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Theoretical Model Group A – Psychoanalytic Therapy

Discuss about the Psychotherapy Theories in Counseling.

Psychotherapy theories provide a framework for the counselors and therapists for interpreting the feelings, thoughts and behavior of a client. It serves as a navigator for the journey of the clients from the diagnosis to the post-treatment phase. One of the integral parts of the therapeutic process is formed by the theoretical approaches and selection of the right counseling approach is crucial for the therapy. According to Sigmund Freud, it is the unconscious forces that are responsible for driving the behavior of an individual (Sharf, 2015). Therefore, this essay will discuss the counseling of Mei Ling and explore the different dimensions of her psychological condition using two approaches from the theoretical model groups that include psychoanalytic therapy and cognitive behavioral therapy.

Psychoanalytic therapy is the process of counseling based on the theories proposed by Sigmund Freud, the founder of psychoanalysis and forefather of psychology. The influential effect of the unconscious mind over the behaviors and thoughts of an individual is explored and offers resolution and insight to the client seeking therapy. Experiences from early childhood are looked by this therapy to investigate whether these events have affected the life of the individual and contributed to the present situation (Peterfreund, 2016). Psychoanalytic therapy is aimed to make changes that are deep seated in the emotional and personality development and it is a long term choice depending upon the condition of the client.

Mei Ling is married for 14 years to Steven and is a nurse in a surgical ward. Since she has discovered that her husband is having an affair and will leave her. Although she has no evidence to her claim, however, this is based entirely upon her assumptions as fear. Going back to her childhood history, it can be seen that she had undergone a similar situation in her childhood when her father deserted her mother and she along with her children were left all alone. Her mother became depressed and Mei took the responsibility to help her mother and take care of her siblings, being the eldest child. Now, that she is married and having her own family, she is suffering from the same depression that her mother suffered but without any valid evidence. It is a memory of her childhood that has brought back the evil thoughts from her unconscious mind to the consciousness that is causing her to face the fear. It is what a repressed memory is and repression is the one on which the foundation of psychoanalysis is based (Morris, Fitzpatrick & Renaud, 2016). Something happens that generates fear and the mind holds on to the memories and reaches underground to some inaccessible corner in the level of unconsciousness. The memories which were sleeping in that level for years suddenly emerged on to the surface. This emergence poses a problem to the individual and brings about behavior that is not relevant to the normal character (Meystre et al., 2015). Since Mei has lived a horrible childhood without her mother, she feels the same can repeat with her when Steven will leave her for another woman. This memory of failed marriage of her mother brings about unnecessary fear in her mind and eventually caused her depression. Therefore, I will conceptualize Mei based on the psychoanalytic therapy of counseling to reach the deeper roots of her unconscious mind where lies the real reason for her depression.

Conceptualizing the Client

As previously mentioned, psychoanalytic therapy is guided by the principal of harboring the deep rooted memories and feelings in the unconscious mind that affect the behavior of the client. Based on this principle, I, being the psychoanalytic therapist, will develop a counseling relationship with Mei in the ways that are context specific and cater the therapy style and technique to the client. I will foster an equal relationship with Mei by adopting unconditional acceptance attitude that will develop with her a trusting relationship. In response to this, she will be encouraged to open up and explore the hidden conflicts and unresolved issues in her unconsciousness that is affecting her behavior and mood. For understanding the unconscious disturbances, I will adopt few procedures to explore the mind of Mei. When Mei attended her counseling, she presented her condition as down and depressed with occasional outbreaks of tears, without citing any proper reason. This cleared the fact that there is something hidden in her unconscious mind that is disturbing her without any evidence of her husband cheating over her. My free association with Mei can be a procedure that will enable her to speak up whatever comes first in her mind regarding her childhood memories of the divorce of her parents. This spontaneous flow of feelings and thoughts to emerge without any restriction will result in the development of a counseling relationship based on trust (Capuzzi & Stauffer, 2016). Therapeutic transference will be another procedure that will help to redirect the feelings of Mei from a significant person towards the therapist or towards me. This transference can be manifested in the forms of dependence and trust and through the exploration and recognition of this transferred relationship, I will understand her feelings and resolve the conflicts arising out of her childhood (McLeod, 2013). Interpretation of the awareness by the therapist of the mental state of the client increases their capacity to integrate the material that the client is not aware of (Sharf, 2015). Thus, Mei will develop a relationship of trust with me as a counselor for effective treatment of her depression.

