Psychodynamic psychotherapy is one of the most efficient ways to identify the key issues that a patient suffers from and define the avenues for further treatment. Although it is rather hard to judge a particular case without actually taking part in the procedure, the video session in question seems to provide sufficient information for further analysis. After applying the concept of free association to the patient’s experience, it will be concluded that she needs to reconsider her relationships with the parents, particularly, her urge to “babysit” them as a result of fear of losing them due to a disease.
Applying the concept of free association, or the state of mind, in which the patient creates seemingly unrelated metaphors of their life (Kalat, 2013, p. 527), one will be able to notice that the patient is projecting her fear of losing her parents onto her dreams. As a result, such scenarios as losing them in a storm (her recent dream) emerge. Indeed, it seems that the patient does not want to recognize her fears; as a result, the latter manifest themselves in the form of her nightmares. Seeing how the very idea of her parents dying or even getting injured is immediately blocked by the patient’s mind, the only way that her fears can be expressed is through her dreams. The fact that her parents are taken away from her by a storm, i.e., something that she cannot control, may mean that the patient is afraid of losing control over their lives, as well as her connection with her parents.
Using the dream analysis technique, which was defined by Freud as a technique of interpreting the symbols viewed by the patient in a dream (Desmond, 2012, p. 6), will also work in the given case. An example of a dream analysis has been provided above; the key parallels between the patient’s fears and her visions have been drawn. It should be noted, though, that the patient is the only person that can locate the correct interpretation of her dreams; while several elements mentioned by the patient seem rather obvious, some parts of her dream may be symbolic of something that the therapist may be unaware of, such as childhood memories. To be more exact, the fact that the patient sees herself as a little girl in her dream is worth more thorough consideration.
Speaking of resistance, which is a patient’s unwillingness to reveal the unconscious thought process to the therapist (Himelstein, 2013, p. 68), the patient tries to block the idea of her parents suffering from her mind. Finally, the fact that the patient relates her insecurity about her parents’ health can be viewed as an example of transference, which is a phenomenon of projecting emotions onto particular objects or people (Starr, 2013, p. 144).
Along with several other techniques, the principles of the free association have helped discover the true meaning of the patient’s disturbing dream and the nightmare that she had. Because of an incredibly strong bond with her parents, as well as her unwillingness to mature and live her own life, the patient has become overprotective towards her parents. As a result, she feels an unceasing urge to retain the connection with her mother and her father.
Speaking of the means to address the issue in question, one must mention that being as dependent on one’s parents as the patient is rather unusual for an adult person. Therefore, the means to change the patient’s attitude by making her more independent should be sought. Reconsidering the self-image may help the patient overcome her fears.
Reference List
Desmond, J. (2012). Psychoanalytic accounts of consuming desire: Hearts of darkness. London, UK: Palgrave MacMillan.
Himelstein, S. (2013). A mindful approach to psychotherapy with at-risk adolescents. New York, NY: Routledge.
Kalat, J. (2013). Introduction to psychology. Stamford, CT: Cengage Learning.
Starr, L. A. K. (2013). A psychotherapy for the people: Toward a progressive psychoanalysis. New York, NY: Routledge.
Becker, J. C., Kraus, M. W., & Rheinschmidt-Same, M. (2017). Cultural expressions of social class and their implications for group-related beliefs and behaviors. Journal of Social Issues, 73(1), 158-174.
With the Great Recession, the increasing inequality amplified social-class inequalities amongst individuals in the social order. This study examines how the variations in social class define the inimitable forms of cultural expression and how cultural expressions encourage in-group philosophies. Two studies were conducted to answer the research question. The first study included a sample size of 113 individuals and confirmed that cultural expressions of social class on virtual platforms indicate the social class of targets. This means that the traditional doings of people observed in uploaded Facebook images suggest that people portray their social class in a way that can be observed by strangers that are beyond coincidental security. In the second study, there is evidence that people express their in-group space grounded on social class. As a final point, this study offers evidence that suggests that cultural expression derived from social class has the power to create and establish social boundaries within people. Lower social classes showed the inclination to remain politically inactive. The suggestions of results to theory and practices are that: psychological reactions are linked to social class.
Conceição, S. C., Samuel, A., & Yelich Biniecki, S. M. (2017). Using concept mapping as a tool for conducting research: An analysis of three approaches. Cogent Social Sciences, 3(1), 1-18.
Researchers in different disciplines practice creative methods to study areas of investigation. Thus, the literature review studies the use of concept maps as a research instrument. The study also includes an all-encompassing definition of “concept mapping.” The study employed three key methodologies to research the use of concept maps. These leading methods include cluster, relational, and word frequency. The approaches are useful in that they are used in various stages of the research process, like data analysis, gathering, and presentation. Each of the three approaches discussed some of the strengths and weaknesses that researchers have to take into consideration.
Davies, M. (2011). Concept mapping, mind mapping and argument mapping: What are the differences and do they matter?. Higher Education, 62(3), 279-301.
In current years, educators and scholars have employed use of software mapping tools for educational purposes. The tools are to impact analytical and critical skills to scholars, thus enabling them to see the association between concepts and the alternative assessment methods. This paper provides a framework of the various tools, together with their benefits and drawbacks. The main argument is that the choice of mapping is dependent on the purpose or objective for which the tools are used. The only limitation is that the tools may be converging to offer instructors and scholars unrealistic and complementary functions.
Destin, M., Rheinschmidt-Same, M., & Richeson, J. A. (2017). Status-based identity: A conceptual approach integrating the social psychological study of socioeconomic status and identity. Perspectives on Psychological Science, 12(2), 270-289.
The psychosomatic research on “Socioeconomic Status” (SES) has increased over the past era. The article builds upon and incorporates prevailing methods to focus more thoughtfulness on examining the idiosyncratic value and connotation that individuals use to attach to understanding their SES as a personality. Drawing from various research areas, it is suggested that the transitory changes in how people interpret their status individualities predict variations in behavior, thought, and motivations. The main emphasis of the article is to study the psychosomatic impacts of prominence change. A new measure is introduced in assessing an individual’s doubt regarding their SES. There are no evident limitations to the study, and its implications are that it extends the literature on socioeconomic status dimensions. The conclusion obtained from the research is that the construction of a person’s identity influences their thoughts and behaviors.
Delgadillo Asaria, Ali, & Gilbody, (2016). On poverty, politics and psychology: The socioeconomic gradient of mental healthcare utilisation and outcomes.
Ever since 2008, the “improving access to psychological therapy” (IAPT) program has distributed evidence-based intermediations for anxiety and depression disorders. To uphold the expected canons of quality, the England government policies have set the expectations that 50 percent of cured patients must meet the recovery principles based on patient-reported result methods. Using data from IAPT, it was discovered that mental health is more prevalent in poor regions, and such areas have low recovery rates. There is a limitation of this work that it is limited to England. However, it clarifies the lack of access to psychotherapy for treating anxiety and depression.
Epping, J., Muschik, D. & Geyer, S. (2017). Social inequalities in the utilization of outpatient psychotherapy: Analyses of registry data from German statutory health insurance. International Journal for Equity in Health, 16(1), 1-8.
The majority of the studies conducted focus on the occurrence of illnesses. However, very little is recognized about disparities in the usage of psychological health services. The purpose of this paper is to examine societal disparities in the use of casualty treatment in the healthcare system. The main influencing factors are low monetary barriers to health and the absence of health guidelines to address the availability of treatment services. A sample size of 10,711 males and females with psychotherapy was selected. The method used was the logistic regression analysis. This was done to investigate the impact of the three socioeconomic (SES) indicators on psychotherapy use. The main findings were that psychoanalysis by SES did not match the social construction of the population covered.
Ford, Lam, John, & Mauss (2018). The psychological health benefits of accepting negative emotions and thoughts: Laboratory, diary, and longitudinal evidence.
People vary in the way in which they are inclined to assent their thoughts and emotions without criticizing them habitually. This practice is referred to as characteristic approval. Acceptance has often been associated with mental health, which may be due to the part acceptance plays in adverse emotional reactions. This study hypothesizes that acceptance assists people in reacting to negative mental experiences. To test this hypothesis, three studies were performed. The first study confirmed that consistently accepting psychological experiences generally projected mental health. In the second study, routine acceptance low negative emotional response to unvarying stressors. Finally, in the third study, it was found that acceptance projected low negative emotions during day-to-day stressors. The limitation of the study is that the sample size used was small. The conclusion drawn from the study is that mental acceptance proved to help reduce negative responses and stressors.
Khazaie, Rezaie, Shahdipour & Weaver (2016). Exploration of the reasons for dropping out of psychotherapy: A qualitative study.
The study aims at exploring the reason why patients drop from psychotherapy in Kermanshah, Iran. The method used in the study is conventional content analysis. The study sample comprised 15 participants, 7 who dropped out of psychotherapy, and 8 who have experienced patient dropout. Data collection was done through semi-structured interviews, and content analysis was done for the transcribed interviews. The results showed distinct causes for psychotherapy to dropout amongst the participants. The limitations of the study are that the sample size is very small, and the study is limited to one geographic location.
Neblett Jr, E. W., Bernard, D. L., & Banks, K. H. (2016). The moderating roles of gender and socioeconomic status in the association between racial discrimination and psychological adjustment. Cognitive and Behavioral Practice, 23(3), 385-397.
Racism-related stress created a major risk to the perceptual functioning of most African American youth in their shift to maturity. Both social and personal factors impact the relationship between mental health functioning and racism-associated stress. Therefore, the study tested the balance of sex roles and SES in the relationship between depression indicators, social sensitivity, and anxiety. The method used to analyze data in regression analysis showed that males from low SES and females from high SES were more susceptible to racial discernment. The limitations of the study include the sample size being small and the study context being limited to African Americans. In the implications for practice, research, and theory, the study proposes cognitive-behavioral mediations for informing assessment and assisting patients.
Villatoro, Mays, Ponce, & Aneshensel (2018). Perceived need for mental health care: The intersection of race, ethnicity, gender, and socioeconomic status.
