Category: Therapy

Sandplay therapy employs the use of numbers and the placement of sand in a section concealed by the sandbox. The therapy creates an impression of the world that is equivalent to the client’s inner state. The play is liberated and artistic because the unconscious progress can be viewed from three perspectives in addition to the pictorial view that resembles a dream scenario.

The therapist can achieve personalization of visions through sequential arrangement of the images as explained by C.G.Jung, which eventually causes the procedures to be induced to ensure the desired results are achieved.

The approach which analytical psychology tries to employ, which Jung identified as the course of individualization, can be defined as the steps that human beings go through to find themselves.

By finding themselves, the humans are able to overcome the doubts and actually incorporate those other arguments with this concept. Being aware of one’s self is the most crucial element of human beings, and according to Jung, the course of finding one’s self commences at birth.

Sandplay applies to both adults and children, and is useful in directing the path to follow if it is necessary to unveil the attributes of unconsciousness. The therapist issues clients numeric figures, which they use to refer to their inner being and thus, act as connectors between their inner-self and the real world. Sandplay tries to fill the vacuum created by lack of finding oneself and success implies that the vacuum is close to being eliminated.

Sandplay empowers the client to overcome the obstacles that define our formation and the worries, and be able to build a commendable bond with the play. When the play carries the client, it becomes possible to experience the inner image of oneself.

It is then obvious that there is creation of a bridge that connects the two worlds: internal and external. The pressure depicted by the images molds the sandbox. The sandbox unveils the fantasy, which strives towards boundlessness, and assumes a definite shape.

The definite shapes dictate the extent that the desire can go. The shapes create a barrier for the desire such that it remains confined. This means that the desire can explore the area within the compartment.

The therapist presents a wide array of numbers to the patient to help him/her choose the appropriate cluster of numbers for building the world that is close proximity. On the other hand, the client can decide to designate one particular number in this process. Clients are fond of this approach because it enables them to figure the issues that are bothering them.

However, it is important to note that the procedures are placed in a sequential manner such that what is not known is at the front line followed by what is known. The element is expected to dictate the path to be followed by the procedures. When the play is in progress, the client is under obligation to adhere to the rules laid out by the elements at the forefront.

The play assumes the role of a negotiator between what can be seen and what cannot be seen and thus, it has extra ordinary attributes for it to be effective in this role. It is also said to be neutral because it does not discriminate any side.

The other significant bridging element revolves around the body and its soul. The picture is portrayed in the sand to enable us identify the relationship that exists between the two entities. It is apparent that the procedure undertaken during molding session can be very intensive and thus, is capable of arousing strong feelings if the elimination of the vacuum is realized in the form of a cute mandala.

It is necessary to create a free but manned area to facilitate the landing of inner forces once expelled. This liberated area makes the client develop a strong feeling of attachment and hence eliminate the fear of rejection.

Similarly, the therapist has a mandate of creating room for the mentioned area and defines its outline. By forming the outline of the free area, the therapist implies that he/she is aware of the strengths and weaknesses of the client and the boundaries used to contain the situation to ensure it does not get out of hand.

This initiative helps to build the client’s trust towards the therapist, and without it, the therapy cannot achieve any results. By building on trust, the probability of failure is not hidden but it is rather brought into the limelight and then manipulated in favor of the client.

At analytic stages of Sandplay, the procedures commence and during this period, various characters represent the areas that lack awareness. The landscape first implies that the problem is in close proximity to self-realization, but is hindered by the traces of the challenge.

On many occasions, analyzing the first step can help in predicting the answer and the appropriate approach for implementing the answer to realize the guaranteed. By predicting the challenge’s possible route, we are able to create answers and place them in strategic routes.

The visions that follow guide the entire session towards engulfing the intensity of awareness with the aim of preventing it from escaping while at the same time penetrating into the inner compartment of the individual to explore the subsequent landscape.

The images develop a lot of resistance to exploration as a sign of what lies ahead. In most cases, the patient becomes cooperative at a later phase, which suggests that vacuum has already been filled – Jungian terminology refers to it as self. The psychic encounter ensues and it causes internal ignition of one self and later on causes the spirit to communicate with the body.

The desire of wanting to fill the vacuum diminishes because it discovers that the need was met prior to demand. This realization forms the bond between awareness and lack of awareness. The encounter stirs the processes that favor change.

In essence, we can say that completeness of desire and realization of oneself, which is comprised of body and spirit, becomes an ambition and uses the situation as the platform for initiating change rather than an opportunity for showcasing abilities.

The above argument is based on the possibility of internal progress and thus, we can be certain that the client’s connection with the changes of the internal vision enhances the approach, and avails an artificial appearance to them.

Judging from previous encounters, having inclusive dialogue with the clients and explaining to them the concepts of the sandplaying therapy can actually induce clients to be cooperative while going through the treatment sessions, which is essential in achieving the objectives of the therapy. The sandplaying therapy relies on the relationship between the two entities that is the therapist and the client.

For the purposes of enhancing the healing process, it is important to bond with the areas that are yet to be realized in oneself. The issue of self-discovery requires oral communication prior to the end of the sandplay session.

It is therefore necessary to wait until the procedures involved in sandplaying are long over and the client has survived the procedures because if this were not so, communication would jeopardize the whole process. The focus of this kind of therapy is to mold and identify the visions in the sand and their alignment with inner fears.

In this light, the encounter is an approach of self-discovery that strives to explore unrealized areas by unearthing what lies under these green areas even if it is not experienced orally. The internal encounters regularly take place after there have been changes in the environment of the individual.

Therefore, it is wise for a therapist to take his/her time in studying the characters and their corresponding meanings, trace the characters to their origin, and call upon sandplay when the need arises. The therapist should also be on the look out for characters that are new during the procedures of sandplay because early detection can help in combating the problem.

The rational emotive behavior therapy (REBT) approach can be applied in dealing with most of the clients’ problems. The REBT approach rests on the premise that the events that occur in our lives do not upset us, but the beliefs held by each individual makes us anxious, unhappy, depressed, and enraged. The use of this approach, coupled with values and code of ethics, enables us to teach some of our clients on ways to become happy.

