Psychoanalytic Therapy And Behavior Therapy: A Discussion

Case Conceptualization as a counselor

Discuss about the Psychoanalytic Therapy and Behavior Therapy.

Mei Ling is seeking counseling for depression, and this is as a result of the thoughts she has been having in the recent past. She has been married for 14 years, and according to her, her husband could divorce her, as he is having an affair. She has been going through some medical examination but no physical symptoms have been seen in the past 4 months. This he has been resulted to the depression diagnosis. She has stated that she has been feeling “down” and depressed for most of the time. Other than this, she has a lot of difficulty motivating herself, and has had a hard time going to work. Other than this, she has been short-tempered, and has feelings of agitation and has been withdrawing to herself most of the time. Mei Ling experienced the divorce of her parents, and she was 9 years old then. After the divorce, her mother became depressed, and also withdrew from her and her siblings emotionally. According to the Psychoanalytic Therapy model, Mei Ling’s problem could be based on the subconscious. This is in consideration with the assumptions made in this model. The model establishes that psychological problems are rooted in the unconscious (Meichenbaum, 2007). It also indicates that the problems could be caused by unresolved issues during development. In Mei Ling’s case, therefore, the depression issues could be as a result of the divorce of the parents which she experienced. There are chances that she did not completely recover from the ordeal, and this could be haunting her currently.

Different ways are applied in the consideration of the situation for each individual patient with the application of the psychoanalytic therapy approach. There are, however, several assumptions which one can apply for all situations. The concepts applied in the case of Mei Ling, therefore, are based on these assumptions. The assumptions include the statement that psychological problems are rooted in the unconscious. It is also stated that the symptoms are as a result of some hidden disturbances (Hooley, Neale, & Davison, 2009). Further, the causes of the psychological issues are as a result of the issu4es that one experienced while growing up which are unresolved. It could also be as a result of repressed trauma by the patient. Treatment in this case aims at bringing the conflicts which are repressed to the surface where the individuals are in a position to work through them. This, therefore, helps these people in dealing with the issues. The participant is helped to work through and understand the conflicts that cause the current situation (O'Donohue, & Fisher, 2009).

Techniques used

As such, this form of therapy ensures that the participant is on a position to work through all the issues in a deeper way. This is made possible by the fact that an individual is in a position to understand the problems they had in their past. As such, one is able to establish the connection between the past and the current problems in their lives. The concepts in this case, therefore are based on the connection between past issues and present problems.  As such, the counselor has to identify the events which could be significant in the individual’s life, which could have triggered the current problems. The psychoanalysts in this case, therefore, believe in the effect the events that took place in one’s childhood or past events could take place in the present. The unconscious feelings, thoughts, as well as the motivations are known to play a major role in the maladaptive behaviors, as well as the mental illnesses.

This form of therapy involves one speaking freely of their experiences from childhood, and mentioning all major events (Chapman, 2006). The therapist pays close attention to all these narrations, trying hard to point out all the major events. One gives the information without interruption, and the sessions are driven by insight, where the therapist looks to foster change.  The therapist applies some techniques while listening to the individual narrates their life experiences. These techniques are used to help in the identification of the cause for the concerns. One of the techniques is the free association. Under this technique, one says everything that comes to the mind without editing it. The therapist in this case is involved in ensuring that the individual states all that is in their mind freely (Macdonald, 2007). The memories, as well as the ideas come out as clearly as they appear in the mind of the individual. As such, the therapist is in a position to identify the true and real information of the participant. Moreover, the individual is in a position to freely express all the feelings and emotions in them. The individual is also assisted in returning to the initial emotional state by speaking out all the concerns. This, in turn, helps the individual to understand the current patterns that cause the conflict within them, and this situation is identified in a clear manner. As such, the therapist is in a position to help the individual go through the conflict.

Multicultural considerations using the theoretical model

The second technique in this form of therapy is the interpretation. Psychoanalytic therapy involves the application of “reading between the lines (Fransella, 2005).” During the individual narration of the events and experiences, the therapist interjects the session with thoughts and interpretations of the topics in discussion. At this point the therapist may even ask about the individual’s dreams. This is important in understanding the individual’s subconscious mind. The third and last technique applied in this form of therapy is the therapeutic transference. Here, the therapist establishes the manner in which the transference relates to some significant people in one’s life. These people may include an individual/s parents. This is helpful in identifying the manner in which such people may have impacted on the participant’s life. As such, one is in a position to get additional insight on the manner in which one deals with people and events and people in their lives.