As a psychoanalyst, I will be using various approaches and techniques as part of my counseling with Mei to get the best results using the psychoanalytic therapy. Rorschach Inkblot Technique is a type of projective test that will help Mei to project the information from the perceptions of her unconscious mind for interpretation of the ink blot. This will be used to analyze the emotional functioning and personality characteristics of Mei (Stolorow, Brandchaft & Atwood, 2014). Freudian slip is another technique that I can use is based on the fact that unconscious feelings and thoughts are transferred to the level of consciousness through parapraxes or a slip of the tongue. It provides a sudden insight of the unconscious mind and makes every behavior look significant (de Jonghe et al., 2013). I will be watching out for any slip of tongue by Mei that can reveal any of her past instances related to her present depression. Another useful approach that can be used for Mei is the analysis of transference as it will help to transfer the feelings of the client to the therapist (Lane, 2014). This approach is valuable as it will provide Mei to re-experience the underlying feelings that require being resolved. These techniques and approaches will help me to analyze the past of Mei for understanding her present and frame a strategy for her treatment. I will be asking her few questions to get an overview of her situation and investigate apart from her past experiences, is there any other mental stress that is the reason for her depression. My first question will be ‘What brings you here?’ Freudian slip model will be used here to analyze her speech and locate any slip of tongue for identifying various possibilities. My next question will be ‘From your viewpoint, what is the problem?' Rorschach Inkblot Technique model will be useful for analyzing her emotional functioning and personality characteristics. ‘What do you feel of your childhood?’ will be my next question for analyzing the underlying feelings of Mei by transference or feeling her situation.

Development of Counseling Relationship

Adoption of the model of psychoanalytic therapy by me as a counselor will help me immensely and I will feel authentic and comfortable. Since Mei is suffering from depression that can be traced from her childhood incidents, it can be well said that the psychoanalytic therapy will be the appropriate model to get over her past by analyzing it and relieve her of the depression. Psychoanalytic therapy has been recognized as a global therapy due to its wide range of clinical applications in helping the clients to change their life perspectives (Huber et al., 2013). The current maladaptive perspective of Mei of her suspecting her husband is tied to her personality factors that are deep-seated and developed in her childhood. Therefore, it will be helpful for me as a counselor to retrieve those underlying memories and bring about a change in her perspective on life to help her live a better life. I will relate her depression with the loss that Mei experienced as a child due to the divorce of her parents. Since she could not come to terms with the loss, she fell prone to depression in her later life. The model will help me to encourage her to recall her childhood experiences for untangling the fixations that have grown around it (Lionells et al., 2014). Since Mei is under the state of depression, I have to be careful while using the technique of analysis of transference as she will have the tendency to get overwhelmingly dependent on me. The model aims at making her lesser dependent and develops functional ways of accepting and understanding the loss of her life, without spoiling her present with unnecessary fear (Zimmermann et al., 2015). Bringing the best in the treatment out of my model will be my aim for counseling Mei and since this model appropriately fits into the requirements, therefore this will make me feel more comfortable and authentic in dealing with her problem.