While dealing some of the clients, it may be important to adopt both instrumental and terminal values. Instrumental values are permanent in nature and they form the core values of what an organization or a group believes in. Some of the instrumental values adopted include, ambition, sincerity, honesty, courageousness, responsibility, politeness, a keen sense of evaluation, confidentiality, trust and obedience.

All these values are applied while listening to clients and when deciding on the most appropriate plan that can be used in addressing the client’s issues. The instrumental values act as a gate pass to the terminal values. On the other hand, terminal values are defined as the goals that an organization, group, or an individual aim to achieve in the long run.

Some of the terminal values applied in our case include, seeing happy families, instilling happiness and inner harmony in our clients, a sense of accomplishment, true friendship with our clients, exhibiting degree of wisdom while addressing some of the clients’ problems, ensuring that our clients live comfortable and enjoyable lives, and social recognition. All terminal values are achieved when client problems are solved or assistance on the same is offered.

One of the applied theories of prejudice formation is the belief theory of prejudice. The belief theory of prejudice “suggests that prejudice results from an aversion toward individuals who hold beliefs which are incongruent with one’s own” (Dienstbier, 1972), p.146).

In relation to the study, the belief theory of prejudice is applied in a more positive way in addressing the issues and problems that most of our clients face in their day to day activities. Real life observations and the psychological evidence among clients aid in shaping how experienced problems can be solved.

While addressing the issues and problems of our clients, the group adopts some codes of behavior to enhance professional-client relationship. According to Bayles (1981), an appropriate ethical conception of the client by cultivating a professional relationship with him/her gives the client freedom to determine the extent to which his/her life is affected, thereby warranting the client to make some decisions.

The main focus of our group is allowing clients to express themselves. At the same time, we are also able to play the role of professionals. Since clients lack the professional knowledge and expertise required in addressing their problems, we assume fiduciary duty. Although the client assumes a significant responsibility and authority in decision making, as professionals we provide special care which is worthy the client’s trust.

Discretion is another code of ethical behavior that our group adopts while addressing the issues of our clients. To begin with, discretion is a broader concept of confidentiality and privacy (Bayles, 1981). This means that not only is the client’s information kept confidential but the value of privacy is observed keenly.

The implication made is that we do not meddle with a client’s business which is unrelated to the problem we were hired to undertake. A Client’s private life, welfare, and behavior are kept discrete thus gaining the value of trustworthiness. As noted by Bayle (1981), confidentiality is an element of responsibility of discretion. Therefore, confidentiality is highly safeguarded while dealing with our clients and so is their privacy.

Another element used is competence which has been considered as the highest moral characteristic. As a group, we take our clients request with high level of esteem, responsibility, and respect. In addition, the requests and the needs of clients are handled with potential competence to ensure a good reputation.

In cases whereby the issue is beyond our specialty, advice is offered to the clients since clients lack the ability to know when a different type of specialist is required. This has always acted as a driving force of the group in meeting the client’s needs and demands. Honesty also is applied in addressing the client’s problems and issues.

In summary, both terminal and instrumental values are adopted by our group while dealing with clients’ problems and in running the group. Some of the terminal values applied include seeing happy families, exhibiting degree of wisdom while addressing problems, instilling happiness and inner harmony in our clients, a sense of accomplishment, and true friendship with our clients among others. The instrumental values include trust, honesty, confidentiality, and a sense of responsibility among others.

The belief theory of prejudice is applied via the observation of the behaviour and the attitudes of the clients in a positive way. Some of the codes behaviour adopted from Michael Bayles includes discretion, honesty, trust, privacy, and confidentiality. Lastly, competence and fiduciary duty are applied while addressing issues affecting our clients.

Reference List

Bayles, M. D. (1981). Professional ethics (Obligation to clients). Belmont. CA: Wadsworth Publishing Co.

Dienstbier, R. A. (1972). A modified belief theory of prejudice emphasizing the mutual casualty of racial prejudice and anticipated belief differences. Psychological Review, 79(2), 146–160.

The aim of the of the research was to try and establish the appropriate outcome measurement techniques and in turn use the research outcome to establish whether psychotherapy is effective.The length of therapy and its relation to effective treatment was also observed.

It is a challenge to measure outcome in psychotherapy but despite this huddle, a few clinicians still monitor outcome. Research has built evidence that if a patient’s progress is monitored, then it becomes less of a task to measure the resulting patient outcome.

A sharp increase in the cost of medical care was the driving force that led more and more clinicians to start getting involved in patient outcome measurement. This resulted in the need to identify effective methods by which this could be achieved. Several methods with different characteristics have been suggested by Ogles, Lambert, and Masters (1996).

The different characteristics of these methods include the content, time orientation of the instrument and the method of data collection. The psychological element that is measured by an instrument is referred to as the content of the measure; multiple elements can however be measured using the same instrument depending on the scope of the measurement.

Papers written by between-study meta-analytic review writers employ a sample of studies and then code the treatment effect size and a numerical code of the length of experience of the therapist and or the different levels of education of the therapist e.g. a master’s clinician versus a PhD. These are then correlated to establish the relationship between the effect size and level of experience.

Investigations done within a study carried to establish the relationship between years of therapist training and outcome were reanalyzed using meta-analytic methods. The outcome was that out of 154 comparisons, thirty nine showed that patients who seek assistance from paraprofessionals stood a better chance of having their issues resolved than those who saw professionals.

Other sub comparisons also indicated that patients got better results seeing therapists who were still or had just completed training. Long practicing paraprofessionals were found to be more effective than the beginners. Hattie et al. (1984) review interestingly noted that the amount of training received by paraprofessionals had a positive effect on the patient outcome.

As would be expected, different indices of change are bound to be obtained if different methodologies are used to arrive at them (Smith, Glass, & Miller, 1980). Some researchers for example base their measurement on behavioral observations while some on specific change.

The Time orientation instrument measures traits that set each individual apart from the rest in the long run and states which only define the individual over a short period of time. This is of importance because it attaches some sort of time frame on the length of the patient outcome measurement.