Ethnic/race minority populations underutilized mental health services. Through the use of “collaborative psychiatric epidemiology surveys,” an analysis of how race, ethnicity, socioeconomic status, and gender influenced the perceived need was undertaken. The representative sample size analyzed included Asian Americans, African Americas, Afro-Caribbeans, and Latinos. The logistic regression. Lastly, foreign-born immigrants have low perceived needs compared to American-born people. The results are that income and education are considered the key factors that influence patients to reduce their need for receiving treatment. The limitation of the study is that it is focused on the American context.
The role of humour in counselling and psychotherapy has become an area of keen interest for researchers in the field. Experts increasingly recognise humours’ positive role in therapy, but its application is to be executed with care. The present thesis reviews the literary insight into the therapeutic use of humour from the standpoints of Psychodynamic, Cognitive-Behavioural, and Humanistic/Existential perspectives. The primary purpose of humour is to be a social lubricant, helping the client and therapist establish a strong therapeutic alliance. In this regard, humour is to adhere to ethical standards of safe practice, meaning that it should be appropriate and tailored to specific client circumstances. Next, the paper argues that humourous exchange can be produced inappropriately, which is particularly topical in counselling today. The paper also reviews the positive aspects of accurate humour implementation, such as alleviating stress and enabling effective coping mechanisms. Lastly, the literature reveals that humour is an effective therapeutic strategy that can be utilised in a wide array of settings.
Introduction
A growing number of practitioners have voiced collective interest in the role of humour in counselling and psychotherapy. Indeed, Corey (2013, p.31) stated that therapy is ‘a responsible endeavour, but it need not be a deadly serious one’. Furthermore, humour seems pertinent and applicable to virtually all therapeutic approaches, spanning from psychodynamic and humanistic/existential oriented clinicians to those with a foundation in cognitive behavioural therapy. For this reason, chapter one will cover the theoretical bases of humour within counselling. Likewise, historically there appears to have been much enthusiasm for the use of humour within therapy. This is evidenced by the many books and papers written on the topic by famous therapists such as Freud (1960), Ellis (2007) and Frankl (1975). On the other hand, outside of anecdotal evidence and personal experience, the amount of empirical research around the use of humour in therapy is undeniably little by comparison. Nevertheless, given humours’ complex nature, such controlled research is not always easily acquired.
Moreover, chapter two will look at the practical applications of humour. Perhaps not unexpectedly, humour appears relatively often in all kinds of social exchanges, and psychotherapy is no exception. Similarly, humour can be applied both appropriately and inappropriately. Thus, practitioners involved in this area of study fluctuate between those who ardently support its use to those who maintain a more sceptical position. Hence, topics to be examined include humour as means of bolstering the therapeutic alliance and humour as a potential diagnostic/assessment tool before concluding with possible risks involved in its use. Finally, chapter three will touch on humours innumerable benefits to one’s overall health and well-being, including reduced stress, greater resilience and decreased depressive and anxiety related symptoms (“Association for Applied and Therapeutic Humour”, 2021). In essence, this thesis intends to argue for humour’s therapeutic value provided it is incorporated sensibly.
Chapter One – Perspectives on Humour from Three Core Therapeutic Modalities
Psychodynamic Perspective (Sigmund Freud)
Freud’s influence on mental health highlighted the unconscious processes that shape our actions (Christoff & Dauphin, 2020). His psychoanalytic model deals with the psyche’s metaphoric structures, specifically the id, ego, and superego. The id relates to ideas of pleasure and desires, the ego with the individual and realism, and the superego with morality and integrity. The pressure between these three structures desires balance and freeing of mental energy to preserve a strong structure (Boag, 2014). As such, ‘humour may be one way to release sexual energy and provide catharsis’ (Gibson, 2019, p.187).
When observing a client’s dysfunctional behaviours, therapists may consider three ideas concerning Freudian theory on humour. Firstly, humour conceals taboo feelings of superiority or sexual desire, which can induce guilt. In this way, humour acts as ‘a guilty pleasure’. Secondly, humour can obscure feelings of aggression or hostility that one may not consciously admit to. Thus, ‘humour is a way for conscious expression of repressed feelings’. Finally, humour can act as a healthy defence mechanism by gently redirecting aggressive impulses. This way, one will be less likely to engage in aggressive and harmful acts (Gibson, 2019, p.188).
Guilty Desires
Delighting in humour may yield guilt or incite tension in our superego since that element contradicts its moralistic needs. One could also feel guilt around generating and appreciating humour because it asserts dominance or superiority over others (Ferguson & Ford, 2008). Freud remarked that a superior state of mind fed aggression (Ferguson & Ford, 2008). Typically, aggression is considered inappropriate in social exchanges, and therefore conflict arises when the id wishes to be hostile. However, the ego and superego prevent this undesirable behaviour from occurring (Freud, 1960). In this way, humour excuses such hostility by masking it as acceptable (Christoff & Dauphin, 2020). Such humour may appear friendly, but it is, in fact, disparaging. In other words, this behaviour could be considered passive-aggressive. Such a cover-up lets one be offensive or spiteful, and because it is ‘just a joke’, one’s guilt is mitigated (Gibson, 2019).
Voicing of repressed feelings
Freud hypothesised that feelings which the ‘conscious mind cannot handle are repressed, placed out of our awareness’ (Gibson, 2019, p.189). Nevertheless, these blocked feelings are the root of many struggles for clients and are exposed in other ways. Freud claimed that humour was an efficient means to disburse psychic energy or maintain balance so that the system’s objectives were achieved by voicing unconscious wishes through humour instead of expressing one’s genuine feelings (Christoff & Dauphin, 2020; Freud, 1960; Swaminath, 2006). One may not consciously accept our preference for aggression, superiority or sexual impulses, so one engages in jokes to disguise one’s guilt-ridden desires (Christoff & Dauphin, 2020). This idea contrasts from the earlier theme because, in the previous point, lessening of guilt inspired humour, whereas in this case, repressed material provokes it. For instance, this concept of repressed thoughts stated through humour relates to the vagueness inherent in prejudiced or sexist jokes (Mallett et al., 2016). If one likes to express or hear a racist joke, one might reason that one is not racist because it is merely a joke, but it is possible that one is racist and compensating through employing such humour. Freud’s model succumbs to the idea that unconscious motivations clarify this humour’s enjoyment (Gibson, 2019).
An Adaptive defence mechanism
Lastly, Freud’s concept of balance between ego, superego, and id offers an additional role of humour. If the id wishes to assert its sexual desires or hostile feelings, but the superego creates guilt and stops these from accessing the conscious mind, pressure builds within the psyche (Christoff & Dauphin, 2020). Gibson (2019, p.190) notes that much like ‘the release of steam in a steam-engine train, this tension must be released’. Otherwise, ‘the system malfunctions’. Thus, Freud claimed that laughter reduced this buildup of tension. In this way, as an alternative to client physical aggression, which would be considered maladaptive behaviour, humour acts as an acceptable means to deal with the conflict between these three structures (Connor et al., 2019). Hence, the well-known expression ‘blowing off steam’ recognised by many people today (Gibson, 2019, p.190). Given the potential roles of humour above, the author believes that the therapy room might act as a haven for clients to gratify these desires. In this view, client humour ought to be encouraged in therapy. Moreover, humour made on behalf of the client during therapy sessions may help the therapist understand and give insight into the client’s fundamental issues (See Chapter Two for further discussion).
Cognitive-Behavioural Perspective (Albert Ellis)
One other familiar style of therapy that embraces humour is Rational-Emotive-Behaviour Therapy (REBT), founded by Albert Ellis (Dryden & Branch, 2008; Ellis & Dryden, 2007; Saper, 1987). While Freud may have examined humour and its connection to the unconscious, Ellis intentionally used humour to help clients alter irrational beliefs and self-sabotaging behaviour (Saper, 1987). Consequently, the therapy’s goal is to test and refute clients’ erroneous beliefs and substitute them with more accurate and flexible expectations and perspectives. One method of accomplishing this is for the therapist to practice humorous hyperbole and even irony to call attention to the ridiculousness of clients’ unreasonable belief systems (Ellis & Miller, 2012). In a video interview, Ellis spoke that ‘people disturb themselves; they don’t get disturbed’ (Psychotherapy.net, 2012).
He later claimed that individuals ‘first take adversities, hassles, and life problems seriously, which is good, but then they take them too seriously and lose their sense of humour’ (Psychotherapy.net, 2012). Likewise, Ellis held the view that individuals unsettled themselves through their irrational thinking patterns, feelings and actions. The very heart of humour exerts itself on all three of these levels (Ellis & Dryden, 2007; Psychotherapy.net, 2012; Saper, 1987; Sultanoff, 2013). Cognitively, it astutely and persuasively offers a fresh perspective to the all-or-nothing and inflexible client. Emotively, humour brings pleasure and laughter, makes life seem meaningful, and actively interrupts feelings of despair and apathy. Behaviorally, it inspires different actions such as independently generating direct opposition to anxiety and supports people in relaxation by temporary distraction (Saper, 1987). Thus, Saper (1987, p.361) asserts that ‘if clients can even briefly experience amusement, it can serve as an antidote to client sadness’. Finally, therapist humour can help clients accept life’s uncertainties and foster a healthy open-mindedness to the world around them (Psychotherapy.net, 2012).
Nevertheless, detractors of REBT’s extensive use of humour allude to the fact that it seems to endorse an aggressive and confrontational approach to therapy (Ellis & Miller, 2012). While Ellis’s humour practice looks to be rather aggressive, he did acknowledge its potential for harm by stressing the importance of implementing humour in a manner that acknowledged and accepted clients despite their mistakes and shortcomings (Ellis & Miller, 2012). The author would agree that given the possibility for client harm, such humour would indeed need to be administered very carefully and competently, if at all.
