Task 1.1. Short Essay:
Give an account of the most significant theoretical issues which underpin the practice of counseling and use examples of how these issues can be addressed through counselling.
Through this draft, I am going to define counselling and through examples, show how issues can be addressed via counselling.
According to Feltham (1995), counselling is a form of help for people who need it. It involves two or more people discussing a problem or concerns that one of them has and the other is willing to listen to. Feltham (1995) went on to say that “counseling is a context of personal management, for example, can still carry the meaning of interviewing in relation to disciplinary procedures where the willingness of the ‘counsellor’ to be a listener may be very limited”.
Counselling is a type of talking therapy used in many ways to address psychological, emotional and other human predicaments depending on the nature of the problem. Usually people go to a counsellor to address problems they find beyond their own personal ken. Mostly, the problems under discussion are of intimate nature and thus confidentiality and trust are required to conduct counselling sessions. Through these sessions, people are usually able to overcome their innermost fears thus enabling them to live a problem free life and change old habits for the better ones.
Counseling may be helpful in treating the following conditions:
Bereavement or grief
Eating disorders, such as anorexia nervosa and bulimia
Long term ailments.
Task 1.2. Examples of how these issues can be addressed through counseling are:
Marriage problems: Marriage counseling addresses marital problems that individuals face in their marriage. Indeed the connubial predicaments can be daunting and thus to overcome marital problems require marriage counselling; sessions that can guide a person towards a happy life. Such counselling can help couples or even one of them to identify the causes of their problems in the marriage such as people with angry disposition or people with self-defeating thoughts. All such negative thoughts can be changed to curtail the growth of the intricate web of marital problems; problems that are often connected and budding. Marriage counseling can also address all sorts of feelings like sadness, love and people who feel insecure in their marriage. These arising problems are addressed.
Drug misuse: Counseling is aimed at helping people who misuse drugs to stop being addicted to it and help them live a drug free life. The counselor or therapist uses the cognitive behavioral therapy to address this issue. They attempt to replace what they see as ‘learned’, maladaptive behavior by using solution focused techniques to produce more positive and healthy behavioral patterns.
Grief: Through our daily interactions as human beings, we at times develop differences with the people around us. These differences at times lead to grievances that need to be addressed. Through grief counseling, counselors work with clients to provide support and understanding as they move through the personal process of envisioning life without the loved one. Even if you are still grieving over a loss many years ago, your therapist will meet you where you are, and help guide you through the next step, towards a better life, moving through this time of pain and being able to find some joy in your life again.
Eating disorders: The most common therapy or eating disorders is cognitive-behavioural therapy. This targets the unhealthy eating behaviours of anorexia, bulimia and the unrealistic, negative thoughts that fuel them. One of the main goals is for the client to become more self-aware of how he or she uses food to deal with emotions. The therapist will help you recognize your emotional triggers and learn how to avoid or combat them. Cognitive-behavioural therapy for eating disorders also involves education about nutrition, healthy weight management, and relaxation techniques.
TASK 2: Presentation.
Task 2.1. Describe the 6 main approaches to counseling.
There are a number of different types of counselling (Jones N.R.). Each type aims to help people deal with negative thoughts and feelings enabling them to make positive changes to their though process.
The 6 main types of counseling are:
Humanistic approach or person-centered approach
Cognitive: Therapists in the cognitive field work with clients to solve present day problems by helping them to identify distorted thinking that causes emotional discomfort. With little emphasis on the historical root of a problem, this approach puts under the microscope the present causes of the predicament? Common traits among the cognitive approaches include a collaborative relationship between client and therapist, homework between sessions, and the tendency to be of short duration. These therapies are best known for treating mild depression, anxiety, and anger problems.
Behavioral Approach: This is based on the premise that primary learning comes from experience. The initial concern in therapy is to help the client analyze behaviour, define problems, and select goals. This therapy often includes homework, behavioural experiments, role-playing, assertiveness training, and self management training. Like its cognitive therapy cousins it utilizes collaboration between client and therapist, and is usually of short duration.
Psychoanalytic Approach: The original so called “talking therapy” involves analysing the root causes of behaviour and feelings by exploring the unconscious mind and the conscious mind’s relation to it. Many theories and therapies have evolved from the original Freudian psychoanalysis which utilizes free-association, dreams, and transference, as well other strategies to help the client know the function of their own minds. Traditional analysts have their clients lie on a couch as the therapist takes notes and interprets the client’s thoughts.
