“Psychoanalytic therapy is based largely on insight, unconscious motivation & reconstruction of the personality” Corey (2013, pg ) As aspiring counsellors and psychotherapists it is important to familiarize ourselves with the mainstream therapeutic approaches. No theories are considered “right” or “wrong” although there are better suited therapies for some individuals & therapies that can be successfully integrated. This essay will be focusing on one humanistic theory (Person Centered Therapy) One Post Modern approach (Solution Focused Brief Therapy) and Cognitive Behaviour Therapy.
Furthermore, it will be looking at the advantages and disadvantages in the integration of therapies.
Person Centered Therapy (PCT) Unlike many other counselling approaches, who view the therapists as the prime facilitator for change, Carl Rogers believed that as human beings we are more than capable of understanding ourselves and resolving our own problems without direct interventions from a therapist. He believed that we are capable of self-growth and change if we are involved in a specific kind of therapeutic relationship. Corey (2013, pg.
60) Although the main source of successful psychotherapy is the client, it is vital that the therapist have a genuine, empathic understanding of the clients inner world and has the ability to communicate a nonjudgmental stance to the client in order to build an effective therapeutic relationship, one that will facilitate the client to explore and utilize their inner and outer resources. Corey (2013, pg. 162) PCT aims to empower and encourage independence in the client by helping clients to define and clarify their own goals. Its main focus is to provide the client with the ability to cope with and identify problems.
This can be achieved through the therapeutic relationship and the therapist’s ability to understand sensitively and accurately the client’s experience and feelings in the here-and-now and to communicate to them that the therapist understands what they are feeling. (Empathy) Cepeda, Lisa M. ; Davenport, Donna S. (2006) The therapist may not approve of some of the client’s actions but the therapist does approve of the client and should be careful to always maintain a positive attitude towards the client (Unconditional positive regard).
Rogers (1959) Disadvantages to PCT Although it is vital that the client experiences the therapist’s essential humanity and feels their emotional involvement (congruence), it is important for the Therapist to remain firmly in touch with their own experiences and emotions during therapy and to set aside their own values and attitudes as they may hinder progress with their client. This can be very challenging as we are all human beings with our own set of values and attitudes, some of which we are aware of and others which we are not.
Other limitations to PCT could include the therapist becoming so dogmatic in application of reflective approach that they fail to be real with client & irritate them by repeating their words in an attempt to make reflective statements. PCT also focuses on present and future rather than issues from the clients past which could be of some significance. PCT could also be hindered with clients who have difficulty articulating their feelings as PCT is a form of talking psychotherapy in which the therapist takes a non-directing role.
Cognitive behavioural Therapy (CBT) CBT focuses on helping clients to understand their own thoughts (cognitive) and emotions that influence their behaviours. It is generally short term and most commonly addresses specific problems. CBT is a gradual process and is viewed as a “reeducating” approach. CBT begins with an aim to teach (or reeducate) clients in how to identify and change destructive and disturbing thought patterns that result in negative behaviours.
It is considered effective in treating many people with psychological disorders, particularly depressive, anxiety, and sexual disorders that have been found to display maladaptive assumptions and thoughts. McLeod, S. A. (2008). Clients learn how to apply logical thinking, participate in experiential exercises and carry out behavioural homework as a way to bring about change. Once a client can identify destructive thinking and the emotions associated, the therapy focuses on the actual behaviours themselves that are contributing the problem at hand. This can be addressed through the client’s homework.
For example, someone who is anxious in social situations may be set a homework assignment to meet a friend at a public place for a drink. Disadvantages to CBT Although CBT has been proven successful in clients who suffer from depression and anxiety it may not be the best therapy option for people suffering brain illnesses or diseases that impair rational thinking. Gale Encyclopedia of Medicine. (2008) CBT requires the Clients respect and commitment to therapy. There is a lot of “homework” and if this in not completed, the client will most likely be disappointed with the therapy outcome.