With all these options to choose from, it is necessary that a few points be noted upon which the appropriate method is then selected. The points that are important in this selection are that it has to be applicable, practical and strong.

Reliability, validity, and sensitivity to change are also vital in ensuring an effective instrument. A good instrument is one that captures the most important characteristics of the targeted group (Newman, Ciarlo, & Carpenter, 1999). In most cases Depression and anxiety disorders are the commonest and most important of these (Narrow, Rae, Robins, & Regier, 2002).

With all the above in mind, it was clear that the task of choosing one particular method of measurement is not easy. A few options of the most commonly used and perhaps the ones perceived to give the best estimates were given. Behavior and Symptoms Identification Scale (BASIS-32) instrument employs a 5-point Likert scale to asses the mental health of a patient (Eisen, Grob, & Klein, 1986).

Its advantages are that is flexible and can be administered as a self report or an interview. The second instrument suggested was the Brief Symptom Inventory (BSI) which is administered in Two-week test–retes.

Its predictive validity is strong in different clinical settings and has been widely used in research including HIV projects (Derogatis, 1993).It is however a n expensive instrument and its nine subscales are largely associated and this brings doubt as to how unique each measured element is from each other.

The main problem encountered during the research was the difficult task of trying to establish a suitable measurement method. This was particularly tasking because there was a need to strike a balance between accuracy, cost and effectiveness.

This was however dealt with by employing more than just one method of measurement and using the consumer report as a from of comparison to ascertain whether the research was anything close to what consumers said.

It was concluded that psychotherapy is indeed effective. It was also established that lengthier and more rigorous therapy is more effective that brief therapy. This was according to readers’ ratings by Consumer reports magazine after the research.

The consumers were rating in terms of problem resolution, satisfaction and emotional change during therapy. The authors of the magazine compared Outcome Questionnaire scores to consumer reports that were taken at least six months after therapy. From this it was established that the Consumer report satisfaction rates seemed overly generalized and too optimistic.

Introduction

In its simplest terms, cognitive behavioral therapy refers to a cathartic approach used by healers to come up with answers to the ever mind-triggering questions concerning non-adaptive behaviors, feelings as well as cognitions. To get such solutions, therapists employ much of methodical and goal-oriented measures.

Based on the usage of the term, cognitive behavioral therapy refers to medical aids premeditated in accordance with cognitive and behavioral studies. Cognitive-behavioral therapy, in its original form stood out as a method of relapse prevention when administering treatment to problems associated with alcoholism but later extended to cocaine-addicted people.

The schemes of cognitive-behavioral psychoanalysis rely on theoretical concerns that education procedures perform vital roles when it comes to the advancement of behavioral practices that are dysfunctional. Cognitive-behavioral therapy (CBT) proves effective to both group and individual settings. Commonly, the techniques employed remain structured for applications, which are self-helping in nature.

Researchers arrived at the development of CBT through a merger of cognitive therapy and behavioral therapy. Marque, some researchers and clinicians concerned in the field of CBT tend to appear more inclined on either behavioral or cognitive therapy.

The trends in health care are moving toward evidence-based treatments. Consequently, majority of varying CBT treatment programs have experienced radical scrutiny to unveil their effectiveness.

In case of treatments demanding diagnosis that follows symptom-based approach, CBT has received incredible favor in comparison to some other treatment approaches, among them psychodynamic treatments. In case of certain treatments techniques driven direct, time-limited and brief of certain psychological disorders using CBT approaches, treatments remain manualized more often.

Therapists, who do not embrace the CBT interventions in treating some disorders and as tools for intervention of aftermath problems of drugs abuse amongst the adolescents, argue that the existing data, which advocates for CBT, lack complete support to warrant the funding and the enormous attention it has received.

They also argue that the CBT concerns do not go beyond to capture issues like unemployment reduction, rather they focuses just on psychotherapy.

The notion that CBT stands out as more effective than other psychotherapy approaches has been heavily challenged over the years.

For instance during psychotherapy conference held at University of East Anglia in 2008, Professor Elliot, Mick cooper and others claimed that people have the capacity to improve enormously after therapy; no matter which therapy was undertaken and that escalated spending by governments on CBT programs discouraged other therapeutic interventions: something that hurt the public at large.

Among the many trials made, there s none applying both mental sop and blinding, that could figure out CBT as efficient for handling dementia praecox. In addition, it has been discovered also that only minimal ardently controlled CBT studies on depression actually prove to be effective and in case of the few found effective, the effectiveness was remarkably small.

The effectiveness of CBT, as one of the psychotherapeutic interventions for drug abuse among teenagers, consequently, presents a wonderful academic topic for introspection.

Literature review

There is a good deal of literature expounding much on the issue of the effectiveness of CBT with adolescent substance abusers. For instance, Covi, Hess, Schroeder, and Preston (2002) concluded that, even if people employ minimal intensive schedules, CBT is effective in reduction of cocaine usage (p.191).

Cognitive-behavioral therapy entangles “a cathartic approach geared towards coming up with solutions of dysfunctional behaviors, cognitions and emotions through the deployment of methodical and goal-oriented measures” (Waldron & Kaminer, 2004, p. 93).

People have recorded amicable empirical support for CBT models specifically designed for adolescent substance abusers in the course of recent years (Waldron & Kaminer, 2004, p.97). According to Crome, (2006) adolescents make use of substances in a maladaptive way in an attempt to proactively deal with environmental circumstances (p.209).

Treatments focus on aiding adolescents to interchange their drug use with behaviors that are less risky by giving them an opportunity to understand the antecedents of drug use.

Moreover, treatments seem designed to enable the adolescent drug users to keep off from circumstances likely to result to drug abuse as much as possible or to make them effectively handle the problems, which may end up translating into increased drug use (Mason & Posner, 2009, p.197).

Empirical evidence considers cognitive behavioral therapy as “…an effective approach for treatment of problems such as anxiety, substance abuse personality, mood psychotic disorders and eating disorders” (Hogue, Liddle, Dauber & Samuolis, 2004, p.94).