Freud work on this approach seeks to describe how behavior is driven or influences by unconscious factors. During psychodynamic therapy, a therapist will help a person consider how their personality and life experiences influence their current thoughts, feelings, relationships and behavior. This understanding enables them to deal with difficult situations more successfully. Psychodynamic approach is a therapy which looks at how past experiences might shape and influence our thinking in regard to both our present relationships with others.
Psychodynamic therapy works towards developing a greater awareness of early patterns of behavior, allowing the client to experience a greater sense of personal authority and well being in the here and now.
According to Beck A. (1921) Humanistic therapies take a holistic approach to a person’s problem in order to help them develop to their full potential and live life to the full.
To achieve this, humanistic therapies incorporate the body, mind, emotions, behavior and spirituality. In addressing the problem, they also look at other people, including family, friends, society and culture.
Humanistic therapies are often used to treat problems such as depression, anxiety and addiction.
Person Centered – Approach
Carl Rogers approach to the study of persons is phenomenological and idiographic. He views human behavior as exquisitely rational. He states that the core of man’s nature is that he is a ‘trustworthy organism’ who is realistic, positive and unique. The entire theory behind person-centered therapy is built on the ‘actualizing tendency’. This is a ‘force of life’ that gives us the desire to strive to make the very best of our existence. The actualizing tendency is holistic in its mechanism, constant in its state and directional in its process. Although it’s a tendency towards autonomy at the same time it is vulnerable to environmental circumstances. Rogers believes that we as individuals know what is good for us, this is called ‘organism valuing’ this is closely related to the actualizing tendency. Among the many things we value is ‘positive regard’ and ‘positive self regard’. So running alongside the need to self actualize is the need for positive regard from others and the need for positive self regard.
Task 2.2. State the types of Therapies in which these 6 approaches may be used effectively.
In person-centred counselling the theory is that the therapist must give ‘unconditional positive regard’ to the client, by viewing the client to be a person of self worth and self value, no matter what their conditions, their behaviour or their feelings. Respecting the client for what they are, and accepting them as they are with their potentialities. I find this an interesting area and question whether giving unconditional positive regard is always possible. Does this mean that the therapist puts aside his/her own values and assumes the attitude that anything goes. I will explore this question from the therapist’s point of view in this essay, and I will refer to unconditional positive regard as UPR. Positive regard is essentially about being accepting of others and conveying this acceptance. It is based on a profound belief in positive human nature.
Psychodynamic therapy: During psychodynamic therapy, a therapist will help a person consider how their personality and life experiences influence their current thoughts, feelings, relationships and behavior. This understanding enables them to deal with difficult situations more successfully. Psychodynamic therapy is recommended for people with depression and other complex illnesses.
Humanistic therapy: Humanistic therapies take a holistic approach to a person’s problem in order to help them develop to their full potential and live life to the full. To achieve this, humanistic therapies incorporate the body, mind, emotions, behavior and spirituality. In addressing the problem, they also look at other people, including family, friends, society and culture. Humanistic therapies are often used to treat problems such as depression, anxiety and addiction. NICE recommends this type of therapy for children and young people with mild depression, and for some cases of schizophrenia.
One thing they all have in common is that they deal with unconscious motivation. Usually the duration of therapy is lengthy; however, many modern therapists use psychoanalytic techniques for short term therapies.
Task 3.1. Write a short essay that describes the historical context of three approaches to counseling.