CBT also requires a strong therapeutic relationship and if this is not achieved, therapy will be unsuccessful. Although CBT is considered relatively short term it is not a “quick fix” and clients should be made aware that it may take a substantial amount of time to overcome unhealthy thinking patterns. Some Clients may also struggle as although they recognize that certain thoughts are irrational or unhealthy, it does not make it any easier to stop having them. Again, overcoming this can be achieved through the homework techniques.
Solution Focused Brief Therapy (SFBT) “Solution Focused Therapy is a philosophy, not a collection of techniques”Eve Lipchik, (1997) SFBT evolved from the work of Steve De Shazer and Insoo Berg at the Brief Family Therapy Centre in Wisconsin. It is a short term therapy approach and focuses on solutions. It is goal-orientated, rather than problem focused. The central philosophy of SFBT can be summed up in three rules of thumb: Rule 1: If it isn’t broken, don’t fix it. Rule 2: If it’s working, keep doing it.
Rule 3: If it’s not working, try something different. Berg & Miller, p. 17, (1992) Similar to CBT, The work that the client continues to do outside the counselling office is just as important as work done with the therapist. Furthermore, it allows clients to take responsibility for changing their own behaviour. Goals are identified early on and because of this, both client and counsellor know what success will look like and can more easily identify when therapy is no longer needed. The Miracle Question aims to allow the Client to visualize an ideal future and connect it to the present.
Clients are challenged to look past their obstacles and hopelessness and focus on the possibilities- to address exactly what the client wants, not what the therapist thinks is best. The question is often structured like this; “Suppose that when we finish this conversation and you leave the room at the end of today’s activity you go to sleep. While you are asleep a miracle happens, and the miracle is that the problem which brought you here is solved. However, because this happened while you were asleep you don’t know how the miracle happened.
So when you wake up in the morning what will be the first things you notice that tell you that thismiracle has happened? ” (De Shazer, 1988) Since, by definition, SFBT is brief, it may be less expensive than other forms of therapy that traditionally require more sessions over a longer period of time. SFBT is flexible and easily adaptable. It can also be easily integrated with other forms of therapy. Disadvantages to SFBT The therapist can be accused of disregarding anything negative, and providing too much praise towards the client.
It is important for the therapist to know when and how to give the Client positive feedback. It has been referred to as “Solution Forced Therapy” due to the belief that therapist pressure Clients to discuss only the positives and keep many of their complaints to themselves in the presence of the Therapist. Efran and Schenker, (1993) It may not adequately address clients with serious mental issues, personality disorders and impaired cognitive functions. Given the length of SFBT, It may not allow time to develop the counselor/client relationship in enough depth to be therapeutic.
SFBT is most dissimilar to more traditional therapy styles in terms of underlying philosophy and assumptions with any approach which requires “working through” or intensive focus on a problem to resolve it, or any approach which is primarily focused on the past rather than the present or future. Finally, it is a misconception that SFBT is philosophically opposed to traditional therapy treatments. If a client is in traditional treatment or has been in the past and it has helped, he or she is encouraged to continue doing what is working.
As such, SFBT could be used in addition to or as a component of a comprehensive treatment program. Integration Person-Centered Therapy, Cognitive behaviour therapy and Solution focused brief therapy are similar in that each therapy views the Client as the main instigator for change. They each aim to help the Client move forward with increased self-awareness and the skills to cope with future problems. Examples of Successfully integrated approaches An example of effective integration exists in Cepeda and Davenport (2006) roposal of the integration of person-centered therapy, with its focus on the here and now of client awareness of self, and SFBT, with its future-oriented techniques that also raise awareness of client potentials. Although the two theories hold different assumptions regarding the therapist’s role in facilitating client change, it is suggested that solution-focused techniques are often compatible for use within a person-centered approach. In addition, Cognitive-behavioral therapy (CBT) and Person-Centered Therapy (PCT) have been shown to bring about positive changes in therapy.
