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Understanding Counselling and its Purpose

When every other person has been reeling from mental disorders, counselling is the need of the hour. Counselling can be defined as therapy that involves talking to a trained therapist, who listens to an individual’s problems for a successful management of negative emotions and other mental health problems (McLeod, 2013). Counselling can help an individual cope with mental health conditions, upsetting life events and other conditions affecting the mental and physical well-being of the individual, uncontrollable emotions and other issues, such as sexual identity (McLeod, 2013). Counsellor can encourage an individual to talk about their feelings and emotions, while supporting the patient without any judgement (Bond, 2015). In today’s day and age, counselling is easily accessible through private sessions apart from individual, group, telephone, and online counselling (Bond, 2015). This paper will assess one such case study along with the counselling theories of Family Systems Theory and Cognitive Behavioural Therapy. It will also look at the history and evolution of the theories, the therapist/patient relationship in both, contrast between them, ethical issues, requirements of each theory, and suggestions for the process of counselling along with suggesting the most appropriate treatment for the patient.

The two theories most appropriate for the patient are the Family Systems Therapy and the Cognitive Behavioural Theory. The Family Systems Therapy depends on the belief that family, on the whole, is one unit (Titelman, 2012). The systems thinking, a concept in the therapy, evaluates the systems of the family to the whole (Titelman, 2012). This method suggests that behaviour of an individual does not remain out of the family system and is mainly influenced by the structure and the overall behaviour of the family (Titelman, 2012; MacKay, 2012). This approach is based on Murray Bowen’s family systems theory, which postulates that a person cannot separate themselves and their behaviour from their network of relationships (Bregman & White, 2011). While the traditional therapy only looks at the immediate family of the individual, Bowen believes that the broader relationship system should also be assessed (Bregman & White, 2011). Moreover, this therapy uses a genogram, which is a pictorial representation of the medical history of the family along with the individual’s interpersonal relationships, used for highlighting the psychological factors, hereditary influences, as well as other related issues in the past that might have affected the past events of the individual’s mental health (Titelman, 2014). On the other hand, Cognitive Behavioural Therapy is a type of theory that places emphasis on changing and modulating the cognition of an individual, which has direct influence on the behaviour and emotions of the individual (Sheldon, 2011). CBT comes out of the confluence of both the cognitive and behavioural theory. While behavioural theory focuses on the quantitative aspects of a behaviour as it can be modelled, changed or measured, cognitive theory focuses on the thoughts, cognitions and the schemas of an individual (Fenn & Byrne, 2013). Both of these theories were first merged together for the panic disorder treatment simultaneously by David Clark in UK and David Barlow in the US, which has only developed overtime (Briers, 2015). CBT is a proactive and swift approach to psychotherapy as it allows the individual to focus on themselves and change their thinking at the root level (James et al., 2020). The patient monitors their thoughts regularly, which can contribute to identifying negative thoughts, gaining clarity about thoughts, and considering other’s viewpoints.

The Two Psychological Theories: Family Systems Therapy and Cognitive Behavioural Therapy

Both the therapies have their unique engagement between the therapist and the client. In the family therapy system, the therapist may work with a person while maintain the perspective of the family system (Norris, 2019). The therapist may also decide about their choice of family member who will attend the therapy session (Norris, 2019). It is not surprising to see the therapist’s close association with other family members in case a child is being treated (Cohen et al., 2011). The therapist might contact the family to discuss their behaviour as well as the progress of the child (Cohen et al., 2011). Thus, the therapist remains in close contact with the individual and the family. In the cognitive behavioural therapy, the therapy and techniques are client-centred. Therefore, the client has the most important role in this therapy (David et al., 2018). However, the therapist still has to guide the individual’s thoughts in the right direction while counselling them on their behaviour (David et al., 2018). The client has their own revelations while becoming cautious of their behaviour and identifying the problems in their thought process and surroundings (David et al., 2018). Hence, the cognitive behavioural therapy focuses on the client and their performance rather than the past actions or other engagements of the individual.

