“People are always changed by disasters, and other life events,
but they need not be damaged by them.” -John D. Weaver
When we study human behavior, specifically focusing on the development of personality and crucial to how a person or individual conducts him/herself, psychology offers a variety of dimensions. The concept of personality is central to our attempt to understand ourselves and others and is part of the way in which we account for the differences that contribute to our individuality. Psychologists have been particularly concerned with shaping of the personality in relation to genetic and environmental influences. We have been fortunate that the study of human personality has been thriving and fruitful. We can choose from as many models we can to help us see ourselves better and maintain good relationships.
In the course of our study, every individual counselor – therapist eventually develops his/her own approach in the therapeutic process. The path that the practitioner takes concerning his/her choice of approach or model depends a lot on his/her own personal preferences, personality and understanding of human nature. An eclectic approach is usually the direction that anyone in this field would take; however, certain emphasis is made on some specific positions simply because these are the dominant theories which help guide him/her in focusing the essentials of the process with the client. Though the attempt is said to be eclectic then, the therapist still has this open option to change or vary some details of his/her strategy along the course of the interaction or treatment phases.
There is a need for integration not only for its theoretical applicability but also for its practical usefulness. Presuppositions or philosophical conceptualizations are the pillars of any worldview, and to successfully establish a new one requires that changes or reinforcements be made at this plane. The integrative approaches were framed at this level so as to remove mental oppositions as they arise every time in one’s thoughts. When this is not adequately laid down, no audience can align their thoughts or understanding with what the author tries to convey. This paper is an attempt to convey a personal understanding of human behavior in the context of psychotherapeutic approaches that are modified for use by the author. It appreciates the accomplishments of the various approaches such as Behavioral, Cognitive-Behavioral, Psychoanalytic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered developments in the profession. The following reflects the views of the author in the healing process of the mind and emotions.
- Key Concepts of My Approach
It is therefore expected that though at this point I value the primary theories or perspectives that I am thus enumerating afterwards, this also implies that I am open to the various developments that are expectedly to occur in my practice in the future. Since this is an eclectic approach at employing strategies I have found to be beneficial personally and that of others, I wish to mention many of these in the following statements. I am persuaded further that key elements or themes are found all throughout my own version of the approach. The smaller yet finer points come only in the between. For the thrust that this paper is taking, I wish to mention then my views individually, on Behavioral, Cognitive-Behavioral, Psychoanalytic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered approaches.
- Behavioral Therapy
This model utilizes what is termed as the learning theory posited by Skinner and Watson and the rest of the Behaviorism school. It assumes that the principles in learning i.e., conditioning (Associative and Operant) are effective means to effect change in an individual. Generally, the thrust of this theoretical perspective is focused on the symptoms that a person is experiencing. Just as many of the errors of the patterns of behavior come from learning from the environment, it is also assumed that an individual will be able to unlearn some if not all these by using the techniques as applied based on the learning principles. To a certain extent I believe that this still works: reinforcements are effective to some extent and in some or many people hence I am incorporating this stance separate or distinct from the Cognitive-Behavioral approach. In behavior therapy therefore, thoughts, feelings and all those “malfunctioning” and unwanted manifestations revealed in one’s activities can be unlearned and the work of a behavior therapist.
The basic concepts include “extinguishing” – utilized when maladaptive patterns are then weakened and removed and in their place habits that are healthy are established (developed and strengthened) in a series or progressive approach called “successive approximations. When these (factors) are reinforced such as through rewards in intrinsic and extrinsic means, the potential of a more secure and steady change in behavior is developed and firmly established (Rubinstein et al., 20074; Corey, 2004). Although few psychologists today would regard themselves as strict behaviorists, behaviorism has been very influential in the development of psychology as a scientific discipline. There are different emphases within this discipline though.
Some behaviorists contend plainly that the observation of behavior is the best or most expedient method of exploring psychological and cognitive processes. Others consider that it is in reality the only way of examining such processes, while still others argue that behavior itself is the only appropriate subject of psychology, and that familiar psychological terms such as belief only refer to behavior. Albert Bandura’s social cognitive approach grew out of this movement. Bandura’s method emphasizes cognitive processes over and above observable behavior, concentrating on not only the influence of the person’s upbringing for example, but also “observation, imitation, and thought processes” (Plotnik, 2005).