Humanistic-Existential Perspective (Maslow, Rogers, May, Frankl, Farrelly)
There have been numerous approaches to the use of humour under the Humanistic/Existential umbrella. Some therapists have created therapies where humour is the chief component of the approach, whereas others have used humour as a therapeutic technique (Frankl, 1975; Rutherford, 1994; Saper, 1987). According to such approaches, a humorous outlook on life is not only a fundamental measure of mental health, but also a method of preserving and supporting healthy living (Martin & Ford, 2007). For instance, Maslow and Rogers agreed that humour is one characteristic spotted in fully functioning individuals. Such a personality trait is a mark of a healthy mind in that one can laugh at difficult life circumstances and still move on with their lives (Dziegielewski et al., 2003).
Likewise, Existentialism suggests that humour is freedom from the confines of reality and life’s hardships (Gibson, 2019). Client behaviour that could appear counterproductive to one’s goals can result from such a loss of freedom (Gibson, 2019). Hence, Gibson (2019, p.195) states that one is healthy and content when one is ‘free and not slaves or prisoners of our feelings and desires’. Similarly, Existential psychologist Rollo May specified how humour works as a ‘healthy way of feeling a ‘distance’ between oneself and the problem, a way of standing off and looking at one’s problem with perspective’ (May, 2009, p.24). Another renowned therapeutic practice that has been regarded as being built on humour is ‘paradoxical intention’, established by Existentialist Viktor Frankl (Frankl, 1975). In this procedure, clients are advised to overstate the bleakness of their problems (Saper, 1987). For instance, Frankl would often ‘tell a joke to depressed clients, let them laugh and then tell them they could not laugh! Why not? Because laughter is incompatible with depression’ (Rutherford, 1994, p.213).
Furthermore, Frank Farrelly’s Provocative therapy is an adapted version of the Person-Centred approach (Kemp, 2015; Saper, 1987). Saper (1987, p.360) describes how therapists in this therapy style attempt to be provocative and self-revealing by using methods such as ‘exaggeration, mimicry, ridicule, distortion, sarcasm, irony, and jokes’. Such techniques bring attention to self-sabotaging behaviours while simultaneously exposing client anxieties and self-limiting beliefs (Saper, 1987). Given this supposed client centred approach, the author would question its perspective on core conditions such as client support, warmth, and unconditional positive regard. Fortunately, Farrelly responded to this concern with some clarifications. Firstly, the provocative therapist is not mocking the client personally but is instead teasing their ineffective behaviours. Secondly, Farrelly agreed that his methods might initially trigger unease in clients but made a distinction between short term pain and long-term gain. ‘Often in therapy, a distinction must be made between short-term cruelty with long-term kindness versus short-term kindness and long-term detriment’ (Saper, 1987, p.361). Despite such reassurances, one would still envisage this therapeutic approach as potentially having more significant risks than its more conservative counterparts. Hence, the author would carry similar reservations about this therapy style as the ones held for Ellis’s humorous techniques in REBT.
Now that some theoretical backgrounds of humour have been observed, one will examine the clinical functions of humour as it relates to current counselling practice.
Chapter Two – Practising Humour in the Therapy Room
Establishing a therapeutic relationship – humour as a social lubricant
One of the critical elements of successful therapy is the strength of the therapeutic relationship (Cooper, 2008). As such, humour has the power to connect people and enhance the therapeutic relationship, for it recognises the client’s and counsellor’s shared mortality (Dryden & Branch, 2008; Richman, 1996). In regular life, humour commonly forms a bond between people and encourages relationship development. Likewise, humour can have similar results in the therapeutic environment and support understanding (Dziegielewski et al., 2003). Hence, humour ‘can be one of the sweetest builders of a warm, connected therapeutic relationship, giving a shared language to both people in the dyad’ (Evans, 2015, p.129).
Moreover, humour can give way to a more ‘normal’ dialogue which usually contributes significantly to a client’s comfort level in the therapy room (Haig, 1986; Martin & Ford, 2007). As a result, clients who reveal little throughout conversation as a form of self-defence may be more willing to be vulnerable (Dionigi & Canestrari, 2018). Similarly, collective disclosures via humorous observations or jokes allow for confidence to be built in the therapeutic relationship and afford the therapist deeper client empathy (Dziegielewski et al., 2003; Sultanoff, 2013). Likewise, a client’s use of humour in therapy can be a reliable gauge of the strength and trust inherent in the relationship. One is much more likely to trust another if one is to be brave enough to appear foolish in the presence of another (Dziegielewski et al., 2003). Digney (2014, p.19) speaks to this point by arguing that people instinctively know when someone is concerned for us. Such care is often revealed via the attention one receives. A safe and open environment is cast when one can partake in laughter, share a joke or engage in humorous exchange. The author points out that such humour indirectly communicates the message ‘I care about you’. He maintains that such indirectness can be more helpful than explicitly stating it to someone.
Additionally, Mosak (1987) explains how private jokes often develop between therapist and client in a long-term relationship. The ‘In-joke’ between therapist and client conveys the same message as it does for any in-group, that ‘we are in a special relationship,’ thus maintaining and increasing rapport (Mosak, 1987, p.39). Equally, Mosak (1987, p.27) describes how Adlerians would understand therapy as an ‘educational and re-educational process’ and believe that knowledge accumulation ensues more freely in a stress-free environment. As such, ‘The low level of tension facilitates a cooperative task-solving approach’ (Mosak, 1987, p.27).
Furthermore, humour is a method of communication. Brooks et al. (2020) and Haig (1986) discuss banter as a communication tool that clients may use in therapy and thereby require a therapist to reciprocate in such an approach. Ultimately, the goal of such banter would be to enhance the therapeutic work/relationship. Haig (1986) and Prerost (1984) note that youngsters may have difficulties engaging in therapy if they felt somewhat patronised, so banter may reduce anxiety in this area as well. Finally, ‘humour is chemical and wired into our neurology’. Thus, ‘laughter sets up the release of oxytocin and vasopressin in the brain, peptide hormones linked to bonding and attachment’, further highlighting humour’s social function (Digney, 2014, p.7).
Humour as a tool for client assessment, diagnosis, and therapeutic intervention
Assessment/Diagnosis
Humour made on behalf of the client often gives therapists valuable information around their insights, emotional state, attitudes, and expectations. By taking such information into account, therapists may achieve a more thorough client conception (Haig, 1986; Martin & Ford, 2007). For instance, Gibson (2019, p.206) believed that ‘clients’ humour may reveal conflict (aggressive humour), control (taking away therapist’s control of the talk), or concealment (avoiding issues)’. Haig (1986) also listed how humour can be used positively in supporting client diagnosis. For example, any response to or use of humour may specify a client’s emotional maturity, worsening of symptoms or transferential material. Hence, laughter can be an insightful admission by the individual participating in the laughing (Mosak, 1987). In this way, German novelist Goethe’s claim that ‘Men show their character in nothing more clearly than in what they think laughable’ appears to be quite apt in this instance (Martin & Ford, 2007). Additionally, Goldin & Bordan (1999) discuss how different therapeutic modalities might view a client’s lack of humour. For example, adult children of alcoholic parents might have trouble having fun and relaxing in social settings. Likewise, in Transactional Analysis, a client’s inability to enjoy humour could indicate an ego state dysfunction stemming from unduly punitive parenting.
Therapeutic Intervention
Furthermore, humour can be a valuable intervention technique. Like all therapeutic interventions, it must be implemented for the possible benefit it might have for the client (Dryden & Branch, 2008; Ellis & Dryden, 2007; Frankl, 1965; Franzini, 2001). As such, best practice would indicate that therapists do not make jokes at the client’s expense or practice humour to ease their own anxiety during a session (Dryden & Branch, 2008). Gibson & Tantam (2018, p.71) claim that humour can also act as a catalyst for internal movement within a client, ‘resulting in a change of perspective, values and behaviour’. In this way, humour can allow clients to view dysfunctional thinking and behaviour patterns more positively and expansively. (Dryden & Branch, 2008; Haig, 1986) Likewise, Mosak (1987) argues that therapists may implement jokes to generate momentum in periods where therapy has plateaued. It can act as a method of challenging clients on possible false agendas (Mosak, 1987).
Moreover, jokes let therapists practice an interpretation style that clients may perceive as less inauspicious than a more traditional interpretation. Hence, a straight-faced interpretation may be less tolerable than one expressed humorously. Such an approach might likewise allow one to state the cause of client difficulties more tactfully (Ellis & Dryden, 2007). Mosak (1987) points out that all forms of psychotherapy have the potential to be hazardous. Nevertheless, if therapy is to flourish, both therapist and client must take risks. ‘Too safe, and there is no reason to move; too risky, and there is no support for movement’ (Mosak, 1987, p.42). In this manner, Mosak (1987) argues that humour carries no more dangers with it than any other form of therapist interpretation. Perhaps then the critical component in humour’s practical use is therapist timing (Goldin & Bordan, 1999). Humour used too hastily can give the impression of incompetence or somebody who is almost immune to the client’s concerns. If used too late, it can appear unrelated to the present moment (Evans, 2015; Goldin & Bordan, 1999).
Potential risks of implementing therapeutic humour
Some critics claim that humour used as a technique is best left out of therapy. The detractors argue that too many hazards exist and not worth the risks involved. In other words, there is a higher chance of client harm and wrongdoing (Shaughnessy & Wadsworth, 1992). Moreover, there are occasions when clients use laughter ‘to cover up anxiety or escape from the experience of facing threatening material’ (Corey, 2013, p.31). Thus, the therapist must differentiate between humour that diverts and humour that progresses therapy (Corey, 2013).
Furthermore, as cited by (Rutherford, 1994), Kubie voiced strong concerns regarding the use of humour in psychoanalysis, believing that it could inhibit free associations. He also thought that therapists might use humour to lessen their own anxieties and fears around specific clients. For instance, therapists might occasionally feel uncomfortable around a client’s presenting issue and therefore implement humour as a means of coping instead of addressing issues openly. In such situations, the therapist could use humour to sidetrack the client and indirectly change the direction of the discussion. When therapists engage in humour, clients may also get the impression that they cannot voice feelings of annoyance and unwillingly feel pushed into compliance. Consequently, Martin & Ford (2007) advise therapists to exercise some introspectivity and consider whether they are using humour as a form of self-defence. Finally, where humour is misused, clients may become confused and question the therapist’s sincerity (Rutherford, 1994).