Crome (2006) observes, “CBT encompasses the use of varying therapeutic systems and approaches including multimodal therapy, cognitive therapy and behavior therapy” (p.204). However, attempts to define the scope of cognitive-behavioral therapy have proved a real problem throughout the development of the technique.

CBT is effective in the treatment of some psychological disorders like mood and anxiety disorders, people have evidently voiced out critics about its effectiveness.

The extent to which CBT models emphasize on alteration of behaviors, thoughts modifications and teaching new skills that would help adolescents to cope with substance abuse varies considerably. However, majority of the models encompass two crucial components: skills building and functional analysis (Waldron & Kaminer, 2004, p.101).

In case of function analysis, the adolescent work in collaboration with a therapist to pinpoint particular thoughts, circumstances and or feelings, which the adolescent encountered prior and after drugs use. Functional analysis aids the adolescent to substantially identify situations which are characterized by high risks and hence posses the capacity to result to hiked drug use.

The exercise also enables the adolescent to gain insight as to why he or she embraces drugs usage in such and similar situations. Information acquired during the functional analysis turns out crucial for the skills-building exercise since the therapist applies it to identify certain areas that would turn out to be of benefit to the adolescent by learning coupled with practice on the prescribed practices.

Gathering such information from the adolescent however, demands that the therapist be assertive in an attempt to resist peer pressure during the questioning of the adolescent and testing of his or her assumptions regarding substance abuse (Waldron & Kaminer, 2004, p.103).

For effectiveness, there must exist a prescribed particular way of adolescents’ management during CBT administration (Cavanaugh, Kraf, Muck & Merrigan, 2011, p.5). This calls upon the therapist to construct a social network, which supports recovery process, increase desirable activities, embrace problem-solving strategies in case of a high-risk behavior and in a gradual way, practice new ways of reacting and behaving.

These are core skills, which according to Waldron and Kaminer (2004), the therapist might consider combining with parent education, motivation enhancement, and comorbid conditions treatments and school outreach programs (p.101).

Through well-controlled clinical trials, both group and individual CBT models have been positively tested. Numerous studies have also sought to test clinically solutions, which integrate the principles of CBT with strategies such as functional therapy, which is a family as well as motivation-oriented therapy.

Waldron and Kaminer (2004) recognize CBT and its proposed interventions as one of the evidence-based substance abuse treatment among adolescents. However, they feel that even though individual CBT interventions seem promising, people need to conduct adequate further testing on its effectiveness (p.97).

However, acquiring of additional CBT support through reviews of the quality of evidence; studies that support outpatient treatments substance abuse interventions are also crucial.

In the 31 controlled trials randomized in one of such studies, CBT turned out as the “outpatient intervention, which proved widely supported by the highest number of strong studies methodological approaches” (Hogue, Liddle, Dauber, & Samuolis, 2004, p.94).

Cannabis stands out as one of the widely abused substances among American adolescents (Crome, 2006). A study of 11,426 teens revealed that 25% of the investigated youths admitted to have smoked cannabis with 13 % having smoked it within a month before and 6% having smoked it at least four times within the month before.

“Poor grades, fear of death, diminished self-esteem, and accessibility of cannabis by household, inadequate religious identity and lack of subtle school experience” (Kadden, 2002, p.2) among others are some of the factors identified by some experts to have the ability to increase cannabis abuse risks among adolescents.

Taking into account the vast negative health effects that the abuse of substances such as cannabis has on adolescents, an effective intervention needs to come into place. Amongst the five evidence-based efficient local treatments of cannabis exploitation, CBT stands out clearly as one of the interventions, which seem cost-effective.

Others include adolescent community reinforcement approach –A-CRA and multidimensional family therapy (MDFT). CBT at times combines with FSN (Family Support Network), which entangles a substance abuse treatment program that targets youths belonging to 10 up to 18 years (adolescents), which normally goes to the outpatients.

The CBT sessions are effective in teaching the adolescents on how to say no to marijuana, seeking solutions to problems likely to render youths to smoke cannabis, dealing with criticisms, anger awareness, thoughts management and coping skills coupled with indulgence in activities unaffiliated to drug abuse.

On the other hand, people have probed the various coping skills prescribed by CBT programs aimed at dealing with dependence on substances or rather drug abuse. They have shed light that from the dimension of cognitive behavior theory, substance abuse and alcohol dependence stems from experiences acquired from the environment through interactions with it.

Drugs create certain longed for desires, including good feelings, dwindled tensions among others. Consequently, if the victims consume the drugs more frequently, the results might be that, the only way out to achieve such results would be only through drug use, particularly if other options to achieve similar results are not available.

The treatment tasks therefore encompass the identification of specific desires that addictive substances and alcohol are employed to achieve: thereby, deriving the possible alternative methods of dealing with such desires (Kadden, 2002, p.2). These are somewhat the main concerns of CBT. Cognitive-behavioral therapy according to Kadden comprises of looking at the entire treatment process form two dimensions: behavior and cognition.

Behavioral approaches place more weight on observable consequences and antecedents of the behavior without inferring from internal invents among them cognitions. Cognitive-behavioral approaches, opposed to behavioral approaches takes into corporation internal events such as emotions, thoughts and cognitions, which seem reflected in behaviors and acts, directly and/or indirectly, to ensure the maintenance of such behaviors.

Learning through associations and learning through consequences are the two mainly identified learning behaviors in the laboratories, which remain reflected in the CBT treatment model. This means that CBT is consistent with the results obtained via scientific research methodologies, which stand out evidence-oriented.

Even though CBT may prove effective, by taking into consideration the above discussion, some weak points exist in its interventions. For instance, existing deficits in the coping skills, especially with consequences and the antecedents of substance abuse among the adolescents, serve to maintain and ensure continuing of the addictive behaviors.

Consequently, ardent effort to enhance studies on the most amicable training programs on coping skills in an attempt to deduce practicability of various utilities as avenues for curtailment and reduction of addictive behaviors are being sort (Kadden, 2002, p.10).

Deficits in coping skills, in addition, prove magnificent challenges that face CBT programs implementations due to existence of the probability that the deficits may result to dependency of substance abuse as the only coping strategies operating in default mode among teenagers.

