Counseling Theory Essay

Counseling Theory Essay

Introduction

The main purpose of counseling has been cited as to help patients with a wide variety of problems, including emotional suffering, behavioral disorders, thinking disorders, and so on, that they may have. To effectively counsel (help) their patients to improve their functioning and therefore overall quality of life, counselors should possess and be able to use the knowledge of theory regarding psychotherapy/counseling and personality. Counseling theories seek to explain how counseling processes change and they suggest various techniques that counselors/therapists can use to help their clients who seek help. Multiple theories underlie counseling practice, and they include: psychoanalysis, cognitive behavioral therapy (CBT), person-centred therapy (PCT), cognitive therapy (CT), behavioral therapy, rational emotive behavioral therapy (REBT), psychodynamic therapy, humanistic approach, reality therapy, group therapy, interpersonal therapy (IPT), and so on. The purpose of this essay is to compare three of these counseling theories. The theories selected for comparison are the cognitive behavioral therapy, the interpersonal therapy, and the person-centred therapy. The Person-Centred Therapy The person-centred therapy, which was originally called the nondirective therapy, then client-centred therapy, is a therapeutic approach that was developed by Carl Rogers in the 1940s and 1950s, and it positively perceives individuals as it emphasizes the belief in individuals’ tendency to move toward and become fully functional. Based on this the person-centred theory can be described as a humanistic approach that is concerned with the manner in which individuals consciously perceive themselves, rather than the therapists’ ability to interpret their unconscious ideas or thoughts (Rogers, 1959). The theory, also known as the Rogerian theory, emphasizes care and understanding as opposed to diagnosis, persuasion and advice. It also suggests a few conditions that should be met if therapy is to succeed and for therapeutic change to happen. The achievement of these conditions is believed to have the potential to spur growth within individuals and to gravitate them toward fulfilling their full potential (Schultz and Schultz, 2009). From the perspective of the client, they must be anxious and vulnerable or incongruent, and in communication with the counselor. The therapists need to be genuine- such that their words, behavior and feelings are in tandem, they should also accept and agree to unconditionally care for the client, as well as understand the ideas, thoughts, feelings and experiences of their clients and communicate their empathetic understanding to the patients (Holdstock and Rogers, 1977; Rogers, 1959). According to Rogers (1959), patients’ perception of the offering of these conditions by therapists facilitated the occurrence of therapeutic change. Therefore, the key concepts suggested by this theory are genuineness, acceptance and empathy, all of which can be applied to a wide range of human behaviors (Holdstock and Rogers, 1977). This therapeutic approach has grown to become one of the most commonly used psychotherapy approaches, and is applicable to individual and group counseling, community programs, marital and family therapy, management, administration, human relations, and so on. It is also applicable to helping individuals of varying ages to overcome problems such as anxiety, depression, stress, personality disorders, drug and substance abuse, eating disorders, among others. By re-establishing their true identities, through this approach, individuals are able to overcome their limitations and improve their self-esteem, self-confidence, self-awareness and self-reliance which are impacted by these issues (Bohart, 2007; Gillon, 2007; Rogers, 1969). PCT purposes to provide patients with a supportive environment that will enable them to re-establish their real identity in order to enable them understand themselves for who they truly are- this is important as they will no longer have to suppress their feelings due to fear of not being socially accepted, supported, and being judged. However, the re-establishment of true identity is a difficult process and counselors depend on two major techniques- unconditional positive regard and empathy- to help them establish trust with the patients and provide them with a supportive, nonjudgmental environment that helps the patient feel safe to explore the various aspects of self. Therapists facilitate this exploration of self by a special relationship marked by unconditional positive regard, empathy and warmth (Kalmthout, 2007; Rogers, 1957, 1959). In some (limited) instances, the counselor can use psychological testing, for example the Q-sort, to assess the patient and determine the extent to which there exists incongruence between the patients’ ideal and perceived real selves. The employment of diagnostic categories is, however, discouraged by the person-centred therapy since it is not compatible with the philosophical perspective that views individuals as unique (Boy and Pine, 1989, 1991; Bozarth, 