These techniques could be applied in the case of Mei Ling to establish the cause of the problems she is currently going through. According to the therapy, the issues which she went through as a child, could be the cause of the current problems. It has already been established that Mei Ling was only 9 when her parents went through with divorce. As such, she was not in a position to get over the issue of divorce. It is also identified that her mother had a lot of issues after the divorce, and even withdrew from her and her siblings. Being the first born, she had to provide emotional support to her siblings, and also worried about the condition of her mother. This, therefore, is the major cause of her anxiety and the issues she is currently going through. These techniques are, therefore, effective in identifying the cause of all the problems Mei Ling is facing currently. The job of the therapist in his case will be to assist her overcome those issues, seeing that they have already been identified.

Narrative theory provides one with the understanding of the numerous complex issues that face diverse people (Dobson, 2010). It is even established that schools find some difficulty in offering counsel to the students due to the cultural differences that are identifiable among the students. This is also the case for the counselors offering guidance and assistance to different participants. Moreover, clinical competency practices are required in the field of mental health due to the differences in the kind of services delivered to diverse ethnic groups. As such, cultural competency is important in offering therapy sessions. It is important for the therapist to consider some multicultural factors when attending to different individuals. Diversity, multiculturalism, as well as cultural competency are significant topics for the past four decades in dealing with mental health issues. For the counselor to have an inclusive approach in the counseling practice, they have to develop multicultural competencies. This is important to ensure all the diverse backgrounds are considered.

Some of the factors that a counselor needs to identify include client’s culture, identity, race, gender, ethnicity, as well as other elements of diversity. These are factors that play a major role in the counseling process. Other factors that the counselor should consider during the counseling include spirituality, religion, maturity, socioeconomic class, geographic location, family history, as well as sexual orientation (Burton, 2010). The first step at ensuring cultural differences are not a hindrance to the counseling process is having knowledge of the differences between the counselor and the client. Self-reflection is, therefore, important   in the process of becoming a culturally-competent counselor. One should identify the personal view on different issues, and compare them with those of the people different from them. This will be vital in ensuring one is able to identify personal feelings, prejudices, as well as stereotypical ideas that one has about the clients from different cultural backgrounds. Further, it is important for the professional counselor to understand all unique cultural differences in a continual process. As such, the counselor should embrace all the opportunities of gaining new skills from the different clients.

Describe the counseling relationship

Counseling does not only involve exploring the core issues and gaining the diverse perspectives on the problems from a psychological perspective. It also involves building a rapport, as well as trust with the counselor (Creek & Lougher, 2008). This is important in ensuring that the client feels comfortable enough so as to be in a position to share all the worries in a free manner. The relationship created between the counselor and the client is, therefore, one of the most important aspects in the therapy process. As such, this is the determinant between a positive and a negative counseling experience. To ensure this is done, the counselor must maintain a particular behavior pattern. As such, they must follow some requirements. A counselor should never impose their beliefs on a client, and should maintain impartial and non-judgment.

In order for the counselor to ensure that the relationship with the client is effective, they need to ensure that the client to feel comfortable enough to express himself. There must be reciprocal trust, and the counselor has the duty of ensuring that the environment is confidential, and they should also offer empathy, understanding, and respect. As such, the counselor has to ensure that the one of his voice does not affect the relationship (Coetzer, 2006). They should also offer the client adequate time to collect thoughts and express their concerns and difficulties while encouraging the client to relax and talk freely. It is also established that some clients may have difficulty expressing themselves than others. To ensure the relationship is comfortable, the counselor must be aware that such clients require additional sensitivity. One may use open-ended questionnaires to encourage the client to open up. For the relationship between the counselor and the client to be effective, the counselor has to put all these factors into consideration.

The counselor must understand some of the duties that they have prior to getting into a therapy session with the client. The counselor must be likable, and should be in a position to exhibit interpersonal skills. They must also be flexible and able to meet all the needs of every individual by providing person-specific attention (Arkowitz & Messer, 2004). Further, a counselor must be in a position to offer multiple sessions where the need arises. The counselor must also exhibit a caring attitude, and have something concrete and applied to offer to the clients. It is also the role of the counselor to offer facilitation to the client of solving the issues in question. They must also show genuine concern, as well as compassion for the dilemmas faced by clients. The counselor must also individualize the interaction with the client depending on the personality type of the client. It is also the duty of the counselor to encourage the client to draw their conclusion on the direction they choose in resolving the problems. As such, the counselor should challenge the client to formulate a behavioral goal and address the ultimate objective.Bottom of Form