Person-centered therapy (PCT) also known as person-centered psychotherapy, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s. It’s one of the most widely used models in mental health and psychotherapy. In this technique, therapists create a comfortable, non-judgmental environment by demonstrating congruence (genuineness), empathy, and unconditional positive regard toward their patients while using a non-directive approach. This aids patients in finding their own solutions to their problems.(Dryden and Mytton, 1999)
Burrhus Frederic Skinner (March 20, 1904 – August 18, 1990) was an American psychologist, author, inventor, advocate for social reform, and poet. He was the Edgar Pierce Professor of Psychology at Harvard University from 1958 until his retirement in 1974. He came up with the operant conditioning chamber, innovated his own philosophy of science called Radical Behaviorism, and founded his own school of experimental research psychology the experimental analysis of behavior. His analysis of human behavior culminated in his work Verbal Behavior, which has recently seen enormous increase in interest experimentally and in applied settings. Discovered and advanced the rate of response as a dependent variable in psychological research. He invented the cumulative recorder to measure rate of responding as part of his highly influential work on schedules of reinforcement. (Dryden and Mytton, 1999)
Sigmund Freud born (May 6, 1856 – September 23, 1939), was a Jewish-Austrian neurologist. Although some of Freud’s ideas have fallen out of favor or have been modified by Neo-Freudians, and modern advances in the field of psychology have shown flaws in some of his theories, Freud’s work remains seminal in humans’ quest for self understanding, especially in the history of clinical approaches. In academia, his ideas continue to influence the humanities and social sciences. He is considered one of the most prominent thinkers of the first half of the 20th century, in originality, intellectual influence and popular resonance on par with Einstein and Keynes.
Freud is best known for his theories of the unconscious mind and the defense mechanism of repression and for creating the clinical practice of psychoanalysis for treating psychopathology through dialogue between a patient and a psychoanalyst. Freud is also renowned for his redefinition of sexual desire as the primary motivational energy of human life, as well as his therapeutic techniques, including the use of free association, his theory of transference in the therapeutic relationship, and the interpretation of dreams as sources of insight into unconscious desires. He was also an early neurological researcher into cerebral palsy. Freud was also a prolific essayist, drawing on psychoanalysis to contribute to the history, interpretation and critique of culture. (Dryden and Mytton, 1999).
Task 3.2. You will also need to discuss the relevance in today’s society of the three approaches discussed.
There are many and different reasons why people seek therapy: getting fed up with things that have been going on for a long time, or hitting a crisis, sometimes is a lot of reason. We all have our ways of coping with what life throws at us, and we all need to find meaning and a sense of purpose in our lives. When the old ways no longer work or we lose our sense of meaning or connectedness, then that can be very difficult. Often this is a shock, if we are used to being able to cope. It can be a real blow to our self-esteem to find that we are not able to sort things out, or make ourselves feel any better. Asking for help can seem like the last resort. However, most people do find that it is a great relief to share how things are going, or how they are feeling. Therapy can then be useful in helping to make sense of what is happening.
Some people tend to minimize their own problems, but everyone is unique, so whatever is troubling you is considered important in therapy. We all deserve extra help at times. There are lots of different labels that therapists use to describe what they do and the methods that they use. Two of the main headings are ‘Humanistic’ and ‘Psychodynamic’. These might sound a bit off-putting! Jargon isn’t always helpful, but I will explain a little: The humanistic approach is about facilitating a process of self-discovery and growth. It sees people as having an innate potential for this, and aims to help people in their own journey.
Psychodynamics is about understanding how we relate to each other and the world, not just on the conscious level but on the unconscious level as well. In psychodynamic therapy, feelings hidden deep inside us are believed to influence how we behave, and how we relate to ourselves and to others. Quite often, some of these ways can get ‘played out’ in the therapy. This type of transference can be used to help explore what normally goes on for a person in their relationships. Once such things are brought into consciousness, they tend to lose some of their grip, and it can become more possible for change to take place.
The major contributors to these perspectives are Sigmund Freud and Carl Rogers. Freud created psychotherapy and psychodynamics at the start of the 20th century whereas Carl Rogers developed the person centered therapy during the 1960’s as a cultural emphasis on emancipation from tradition and exploration of new ideas and attitudes.
One problem in comparing these two approaches lays in the fact that they make rather different kinds of contribution to counselling and they cannot be compared. However both perspectives offer different models of the person and different ways of bringing about personal change, so they do present some interesting contrasts that relate to the person’s autonomy, the nature of subjectivity and whether and how people can change.