Haig (1986) also reminds us of humour’s double-edged nature by listing several ways in which humour is likely to be unhelpful. One such client is the ‘people pleaser’ who might use humour to gain therapist acceptance. For instance, the client may attempt to stroke the therapist’s ego by amusing them or, more importantly, hiding any potential resentment felt towards them. On the other hand, the therapist may use humour in an egotistical manner to validate their intelligence or use dry humour to criticise the client. Moreover, as cited by (Franzini, 2001), Kuhlman argues that poorly timed humour may alter client feelings when expressing such feelings would have been therapeutic. In this way, Goldin et al. (2006) state that humour is not appropriate when clients are suffering from feelings of depression or going through the grieving process. Similarly, the authors recommend that therapists be suspicious of client humour that seems to support unhelpful behaviours. In such examples, therapists need to abstain from coercing with clients. Engaging with the client in this humour sends the message that one supports such behaviour, which goes against therapy and client growth goals (Goldin et al., 2006).
Nonetheless, Evans (2015) argues that this shadier side to humour is one therapist rarely acknowledge. ‘When humour tips over into cruelty, mockery, snideness or sarcasm it can be experienced as wounding, excluding, judging and devastating by those who feel like the target’ (Evans, 2015, p.130). Such is the case especially for individuals who have chronically found themselves at the wrong end of others’ gags in the past. As such, they may be overanxious around others’ intentions, seeing genuine jokes as covering for concealed disclosures intended to insult (Evans, 2015). Similarly, when the therapeutic relationship has not been established, the higher the chance for client harm as our humorous intentions may be misread. Consequently, Evans (2015, p.131) highlights the below three questions which practitioners can reflect on before implementing humour.
Has the client frequently experienced humour used as a weapon against them?
Do they have a deep history embedded with shame, feeling humiliated, shy, or highly anxious?
Are there cultural, language, or gender considerations that may increase the client’s likelihood of misunderstanding?
Moreover, Richman (1996) and Maples et al. (2001) echo the above sentiments, advising counsellors working with individuals of diverse cultural backgrounds to be aware of the different meanings potentially associated with humour. Not all cultures express and appreciate humour in the same way. Interestingly, Salameh, as cited by (Saper, 1987) established a five-point rating scale for categorising the extent humour was beneficial or damaging in therapy, possibly as a result of such client protection issues. The scale commences with destructive humour. Such humour would consist of negative and mean-spirited comments designed to hurt the client. Following on then from this is harmful humour, minimally helpful humour, very helpful humour, and outstanding humour. This last level (Level 5) is defined as empathetic humour, occurs naturally, and helps create client change and growth.
Hence, chapter three will look at these more beneficial aspects of humour as it relates to psychological wellbeing.
Chapter Three – Humour and its Role in Psychological Wellbeing
Humour as a coping mechanism for stress
Research has offered extensive backing for the idea that humour regulates emotions that positively relate to mental wellbeing (Abel, 1998; Abel & Maxwell, 2002; Akram et al., 2020; Cann et al., 2000; Cann & Collette, 2014; Crawford & Caltabiano, 2011; Kuiper, 2012; Perchtold et al., 2019; Samson & Gross, 2012; Tugade et al., 2004). Firstly, humour lessens the harmful impact of stressful events by generating an optimistic viewpoint for understanding worrying events (Conversano et al., 2010; Dziegielewski et al., 2003; Morgan et al., 2019). Secondly, it weakens unwanted emotional responses to the demands of life by discouraging negative ideas in place of positive ones (Martin & Ford, 2007; Samson & Gross, 2012). As American singer Lena Horne once claimed, ‘It’s not the load that breaks you down, it’s the way you carry it’ (Gibson, 2019). Thus, humour allows individuals to reevaluate stressful events in lighter, less alarming ways and subsequently experience less emotional suffering.
Numerous authors have echoed this stance (Abel, 1998; Abel & Maxwell, 2002; Ellis & Dryden, 2007; Frankl, 2004; Freud, 1960; May, 2009; Samson & Gross, 2012). Moreover, society today consists of several stressors, and thus client issues may present in many forms (Yim, 2016). For instance, physical stressors might include headaches, emotional stressors such as anxiety and depression and social stressors such as relationship breakups (Gibson, 2019). Likewise, authors Boyle & Joss-Reid (2004) describe how humour helps healthy and unhealthy individuals manage stress for different reasons. For example, hospital patients practice humour to endure long-lasting pain, college students practice humour to lessen the anxiety associated with assignments, and healthy individuals use humour to preserve energy and mental wellbeing. Cheng & Wang (2014) also suggested that humour restores one’s psychological reserves that often become depleted by responsibilities one finds discouraging. In this way, they argue that humour supports a persistent and resilient outlook on life as it is both physically and emotionally invigorating.
Humour as a coping mechanism for depression and anxiety
A few authors maintain that undergoing adverse life events makes one more susceptible to anxiety and depression (Gibson, 2019; Hassanzadeh et al., 2017). Nonetheless, if one uses humour to deal with such events, one can reduce these unwelcome emotions (Gibson, 2019). In other words, ‘coping humour can moderate the relationship between stress and negative moods’ (Gibson, 2019, p.157). Similarly, on a more practical note, humour is perhaps a useful coping tool for the simple reason that it is not easy to feel happy and sad concurrently (Gibson, 2019). Martin & Lefcourt (1983) also studied whether partaking in coping humour (as categorised on their Coping Humour Scale) allowed people to escape these universal emotions. For instance, their study established that when adverse life events such as losing a loved one or job arose for individuals, those with high CHS scores exhibited lower negative moods than those with low CHS scores. Given that such emotions are unhealthy when experienced chronically, these results might suggest that some form of humour in times of hardship is worth implementing in one’s life.
Moreover, Yim (2016) spoke of today’s increased stress levels induced by tougher competition and socioeconomic stressors. The author insists that such stress is detrimental to one’s mental health, leading to depression and lower living standards while simultaneously impacting one’s self-esteem (Yim, 2016). Further, in episodes of endogenous depression, he states how laughter can positively alter dopamine and serotonin levels in the brain. This has noteworthy implications for the biological origins of depression where ‘neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin’ are impaired. In other words, ‘there is something wrong in the mood control circuit of the brain’ (Yim, 2016, p.247).
Adaptive and maladaptive humour styles
Although humour appears to be a significant coping device for stress, it might not be a good strategy if it serves a dysfunctional purpose (Abel, 2002). For instance, humour that is excessively self-deprecating or employed for self-protection and evasion purposes may be linked to less effective coping methods (Gibson, 2019). In contrast, humour that allows for objectivity and a detachment between oneself and the problem may be favourable to coping (Martin, 2001; May, 2009; Perchtold et al., 2019). For this reason, a few authors (Kuiper & Leite, 2010; Leist & Müller, 2012; Martin et al., 2003) have analysed four humour styles that mirror ways individuals regularly use humour in their lives. Two are understood to be ‘adaptive or advantageous for personal wellbeing (self-enhancing humour) or interpersonal relationships (affiliative humour), and the other two maladaptive or disadvantageous to personal wellbeing (self-defeating humour) or interpersonal relationships (aggressive humour)’ (Martin & Ford, 2007, p.241). These findings suggest a client’s style and why they use humour to be important in many interpersonal problems. Hence, it would be practical for therapists to distinguish between potentially adaptive and maladaptive humour styles in humorous interactions with clients.
Moreover, Saxon et al. (2016) conducted a study on gender differences that suggests men and women practice humour differently. While men and women used humour to cope in equal measures, men voiced their emotions through humour, whereas women implemented humour to acquire emotional backing. Though such findings may be useful to bear in mind while working with both sexes, one must be careful not to extrapolate these results beyond this one study.
Furthermore, given the seemingly growing use of humour in therapy by practitioners, the author believes the connection between humour and wellbeing needs to be examined further. In other words, the current literature is inconclusive as to whether a strong sense of humour promotes enhanced coping and greater emotional wellbeing or whether a great sense of humour is the product of healthy self-esteem and resourceful coping skills (Martin & Ford, 2007). Lastly, humour undeniably provides robust support against the adverse effects of stress and negative moods such as depression and anxiety. That said, one would be misguided to presume that all clients require is humour to manage these symptoms, and all will be good. In other words, more research is needed to conclude whether humour is superior to other types of stress relievers. On the other hand, individuals often come to counseling to improve wellbeing and relieve stress of some kind. Thus, it would be prudent for both therapists and clients alike to contemplate the use of humour, given the qualities mentioned above in this chapter.
Conclusion
In conclusion, humour is an integral component of social interaction that presents a range of emotional advantages to an individual’s well-being. Many individuals come to therapy with the weight of severe mental health issues that must be addressed. Thus, humour has the potential to accelerate the treatment process to a significant degree. For instance, it can significantly contribute to the working mechanisms involved in severe cases of anxiety, depression, and stress. As such, Sigmund Freud recognized the therapeutic potential of humour in reducing tension (Connor et al., 2019). Proponents of the Cognitive-Behavioural Perspective also state that problems should not be taken too seriously while acknowledging that the use of humour cannot be excessive. Lastly, the Humanistic perspective considers therapeutic humour to correspond to client-centred ideas. Therefore, this approach is underpinned by considerable theoretical background.