In the cognitive approach alone, the therapist understands that a client or patient comes into the healing relationship and the former’s role is to change or modify the latter’s maladjusted or error-filled thinking patterns. These patterns may include wishful thinking, unrealistic expectations, constant reliving and living in the past or even beyond the present and into the future, and overgeneralizing. These habits lead to confusion, frustration and eventual constant disappointment. This therapeutic approach stresses or accentuates the rational or logical and positive worldview: a viewpoint that takes into consideration that we are problem-solvers, have options in life and not that we are always left with no choice as many people think. It also looks into the fact that because we do have options then there are many things that await someone who have had bad choices in the past, and therefore can look positively into the future.
Cognitive-Behavioral Therapy postulated primarily by Ellis and Beck “facilitates a collaborative relationship between the patient and therapist.” With the idea that the counselor and patient together cooperate to attain a trusting relationship and agree which problems or issues need to come first in the course of the therapy. For the Cognitive Behaviorist Therapist, the immediate and presenting problem that the client is suffering and complaining from takes precedence and must be addressed and focused in the treatment. There is instantaneous relief from the symptoms, and may be encouraged or spurred on to pursue in-depth treatment and reduction of the ailments where possible.
The relief from the symptoms from the primary problem or issue will inspire the client to imagine or think that change is not impossible after all. In this model, issues are dealt directly in a practical way. Coaching the patient on the step by step procedure of CBT is a basic and fundamental ingredient. Here the client is enlightened as to the patterns of his thinking and the errors of these thoughts which bore fruit in his attitudes and behavior. His/her thoughts and beliefs have connections on his/her behavior and must therefore be “reorganized.” For instance, the ways that a client looks at an issue of his/her life will direct the path of his reactivity to the issue. When corrected at this level, the behavior follows automatically (Rubinstein et al., 2007; Corey, 2004).
- Psychodynamic Therapy
The Psychodynamic perspective is based on the work of Sigmund Freud. He created both a theory to explain personality and mental disorders, and the form of therapy known as psychoanalysis. The psychodynamic approach assumes that all behavior and mental processes reflect constant and often unconscious struggles within the person. These usually involved conflicts between our need to satisfy basic biological instincts, for example, for food, sex or aggression, and the restrictions imposed by society.
Not all of those who take a psychodynamic approach accept all of Freud’s original ideas, but most would view abnormal or problematic behavior as the result of a failure to resolve conflicts adequately. Many of the disorders or mental illnesses recognized today without a doubt have their psychodynamic explanation aside from other viewpoints like that of the behaviourist, or the cognitivists. From simple childhood developmental diseases to Schizophrenia, there is a rationale that from Freud’s camp is able to explain (Kaplan et al, 1994).
- Existential Therapy
The Existential approach, as put forward by Nietzsche, Kierkegaard, Sartre, Heidegger, Rollo May, and Frankl, believes that the individual’s potential may lie dormant but that it is there waiting to be ushered in time. It recognizes that man is able to achieve great heights and that these are just waiting to be tapped not only by him/herself but that also when helped by a practitioner who is persuaded of this notion. It examines such major issues as free will and the challenges of exercising this free will, the issue of mortality, loneliness and in general, the meaning of life.
The Therapy is effective when the practitioner works with elderly care and death and dying issues. It focuses on the individual needs but takes into consideration the significant relationships and the meanings they bring into the person’s life. Transcending the issues and problems are primary intentions of the therapist at the same time being realistic that certain limitations do exist and may hinder the process of recovery (Rubinstein et al., 2007; Corey, 2004).
- Humanistic Therapy
Allport, Bugental, Buhler, Maslow Rollo May, Murphy, Murray, Fritz Perls and Rogers are those that helped usher in the Humanistic theory and consequent therapy. It holds in view the individual as possessing the options or freedom to choose, creativity, and the capability to attain a state where he/she is more aware, freer, responsible and worthy of trust. Because the human mind has immense potential, the approach assesses as well that forces from the environment bear on with the individual and depending on the interplay that occurs within the individual person, the result will either be destructive or constructive to the person. In sum, humanism takes into the perspective that essentially humans are good and not evil, and that the therapy facilitates by harnessing on the human potential through the development of interpersonal skills. This results to an enhanced quality life and the individual becomes an asset rather than a liability to the society where he revolves in (Rubinstein et al., 2007; Corey, 2004).