Both approaches focus on subjectivity and the inner world of the experiences in live, however psychodynamics are focused on the impact of the unconscious mind on meanings, motivations, behaviors and conscious experiences. They refer to inner conflicts (especially between the different aspects of the psyche – id, ego and superego) and the defensive processes used unconsciously to defend against the anxiety these conflicts creates, including repression, sublimation, projection and reaction formation. The aim of psychoanalytic psychotherapy is to release repressed unconscious material by bringing it into consciousness. The person centered approach primary focus on the significance of a person’s conscious feelings and thoughts while not entirely rejecting the relevance of unconscious feelings. Thus Rogers says that each person lives essentially in her own particular and subjective world. . While he accepts that a person will not be conscious of all aspects of her subjective world he believes that the person’s awareness of herself is the most important source of knowledge about her. The aim of person centered counseling is to help clients restore their ability to become aware of what they really feel. For this the therapist provides an atmosphere of non-evaluative, unconditional regard, a warmth and respect for clients regardless of what they think or do. They encourage their clients in a non-directive way to explore and express whatever feelings they have.
Given this contrast between the approaches is easy to imagine that they will use very different types of methods to understand the subjective world of their clients. Psychodynamic techniques include dream analysis, free association, and the analysis of transference and resistance to reach and understand the unconscious conflicts. The experiential world of childhood and its significance in adult life plays a very important role. This approach focuses on interpretation on the basis of clinical evidence. They work with the understandings produced by this to try to give patients greater insight into their own unconscious motivations. Their assumption by doing this is that it will create a climate that will lead to positive change.
The analyst plays a crucial role in bringing about change in clients for the aim of psychoanalytic therapy – to bring unconscious material into conscious awareness – requires the help and the skill of the analyst. In contrast Rogers’ therapy focus on the here and now, encouraging full awareness of senses and feelings, freedom to use bodily expressions as well as words, and discouraging both interpretation and evaluation. The emphasis is on encouraging clients to make their own choices and to work by themselves at reaching awareness of their feelings. They listen carefully and without interpretation, try to reflect back what they hear their clients to be saying This way it allows the client to become more aware of her feelings and to feel they can express these without censure. Once a client realised that she can do this and still be accepted, she can begin to open to what she really feel. This will make emerge a more consistent sense of self. The client will now be open herself up to relationships and situations which before would have been experienced as threatening. These methods tend to focus more on current experiences of the client in contrast to the psychoanalytic emphasis on the experiences of childhood.
One of the critics made by psychodynamic therapists to humanistic type counselling is that this is likely to be superficial and changes are short term; they think that without full awareness of unconscious motivations and the influences of unconscious residues from childhood, clients may be in no position to make effective choices and change themselves. However these emphasise the idea of autonomy, the potential for personal grow, and our capacity at least in part to create ourselves through the self-actualization tendency, there is a drive to perfection in all-living matter and all human being is essentially good Psychodynamics observe the client as an entity with something wrong, Freud was pessimistic about human nature and had worrying doubts about the future of human kind. They see the person as a patient and not as a client as the client centered therapy does.
Psychodynamic therapy incorporates a broad range of approaches to psychotherapy. It is intended to help clients gain an understanding about the causes of their problems, and to equip them to deal with future difficulties. Much effort is made to ensure that the counseling environment is conducive to self-expression and trust, with emphasis placed on the client-therapist relationship.
Psychodynamic Therapy has its roots in the theories of Sigmund Freud and his ideas regarding psychoanalysis. The psychodynamic approach itself was developed in the 1940s and 1950s by the Object Relations School of Psychoanalysis. Melanie Klein, Margaret Mahler et al pioneered an approach that focused on the relationship between the client and their close friends and family. Their work proved highly significant in the field of psychodynamic counseling.
Psychodynamic therapy has evolved considerably since the teachings of Freud. Although many of his theories have less resonance to modern psychodynamic therapists, some remain pertinent: that emotional problems originate in childhood that these experiences can have unconscious effects and that subconscious thoughts sometimes emerge during the process of counselling.
The Psychodynamic approach therefore focuses on unconscious thought processes, which manifest themselves in an individual’s behavior. It allows the patient to explore unresolved issues and conflicts from the past that are believed to affect them in the present. Psychodynamic therapy has been used to treat a multitude of problems including depression, social isolation and anger.