Humour also enables clients to gain a new perspective on their concerns, guiding them through dark points in their lives toward readjustment and healing. In this way, it can help individuals remain hopeful and direct attention to more positive, light-hearted aspects of life. Moreover, leaders in the psychotherapy field state that humour positively affects both parties’ therapeutic process, as it enables improved assessment of clients’ personality, which, in turn, leads to more specific counselling strategies (Haig, 1986; Martin & Ford, 2007). Conversely, the risks inherent in the inappropriate use of this tool should also be considered. To this end, the concept of therapeutic humour has a range of opponents who criticize it for lacking professionalism. According to such authors, humourous exchange is not suitable for discussing serious matters, such as mental health and related issues (Goldin et al., 2006). That said, there is a fine line between positive, therapy-progressing humour and inappropriate mockery. The therapist’s level of proficiency, among other skills, involves being able to differentiate between these two concepts in order to implement humour effectively. Therefore, this tool should be seen as another therapeutic approach, which is, while helpful, not universally applicable. Finally, humour unlocks new opportunities in therapy by providing therapists with a tool of immense potential. If a therapist can adopt humour judiciously, its positive effects will soon become evident. People naturally desire laughter and positivity, and astute therapists must take advantage of this idea in therapy. As Rufus Wainwright once said, ‘There’s no life without humour. It can make the wonderful moments of life truly glorious, and it can make tragic moments bearable’.
References
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Dionigi, A., & Canestrari, C. (2018). The use of humor by therapists and clients in cognitive therapy. The European Journal Of Humour Research, 6(3), 50.
Dryden, W., & Branch, R. (2008). The Cognitive Behaviour Counselling Primer. PCCS Books.
Dziegielewski, S., Jacinto, G., Laudadio, A., & Legg-Rodriguez, L. (2003). Humor: An Essential Communication Tool in Therapy. International Journal Of Mental Health, 32(3), 74-90.
Ellis, A., & Dryden, W. (2007). The Practice of Rational Emotive Behavior Therapy (2nd ed.). Springer Pub. Co.
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Medard Boss, a Swiss psychotherapist and a representative of existential psychotherapy, expressed that a person cannot claim the existence of a thing if someone’s understanding does not reveal this thing. The views of Medard Boss consisted in the perception of the body primarily as an existential concept, with the help of which a person produces a bodying forth. According to his theory, just as people do not exist separate from the world, the world cannot exist differently from people.
While medicine considers the body a subject to causal and mechanistic processes, Boss does not agree with this approach. From a psychological point of view, Boss sees the main task of existential analysis in curing neuroses and psychoses by overcoming all preconceived concepts and subjectivist interpretations that have obscured existence from a person (Groth, 2019). According to his works, a person exists in existential space precisely because of the body, and the person himself, also being spatial, adheres to what is available to his perception. This means that for people, spatiality is part of an ontological structure, without which they would not exist in the world. From all of the above, there can be no object without human perception.
This idea does not seem modern and adaptive to contemporary psychology. While the opinion of medicine has not changed, and the body is still a body regardless of external circumstances, the psychological point of view radically changed the vector of existential understanding. The most common psychological opinion in the modern world has approached the medical one. This view can still be considered and discussed in theoretical psychology, but its application will no longer be justified in practice.
Reference
Groth, M. (2019). Medicine and Dasein-therapy: Medard Boss and the Beginnings of a Human Therapeutics. Free Associations, (76), 60-88. Web.
Confidentiality entails secrecy and limited knowledge of personal information in clinical practice. The limited knowledge of personal information implies that clinicians limit the information that concerns their patients depending on sensitivity and privacy. In the field of psychotherapy, confidentiality is one of the primary elements that are significant in patients that therapists interact with on a daily basis. Imperatively, it is very crucial to ensure that the information that patients or clients relay to therapists is confidential since most of them relate to issues that affect their personal lives. Therefore, several individuals prefer to have the information private or confidential.
The concept of confidentiality calls for absolute secrecy on matters that concern the welfare of patients, and thus, medical practitioners need exercise great caution in their practice. In essence, confidentiality is one of the ethics that govern the character and conduct of medical practitioners. Hence, it is within this background that the paper examines conflicts, effects of breaching confidentiality, and the proposed solutions.
Potential Conflicts or Difficulties
Confidentiality is one of the major codes that govern the conduct of therapists and other individuals in the medical arena. However, some situations compel the therapists to seek attention from third parties, who may be the family members, relatives, or close friends of the patient (Lefley & Wasow, 2013).
During such scenarios, the therapists jeopardize the role played by confidentiality in securing personal information concerning the patient. Some of the factors that compel therapists to break the confidentiality regarding patient information include abuse, court orders, and life threatening problems. Irrespective of its vital nature, confidentiality may be broken and personal information disclosed, especially if the information is sensitive and requires legal or medical attention. It is advisable for therapists to seek the consent of their clients before disclosing any information that concern their personal lives. Conversely, therapists and medical practitioners overrule the concept of confidentiality and personal consent if the information requires urgent medical or legal attention.
When individuals share information that is life threatening, it compels the therapists to share it with others in the medical field or in concerned fields. The primary objective that compels the therapists to share confidential information is the need to save the life of the individuals or those around them. For instance, if individuals have contagious diseases, therapists must share the information concerning the disease to individuals around them, and thus, save them from the infections. Moreover, information concerning abuse or violence calls for legal attention, therefore, therapists and medical practitioners need to share them with the legal authorities.
Jackson (2013) explains that medical practitioners can only disclose personal information if the information calls for legal or medical attention. Issues such as abuse require both medical and legal attention, and thus, regardless of patient’s refusal to grant consent in sharing of information, therapists should share the information with the relevant authorities.
Whenever, therapists share personal information concerning an individual with the relevant authorities, it leads to conflicts. As a result, several therapists face legal suits filed by individuals, who become annoyed when they realize that the psychotherapist shared their personal information (Dutton& Sonkin, 2013). Medical practitioners and therapists face a dilemma when they come across information that requires legal or medical attention.
The dilemma relates to the need to share the information with the legal authorities or the medical officers and the need to uphold the confidentiality code that requires secrecy and limited sharing of information. Furthermore, the dilemma of sharing information and upholding the code of confidentiality creates some difficulties among the medical practitioners or therapists. The difficulties arise because, while psychotherapists practice confidentiality of information given by their clients, they must share information that has public interest with relevant authorities.
Effects on Client Well-Being
The effects that transpire when medical practitioners and therapists fail to share information about the client are diverse and have different consequences. Some of the effects include continued abuse, absence of justice, and death. Creek and Lougher (2011) explain that in cases where the life of an individual is in danger, there is a need to share the information with concerned authorities. Therefore, it is crucial for psychotherapists to weigh the information relayed by their clients, so that they can ascertain whether to share or treat as confidential. The type of information that an individual shares determines whether to retain them as confidential or breach the code of secrecy.
If the information concerns an abuse or contagious disease, medical practitioners or therapists must share the information with the relevant fields so that the welfare of the individuals and those around them is sustained or improved.
The well-being of the client is affected since the problem that requires medical or legal attention fails to receive the expected system of redress. As a result, the problem remains and continues to affect not only the subject individuals, but also those around them. For instance, if a psychotherapist receives information concerning sexual abuse and upholds the code of confidentiality, the perpetrators do not receive the required justice, and thus, continue with their heinous acts. It is imperative to highlight that the therapists and medical practitioners breach the code of secrecy with the intention of improving the welfare of the public or individuals at risk.
Lefley & Wasow (2013) elaborate that, in some cases, medical practitioners share personal information and breach the code of secrecy in the quest to improve the livelihood of the public. Essentially, therapists need to share information concerning an individual if it relates to their lifestyles since it helps relatives, friends, and the family to understand how to handle them.
Therefore, absence of information from the psychotherapists to relevant authorities can result in continued suffering and extended engagement of heinous and unlawful activities by criminals and abusers. In extreme cases, the suffering of an individual leads to death, especially if the therapists retain their confidentiality and disregards the need to share the information to medical practitioners or legal authorities. According to Jackson (2013), the need to share personal information is relevant if its magnitude is serious and requires urgent medical or legal attention. If a therapist gets information from a client concerning certain disease, which has a high mortality rate and keeps it confidential as per the will of the client, there is likelihood that the outcome can be the death of predisposed individuals. As a result, it is very significant for psychotherapists to ensure that they ascertain the effect that information shared by their clients has on their personal well-being.
Effect of Conflicts on Therapist’s Practices
Since personal information is very crucial and requires high levels of professionalism and confidentiality, therapists need to exercise outstanding levels of integrity and expertise. Remarkably, sharing personal information of a client leads to distrust and negative publicity among the clients. As a result, it is important for psychotherapists to ensure that they exercise professionalism in their daily activities so that they can win the trust of their clients, receive information from them, and administer the required solutions. Since therapists subject themselves to conflicting situations that need clear definitions on what is ethical and legal, they are always in a dilemma (Gillingham, 2013).
The dilemma exists since ethics dictate that the information shared by the client should be confidential and any breach is a violation of the law, whereas the legal framework of dictates that information concerning issues such as abortions or sexual abuse need medical and legal attention. These dilemmas affect the daily activities of therapists and modify how they undertake their operations.
The need to exercise professionalism is a dictation that occasion due to the dilemma between the obligation to share information and making it confidential in line with the ethical requirements of the society and the client. For effective psychotherapy, trust is very important as it facilitates sharing of information between the client and the therapist, and thus, delivery of the necessary solutions (Dutton & Sonkin, 2013).
Fundamentally, it is advisable that psychotherapists seek the consent of the client before sharing their personal information. While the client’s consent is important before sharing personal information, cases such as refusal of consent to share compels therapists to breach the secrecy code and give the information to the required legal or medical authorities. For example, if a person shares information concerning sexual abuse to psychotherapists, it is expected that the therapists relay the information to the legal authorities so that they can undertake the required legal procedure and deliver justice to victims.
Proposed Solutions
Although confidentiality is one of the important codes that govern the conduct of psychotherapists, some of the information require medical or legal attention, and thus, lead to the breach of this code. Some of the solutions include the consent of the client and empowerment of the society concerning countermand confidentiality. Since therapists need to sustain the trust of their clients, they need to execute the act of sharing information without compromising their rights.