- Family Systems Therapy
This theoretical viewpoint has been the by-product of the works of Bateson, Minuchin, Bowen, Ackerman and many others. Usually done in pairs or by a team of practitioners, family systems therapy has its roots in behavioral and psychoanalytic principles. This model understands that the family is a unit and its members or any of its members with an issue or a problem must be addressed in the context of the family as a unit. It puts its emphasis on the relationships among the family members, their patterns of communication more than their individual traits and/or symptoms. The systems theory portion of the therapy indicates that whatever is occurring or happening is not isolated but is a working part of a bigger context. In the family systems approach then, no individual person can be understood when removed from his relationships whether in the present or past, and this is specially focused on the family he belongs to (Rubinstein et al., 2007; Corey, 2004).
- Gestalt Therapy
Gestalt therapy has this goal of reducing if not removing the symptoms with the rationale that the individual has personal responsibility and that the here-and-now experience is thus very important. This two-fold emphasis on the present moment as experienced by the person and that another reality is that our existence is entangled actually with other aspects and parts of the environment. It is when we understand that we are related with other things that insights to our issues are achieved and help us in finding solutions to our existence. When we are free from the obstructions of things that are “unfinished” then we reduce the obstacles and enhance the opportunities to our optimal satisfaction and fulfillment and eventual growth (Rubinstein et al., 2007; Corey, 2004).
- Client-Centered Therapy
Developed and known because of the works by one person – Carl Rogers – Client Centered Therapy focuses on the person who needs aid and his/her improvement depends on the client himself although with the facilitation and assistance of the therapist. The rationale for the direction of the therapy lies in the notion that humans basically possess the ability to move towards the fulfillment of his/her possibilities. According to Rogers, “Individuals have within themselves vast resources for self-understanding and for altering their self-concepts, basic attitudes, and self-directed behavior; these resources can be tapped if a definable climate of facilitative psychological attitudes can be provided” (Rogers, 1980, p 115-117 in Rubinstein et al., 2007).
This approach is very popular today and many therapists usually incorporate this model into their own eclectic method. Rogers identified three important concepts termed as conditions: these are congruence, unconditional positive regard and empathy. Many in the mental health circles have these in their day-to-day jargon. In the aforementioned conditions, a person moves toward what Rogers call “constructive direction” when these three conditions are afforded.
- The Role of the Therapist
I aspire to be a therapist – counselor whose practice is characterized as empowering and collaborative. By empowering, I understand the limitations of my role and as such I am constrained at the same time to impart my best knowledge and efforts to enable my client/patient to understand him/herself, and lead the treatment to the point where he/she is able to stand on his/her own without my help anymore. Further, it means that I recognize the patient or client as a person who is not only complex, he/she is also is imbued with the nature that inherently can heal, grow and mature. They contribute to the process, and their attitude towards the whole duration of the healing relationship is a crucial aspect to the attainment of their goals. The therapist then must remove by all means any barrier or obstruction to the achievement of goals especially when these come potentially from the therapist him/herself (that’s me).
By collaborative, again because there are set limitations on my capacities, I recognize the availability and expertise of others in realms that I hardly know and that working with them, collaborating with them, gives my client more options, and provides him/her the best and comprehensive interventions that there is in the field. A therapy that is beneficial looks beyond my set style and preferences of diagnosis and treatment; it is progressive and seeks to enhance the initial strategies that had been established and continually expands oneself by learning and researching. Most importantly, by collaboration, my client is the most significant “collaborator” and that notion should not be missed all throughout (Rubinstein et al., 2007; Corey, 2004).
The effectiveness of therapy in counselling is dependent substantially on two factors; namely, the patient’s cooperation, and the expertise of the therapist. Many experts in the field of Psychology have observed the significant contribution of the client to the over-all process. The individual’s perception of the therapist is extremely crucial to the ensuing treatment. Without the needed initial positive perception of the therapist on the part of the one seeking treatment, the whole process will not generate a desired momentum that would set the entire scheme in a strategic stance. Of course, the expertise of the therapist is another major factor – actually, the other half – but it’s a given to the whole package of treatment (Rubinstein et al., 2007; Corey, 2004).