1991). Through diagnosis, a therapist is better placed to devise a treatment plan. The Rogerian theory outlines a number of goals whose achievement should be sought. Therapists should aim to guide patients towards: a realistic and conscious perception of self; improved self-confidence, self-efficacy and self-direction; sense of worth; better ability to cope with stress; improved maturity, social skills and adaptive behavior; and a more/ fully functional life (Rogers, 1961). This therapeutic relationship has been cited to be of primary significance since the patients are able to incorporate this relationship’s qualities (genuineness, empathy, warmth, communication, positive regard, non-judgmentalness and respect) and transfer them to the other aspects of their relationships. The person-centred theory also employs a number of techniques including active listening, clarification, reflection of feelings, and providing support to the patients (Rogers, 1959). The major limitation to this theory has been the potential danger that could arise from the passivity and inactivity of the therapist. This is because most patients could need increased direction and structure. It may also prove challenging to translate the key concepts/conditions into practice in some culture. Additionally, the theory’s extoling of an internal evaluation locus may, in some instances, lead to patients being influenced by social expectations rather than their individual preferences (Kirshenbaum, 2009). Cognitive Behavioral Therapy This theory (CBT) suggests the use of patterns, behaviors and beliefs as a way of changing negative thoughts/attitudes in order to lead less stressful and more productive lives. CBT was developed by Aaron Beck, and it emphasizes the significance of thoughts and belief systems in influencing feelings and behaviors. It focuses on the understanding of distorted beliefs and the incorporation and use of various behavioral methods and techniques to change and improve maladaptive behavior (Beck, 1967). The theory also pays attention to the patients’ unconscious thoughts and the important belief systems. Unlike in the PCT, in CBT therapists play an educational role and work in collaboration with patients to help them understand their distorted belief systems and propose techniques to change the said beliefs (Wills, 2009). With respect to this, therapists could give patients assignments that will enable them assess alternatives and determine the best methods that will help patients solve their problems. Given that therapists collect data to help them decide the best strategies, they may ask patients to note down their dysfunctional thoughts and evaluate their issues through brief questionnaires designed for various psychological disorders (Beck, 1967). Cognitive therapists have identified the different varieties of maladaptive thinking or behaviors and have listed specific strategies relevant to each psychological issue/disturbance, including depression, addiction, phobias, and anxiety. It is also applicable to marital problems, stress, substance abuse, assertion training, panic attacks and skill training (Clark, Beck and Alford, 1999). CBT is based on the Cognitive Model of Emotional Response, which suggests that our feelings and behaviors are influenced by our thoughts, rather than externalities- events, people or situations. This is beneficial since individuals have the ability to change how they think so as to feel or behave better even if situations do not change (Kellogg and Young, 2008). CBT is also briefer and time-limited- it is deemed the most rapid in relation to the attainment of results, with clients receiving an average of 16 sessions regardless of their problems or the CBT approach employed, while others (e.g. the psychoanalysis) take years. Its brevity is attributed to its instructive nature and use of homework assignments. It is also limited in that patients are helped understand from the beginning of the process that it will end at some point that will be decided by both the patient and therapist. Although not its key focus, an effective CBT is dependent on a sound therapeutic relationship, besides teaching patients rational skills self-therapy skills that will enable them change their negative thoughts. In CBT, patients and counselors collaborate with therapists seeking to learn the patients’ goals and helping them achieve their goals (Beck et al., 2004). The therapists listen, encourage and teach patients, while the clients state their concerns/needs, learn and apply their learning. CBT is structured and directive- each session has specific goals and specific techniques to be taught, although the focus is on the patients’ goals. CBT is educational and is based on the assumption that most reactions (emotional and behavioral) are learned and can therefore the unwanted/destructive ones can be unlearned. It teaches various techniques that are not only beneficial then, but also applicable in the long-term (Beck, 2005; Freeman et al., 1990). Homework and assignments comprise a critical part of CBT, as they are a means to help patients improve and practice the learnt techniques.