CBT and PCT, like all single-theory approaches, have limitations. Literature suggests that when the change-producing techniques of CBT and PCT are combined and applied, counselling is more effective. Josefowitz & Myran,2005; Tursi & Cochran, 2006. The strength of CBT is its emphasis on process and action (i. e. goal setting, collaborative action, etc. ), but it has been criticized for its little emphasis on developing a strong therapeutic relationship. The strength of PCT is its emphasis on the therapeutic relationship between the client and counsellor but it has been criticized as lacking in structure.
By combining CBT and PCT, we will not only be providing the Client with structure but will be creating an environment in which the Client feels free to communicate openly and effectively. Guterman & Rudes (2005, p. 224. ) Integration & Multiculturalism We live in a multicultural society. Contemporary Theories have little applicability in working with clients from diverse cultural backgrounds. Therefore, it can be harmful when a therapist expects that their clients will fit into a given theory as these have limitations when applied to culturally diverse populations.
The Clients cultural values may not be consistent with the values espoused by the theories. Corey, 2013, pg 426 Thus, integration allows the therapist to fit a combination of techniques to the unique needs of the individual client- whether they encompass social, cultural, spiritual or political dimensions or a combination of these. Integration & Spirituality Spirituality and religion shape many of our values and this should be taken into consideration when constructing and integrated approach. Both religion nd counseling help people to ask questions that will assist them in finding meaning and discovering who they are. Both facilitate healing and therefore will complement each other when successfully integrated, ensuring all of the client needs are met. Challenges When taking into consideration an individual’s culture and spirituality, it is important we monitor our own beliefs and be careful not to influence a client to embrace or reject certain beliefs that we as therapists, believe will be beneficial or are no longer relevant to the client’s development.
Therapists may struggle to separate their own spiritual/religious beliefs and values to those of the client and this may create an unethical and even harmful environment for the client and therapy will most likely be unsuccessful. It is also important as counsellors, to be aware of mixing methods with incompatible underlying assumptions. Blending different theories can result in confusion. Syncretism is a term used to define when a therapists lack of knowledge and skills in selecting interventions, looks for anything that might work, often making little attempt to determine whether the therapeutic procedures are effective.
Pulling different techniques from various therapy approaches without sound rationale results in syncretic confusion and will most likely reflect the therapists own biases and preconceived ideas. Lazarus, 1996: Norcross & Beutler (2011) Integrating Theories is an art form. Becoming a therapist is not an easy journey. There is a great deal of work involved, including much self-introspection, experience, and training. Constructing your own approach to psychotherapy is a lifelong process. In saying this, constructing an integrative approach to counselling involves developing an extensive knowledge of all the existing therapies.
This can be time consuming and overwhelming for aspiring counsellors, thus there is the argument that it may be easier to select one or two approaches that complement the therapist, perfect them, and apply these to all Clients. Just like it would be easier to perfect a single therapy method and apply to it to all Clients. Carl Rogers did not present the PCT as a fixed and completed approach to therapy. He hoped that others would view his theory as a set of tentative principles relating to how the therapy process develops, not as dogma. Rogers expected is model to evolve and was open and receptive to change. Victor Frankyl reminds us that the psychotherapeutic process consists of a continuous chain of improvisations. He goes on to say that the choice of appropriate treatment depends not only on the individuality of the client but on the personality of the therapist as well, and, the how the crucial agency in psychotherapy is more about the relationship between the client and therapist rather than on the methods used. Frankl (2006)
In conclusion, I believe therapy approaches are not there for us to follow to a T. Each individual is different. They have their own history and set of values and beliefs. It is up to the therapist to determine from the relationship what kind of approach is best suited. By integrating the models we are allowing for a more holistic approach to therapy and are providing ourselves with an endless supply of resources and techniques. Integration will promote open mindedness and lend itself to not only improving on mainstream therapy techniques but possibly create new approaches for an ever changing society.
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