Since a “working alliance” has to be established first before the actual treatment is administered, there are important or vital considerations for this “working alliance” between client and therapist to occur, and this is in précis, the intentions of this paper. What we will be considering in this paper are the challenges that new therapists face as they practice their profession.
- The past baggage of the client.
From any vantage point, the level of trust by client on his therapist, whether that perception is based on attractiveness, trustworthiness or as someone who knows what he may be dealing with in terms of credentials, are valid, and is the utmost concern of the helping relationship. Trust in the part of the client is necessary for the healing process. However, because the full ramifications of the issue almost always hinge on the perceptions of the client, the problems and hindrances need to be addressed or at least cited for clarity and deliberation at the outset of the relationship.
As hinted above, the client may be bringing (emotional) baggage into their mutual involvement which may be due to prior engagements with other professionals in the therapeutic relations, whether positive or negative. Oftentimes, in many cases, these may be liaisons which were unsuccessful, distasteful or even traumatic for a few. The author pointed out that any form of future therapy will be affected due to these previous experiences, and it has to be dealt with right away at the outset (Horvath & Luborsky, 1993, p. 4).
- The fitness of the therapist
By fitness, we mean sufficient, wide-ranging exposure, and right training to the kind of illness/es or disorder/s that he may be dealing. Even with years spent in the academe will not guarantee the development of skills in handling such complex and true-to-life situations or scenarios. At times, the theoretic skills acquired, instead of enabling the new therapist, may deter or hamper the process. This means to say that the therapist must possess more than head-knowledge; he should not allow his schooling to affect him to the extent that it made him conceited with no room for more learning especially when additional knowledge are available in the patient himself. He must also have the sensitivity to employ his gut-feeling to at times, direct the course of the therapy (Rubinstein et al., 2007; Corey, 2004).
Therapeutic relationships are almost always exhausting, but it will be an undesirable experience for the alliance partners when just one of them becomes disinterested, hence as Luborsky pressed that “reciprocity” must be established, cultivated or maintained until the relationship is terminated, hopefully because the client is well (Horvath & Luborsky, 1993, p. 4).
III. The Therapeutic Process
The therapeutic process is initiated by the therapist primarily as soon as the client or others who refer or brought the patient in for the assumed long haul of the healing relationship. It would be impossible to do all approaches at one time. By eclectic and as frequently emphasized, the usage of any of the methods will be dependent on the need of the patient, and other pertinent information that help guide which of these the therapist will be using. The therapist then is enjoined to be able to diagnose well; it is at this stage that any practitioner is well aware of the risks should he/she fail to diagnose properly the needs and or issues /problems of the client. However, as he/she matures and advances in the profession, many instances occur that the mistakes made in diagnosis are oftentimes corrected while at the treatment stage, hence the traits of flexibility and humility (admitting mistakes for instance) are valued highly in this profession (Rogers, 1980, p 115-117 in Rubinstein et al., 2007).
Employing the Behavioral, Cognitive-Behavioral, Psychodynamic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered Eclectic stance primarily involves the incorporation of distinct concepts within a single framework. The important thing is that of flexibility and resiliency on my part when to apply or implement which of the theories in the context of my client. It starts with the identification of specific problems and especially the root causes. When this is confidently achieved, the therapist is actually midway to attaining his/her goals which includes not only the relief of the symptoms that the sufferer is currently experiencing but especially the reduction of the occurrence if not altogether eliminated.
The specific treatment goals are likewise essential and it helps in the remaining aspects or levels of the process. The diagnostic part by itself in most cases is considered therapeutic since many clients have experienced immediate relief; in the language of psychoanalysis, the “cathartic” effect is helpful already. In addition, another important ingredient in the process is to identify effective reinforcers which help people in crisis for instance or those in acute and chronic mental and emotional anguish to sustain their plan for change and control of their disorders. Helping the client set up a kind of self-help management program is a very effective strategy to pursue within the relationship (Rubinstein et al., 2007; Corey, 2004).