Leichsenring, Hiller, Weissberg and Leibing conducted an empirical research to unveil the evidence of effectiveness of CBT in treatment of particular mental disorders. The data for their study was availed by searching through databases using certain keywords in 2005.

Their study followed the guidance of the evidences that CBT approaches were vital for the treatment of certain mental disorders put forward by Canadian Task Force on Preventive Health Care (Leichsenring et al, 2006, p.234).

Effectiveness of CBT in treatment of a number of mental disorders was found out to be demonstrated by various randomized trials which were well controlled followed by a number of meta-analyses (Leichsenring et al, 2006, p.249).

However, the authors voiced out that despite the fact some evidence existed to support the efficacy of CBT enormously in psychotherapeutic treatments of some mental disorders, a gap exists that demands the conducting of further extensive studies in an attempt to clarify or correlate the current evidence.

Especially for adolescents, the initial milestone of substance abuse entails cigarettes smoking, followed by alcohol and or taking drugs with perceptions of experimentation. The entire problem of substance abuse amongst teenagers has to do with faulty perceptions and believes about drugs abuse.

Treatment programs, which people may consider as effective, should thus incorporate strategies that aid in alteration of such faulty attitudes and beliefs. The programs need also to teach the youths on the rejection behaviors when presented with opportunities to abuse alcohol, marijuana, tobacco or any other addictive substance.

Well-documented scholarly evidence proves that, inculcating resistance skills turns out to be the only proactive way of reducing substance abuse amongst the adolescents. Waldron and Kaminer (2004) hold similar opinions but look at substance use problems amongst adolescents as involving behavior learning started and maintained in accordance to environmental factors contexts (p.259).

Programs that revolve around this premise focus on aiding adolescents to expect and keep at bay situations perceived as to present high risks as a strategy to promote abstinence of substance use.

The major techniques that amicably help in behavior change entails clear understanding of the circumstances prevailing in the environment, making attempts to learn ways which help in urges management without forgetting to take part in positive behavior activities. Evidently, drawing from the definition and operational elements of CBT, the techniques advocated for by Waldron and Kaminer address the CBT issues.

Anxiety is perhaps one of the reasons that adolescents might find themselves in the helm of substance abuse. With reference to Burleson and Kaminer (2005), using CBT treatment approaches constitute the most effective modern approaches in substance abuse-related disorders among adolescents (p.1752). Employing CBT to treat anxiety associated psychological disorders require the CBT intervention strategies to be highly effective.

In April 2007, researchers in Boston University carried out extensive literature review regarding all cognitive therapy studies, which reviewed the effectiveness of CBT in relation to anxiety disorders placebo. Surprisingly, out of 1,165 studies that were identified relevance to their research topic, only 27 were consistent with their research criteria. There was no evidence supporting the use of CBT in anxiety disorder treatment.

In particular, the intensity of symptoms of anxiety disorders immensely dwindled upon administration of CBT as opposed to placebo. The decrement effects seemed particularly pronounced for those individuals inflicted by obsessive-compulsive disorder and acute stress disorder.

These results are essential since a part from identifying CBT interventions as effective for management of anxiety, takes adolescent substance abuse treatments to an extra mile. However, people should view CBT as a cure-all for anxiety. It rather provides beneficial and helpful results for adolescents inflicted by anxiety disorder.

However, according to Crome, 2006) adolescents’ substance abuse requires special demands (p.205). Hogue, Liddle, Dauber and Samuolis (2004) attempted to evaluate the differences in the various substance abuse interventions by comparing two approaches: CBT and MDFT.

The results indicated that family-focused substance abuse interventions yielded better responses (p.59), especially with the strategies shrouded within CBT approaches. On a different dimension, Researches reveal that substance abuse treatments engineered for adults hardly work satisfactorily to adolescents and thus requires modification before they become effective to them (Crome, 2006, p.94).

Some of the modifications include incorporation of family perspectives for the CBT interventions meant for adolescents. To this end, Multi-Systemic Therapy, Multidimensional Family Therapy for Adolescents (NDFT) and Brief Strategic Family Therapy remain the most preferred interventions for substance abuse among adolescents (Crome, 2006, p.94).

The multidimensional family therapy encompasses a family-based outpatient substance abuse treatment specifically designed for adolescents. This approach looks at the adolescents’ substance abuse problem form the network influences context. It therefore employs the networks in its attempts to cope with undesired behaviors and increase the indulgence in the wanted behaviors among adolescent substance abusers.

Brief strategic family therapy entangles the treatment of adolescent substance abuse indulgencies normally accompanied by unacceptable conducts either at school, or at home. Multi-systemic therapy on the other hand targets composite systems that result to delinquent undesired behaviors.

These three treatments are, however, behavioral approaches which in actual sense forms an integral part of CBT. The effectiveness of these interventions also translate to effectiveness of the CBT in the treatment of substance abuse among teenagers since all CBT does, is to go an extra mile to incorporate cognitive aspect of substance abuse coping strategies.

A number of CBT programs have been evaluated using various program evaluation techniques. Ringwalt et al. (2010), claims that “investigators have used both one and two-tailed tests to determine the significance of findings yielded by program evolutions but, many authorities now are in agreement that one-tailed test is not effective” (p.135).

Again, “there remains some conceptual confusion as to how one-tailed tests should be used when investigators find that the program they are evaluating has yielded results in an unanticipated direction” (Ringwalt et al., 2010, p.137). Consequently attempting to evaluate the effectiveness of CBT interventions on adolescent substance abuse on the basis of one-tailed tests, would be a subject of comprise and arguments.

Boisvert, Martin, Grosek and Clarie (2008) conducted a study to evaluate the effectiveness of drug abuse interventions by use of mixed methods. The results indicated that abundant relapse risk reduction was possessed by all members who were involved in the study.

Consequently, ardent evidence “suggests that a peer-supported community program focused on self-determination can have a significant positive impact on recovery from substance addictions and homelessness” (Boisvert et al., 2008, p.217).