When the application of the family systems therapy and the cognitive behaviour therapy are considered, there are differences between the two. While family systems therapy is based on the notion that an individual’s mental problem belongs to the entire group, cognitive behavioural therapy focuses on the individual as the whole, ignoring their past connections and other relationships (Haefner, 2014; Briers, 2015). Further, FST is more focused on uncovering the issues of an individual because of their family while CBT is more inclined towards modification of an individual’s thoughts to change their behaviour and emotions (Haefner, 2014; Briers, 2015). Finally, FST wants to find the hidden meanings and inspirations of the unconscious while CBT focuses on finding the underlying problem of the individual so that the issues can be addressed at their roots (Haefner, 2014; Briers, 2015). The family systems therapy has more ethical concerns compared to other psychotherapies. The individual has to decide between the actions of the individual and their family is not fair to both of them along with facing issues where they might have to break the confidentiality of the patient to discuss their progress with the individual (Haefner, 2014; Briers, 2015). This method also includes some manipulative therapeutic techniques, which are against the basic ethics of the psychotherapy. Cognitive behavioural therapy, on the other hand, also has ethical issues. The therapist of the CBT might have to harm the patient for their benefit in the exposure therapy, which is also against the ethical guidelines (Gunter & Whittal, 2010; Rakovshik & McManus, 2010). Thus, both the FST and CBT have their own ethical concerns.

Both the family system therapy and cognitive behavioural therapy have their techniques. The main techniques of the FST include couples therapy and narrative therapy. Couples therapy is mainly used to resolve any conflict between the couple and positively affect their communication (Bregman & White, 2011). Couples therapy mainly includes session between the two partners but can also include individual sessions to check the progress of each partner with their partner (Bregman & White, 2011). On the other hand, narrative therapy allows the individual to develop and share their story, including experiences, behaviours, and roles, in their own words so that they can understand themselves better (Sheldon, 2011). In the cognitive behavioural therapy, the two prominent therapies are cognitive restructuring and exposure therapy. Cognitive restructuring involves a group of techniques which aim to inculcate the habit of recognising one’s own dysfunctional thoughts, developing rational ways of understanding difficult situations (Sheldon, 2011). It also involves making a note of thoughts in challenging times, recognising cognitive distortion, and participating in behavioural exercises to find whether their thoughts are correct (Sheldon, 2011). Exposure is the basic CBT technique which assists people in facing their fear through systematically engaging with it. This technique has been proved highly effective for people with anxiety and phobias (Sheldon, 2011). Therefore, while family systems therapy focuses on improving communication between groups, the cognitive behavioural therapy pays more attention for the overall improvement and development of an individual to deal with problematic situations.

Engagement between Therapist and Client

While the therapeutic process is a long and cathartic process, it is equally beneficial for life and outlook. Therapy allows an individual to become clairvoyant and open to gaining new perspectives so that each individual can overcome their negative thinking and lack of communication. Family Systems Theory allows an individual to address any issues they might face with their family or in any other relationship (Bregman & White, 2011). It promotes healthier communication so that the dysfunctional patterns in the family affecting both the individual and other family members might be addressed (Bregman & White, 2011). This would bring an overall change in the functioning of the individual with their other relationships. In case of Tom, he would be able to communicate his problems and issues to his partner. The use of cognitive behavioural therapy would induce a healthy habit of controlling the flow of their thoughts towards negative and disruptive thinking (Sheldon, 2011). This therapy would allow them to be avoid any further maladaptive behaviour patterns. In case of Tom, he would be better able to control his anxiety and PTSD along with his uncontrollable, negative thoughts. For both the therapies, the number of sessions for his therapy would also determine the effect on Tom. For family systems therapy which is generally short-term, typically 12 sessions of approximately an hour would be suitable (Bregman & White, 2011). On the other hand, cognitive behavioural therapy would prove effective usually between five to twenty sessions, with sessions of half an hour to an hour (Sheldon, 2011).