The cognitive behavioral therapy (CBT) is a form of talk therapy. The therapist works in a structured way, where one attends a limited number of sessions (Lemma, 2016). CBT assists one to become aware of all the negative and inaccurate thoughts so as to see the challenging situations. As such, one is in a position to see the situations clearly and analyze them well and respond to them in an effective way. CBT helps one to change the manner in which they think, and the way they behave. The changes help one feel better, as it focuses on the state happening at the moment (Jones-Smith, 2012). Rather than focusing on the events that took place in the past, this form of therapy focuses on the current happenings in one’s life.  As such, with the application of this form of therapy, the Mei Ling situation would be solved by considering the problems she is currently going through. Mei Ling was seeking counseling for depression. She described her symptoms as feeling down and depressed most of the time. She also added that she would burst into tears and could not explain the reason. Further, going to work was difficult as she was not in a position to motivate herself. Additionally, she felt agitated, and was on the edge. She also felt short-tempered, and also lacked the strength to interact with other people. According to CBT, it is important to focus on the current issues, rather than looking at the past problems. As such, the problems that Mei Ling is experiencing are as a result of the negative thoughts she has. These thoughts include the feelings that her husband could be having an affair and their marriage could end. As such, the therapist will establish the problem to be as a result of these thoughts.

Concepts used

CBT applies the general concept while restructuring the approach to apply. In this case, the components of cognitive therapy with behavioral therapy are combined to identify a therapeutic structure to use. The practice follows six phases which include the psychological assessment which is the stage where the individual’s thoughts are established. The second phase is the reconceptualization which comprises the most significant part of the process. The therapy then follow the third step which is skills acquisition where the skills to be used by the patient are identified (Norcross, & Goldfried, 2005). The fourth stage is then followed where the skills are consolidated and training of the participant begins. The fifth step is the generalization and maintenance and in this case the sustenance of the skills possessed by the individual is ensured. Finally, the post-treatment evaluation and follow-up is done on the individual. The other concept used in CBT is the negative cognition where behavioral-cognitive pathology is applied in tracing the focal point of CBT. The maladaptive behaviors are used as the major targets of the therapy.

The CBT disturbances are categorized in three cognition underlying psychological disorders. First, the automatic thoughts of the individual are derived as well as from other people so as to establish the psychological disturbance. Secondly, the rules or immediate beliefs refer to the thoughts which are developed by the patient to the prospect of himself, as well as the other people who guide the person/s behaviors. Lastly, the major beliefs involve the thoughts that are developed by the patient which provide the main target of the therapy. The schemes are considered as the main components which influence one’s views and beliefs systems, as well as the internal values. These are also in the determination of one’s assumptions on the occurrences that happen in life (Smith, 2012). CBT therapeutic framework is further founded on dysfunctional behaviors which impact on a person/s behavior negatively contributing to the stressors. The cognitive theory also involves three schemes which include the connection of negative schemes. These include the self, the world environment, and the future. The patient views himself in a negative manner, otherwise known as cognitive schemes. First, they have a perception of themselves as helpless, deficient, or even unlovable. Secondly, they have a negative perception of the world, and end up withdrawing from everybody. Finally, they believe that the future will only bring further hardships, as well as deprivation and frustrations.

CBT follows an approach which is problem-based, where the process is oriented on actions as well as interventions. These are established on the consideration of the person/s thoughts which can destroy a person’s behaviors (Psychodynamic treatment of anorexia nervosa and bulimia, 2000). The intervention is comprised of some techniques which include the cognitive element which is based on the thoughts, as well as the beliefs of the individual’s thoughts. The behaviors of the patient are explored

Here the various elements including escape, avoidance, as well as the maladaptive developmental coping behaviors are established. Intervention component is then identified which comprise some elements. First, the realistic thinking is applied where the therapist makes the patient differentiate between the reality, and the cognitive stressors which are generated by tension. The self-instruction training is then done on the patient where the patient is provided with skills to assist them in coping with the tensions.

The problem-solving step is then initiated where the therapist together with the therapist go ahead and evaluate the patient, assessing the response behaviors which are appropriate for the patient (Sadock, Sadock, & Sadock, 2008). These are then combined with the social learning theory that is in support of the fundamental domain of the technique. The cognitive mediation is then grounded on the manner in which the individual behaves, as well as his emotions and physical reactions. The treatment, therefore, begins with two major occurrences or happenings. The first occurrence is the identification of the behaviors in the patient which do not go in line with the normal functioning, as well as the unhelpful behaviors. This is necessary as it helps in the identification of common knowledge which is present between the patient and the therapist. The second happening is the critical examination of the manner in which the behaviors of the patient were derived. Where these two factors are well established, the treatment process is carried out effectively.