Therefore, there is a need to engage in some activities that reduce the effect that the breach presents to both the clients and the therapists. When therapists receive information that needs medical and legal attention, or is life threatening, they must use the required expertise to explain the seriousness of the problem to the client. The therapists must undertake the explanation in a manner that does not only give the clients an assurance, but also makes them consent to the sharing of information. According to Lefley & Wasow (2013), all information given by the client to the therapists is confidential, unless the client consents to its sharing. Therefore, by getting the consent to share the information, conflicts and difficulties associated with the sharing of personal information reduce.
Empowerment of the society is another solution that helps reduce the effect of conflict among clients, the society, and the therapists. When the society achieves empowerment and receives the knowledge concerning what information goes beyond the code of confidentiality, it becomes easy to share the information with the relevant authorities, as they have a prior understanding. Imperatively, the society needs to understand that irrespective of the code of confidentiality, some information overrides the code and compel psychotherapists to inform medical practitioners or the legal authorities for their benefit and those around them. Gillingham (2013) explains that therapists need to apply professionalism and reason together with the clients so that conflicts that emanate from shared information reduce. It is significant to elucidate that reasoning together of the clients and psychotherapists can take place effectively if the clients have the required skills concerning what needs sharing and what calls for confidentiality.
Conclusion
In the field of psychotherapy, confidentiality of personal information is very crucial. The crucial nature of the shared information is due to its sensitive nature and the obligation to retain the trust of an individual. Conversely, there are situations that compel therapists to share the information given by their clients to medical practitioners or legal authorities so that they can administer the right system of redress. When psychotherapists share personal information, conflicts arise because subject clients become annoyed and sue them in court for breaching the code of ethics. Client consent and public empowerment regarding confidential information and delineation of what requires sharing are among the solutions that minimize conflicts related to sharing of personal information.
References
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When providing counseling, it is essential for a therapist to possess the right skills. This means that the individual should be certified by the professional body in his or her country (Murphy & Dillon, 2011). Further, the person should have been exposed to situations that he is qualified to handle. It is assumed that certification arises out of supervised exposure to different clinical situations. If a clinician takes on a case that is beyond his or her area of expertise, then a more experienced professional should accompany him or her. During training and on the job, a counselor should know how to read nonverbal and verbal communication. This skill is almost obligatory in effective psychotherapy. Additionally, the person should know how to use a client’s context in understanding his or her case. Having strong emotional attentiveness is also necessary for therapy as one can select the right locations or the right approach to use on a patient.
Strong attending and listening capabilities are also indispensable in counseling. This means that one should refrain from judging the client or his situation. No single individual operates in a value-free world, but the most effective counselors are the ones who can truly listen to a client without imposing their values on them (Murphy & Dillon, 2011). Great interviewers are able to accept the fact that a client has different views and will, therefore, assess situations using different standards. With regard to listening and attending, a clinician ought to be patient with a client even when the client lushes out against him or her or when progress is slow.
One should be sensitive to the ethical and multicultural aspects of a client. Sometimes the client’s race, social class or background has a strong effect on the outcome of the counseling process. Therefore, a good counselor should be aware of those differences and use them for the benefit of the client. However, effective psychotherapy also entails detaching stereotypes about certain groups from the reality of a client’s experiences. For instance, while African Americans tend to be more sensitive to nonverbal communication, not all of them will possess this trait. Some of them may request for plenty of verbal clarifications. Therefore, it is the counselor’s duty to detect these generalities as well as individual differences. When handling clients that come from a background that differs greatly from the counselor’s, it is necessary to use members of that community to learn about hidden cues and to make clients as comfortable as possible (Murphy & Dillon, 2011).
Ethical and diversity issues in counseling responsibly
Ethical issues in responsible counseling stem from ethical standards and principles governing the profession. A counselor ought to merge his or her personal values on ethical practice with industry practice especially when solving ethical dilemmas. Nonetheless, certain rules of thumb exist when carrying out responsible counseling. A session ought to be confidential and private. No information should be dispensed to parties outside the clinical setting. Further, the client and counselor should refrain from interacting in another professional capacity outside the client-counselor relationship. For instance, a counselor who does retail business with a client may not appear professional to the client in the clinical setting. Additionally, a counselor should not have a sexual relationship with previous clients (Murphy & Dillon, 2011). It is unethical to counsel individuals who are related to or who know the counselor because this may impose an additional burden on the client. Counselors ought to make sessions as comfortable as possible for the client without crossing certain boundaries. For instance, holding the client’s hand may sometimes be appropriate when this will strengthen clinical outcomes. Decisions should be based on the therapist’s discretion.
Diversity issues in counseling stem from the fact that a counselor and a client will always have different worldviews. The two entities may not belong to the same age, social class, ethnicity, gender or sexual orientation. Consequently, the way they see the world will be quite distinct. Responsible counseling involves first understanding the counselors own worldview. This involves knowing all about his or her cultural attitudes, backgrounds and beliefs. Counselors should also be aware of the limits of their multicultural competence. Furthermore, they need to have knowledge about cultural stereotypes, discrimination and depictions of culture in daily settings such as work. Since they know their limitations, responsible counselors will seek help when working with culturally divergent clients. Additionally, diversity issues also involve understanding the client’s worldview. First, the counselor should know about his or her own biases against the ethnicity or group that the client belongs to. He or she should also know about the manifestation of biases against the group and whether cultural background has an effect on a patient’s psychological issues. Some sociopolitical issues may affect individuals from certain groups, so a counselor should be able to delineate these macro effects from the client’s personal psychological issues. A responsible counselor should address clients in a language they understand and should endeavor to learn more about the client’s group. He or she ought to work towards eliminating cultural biases on his part in order to enhance clinical outcomes (Murphy & Dillon, 2011).
Reference
Murphy, B. & Dillon, C. (2011). Interviewing in action in a multicultural world. Belmont, CA: Brooks.
Difference between thought-focused treatment and psychodynamic techniques
Thought-focused treatment and psychoanalytical methods are used to achieve similar goals in the treatment of psychological dysfunctions, but there exist differences in the two approaches. The first variability arises in the application. Thought-focused treatment relies heavily on mental comparisons. It can be applied as a stand-alone method, or it can be combined with other nonpractical approaches. Moreover, the complexity of the human thought process between different individuals makes this approach rigid. On the other hand, cognitive treatment approaches are potent and flexible, with a wide range of applications. Usually, the application of the thought-focused treatment comes with a range of benefits that act as its strengths. For instance, accessing our thoughts is a minor task for anyone (Seligman & Reichenberg, 2009). When we decide to contribute to a particular subject area, our mind’s recollection of the said subject allows us to demonstrate how much we know as well as to conduct a meaningful conversation with different people.
Moreover, it is of vital importance to note that therapists who prefer a thought-focused treatment approach spend time easier and less demanding than those who gain information about the patient’s feelings from the victims themselves. In addition, writing down one’s thoughts and conducting an analysis are easy tasks, but cognitions offer resistance to alterations and analysis. According to most therapists, the largest difference between the two methods exists in the speed at which one responds to positive gains in the first few stages of treatment. Thought-focused treatment offers faster reception, which is easily noticeable from how optimistic and motivated the patient becomes. These positive changes in the patient boost the treatment process. On the other hand, psychoanalytical psychotherapy takes up more time and hence slows down the treatment process. The delay results from the long period required in order to alter one’s behavior.
REBT Irrational beliefs
According to REBT, there are twelve irrational beliefs held by humans. They include the following (Beck et al., 2006).
There is a notion that there is an utmost necessity for adults to be loved by significant others for all they do.
Certain actions are classified as awful and iniquitous, so people who commit them are judge to be sentenced to eternal damnation
There exists the idea that things are horrible when they do not meet our expectations
The human misery is invariably externally caused and forced on us by outside people and events
Whenever something seems dangerous and fearsome, we should react by being extremely upset and continuously obsessed about it
There is a thought that it is easier to avoid than to face life challenges and responsibilities
There is also a belief that we have to have something that is of greater strength than we have for us to rely on
People believe our competence and intelligence should be unmatched and lead us to achieve success in all spheres of life
All things that have previously affected us are supposed to forever exert a similar influence on us
We should always maintain steady and faultless control over everything
The idea is that ii is possible to achieve human happiness through inertia and inaction
Our emotions are considered to be beyond our control, and we, therefore, cannot help but feel disturbed about various things.
Examples
The belief that human woes are due to external forces implies different people or events exert external pressure on our lives resulting in the human misery we later experience. For instance, people often get involved in fraudulent activities in search for quick ways to get rich. In the process, they lose the little they had and get into financial difficulties. It is common for such people to lay the blame on the federal government whereas they make the decision to engage on the fraudulent activity on their own.
Another belief states it is of vital importance for grownups to be loved by all the other people around them for the actions they take. For example, there are people who spend a larger part of their lives doing things to please others and win their approval rather than achieve self-fulfillment. Another unreasonable belief is the notion that all things are horrible simply because they did not turn out as per our expectations. A perfect illustration of such a situation would be a talented mechanic who is faced by a vehicle mechanical failure to which he cannot find a possible solution. Since he has to do that as stipulated by the job contract, he slides into a panic attack. The mechanic then begins to perceive everything in a pessimistic manner and believes his life is ruined due to his minor predicament.
Cognitive Distortions
One of the greatest contributors to the study of cognitive therapy as a treatment approach for depression and other mental problems was made by Aaron Beck. Cognitive distortions refer to the conviction in our minds that some things are true though they do not exist in reality. The misled thoughts result in negative thinking lowering our self-esteem. The first cognitive distortion advanced by Aaron Beck is filtering (Beck et al., 2006). It refers to how humans pinpoint the bad side of a situation and make it look significant.