Humanistic Psychology Assumptions
Humanistic psychology begins with the existential assumptions that phenomenology is central and that people have free will. Personal agency is the humanistic term for the exercise of free will. Personal agency refers to the choices we make in life, the paths we go down and their consequences. A further assumption is then added – people are basically good, and have an innate need to make themselves and the world better. The Humanistic approach emphasizes the personal worth of the individual, the centrality of human values, and the creative, active nature of human beings. The approach is optimistic and focuses on noble human capacity to overcome hardship, pain and despair.
Both Rogers and Maslow regarded personal growth and fulfillment in life as a basic human motive. This means that each person, in different ways, seeks to grow psychologically and continuously enhance themselves. This has been captured by the term self-actualization which is about psychological growth, fulfillment and satisfaction in life. However, Rogers and Maslow both describe different ways of how self-actualization can be achieved.
Central to the humanist theories of Carl Rogers and Abraham Maslow are the subjective, conscious experiences of the individual. The humanistic psychologists argued that objective reality is less important than a person’s subjective perception and subjective understanding of the world. Because of this, Rogers and Maslow placed little value on scientific psychology especially the use of the psychology laboratory to investigate both human and other animal behavior.
Humanism rejects scientific methodology like experiments and typically uses qualitative research methods. For example, diary accounts, open-ended questionnaires, unstructured interviews and unstructured observations. Qualitative research is useful for studies at the individual level, and to find out, in depth, the ways in which people think or feel (e.g. case studies).
The humanist’s view human beings as fundamentally different from other animals mainly because humans are conscious beings capable of thought, reason and language. For humanistic psychologists’ research on animals, such as rats, pigeons, or monkeys held little value. Research on such animals can tell us, so they argued, very little about human thought, behavior and experience.
Task 5.1. Using person –centered approach in treating addiction
Drug addiction is a very complex illness or addicted life style characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.
Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.
Principles of Effective Treatment
Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop using and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment programs:
Addiction is a complex but treatable disease that affects brain function and behavior.
No single treatment is appropriate for everyone, they are individual differences
Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
Remaining in treatment for an adequate period of time is critical.
Counseling individual and/or group and other behavioral therapies are the most commonly used forms of drug abuse treatment. .
An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
Many drug–addicted individuals also have other mental disorders.
Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
Treatment does not need to be voluntary to be effective.
Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
Effective Treatment Approaches
Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual’s life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person’s success in achieving and maintaining a drug–free lifestyle.
Medication Medications can be used to help with different aspects of the treatment process.
Withdrawal: Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself “treatment” it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.
Treatment: Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are poly drug users (users of more than one drug) and will require treatment for all of the substances that they abuse.
Behavioral Treatments; Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.
Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as:
Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approaches principally in their use of the community treatment staff and those in recovery as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime–free lifestyle.
Task 5.2 prepare a five minute presentation on the chosen topic.
Drug addiction is a big issue among people of all ages; seek early help to prevent it. It is possible for one to overcome the problem of addiction with the help of a counsellor. As you have a one to one section with the client you are able to help them in these ways.
Feltham C. (1995), What is Counselling? the promise and problem of the talking therapies. Sage Publishers Limited
Gilbert, J. (2001) Cross cultural issues in Counselling Skills Training:
Lessons from Lesotho. The Health Exchange, April, 18-19.
Jones N.R. (2004). Theory and Practice of Counseling and Therapy, Forth Edition. Holt, Rinehart and Winston Ltd.
Jones N.R. (2000). SIX KEY APPROACHES TO COUNSELLING AND THERAPY. Martin’s Printers Limited.
M. Jill and D. Windy (1999), Four Approaches to Counseling and Psychotherapy, Routledge.
Ponton, L. (2006). Characteristics of Effective Counseling. Psych Central. Retrieved on 16/12/2011.
http://www.clinical-partners.co.uk/how-can-we-help-you/…/grief-and-loss.a access date 20/12/2011
http://www.therapytribe.com/therapy/Anger_Management_Counseling.html access date 20/12/2011
http://www.apa.org/topics/anger/control.asp. access date 15/11/2011
http://www.counselling-directory.org.uk/depression.html. access date 16/11/2011.
http://www.nhs.uk/conditions/anger-management/Pages/Introduction.aspx. access date 16/11/2011.
http://themarriagecounselingblog.com/counseling/problemsmarriagecounselinghelp/. access date 17/11/2011.
http://www.helptoheal.co.uk/drug-misuse-counselling.html. access date 17/11/2011.