I feel psychoanalytic therapy will be one of the most appropriate models for counseling Mei as it is highly relevant to her depressive disorder. The model is designed effectively to help the clients explore their entire range of emotions that includes the underlying feelings that are not aware of. The model helps to relate the unconscious elements of the past life of the clients with their present experiences and make them understand how their mood and behavior gets affected by the unconscious feelings and unresolved issues from the past. This model will help me to make few assumptions regarding the case of Mei and that begins with the fact that psychological problems are often deep-seated in the unconscious mind. Symptomatic manifestations are the results of the latent disturbances and the prime causes include repressed or development trauma and finally the treatment will focus on bringing to consciousness the repressed conflict to enable Mei to deal with the problem and get rid of her depression (Kohut, 2013). To get the best out of my counseling, I would ask Mei to relax on a couch and ask her the questions regarding her childhood memories. This will give a probable picture of why does she suspect her husband and fear about the consequences that would happen if he leaves her. If required, the technique of dream analysis can also be implemented as it is the most followed path to unconsciousness to bring back any other significant memory that relates with her childhood and has any effect on her present depression (Busch, Rudden & Shapiro, 2016). However, this therapy is time-consuming and do not provide quick answers with a handsome investment of money and time. Retrieving the repressed memories that are unpleasant and painful might increase the distress. Considering the benefits and drawbacks of the model, it can be said that this could be one of the best models for presenting the problem.

Approaches and Techniques

Multiculturalism is known to play the fourth force in the field of psychology as it enhances the ability of the self–recognition of the counselors to understand the clients and encourages their inclusion. Observation of the multicultural considerations will ultimately help in understanding the benefits and hindrances of the treatment by the counselor (Draguns, 2013). The multicultural considerations for Mei include age, ethnicity, job and marriage. Since Mei is 33 years old, therefore, she has long passed her childhood and stress has to be given to retrieve her repressed memories. Since she belongs to the Chinese ethnicity, therefore her traditional and ethical values have to be respected while asking her the interview questions (Moodley & Palmer, 2014). She works in a surgical ward as a nurse and so she might be well accustomed to the process of interviewing and caring. It is expected that she will be co-operative during the interview process without complaining about its tediousness. Since she is happily married for 14 years to Steven with 2 sons, therefore passing on positive vibes of a happily married life can boost up her confidence and help her forget her childhood trauma of the divorce of her parents. Application of the psychoanalytic model with the multicultural considerations will provide maximum benefits to Mei and her treatment.

Cognitive behavioral therapy is used in the evidenced based practice as a psychosocial intervention for the treatment of mental disorders like depression. It is focused on the development of the personal coping strategies and aims at solving the unhelpful patterns and current problems in regulation, emotional, behaviors and cognitions. Cognitive behavioral therapy has been widely recognized as an effective treatment for depression based on the fact that the mood of a person is related directly to the thought patterns (Hofmann et al., 2012). The prime objective of cognitive behavioral therapy is to help the client recognize the negative thought patterns and evaluation of their validity. This will help them to replace the negative thoughts with much healthier thought processes.

Mei Ling is a 33 year old nurse who works as a nurse in a surgical ward. She is married to Steven for 14 years and has 2 sons. They had a happily married life until recently, she is anticipating that Steven is having an affair and will leave her. This negative thought has exerted a profound impact on her thought process and altered her behavior greatly. She often burst out into tears without any reason and has secluded herself from the social activities. She has started to doubt her cognition as she feels she has to pretend to be happy in social gatherings when she is actually sad and this is giving her a feeling of agitation and on the edge. Her behavior has also changed towards her kids as she has got short tempered with her sons and do not spend much time with them. These clearly describes that the very thought of her husband having an affair followed by his departure has given birth to all these negative thoughts and irrational behavior. Although she has a family history of divorce which followed the same trait, it has also contributed to the development of the negative thoughts (Kendall & Hollon, 2013). The cognitive behavioral therapy divides the approach into behavioral and cognitive components. The cognitive component helps to identify the client and the therapist to identify the negative thoughts that are generating the negative emotions. The behavioral component facilitates the therapist to help the client assess the impact of the daily activities on the mood of the client to improve the symptoms of depression (Kendall & Hollon, 2013). Both the components will be applied by me to conceptualize Mei with her present problem with the cognitive behavioral therapy model. Each of these components will analyze the thought and mood of Mei to generate positive thought replacing the negative thoughts and assist her to relieve the symptoms of depression.