The second distortion is polarized thinking. This refers to situation where people can only be categorized into two extremes of evaluating a situation. For instance, those who are not perfect are meant to fail; there exists no golden mean. The third is overgeneralization. Under this cognitive distortion, people simply arrive at a general conclusion immediately after the occurrence of one incidence. They feel that the single event is the first in a series of other incidences to follow. For example, a person who performs poorly in his first mathematical unit in campus may jump into the conclusion that he/she is extremely poor in all mathematical units and, therefore, cannot pursue them.
The fourth cognitive distortion advanced by Aaron is the expectation of the occurrence of a disaster. It refers to the use of statements on the occurrence of a situation simply because we have heard of it from someone else. For instance, after the Tsunami that hit the ocean bordering nations, all other countries surrounded by huge water bodies, such as sees, might begin to say, “What if it happens to us”. This statement depicts the anticipation of a disaster.
Another cognitive distortion is that of personalization. This refers to a situation in which a person believes he/she is to be blamed for anything that happens in any situation he/she is involved. It results in comparison of who is smarter or more gorgeous of the two parties involved. For instance, a teacher on duty in a school may choose to return home early since the students under his supervision seem calm and responsible. However, a few hours later, an incident arises in which students get into a fight and one is killed. The teacher may feel responsible for the student’s death because his/her early leave could have triggered the incident (Seligman & Reichenberg, 2009).
The sixth distortion is the fallacy of fairness. This occurs when we are faced by feelings of resentment because we feel other people are faulty since they do not necessarily agree with our definition of fairness. The seventh distortion is blaming in which people blame others or themselves for everything that happens. However, it is vital to note that no external party can influence one’s emotional control or reaction without one’s consent. Other distortions include emotional reasoning, fallacy of change, global labeling, always being right and heaven’s reward fallacy (Beck et al., 2006). Heaven’s reward instills the expectation that all the sacrifices of self-denial should be repaid in equal measure. Whenever our expectations are not met, bitterness engraves us. For instance, a person who spends a large part of his/her time doing voluntary jobs for an organization only hopes of securing employment to be sent away in the long run.
Shaping
This refers to the approach taken in effecting a steady modification of one’s behavior. The effectiveness of the shaping process is dependent on the approximations of the targeted behavior and the strategies used to lead to a change in the behavioral pattern of the patient. For instance, Seligman and Reichenberg (2009) offer four steps that can be used in overcoming social anxiety and, therefore, improving their interactions with different people. The first step stipulates that a person should take the first five to ten minutes at any social function before trying to hold a conversation with anyone. Another five to ten minutes during which one should greet at least two individuals should follow. The third step is to take the next 15 minutes to make a formal introduction of oneself to a person and ask a question in his/her turn. The final step is to repeat the previous step and develop a conversational discourse.
Token economy
A token economy refers to a form of behavioral alteration that promotes desirable behavior and cuts down objectionable conduct by use of tokens. Tokens are awarded to encourage the display of the desirable behavior. During certain times within the treatment schedule, the tokens are collected and exchanged for a valuable object or dispensation. The application of the token economy is most effective in group settings, such as hospitals, schools or prisons where the conduct of one or more individuals may be belligerent and unpredictable (Seligman & Reichenberg, 2009). However, the overall goal of the token economy is to teach acceptable behavioral tendencies that can be used in one’s daily operations. However, this does not overrule the fact that token economies can be used individually.
For the token economy approach to be effective, there are certain requirements to be followed. The first of these is the token, which should be something that is physically attractive. Others include a precisely defined behavioral target, back-up rein forcers, a way of exchanging tokens and recording the data. Finally, there should be constant execution of the token economy by the staff.
References
Beck, A.T., Freeman, A., Davis, D.D. & Associates. (2006). Cognitive Therapy of Personality Disorders, (2nd ed.). New York: Guilford Publications.
Seligman, L. W. & Reichenberg, L. W. (2009). Theories of counseling and psychotherapy: Systems, strategies, and skills. (3rd ed.). Boston: Pearson.
In 2000, Shay Joseph and Wheelis Joan co-edited the book “Odysseys of Psychotherapy.” This book offers a set of 18 essays by leading psychotherapists representing diverse disciplines and programs in London and the United States. The book consists of personal descriptions of the psychotherapists’ evolution, about preliminary family upbringing, and the pursuit of the psychotherapy profession, as well as their initial training and mentors. The book also depicts the moments in their career paths and the encounter, which inspired them to change or modify the beliefs in which they were first nurtured.
Main Body
Shay and Wheelis argue that the fundamental metaphor of the book is the fact that the change processes in the field are reproduced in the changed process themselves in exceptional and thoughtful psychological counselors (2000, p. 7). Nevertheless, they proceed to say that senior psychotherapists do not reproduce all the perspectives. Shay and Wheelis hope that their selection is wide and sufficient to elucidate a leading force of the volume that, a broad set of therapists has common critical conclusions yet they differ broadly from each other.
Certain contributors expose rather outspoken anecdotes of their respective personal family history, rearing, and encounters that drove them to consider the discipline of psychotherapy and psychiatry as their career paths. Also, the majority of the participants commenced their professional career paths guided by, and maintained, a fundamental psychoanalytic view on the conventional imposing paradigms of psychopathology.
Nevertheless, virtually all the contributors discovered that, in their clinical encounters, this conventional model was not often effective in addressing many of the cases they encountered in practice. Consequently, most of the psychotherapists experienced a drift from theory and technique towards a more dynamic, interactional, and interpersonal two-people psychological perspective method of therapy. In this light, they demonstrated how unique life events and circumstances influenced their judgment and approach to psychotic patients in their intervention practice.
Further, the authors underscore the influence of the contributors’ mentors on their philosophical and practical work. The majority of them attribute their change in understanding, to certain personalities or groups, including the realization that ensued during the interaction process between the mentor and their retrospective client.
Apart from the main text of the body, the authors write two chapters of their own, at the start and end of the book. They summarize the vital substance of the book and the psychotherapist involved. They underscore how the theory and approaches of psychotherapy were developing. The past psychotherapy models and events are currently the baseline from which prospective improvement, alterations, and evolution will happen.
Personal Opinion
Shay and Wheelis wrote a captivating and diversified set of essays and encounters of psychotherapies derived in the immediate post-WWII period of customary psychoanalytic models, and who concurrently diverged in their practical approaches driven by their clinical experience and incorporated with the judgment of their mentors. Hence, it reflects the varied theoretical and practical paradigm presented to the growing psychotherapist and the challenges of distinguishing individual theoretical understanding and intervention from the preliminary psychological, interpersonal, and educational experiences of a person taking up a therapist role.
Conclusion
Reading this set of essays teaches a historical view of the evolution and alterations of psychotherapeutic approaches other than the standard paradigm of classical psychoanalysis, and its relevance to the diversified range of clients presenting with psychological disorders for help and treatment. Its diversity and the captivating vignettes given, explaining such evolutionary alterations is significant; moreover, trainees and professionals alike can easily read and understand them.
Reference
Shay, J., & Wheelis, J. (Eds.). (2000). Odysseys in Psychotherapy. New York: Ardent Media Inc.
In modern highly multitasking and stressful life, many people tend to encounter psychological problems. They are manifested in personal relationships, career, and self-understanding issues that inhibit a balanced and harmonious life. It is widely recognized that childhood problems can cause difficulties in adulthood. Attachment-based psychotherapy is one that explores how one’s childhood experiences affect his or her current social and psychological challenges (Diamond et al., 2021). This paper aims to scrutinize attachment-based psychotherapy, including its theory, practical implications, and clinical effectiveness, thus contributing to psychotherapy research.
Overviewing Attachment-Based Psychotherapy
Many people visiting psychotherapists have disorganized and insecure attachments. Accordingly, they are also likely to mistrust specialists and fail to communicate constructively. Slade and Holmes (2019) state that attachment-based therapists act as change agents by serving as a reliable base (Slade & Holmes, 2019). The core of this therapy modality refers to discovering a client’s childhood experiences and rebuilding them by working on attachment regulation. The main goal of the therapist is to help the client connect with his or her inner child without judgment. These assumptions are based on an attachment theory developed by clinicians John Bowlby and Mary Ainsworth. Even though the theory was elaborated in the 1950s, it was seriously researched and accepted by practitioners only after decades (Slade & Holmes, 2019). The practice techniques of the mentioned psychotherapy show that attachment is likely to moderate treatment effectiveness. Among the potential improvements resulting from a series of attachment-based therapy sessions there are emotional expressivity, relationship satisfaction, adequate self-esteem, decreased depressive and anxiety symptoms, and a more stable mental state.
Discussing Theoretical Perspectives
The attachment-based psychotherapy uses an attachment theory that explains how children tend to be attached to their caregivers from birth and across early development. In building their theory, Bowlby and Ainsworth focused on Freud’s psychoanalysis, paying special attention to the first years of a person’s life, when a mother and a baby are in a close interaction that largely determines the further development of the child (Levy & Johnson, 2019). However, the authors considered that from an early age, a child has all the prerequisites for inclusion in social life, while from Freud’s point of view, the infant is aimed at the mother as a source of satisfaction for his or her needs. According to Bowlby, children are highly dependent on their adults, which means that they must have special behavioral mechanisms that would guarantee security.
The attachment theory explores the interpersonal connections between two people, which determine both the mental and psychological structure of a person, such as an attitude toward herself or himself, the world, various experiences, cognitive and creative abilities, et cetera. Since the first connections with another person arise in infancy age, the experience of relationships gained in early childhood is natural (Diamond et al., 2021). Without proper relationships, grown-up children may feel confusion, insecurity, depressive symptoms, anxiety, and other negative experiences. Therefore, by building attachments with caregivers in early childhood, future adults can avoid many problems (Diamond et al., 2021). In turn, those who fail to achieve it as children for any reason can work with therapists to rebuild their attachments.
The so-called object of attachment (attachment figure) is one of the central concepts of attachment theory. In many cases, this person is the mother for most people. However, a blood relationship does not play a special role since, in the absence of a biological mother, anyone who is able to establish an attachment relationship with a child can replace her. According to Bowlby, the key function of the attachment figure is not to satisfy the innate need for love (as in classical psychoanalysis) and not to satisfy the physiological needs of the child (as in behaviorism) but to provide protection and security (Green & Scholes, 2018). Therefore, the presence of attachment is a necessary condition for the exploratory behavior and cognitive development of the child.