~Identifying clients in crisis
Despite breakthroughs in scientific researches and the success of many crisis interventions by established churches, there are “fly by night” operations which prey on funding of private and government groups on such types of operations. There are those who minister lacking the necessary spiritual maturity and corresponding abilities in this kind of endeavor, hence the necessity of proper credentials to minimize abuses in the profession (Buttman, p.59). Crucial to the treatment or interventions of people in crisis is the identification of clients experiencing crisis in life. “Knowledge of the three core components of crisis intervention theory (a precipitating event, client perception of the event, and the client’s usual coping methods)” is essential in this kind of work (Walsh et al, 2005).
- The Goal of Therapy
Trauma inducing and crisis triggering situations have spiraled its occurrence and in its primacy in the US and in many other countries in recent years. Its broad spectrum ranges from the national disaster category such as that of Hurricane Katrina or the 911 terrorist strikes in New York, Spain and England, to private instances such as a loved one’s attempt at suicide, the murder of a spouse or child, the beginning of mental illness, and the worsening situation of domestic violence (Teller et al, 2006).
The acute crisis episode is a consequence of people who experience life-threatening events and feel overwhelmed with difficulty resolving the inner conflicts or anxiety that threaten their lives. They seek the help of counselors, paramedics and other health workers in crisis intervention centers to tide them over the acute episodes they are encountering. These are defining moments for people and must be adequately addressed else they lead lives with dysfunctional conduct patterns or disorders (Roberts et al, 2006).
In the integrated or eclectic approach the goal of the therapy is not just relief to the patient or client. Although an immediate relief is very helpful, this may not always be the case in most illnesses. The goal as mentioned in the preceding pages is to provide long-term reduction of the symptoms and the occurrence of the disease altogether if possible. The management then is not impossible but neither is this easy.
Specifically, the counselee or patient must want to heal or believe that there is going to be curative effects in the process. It presupposes that he/she must learn to trust the therapist in his/her capabilities as well in leading or facilitating the changes or modifications. It is very much essential that (in the perspective of a cognitive-behaviorist) that the client understands ownership to the deeds and choices in thought patterns he/she made are crucial to the recurring or occurring condition that s/he experiences (Rubinstein et al., 2007; Corey, 2004).
Moreover, the identification of specific treatments or interventions according to the diagnosed issue will be accommodated and implemented based on the chosen treatment modalities fit with the therapeutic approach utilized. It may be a single modality based on a single approach (e.g., learning principles and desensitization for a patient with specific phobias) or it maybe a combination of many modalities (CBT, Rogerian, Phenomenological, or Family systems) (Rubinstein et al., 2007; Corey, 2004).
- The Nature of the Relationship between the Therapist and the Client
The client throughout the process is a person in need of help and support and this reality is throughout reinforced in the process until the need to terminate the relationship. The therapist is the helper, who ushers the client to discover insights into his needs and problems and until the client is able to stand on his/her own the therapist aids him/her in more ways than one. Because of usual and common abuses that either the client suffers or that the therapist at times undergoes, definite boundaries are set in place at the outset. This must be established at the initial stage and from time to time emphasized to mind either of the parties in the limits of the relationship. The therapist is guided by morality and ethics of his/her profession in the proper exercise of his/her duties and bound by law to implement this in the process and make this known as well to the client. The therapist terminates the relationship readily or refer the client to another competent practitioner should the limits be reached and the relationship has become unrealistically difficult for either of the two parties.
- Best Practices for Techniques
Techniques or the utilization of various modalities come in a variety of forms and each when employed has the potential to meet the individual’s needs. The modality of choice at particular client/patient depends on such considerations as family support, financial constraints or financial capability, the patient’s preference, diagnosis, and age of patient (Rubinstein, et al., 2007). Employing the cathartic method, teaching the client to examine his/her thought patterns, to discern the errors of judgment and gain insight into him/herself, and to handle with patience the whole process are fundamentals in the process. When the therapist is able to shift effectively in various standpoints and enables the client to gain a better, realistic and eradicate unrealistic expectations of the self and others, they are both on the way to achieving wholeness and healing that which the client so need and aspire. This requires practice, or constant training and endurance on the part of the therapist (Rubinstein et al., 2007; Corey, 2004).