Adoption of the Psychoanalytic Therapy Model

Developing a counseling relationship by the therapist with the client is essential as a primary and secondary element of therapy. The primary element considers itself and the secondary element considers supportive effects. The model of cognitive behavioral therapy is based on the collaboration between the client and the therapist and both of them work for the determination of the goals and terms of success (Cummings et al., 2013). For developing a counseling relationship with Mei, I will have to be honest and open to her for sending explicit and clear messages to her with honest feedbacks. I will have to work with the schemas where I will be putting together the collections of rules, experiences and beliefs of Mei regarding herself and the world around her. Since Mei has developed the concept that she is on the edge and agitated and about to lose her husband, this has created a negative vibe and I will have to create a place of trust where she can depend on me as a support of trust and help. I will have to be sensitive about her relationships and bring about the changes gradually or she will find herself incompatible with the core ideas of the therapy. Therefore, as the therapy will progress, the changes in the schema will bring about the changes in her thought process (Farmer & Chapman, 2016). The primary elements of the therapy includes guided discovery of the schema beliefs, recording of the dysfunctional thoughts and relaxation trainings. Relationship forms the secondary element of therapy and therefore, analyzing her interpersonal schemas, emotional processing, previous attachments and other various other processes will help to develop a counseling relationship with her (Sharry et al., 2013). Accurate empathy, warmth, rapport, trust and genuineness are the important factors for building up a relationship with the client by the therapist. A good counseling relationship is essential in cognitive behavioral therapy because if the client finds the therapist helpful, they start feeling better and their problems begin to reduce.

Cognitive behavioral therapy employs several approaches and techniques as part of the counseling. For Mei, I can apply the ABC techniques of the irrational beliefs as proposed by Albert Ellis that includes activating event, belief and consequences in three different columns (Hayes et al., 2013). The first column of activating event is also known as the objective situation and it records the event that is responsible for the negative dysfunctional thinking or high emotional response of Mei. In the second column of belief, she will be asked to write down the negative thoughts that have occurred to her. The third column of consequence consists of the dysfunctional behaviors and negative feelings that ensued. The second column acts as a bridge between the distressed feelings and the situation and the third column describes the negative thoughts and describing emotions that Mei thinks have been caused by the first column of activating events (Cuijpers et al., 2013). According to Albert Ellis, activating event is not responsible for causing behavioral consequences due to negative emotions but the client makes unrealistic interpretations and develops an irrational belief that results in the consequences  The resulting consequence might be healthy or unhealthy depending on the belief whether it is rational or irrational (Fava et al., 2014). This technique will help to find out the belief of Mei and give appropriate justification of her emotions. A series of questions can be asked to Mei that is based on the technique of this model. This will begin with the question ‘Why did you pick up this thought?’ This will give a picture of the objective situation or activating event that is going on in her mind. The next question will be ‘Is that actually true?’ This question will provide with the justification of her thoughts whether the belief that she possess is rational or irrational. The next question is ‘What if we looked at this situation differently?’ This will provide Mei with a possible solution to her cognitive distortion and look at the consequences from a different viewpoint.