Interpersonal Psychotherapy

The interpersonal psychotherapy was developed by Gerald Klerman, in conjunction with his wife Myrna Weissman and other colleagues. IPT was initially designed as a 12-16 session system that would be used for research purposes. Klerman believed in the testing of all methods used in the treatment of psychiatric disorders before they were recommended to the larger population. For this reason, he asserted the need to categorize and specify disorders and create treatment/intervention manuals that were more appropriate to each (Klerman, et al., 1984). Although the theory was developed for the treatment of depression, it has been carefully applied to other disorders although fewer compared to the other theories. IPT is present-oriented and short-term in nature, is based on the attachment and communication theories, and recognizes the important role that social factors play in everyday functioning. Thus, its focus is on the present interpersonal issues, which it targets as a way of treating depression and other problems. IPT identifies various interpersonal problems or situations that bring about psychiatric issues among individuals and recommends solutions that are individualized to the patients (Stuart, 2004; Swartz and Markowitz, 2009; Weissman, Markowitz and Klerman, 2000, 2007). IPT identifies grief, role transitions, interpersonal role disputes, and interpersonal deficits as the four primary interpersonal problems (Klerman et al., 1984; Markovitz and Swartz, 1997; Stuart, 2006). Grief refers to the persistence of depression or depressive symptoms beyond a particular mourning period following the death of a person significant to the patient, while interpersonal role disputes arise due to the disagreement of two or more people with regard to the nature of their relationship. IPT emphasizes the presence of current covert or overt dispute with another person and distinguishes three stages of role dispute: renegotiation, impasse, and dissolution. Role transition problems are witnessed among patients struggling with major life changes, such as job change, retirement or divorce, whereas interpersonal deficits signify long-term patterns of lack of relationships, denoted by poor prognosis among such patients (Markowitz and Swartz, 1997). In ITP, the therapist first undertakes a formal (DSM-IVTR) diagnosis, which covers a complete medical evaluation of patients (Klerman et al., 1984). This is followed by the conduction of an interpersonal inventory with the patient, whereby all the important interpersonal relationships they have are reviewed with the aim of establishing associations between changes in any of them and the onset of depression (Stuart, 2006). IPT does not provide a causal theory of depression, but rather views depression as a result of many factors, with interpersonal factors having the potential to cause and/or worsen depression. Therefore, it suggests that patients should acknowledge that their depression is associated with some aspect of their interpersonal functioning problems (Weismann and Markowitz, 1994). In IPT, the counselor assumes the role of an active problem solver and the client’s advocate, and while therapeutic relationships are important in realizing change, no transference interpretations are employed and patients are expected to develop expertise on depression, which they will actively use in solving their problems (Markowitz and Swartz, 1997). The two major goals of IPT are the reduction of patients’ depressive symptoms and to improve the interpersonal problems linked to the depression Klerman et al. (1984). The therapist and patient need to agree on the conceptualization of the problem, which promotes therapeutic relationships and points to the therapy’s goals and strategies (Markowitz and Swartz, 1997). Klerman and Weismann (1993) describe three stages in which IPT is undertaken. Assessment, diagnosis and conceptualization form part of the first stage. The second stage focuses on the problem highlighted by stage 1 whereby therapists help patients deal with and overcome these problems (Markowitz and Swartz, 1997). Termination is the third IPT stage; it comprises the last sessions of therapy where the patients and therapists discuss progress, the ending of the therapeutic relationship is acknowledged, and likelihood of relapse and potential triggers discussed (Markowitz and Swartz, 1997). Basically an eclectic approach, IPT has seven categories of intervention, each of which uses specific techniques. They include: explanation, encouragement of affect, communication analysis, clarification, use of therapeutic relationship, behavior change, and adjustive techniques (Klerman et al., 1984).

Conclusion

While various counseling theories, all of whose aim is to help therapists predict and explain behavior, exist, they should each be critically evaluated with regard to their processes and provisions in order to determine the ones most appropriate to the prevailing circumstances, patient conditions, available time, client preferences, and patient needs/goals to be achieved. This is important as some theories are more complex, more time and resource-intensive, and more applicable/appropriate in certain situations than others.

References

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