VII. Methods of Therapy
Every theoretical approach has its own assumptions. In the psychodynamic theory, the following three assumptions help guide a student of human behavior or an expert in this field determine the underlying factors that explain the overt manifestations of specific behaviors. These assumptions therefore, help guide the diagnosis of the presence or absence of mental illness. They are the same assumptions that guide the therapist in choosing what treatment that will better help heal, cure or alleviate the symptoms.
These assumptions are:
- “There are instinctive urges that drive personality formation.”
- “Personality growth is driven by conflict and resolving anxieties.”
- “Unresolved anxieties produce neurotic symptoms”
(Source: Kaplan et al, 1994).
The goals of treatment here include alleviating patient of the symptoms which specifically works to uncover and work through unconscious conflict. The task of psychodynamic therapy is “to make the unconscious conscious to the patient” (“Models of abnormality”, National Extension College Trust, Ltd). Employing the psychodynamic viewpoint, the therapist or social scientist believes that emotional conflicts, or neurosis, and/or disturbances in the mind are caused by unresolved conflicts which originated during childhood years. In the psychodynamic approach the treatment modality frequently used includes dreams and free association, at times hypnosis (as preferred by either the therapist or by the client). The therapist actively communicates with the client in the on-going sessions. The scenario appears that a given patient may have up to five times a week session and runs up to five years in length (Rubinstein et al., 2007).
The methods of therapy incorporate the methods of the eight models. In Behavioral Therapy – the development of behavioral skills that encourage effective actions which is done through incorporating principles in learning or classical and operant conditioning. It utilizes shaping, modeling and such concepts as behavior modification, counterconditioning and exposure, and systematic desensitization. Behavioral or action therapies utilize insight just as much as the psychodynamic model. Just as the cognitive–behavioral model also recognizes the concept of insight as well, this is only a matter of emphasis or focus. In behavioral/cognitive-behavioral therapies the focus is on the modification or control of behavior and insight usually becomes a tangential advantage.
Techniques include CBT through such strategy as cognitive restructuring and the current frequently used REBT for Rational Emotive-Behavior Therapy where irrational beliefs are eliminated by examining them in a rational manner (Corey, 2004; Davison and Neale, 2001). Whereas in insight therapies the focus or emphasis is on the patient’s ability in understanding his/her issues basing on his inner conflicts, motives and fears. Techniques then include reflection of feelings and free association; the former as employed in the client–centered therapy and with the latter in psychodynamic therapy. Cognitive Strategies are utilized to promote functional thoughts which are likely to result in adaptive and healthy habits (Corey, 2004; Davison and Neale, 2001).
Client-centered therapy avoids the imposition of goals on the patient or client during therapy. It is the client who takes the lead in the session and of the conversation. It is the job of the therapist to create the conditions conducive to the client’s positive judgment of those experiences that are intrinsically satisfying to the client. The ‘goal’ then is to reach the point where the client desires to be a good and “civilized person.” Unconditional positive regard enhances this atmosphere however, and although the goal may be difficult to achieve, unconditional positive regard eventually, according to Rogers, encourages even the “`unbehaved” to conform or even transform (Corey, 2004; Davison and Neale, 2001). Gestalt therapy techniques on the other hand, include the I-language, The Empty Chair, Projection feelings, Attending to Nonverbal Cues, and the Use of Metaphor (Corey, 2004; Davison and Neale, 2001).
The techniques may sound a lot like pulling “this and that” from one’s tool box but in practice it is far from whimsical and impulsive. There is given time to much thought and analysis per client and an evaluation in between is mustered in order to be kept on track according to the specific goals that had been established at the outset. Here, professionalism counts and much of the efforts poured into every patient’s benefit.
In order to avoid what Corey says as a syncretistic and hodgepodge type of “eclectism” a theoretical rationale must be underpinning in the overall approach of the therapist (Corey, 2001, Article 29 in Lazarus, 1986, 1996; Lazarus, Beutler, & Norcross, 1992). This means that I as the therapist must establish firmly my own worldview, which contains my value system, and communicates this at the outset to the client and intermittently in the therapeutic process.