Discussion

Based on the above revelations, cognitive behavioral therapy encompasses one of the psychological interventions guided by human conducts, emotions and cognition. Within its sphere, it takes into account numerous treatment strategies that require ardent knowledge of etiology, coupled with the maintenance of varying treatments for mental disorders.

In substance abuse management among the adolescents, the CBT approach requires therapists and the patients to work in collaboration in an attempt to identify the problems related to behavior, thoughts and feelings. The chief concerns of CBT focus on symptoms, distress reduction and promotion of crucial behavior responses.

The therapist deserves to be well acquainted with practical and psychological skills to aid him or her in harnessing the patient’s problems and where possible prevent reversion of the problems upon administration of the treatment.

The existing literature on effectiveness of CBT in treatment of substance abuse among adolescents largely records an immense efficacy with some of the literatures giving a picture of existence of gaps in the studies on CBT interventions.

Consequently, therapists have called attempts to conduct further research on effectiveness of the CBT programs for particularly, an attempt to provide pivotal information deemed vital to warrant the heavy spending on the programs.

Empirical studies however, prove the benefit of cognitive-behavioral therapy, in that its one of the cost-effective psychotherapeutic interventions and since it shrouds the commonly advocated for special interventions for substance abuse amongst the teenagers such as Multi-Systemic Therapy, Multidimensional Family Therapy for Adolescents (NDFT) and Brief Strategic Family Therapy.

However, it then extends beyond to incorporate cognitive interventions, CBT evidently prove efficient in the management of substance abuse in adolescents. Anxiety arising from various environmental factors whether at home or school may plunge adolescents into the substance abuse mayhem.

People need to consider a conclusive study seeking to unveil relationships existing between anxiety and substance abuse among adolescents. The current reviews, however, depict that any form of psychotherapy which can aid teenagers to develop and inculcate ardent coping skills while still giving them an opportunity to identify substantially everything that bother them has the ability to reduce anxiety among adolescents.

References

Boisvert, R. et al. (2008). Effectiveness of a Peer-Support Community in Addiction Recovery: Participation as Intervention. Occupational Therapy, 15(4), p. 217.

Burleson, J., & Kaminer, Y. (2005). Self-Efficacy as a Predictor of Treatment Outcome in Adolescent Substance Use Disorder. Addictive Behaviors, 30(1), pp. 1751-1764.

Cavanaugh, D. et al. (2011). Toward an effective treatment system for adolescents with substance use disorders: The role of the states. Children and Youth Services Review, 1(1), pp. 1-7.

Covi, L. et al. (2002). A Dose Response Study of Cognitive Behavioral Therapy in Cocaine Abusers. Journal of Substance Abuse Treatment, 23(1), pp. 191-197.

Crome, I. (2006). Psychological perspectives on treatment interventions for young people with substance abuse problems in the United Kingdom. Drug Prevention Policy, 13(3), pp. 203-224.

Gonzalez, M., Schmitz, M., & DeLaune, A. (2006). The Role of Homework in Cognitive–Behavioral Therapy for Cocaine Dependence. Journal of Consulting and Clinical Psychology, 74(1), pp. 633-637.

Hogue, A. et al. (2004). Linking Session Focus to Treatment Outcome in Evidence-Based Treatments for Adolescent Substance Abuse. Psychotherapy: Theory, Research, Practice, Training, 41 (1), pp. 83-96.

Kadden, R. (2002). Cognitive-Behavior Therapy for Substance Dependence: Copping Skills. Farmington: University of Connecticut School of Medicine.

Leichsenring, K. et al. (2006). Cognitive Behavioral Therapy and Psychodynamic Psychotherapy: Techniques, Efficacy, and Indications. American Journal of Psychotherapy, 60(3), pp. 233-259.

Mason, M., & Posner, M. (2009). Brief Substance Abuse Treatment with Urban Adolescents: a translational research study. Journal of Child & Adolescent Substance Abuse, 193(18), pp. 206-220.

Ringwalt, C. et al. (2010). The use of one- versus two-tailed tests to evaluate prevention. Evaluation & the Health Professions, 34 (1), pp. 135-150.

Waldron, H., & Kaminer, Y. (2004). On the learning curve: The emerging evidence supporting cognitive-behavioral therapies-adolescent substance abuse. Addiction, 99 (1), pp. 93-105.

Constructivism

Constructivism is an approach used to gain insight into an individual’s psychology and to initiate change in a person (Berg, 1994). Today, it influences many techniques of psychotherapy by concentrating on an individual’s inner and outer mechanisms of constructing meaning.

Constructivism is not based on a particular theory or method. Rather, it is a combination of several forms of psychotherapies and methods including existential-humanistic and cognitive-behavioral therapies, and psychoanalysis. It also includes other techniques used to transform family dynamics (Berg, 1994).

Today, many psychotherapy approaches are based on constructivism and they range from solution-focused approaches to narrative methods (Simon, 2009). Each of these methods utilizes different approaches and mechanisms to achieve healing (Simon, 2009).

Constructivist Theory

Constructivism is based on the notion that individuals will understand his environment well by contemplating the occurrences in their personal lives. Each individual has a clear set of dimensions and thought systems which they apply in their daily lives (Guteman, 1994). Constructivism healing is concerned with the sense-creating system which individuals utilize to comprehend occurrences in their lives (Guterman, 1994).

Each person who attends a therapy session harbors a distinctive set of life experiences. An individual’s response to these life experiences determine the emotions, beliefs and attitude that he or she will carry through life (Guteman, 1994). The belief behind constructivism is that our knowledge of our surroundings is not based on objectives but rather on constructions, feelings, and convictions that we attach to our life experiences (Guteman, 1994).

The Purpose of a Clinician in Constructivist Healing

The role of a clinician in constructivist treatment is to infer how an individual’s reaction to past life experiences have influenced his or her present circumstance that is troubling the individual (Fish, 1993). The clinician does not view the client’s story as a reality. Instead, he or she presumes that the client’s current problem resulted from prior constructions from the client’s life experiences (Doan, 1998).

The clinician, therefore, engages the client in order to generate the occurrence-thought-reaction chains formed by the client in the past and which are more likely to underlie his present or future conditions (Doan, 1998).