As a counselor, adoption of the cognitive behavioral therapy will make me authentic and comfortable as the basic principle of the model connects cognition with the emotional responses of the client. Cognition in the form of preconceived judgments and thoughts determines and precedes the emotional responses of the individual (Karlin et al., 2012). This theory of the model is applicable for the scenario of Mei as her disturbed childhood has a role to play in her present situation that is fetching negative thoughts about the future. This model helps the client to focus on the current problems and helps to solve them. It requires an active commitment from both the therapist and the client. The therapist helps the client to learn about the identification of the unhelpful or distorted thinking patterns, change and recognize the inaccurate beliefs, relate to others in a positive manner and change the behavior accordingly (Feng et al., 2012). Adoption of this model will help me to guide Mei with her down and depressed mood that she is having since last 4 months. The depression has reached such heights that she is bursting into tears without any knowledge. This model will help me let her find out the reason for this disturbance. Is it a fear of the future or just a negative thought that she is nurturing. She is having the belief that her husband is having an affair and might leave her putting an end to their happily married life. Although she has no evidence to this thought but she is scared of the future. Application of the cognitive behavioral therapy will help her to recognize and change these inaccurate beliefs and make her stronger to face the future whatever it beholds. She has withdrawn herself from the social activities and also do not spend much time with her kids, apart from being short tempered. Again, this model will help her to relate with others in a positive manner and change the behavior accordingly to live a happier and healthier life. Therefore, it can be well said that my adoption of the model of cognitive behavior therapy will be absolutely authentic and make me comfortable in the counseling of Mei.

Considering the treatment point of view, this model is said to be one of the most appropriate model of counseling for Mei due to its several application advantages. Cognitive behavioral therapies facilitate the clients to do self-counseling and therefore, they are instructive enough to provide the skills rationally to the clients (Thoma et al., 2012). Treatment with this model is of shorter duration and therefore, has better compliance among the clients. This model is focused on getting better rather than feeling better and yield long-term results. This model is considered to be cross-cultural and follows the universal laws of cognition and behavior. The sessions of this model are very much structured and therefore, the therapist does not lose focus while carrying out the counseling (van Ballegooijen et al., 2014). This provides positive results in a shorter period of time. Since it is adaptive and can be researched, therapists follow this model for setting defined goals and techniques for the counseling session. Apart from the benefits, several drawbacks have been recognized for the model of cognitive behavioral therapy. Faulty cognitions are a part of the model and its precise role is not determined. The scope of the cognitive model is narrow as it explores a single portion of human functioning (Kendall, 2013). Considering both the advantages and drawbacks, it can be said that this model would be one of the best and appropriate model for the solving the problem of Mei.

It is a common observation that people belonging from various cultures have different thought processes and reasoning skills. As cognitive behavioral therapy is concerned with the thought and thought processes of the client, therefore multicultural considerations have to be taken into account. Cultural norms like behavior in different situations tends to have an impact on the therapy and different cultural backgrounds of the therapist and the client results in complications regarding understanding of the thought process of the client and arriving at a solution (Chowdhary et al., 2014). Multicultural considerations like age, ethnicity, job and marital status of Mei have a role to play in employing this model. Since she is a middle aged woman, she is ought to think rationally and the deviations of her thoughts from normal reveals the intensity of the depression. She is of Chinese ethnicity and since their tradition gives importance to family values and bonding, therefore she is prone to develop negative thoughts regarding leaving of her husband as she has a childhood experience of her family falling apart (Rathod et al., 2013). Since works as a nurse, she is expected to have a strong mentality of supporting people. Since she needs a mental support now, there has to be something wrong with her mental balance. She has an experience of a failed marriage in her past and therefore, she is skeptical about her own marriage that his giving rise to negative thoughts in her mind. Considering these factors, it can be said that multicultural considerations have to be made while employing this model in order to get the direction in the treatment of the depression of Mei.

From the analysis of both the models of psychoanalytic therapy and cognitive behavioral therapy, it can be concluded that cognitive behavioral therapy would be the most appropriate and best fit model for Mei Ling. This is because it is a quicker process with lesser investment of money and provides long-lasting results over the other model. Since she is going through the depression for last 4 months, it will be beneficial to provide her relief rather than extending the episode. In addition, it is very much structured and do not pull out the history of the client from the unconscious mind which can be more disturbing rather than being beneficial. All these factors collectively state that for Mei, cognitive behavioral therapy would be the best model for the counseling and treatment of depression.

References

Busch, F. N., Rudden, M., & Shapiro, T. (2016). Psychodynamic treatment of depression. American Psychiatric Pub.

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