Multiculturalism is characterized by the theoretical, as well as philosophical mannerisms that culture varies between different people. The differences could be as a result of difference in norms, values, traditions, as well as worldviews (Tan, 2011). The cognitive behavior theory, therefore, puts into consideration these differences when identifying the issues and solving the problems affecting different patients. As such, there should be no superior and inferior treatment as all there should be the assumption of equality between all the individuals from all cultures. In the psychology field, multicultural counseling is defined as the therapy process which puts into consideration the treatment techniques, as well as the goals to be achieved after the therapy. The objectives are supposed to be in line with the cultural ties, life experiences, cultural values, as well as the diverse backgrounds (Seiler, 2008). The clinicians should, therefore, be familiar with the different backgrounds and identities present in the world. The cultural factors which are given attention in the field of therapy include education, gender, religion, disabilities, indigenous heritage, national origin, age, generation influences, as well as the sexual orientation. In regard with these considerations, multicultural counseling lays focus on the issues relating to power, marginalization, as well as privilege. The major element in multicultural counseling is the ability to connect with connect with the clients who are influenced by development of the identity, as well as the diverse world perspectives.Bottom of Form

There are many methods which can be used to enhance the elements of CBT for anxiety with the to ensure cultural sensitivity (Watts, 2003). This can for instance be achieved by ensuring that the clinicians clearly understand and appreciate the different experiences that may have been acquired by different clients. This can be achieved by the application of the therapeutic stance where multicultural perspective is combined with the perspective with CBT. This calls for the lesson on self-education (Weiner, 2003). This education is supposed to be based on issues such as beliefs, values, history, as well as the experiences. As such, the clients are in a position to connect with the clinicians in an effective manner. A therapist can also opt to invite discussion on issues that are marginalized. This can be done where the clinicians introduce their identities, and welcome the views of the client. Other than addressing the issue which could potentially be life experiences, other topics such as marginalization can be discussed giving the client space to state their own experiences (Woods, 2003). The clinician should then be in a position to identify the issues which bring anxiety to the client.  The enhancement of the psychoeducation is also important in identifying issues that cause anxiety to the individual. Where one is dealing with patients who have been marginalized in the past, it is important to offer psychoeducation. The clinician should also adapt cognitive restructuring, and modify the exposure situations. Exposure is a common method in CBT treatment, and should be applied in dealing with patients who have been marginalized.

The counseling relationship

The cognitive behavior therapy has faced criticism often times as a result of its failure to recognize the role played by the therapeutic relationship. It is, however, important to note that this form of therapy puts into consideration various dimensions in overcoming therapy impasses. The clinician, together with the client can, therefore, establish a model which will enable them understand the significance of various concepts (Whitfield, & Davidson, 2007). These include validation, victim resistance, self-handicapping, sunk-cost commitment, conceptualization factors, as well as the schematic mismatch. These factors are significant in enhancing the relationship between the patient and the therapist. Identifying these factors is important because it helps establish the raptures which may be present and that may affect the relationship between the two parties (Prochask & Norcros, 2014). This, in turn, helps in resolving these issues, and hence getting rid of the barriers. The therapeutic relationship helps to provide the opportunities which are used in the modification of the cognitive, as well as the emotional problems. This is in line with CBT, where there is the risk of the presence of foreshadowing by the techniques as well as the protocols which are applied. As such, it is important to ensure the relationship between the two parties is maintained, so as not to give credibility claims that CBT does not consider the importance of this relationship.

The success of the counseling sessions highly depends on how well the therapist plays his roles. As such, it is important for the counselor to establish what is required of him before engaging in the counseling process (Stricker, Widiger, & Weiner, 2003). The counselor must understand some of the duties that they have prior to getting into a therapy session with the client. It is important for the therapist to possess some traits. The counselor must be likable, and should be in a position to exhibit interpersonal skills. They must also be flexible and able to meet all the needs of every individual by providing person-specific attention (Ronen, & Freeman, 2007). Additionally, a counselor must be in a position to offer multiple sessions where the need arises. The counselor must also exhibit a caring attitude, and have something concrete and applied to offer to the clients. It is also the role of the counselor to offer facilitation to the client of solving the issues in question. They must also show genuine concern, as well as compassion for the dilemmas faced by clients. The counselor must also individualize the interaction with the client depending on the personality type of the client. It is also the duty of the counselor to encourage the client to draw their conclusion on the direction they choose in resolving the problems. As such, the counselor should challenge the client to formulate a behavioral goal and address the ultimate objective (Prout, & Brown, 2007). In CBT, the client must identify the causes of the behaviors or symptoms that they are experiencing. This must be in relation to the occurrences that happened in the recent past. As such, the counselor should ensure that such happenings are identified and dealt with accordingly. This, will in turn, help the client to identify the most suitable way to handle the issues they are dealing with.

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