Narrative Method

Narrative approach is a kind of psychotherapy that utilizes narrative. This method was conceived between 1970 and 1980 mainly by Michael White from Australia and David Epston of New Zealand (White & Epston, 1990).

Narrative therapy involves the client working together with the therapist. During the process, the therapist will pose some questions to the client designed to generate positive and detailed stories of the client’s personal life experiences that do not form part of his or her problem.

The aim of the narrative method is to detach individuals from elements that are assumed to be essential part of the person but which are not in reality. This technique is known as externalization (Etchison & Kleist, 2000). The purpose of externalization is to enable people to figure out their association with their problems.

The maxim of narrative form of therapy is that ‘‘the person is not the trouble but rather the trouble is the trouble.’’ In the process, the positive qualities of an individual are externalized to enable him or her visualize an aspired identity.

Essentially, the narrative method entails deconstructing old meanings and constructing new ones in order to imagine what is considered as an individual’s ideal identity. This is achieved through quizzing and working with the client.

Narrative Therapy Philosophy

The perspective of narrative treatment is that our identities are built around our life stories as found in anecdotes. The goal of a narrative clinician is to aid clients in describing accounts in their lives and how they relate to them. The narrative method helps individuals to view problems as influences on their lives but not as intrinsic components of their lives (Fish, 1993).

This is useful for establishing distance between problems and the lives of individuals. By making problems an extrinsic factor, it becomes simpler to analyze the influence that problems have on our lives (White & Epston, 1990).

There is yet another form of externalization that takes place in narrative therapy. This kind involves mulling over one’s motives, values, allegiances, and hopes. Examination of these elements can help to re-write individuals’ life experiences making them more problem-resistant (Doan, 1998).

The word ‘‘narrative’’ refers to our identity complex as constructed from our life experiences. Some ways of reconstructing this complex is by rewriting our beliefs about values and reminiscing discussions with important people (White, 2007). These are just some of the ways of recovering our lives from problems.

Criticism of Narrative-Focused Method

Narrative therapy has been criticized on various grounds. First, it is viewed as being too theoretical and methodical as opposed to being a practical form of treatment, making its effectiveness questionable (Etchison & Kleist, 2000). Second, the healing approach has been accused of subscribing to the theme of social construction theory that there exist no absolute truths (White, 2007).

The therapy has also been accused of ignoring the fact that therapists themselves are subject to biases which could make the treatment ineffectiveness. Finally, there is lack of clinical and empirical evidence to support the contentions of the narrative method (White, 2007).

Solution-Focused Therapy

Solution-focused treatment is a kind of ‘‘talking’’ therapy (Berg, 1994). This form of therapy is based on social construction theory. The method concentrates on clients’ aspirations instead of the problems that drove them to seek treatment. The concern of this method is the present and future situation. In this approach, the clinician enquires about the client’s life accounts and perceived strengths (Simon, 2009). The aim of the therapist in making this inquiry is to help clients imagine their desired future (Guterman, 1996).

The philosophy of solution-focused therapy is that change is continuous (Thorana, 2007). The method helps individuals to determine elements in their lives which they would like to be changed and those issues in their lives that they would wish to continue as they are (Guteman, 1994).

This approach is concerned mainly with two issues: The first is aiding people to discover their aspired future while the second is to determine which parts of the desired ideal future are already taking place at present (Thorana, 2007). Social-focused therapy is largely practical and it does not require a theoretical background.

Use of Questions

Solution-focused therapy employs questions to help clients imagine how a problem-free future would look like (Simon, 2009). There are various types of questions used by therapists in this case. One form is scaling questions which are designed for establishing significant distinctions for the client as well as setting goals. Another form of questions used in this therapy is exceptions-searching questions (Thorana, 2007).

These are utilized to when the client exhibits no apparent problems but, nevertheless, wishes to improve on his current conditions. The third type of questions is coping questions. These are meant for generating information regarding the clients’ strengths. Lastly, there is the problem-free talk technique which is used to relax the client and also to identify strengths (Thorana, 2007).

Conclusion

Constructivism is a very significant approach used in counseling and psychotherapy today (Guteman, 1994). This method involves gaining insight into a person’s psychology in a bid to initiate positive change (Fish, 1993). The constructivist theory holds that problems are not real but instead they are psychological constructs created by one’s environment (White, 2007).

Some variants of this approach are the solution-focused and narrative-based therapies. Some critics of constructivism have argued that it is too theoretical and it lacks empirical evidence to support it (Doan, 1998). The major pioneers of this concept include Michael White, David Epston, and Michael Mahoney.

References

Berg,K. (1994). Family based services: A solution-focused approach. New York:Norton.

Doan, R. (1998). ‘‘The King is Dead: Long Live the King: Narrative Therapy and Practicing What We Preach’’. Family Process, 37(3), 379-385.

Etchison, M., & Kleist, D. (2000). ‘‘Review of Narrative Therapy: Research and Review’’. Family Journal, 8(1), 61-67.

Fish, V. (1993). ‘’Post Structuralism in Family Therapy: Interrogating the Narrative/Conversational Mode’’. Journal of Family Therapy, 19(3) 221-232

Guterman, J. T. (1994). ‘‘A social constructionist position for mental health counseling’’. Journal of Mental Health Counseling, 16, 226-244.

Guterman, J.T. (1996). ‘‘Doing mental health counseling: A social constructionist re-vision’’. Journal of Mental Health Counseling, 18, 228-252.

Simon, K. (2009). Solution focused practice in end-of-life and grief counseling. New York: Springer Publication.

Thorana, S. (2007). Solution-focused brief practice with long-term clients in mental health services: I’m more than my label. New York: Taylor & Francis.

White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton.

White, M. (2007). Maps of narrative practice. New York: W.W. Norton.

Group therapy and its use in addiction treatment

Group therapy is a strong therapeutic tool and has been greatly effective over the years, in the treatment of substance abuse. On most occasions, it is as equally effective as the individual type of therapy, since the groups are associated with many traits that have good rewards. Some of these types of rewards include the reduction of isolation and quick recovery.