Finally, keeping in mind Tom’s condition of anxiety and PTSD along with having a uncontrollable thoughts which are making him “overwhelmed and confused”, cognitive behavioural therapy would be most beneficial for his condition. Tom’s condition involves having anxiety and PTSD, which is supported by the nature of his thoughts and the brief relationships he has. However, certain things should also be noted when conducting a cognitive behavioural therapy on the patient. For people like Tom who has PTSD, change could be hard. Knowing that certain thoughts and negative is just not enough, people must also know how to change them. Moreover, this thought process could only be changed if the person is willing and ready to change. Further, the speed and the process of change could take time. Although CBT is a short-term therapy, the change is often long and gradual. The person with CBT would have to systematically change their each and every thought which could take time to be implemented. A successful therapeutic outcome for Tom would involve his acceptance of his condition and having a positive outlook for the change that he has seen and will see. It would also come with a realisation that while his past with dysfunctional childhood could not be changed, he could always influence the course of his future.

To conclude, counselling is now regularly used for successfully managing any mental health condition, negative thoughts and emotions, and other issues affecting the individual well-being. When two therapies are compared, which would be best suited for Tom, there are considerable differences. Family Systems Therapy believes that each problem arises out of the relationships a person has had. On the other hand, the cognitive behavioural therapy focuses on changing the cognitive distortions and negative thoughts and attitudes which affects behaviour to positive and productive thought processing and behaviour. In FST, the therapist would guide the individual to have better communication and relations with the family while CBT therapist would direct the individual to take measures to change their thought processing and behaviour. With this, there are huge differences in the application, techniques, and the possible outcomes of both the therapies. Further, it would be best suited for Tom if he receives the cognitive behavioural therapy as it would reduce his anxiety and PTSD along with the negative and dysfunctional thoughts, emotions, and behaviour associated with it.

References

Bond, T. (2015). Standards and ethics for counselling in action. Sage.

Bregman, O. C., & White, C. M. (Eds.). (2011). Bringing systems thinking to life: Expanding the horizons for Bowen family systems theory. Routledge.

Briers, S. (2015). Cognitive behavioural therapy. Pearson UK.

Cohen, L., Ferguson, C., Harms, C., Pooley, J. A., & Tomlinson, S. (2011). Family systems and mental health issues: A resilience approach. Journal of Social Work Practice, 25(1), 109-125. https://doi.org/10.1080/02650533.2010.533754

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004

Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579-585. https://doi.org/10.1177%2F1755738012471029

Gunter, R. W., & Whittal, M. L. (2010). Dissemination of cognitive-behavioral treatments for anxiety disorders: Overcoming barriers and improving patient access. Clinical psychology review, 30(2), 194-202. https://doi.org/10.1016/j.cpr.2009.11.001

Haefner, J. (2014). An application of Bowen family systems theory. Issues in mental health nursing, 35(11), 835-841. https://doi.org/10.3109/01612840.2014.921257

James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane database of systematic reviews, (11). https://doi.org/10.1002/14651858.CD013162.pub2

MacKay, L. (2012). Trauma and Bowen family systems theory: Working with adults who were abused as children. Australian and New Zealand Journal of Family Therapy, 33(3), 232-241. https://doi.org/10.1017/aft.2012.28

McLeod, J. (2013). An introduction to counselling. McGraw-hill education (UK).

Norris, D. R. (2019). Therapy at professional counselling associates: a field practicum report (Doctoral dissertation, Faculty of Social Work, University of Regina). https://hdl.handle.net/10294/10053

Rakovshik, S. G., & McManus, F. (2010). Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance. Clinical psychology review, 30(5), 496-516. https://doi.org/10.1016/j.cpr.2010.03.004

Sheldon, B. (2011). Cognitive-behavioural therapy: research and practice in health and social care. Routledge.

Titelman, P. (2012). Triangles: Bowen family systems theory perspectives. Routledge.

Titelman, P. (2014). Clinical applications of Bowen family systems theory. Routledge.

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