The working model is another fundamental concept in terms of the attachment theory. Being introduced to rethinking and developing the psychoanalytic concept of relationship it is extremely important in the context of the attachment theory. Green and Scholes (2018) state that Bowlby suggested that in the process of interacting with other people and surroundings, an individual constructs working models of the most significant aspects of the world. Using them, a child perceives and interprets various events. A working model may be visualized as the deep structure of self-consciousness or attitude, although the relationship of this model to consciousness is highly ambiguous (Green & Scholes, 2018). Children do not realize themselves as individuals, but they perceive and understand themselves and the world around them through working models. It should be stressed that a working model does not lend itself to a specific description and scientific analysis as it is a dynamic and adaptive modality.
Discovering Practice Techniques
There are two key processes that are practiced in attachment-based therapy, such as building secure relationships and strengthening the adaptive capacities of a person. These processes refer to those specific feelings, thoughts, and behavioral patterns that were learned in childhood to avoid or facilitate certain connections. Therapists begin the first process by creating trustful and open relationships with clients to ensure their comfort and safety. Diamond et al. (2021) emphasize that the quality of these relationships largely determines the effectiveness of psychotherapy. In particular, they use the elements of security-engendering relationships to create responsive attitudes around difficult issues for clients. Therapists also practice both discovery and communication of emotions and feelings that cause frustration (Diamond et al., 2021). In other words, they focus on what specifically patients cannot feel, think, or perceive in a safe way. It allows for enlarging clients’ adaptive capacities to suppress or emphasize early childhood attachments.
Speaking about practice techniques adopted in attachment-based therapy, it is critical to mention that the recognition of attachment dynamics is its cornerstone. As clarified by Slade and Holmes (2019), “The invitation to give voice to one’s emotions in therapy will invariably activate different defenses in different patients” (p. 161). Therapists are to notice the moment-to-moment efforts of patients and adjust the way they provide sessions. Openness and flexibility foster further exploration of a client’s experiences, also giving a resource to change them in a positive way. Slade and Holmes (2019) also add that a client’s attachment orientation can be approached in different ways. For instance, affective interventions are preferable for preoccupied patients, while avoidant patients would benefit from cognitive interventions. Furthermore, experienced therapists reported that they tended to apply a complementary style of discussion during the first sessions with clients (Slade & Holmes, 2019). However, upon the establishment of trust between them and their patients, they switched to responding in an out-of-their-style manner to facilitate change.
Considering the emphasis on the caregiver-child dyad, a number of interventions for caregivers were developed. In real-life interactions, it is recommended to communicate with children in a positive and sensitive way (Levy & Johnson, 2019). As an example, a “Circle of Security” intervention integrates group discussions, didactics, and video recordings for parents. Another mother-infant therapy strategy implies infant-led play to reinforce a child’s security and autonomy. Levy and Johnson (2019) prioritize caregivers’ ability to “mentalize and increase their own sensitivity, responsivity, and attunement to their children” (p. 190). While this strategy is helpful to children’s attachments, it does not treat caregivers’ psychopathology, specifically depression (Levy & Johnson, 2019). However, the authors also suggest that further research is necessary to better understand the impact of attachment-based parenting on care providers, which is extremely important for high-risk populations.
Evaluating the Effectiveness of Attachment-Based Psychotherapy
Compared to other traditional psychotherapy models, such as cognitive-behavioral therapy or interpersonal therapy, the body of research regarding attachment-based therapy is limited. Nevertheless, it is possible to discuss a range of recent studies that demonstrate a high level of effectiveness in working on attachments. Waraan et al. (2021) conducted a controlled-randomized trial to analyze the role of the mentioned therapy in treating depression in adolescents. The authors used attachment-based family therapy (ABFT), blinded evaluators at the baseline and post-treatment by means of the Hamilton Depression Scale and Beck Depression Inventory. As a result of analyzing 60 adolescents, the research found a significant reduction in depressive symptoms compared to traditional psychotherapy (Waraan et al., 2021). However, final remission rates showed no distinctive difference between the two mentioned models of psychotherapy. These results indicate that depression in adolescents is complicated and requires a combination of methods to overcome it. At the same time, the authors note that no other model of therapy based on family sessions is more effective for addressing depressive symptoms.
Other scholarly studies also confirm the development of primary adaptive emotions in adolescents through ABFT. Another relevant study by Lifshitz et al. (2021) focused on attachment-based family therapy in 39 suicidal adolescents in terms of a randomized clinical trial. During and after 16 working sessions, the participants demonstrated a shift from general distress to maladaptive shame, which turned to adaptive assertive anger and then to subsequent grief/hurt (Lifshitz et al., 2021). The clinical significance of these results refers to identifying a specific pathway to developing adaptive emotions. The ability of family therapy to impact patients’ perception of self and others is also reported by Levy and Johnson (2019), who point to the reduction of social deprivation and psychological discomfort. For example, many patients report feeling shame as a link to their childhood, and the ability to remember or imagine specific situations is critical as the initial step of attachment therapy (Levy & Johnson, 2019). This strategy allows working with loss, loneliness, pain, and even vulnerability, which appeared in childhood and/or adolescence.
Speaking about the effectiveness of attachment-based psychotherapy for adolescents, it is essential to note that many therapists use its principles. Cognitive-behavioral therapy and interpersonal therapy employ the assumption that attachment constructs between a counselor and a patient largely determine the outcome of treatment (Green & Scholes, 2018). More to the point, transference-focused psychotherapy (TFP) and supportive psychodynamic psychotherapy (SPT) have an emphasis on developing collaborative engagement as the basis for psychotherapy success (Levy & Johnson, 2019). These findings indicate that attachment-based therapy is flexible and adaptive, which means that its principles can be applied in different contexts. In particular, not only major depression but also binge eating disorders, social isolation, and borderline disorders can be approached by means of working with attachments. The mentioned therapies are found to enhance responsiveness and sensitivity in patients, which leads to encouraging interpersonal and intrapsychic effects.
Further research needs to explore the areas in which attachment-based psychotherapy may benefit clients. The so-called in-session effects, as well as attachment constructs, should be targeted as research prospects. In addition, children’s and caregivers’ attachment styles can be examined in future studies so that practitioners can utilize new knowledge regarding current styles adopted by both parties. In general, there is a need to connect research and practice regarding attachment-based psychotherapy since only a few recommendations are presently made for therapists.
Conclusion
To conclude, it should be pinpointed that attachment-based psychotherapy aims to transform negative childhood experiences by building trustful relationships and extending one’s capacity for adaptation. This modality of psychotherapy is based on Bowlby’s theory of attachments, which prioritizes the connection between children’s early childhood and their caregivers. The review of the related literature shows the moderate effectiveness of attachment-based therapy, which is caused by the complicated nature of treating depressive and suicidal symptoms. As a relatively new modality of psychotherapy, the work on attachments presents a promising way for therapists to better understand clients’ needs and choose the best interventions to help them.
References
Diamond, G., Diamond, G. M., & Levy, S. (2021). Attachment-based family therapy: Theory, clinical model, outcomes, and process research. Journal of Affective Disorders, 294, 286-295.
Green, M., & Scholes, M. (2018). Attachment and human survival. Routledge.
Levy, K. N., & Johnson, B. N. (2019). Attachment and psychotherapy: Implications from empirical research. Canadian Psychology, 60(3), 178-193.
Lifshitz, C., Tsvieli, N., Bar-Kalifa, E., Abbott, C., Diamond, G. S., Roger Kobak, R., & Diamond, G. M. (2021). Emotional processing in attachment-based family therapy for suicidal adolescents. Psychotherapy Research, 31(2), 267-279.
Slade, A., & Holmes, J. (2019). Attachment and psychotherapy. Current Opinion in Psychology, 25, 152-156.
Waraan, L., Rognli, E. W., Czajkowski, N. O., Aalberg, M., & Mehlum, L. (2021). Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics. Child and Adolescent Psychiatry and Mental Health, 15(1), 1-14.
Co-dependency is the need to maintain a one-sided relationship that can either be emotionally destructive or abusive. In psychotherapy, confronting co-dependent behavior enhances self-assurance and self-acceptance. Essentially co-dependency in clinical support determines an individual’s ability to form and maintain healthy and mutually satisfying relationships and is leveraged in therapy to enable patients to relieve stress-related or depressive symptoms and foster healthy relationships. Psychological reliance on family members and relationships is predominant in therapies linked with the family systems theory to enhance emotional functioning. Co-dependence in clinical settings is well-defined and understood when linked with the Family Systems theory that posits that the family is the most single, interdependent unit of emotional support.
The family has the highest potential to form intimate relationships and confront overreliance behavior with the appropriate psychoeducational intervention. Scaturro et al. (2014) underscore that co-dependence fusion may influence emotional distress if not applied using the appropriate strategies. For instance, psychoeducational intervention ought to distinguish between co-dependence and normative nurturant behaviors to avoid overgeneralization by the partners. However, Lee (2014) highlights the shortcomings and limitations of co-dependence, including language, the end of the relationship, training addiction professionals, and shaping perceptions. Integrating co-dependence with the family systems theory requires appropriate measures to enhance complementarity.
The research position that co-dependency is practical in the context of family systems theory since families form the strongest bond to determine an individual’s behavior. The research position by Scaturo et al. (2014) indicates how family systems theory can be used to influence emotional attachments and practical treatment while articulating family dynamics that may inhibit co-dependency treatment. Helping the family understand a new perspective of how addiction and its influence on the patient’s behavior positively implicate co-dependency.
Scaturro, D. J., Hayes, T., Sagula, D., & Walter, T. (2000). The concept of co-dependency and its context within family systems theory. Family Therapy: The Journal of the California Graduate School of Family Psychology, 27(2). Web.