gender, racial, religious and cultural barriers to forming a helping and enabling atmosphere, the counsellor would need to be especially considerate and aware.
In conclusion, both the psychodynamic and cognitive-behavioural theories of counselling have been shown to each offer their own specific methods of therapy in the management of the client in the presented case scenario. Psychodynamic theory has been shown to be deeply seated in the Freudian school of therapy whilst the cognitive-behavioural techniques were revealed to be espousing more contemporary, action-orientated approaches. The client in the case scenario was seen to be able to gain insight and growth, in varying degrees, from each form of mediation. However, given her traumatic and oppressed history, the critique of the two alternative therapies suggests that the client may have been better served by the more gradual and empathic psychodynamic approach. Limitations of each theory were presented, revealing that psychodynamic counselling can be a costly, drawn out process that can possibly lead to a client dependency on the therapy, whilst cognitive-behavioural techniques were shown to ignore the effect of past experiences and to rely heavily on the client s own abilities and commitment. Both philosophies were seen to be limited in that they assume a reasonable level of intellectual and conceptual ability on the part of the client. Finally, the compiling of a thorough client history was presented as a necessary step which would enable the counsellor to be sensitively prepared for any cultural, family, ethnic, religious or gender issues that may impede the therapeutic process.