This model of group therapy provides some information that is important to the client, who may require this service for the first time. The model also helps the peers in schools to avoid and abstain from any form of abuse of substances.

The possibility of having a professional single treatment in the model also enables people using it to attend to a number of clients at the same time. The model has also been credited with the provision of feedbacks when tasked with providing the values and the abilities of the members of each group.

The model helps in solving this problem since it helps the clients to overcome past experiences in their families that may be harmful. The substance model is also important as it gives the members the opportunity to learn the skills needed in the society.

This helps them to cope with their everyday life instead of looking for solutions to end their abuse of substances. The substance and drug abuse is also solved through the support, encouragement, and reinforcement of members, when they are carrying out some anxious and difficult tasks.

How counselors can intervene in the group process

Counselors can intervene in the group process, when majority of the members are faced with the self-denial, to try and solve this problem by helping the members accept their own problems.

The counselors can also intervene when there is a confrontation between the members, to help solve the problem. They can also intervene in the case of a critical situation when a member proves a hard nut to crack in trying to solve the substance abuse problem in him or her.

Counselors are also important in the group process, as they provide information to the members concerning recovery and addiction, and also aid in clarifying issues and providing answers to the questions asked during the session. They can intervene in the case where the members of the group are in need of psycho educational tips, which can help them relate with the material personally, rather than intellectually.

The counselors also intervene in the group to ensure that there is interaction and participation between all members, as it enhances the sharing of feelings, experiences and thoughts. The counselors also make sure that there is a healthy reinforcement between the members, through healthy behaviors that build a healthy interaction between them.

The counselors are also involved in validating issues or problems that may be shown by individual members. When a group member for instance struggles with relapse, the counselors acknowledge and try to elicit support from the rest of the members without becoming judgmental.

The counselors also challenge the members to practice behaviors that are counterproductive, and this involves giving a prompt feedback on his/her present behavior.

Group culture

Group culture is the culture of both the formal and informal groups, and it helps them to carry out tasks that are important to the system of the organization.

In group culture, individuals are recruited and assigned various roles to play in the group, so as to facilitate the achievement of the group’s goals and objectives. In group therapy, the group culture is a common way of doing things and this greatly helps in fostering success of the therapy.

Group culture can be defined in other terms as a participatory democracy. This is the culture where people speak with one voice, through their actions. In this form of culture, a group of people start solving their problems themselves, by first assessing the solutions within them.

The group assesses the solutions at hand rather than the solutions from outside. A group culture is involved in the decisions that control lives, by taking a direct action of reclaiming the power from fear, detachment and isolation. Individuals basically challenge oppression and unearth the self-empowerment within them.

In a group culture, the group primarily focuses on one specific incident or worry amongst the members, that is very crucial to them. They then converge and each member of the group epics his/her own thoughts and feelings. They form forums where they focus on counseling, problem solving and discussions, without interference from other people outside the group.

Group process refers to actions that are specific to groups. Such actions are a result of emotional construction. As far as group process is concerned, the main variable is cohesion because it is discussed widely in many clinical and therapeutic studies. However, there is a big difference regarding operational and conceptual definition of the variable.

In many studies, cohesion is used to mean emotional bonds among members of a particular group. It also refers to the shared values within a group. The values serve as the blueprint of the group because they control group behavior. Group dynamics studies employ cohesion in therapeutic association. However, it means something different in the group process because it refers to the positive therapeutic results.

Scholars use the variable in a number of ways, depending on what they want to express. Regarding group process, the variable means blending, oneness, infectivity, and groupthink. Regarding group dynamics, the variable refers to anti-group culture, aggregation, disintegration, and individuation.

By understanding applicability of the variable, the therapist can comprehend how members of the group perceive their leader (Bednar, Melnick, & Kaul, 1974). In some circumstances, the leader is perceived positively meaning that he or she is viewed as an engaging person while in other circumstances he or she is viewed negatively meaning that he or she is believed to be argumentative.

Apart from cohesion, other variables affecting the outcome of the group include group potency, team-member exchange, and emotional climate. These variables affect the functioning of the group in a number of ways. In the formation of the group, members have certain expectations and objectives.

However, strengthening the group is usually the first objective of any group. Therefore, each group member would work hard to ensure that the group is strong. A strong group would reward its members in the long run (Yalom, & Leszcz, 2005). In this case, members calculate what they would obtain from the group before joining it.

Group process refers to the formation of the group, as well as its development. However, group dynamics refers to the aspects of the group, including the mode of communication, leadership, interaction, and the rules governing human behavior. Group dynamics is very different from the group process. Group process would entail cohesion because people must agree to work together.

The dynamics of the group influence the behavior of members because they determine whether interactions are two-way, aggressive, or accommodating. Through the study of variables associated with group dynamics, the group environment would be understood better.

Variables at the group dynamics level include the number of group members, the time limit set by group members, the responsibilities delegated to each group member, the effectiveness of the individual regarding time management, the availability of skilled individuals in the group, and the societal standing of group members.

Apart from the above variables, other factors influence the performance of the group (Wilson, Rapin, & Haley-Banez, 2004). These factors include the communication technique employed by group members and distribution of power in the group.

Individuals trusted with power should be those that command respect from various group members. Variables at the process level are different from variables at the group dynamics level. Those occurring at the process level bring together the group while those occurring at the dynamics level influence the performance of the group.

References

Bednar, R. L., Melnick, J., & Kaul, T. J. (1974). Risk, responsibility, and structure: A conceptual framework for initiating group counseling and psychotherapy. Journal of Counseling Psychology, 21(1), 31-37

Wilson, F. R., Rapin, L. S., & Haley-Banez, L. (2004). How teaching group work can be guided by foundational documents: Best practice guidelines, diversity principles, training standards. Journal for Specialists in Group Work, 29(1), 19-29

Yalom, I. D., & Leszcz, M. (2005). The therapeutic factors. In The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.

Introduction

Therapy of conflictual histories is one of the most critical therapeutic challenges. That is why there are different methods for addressing this problem. However, the paper at hand aims at reviewing and analyzing only four theoretical tools: mourning, hauntology, nostalgia, and narrative therapy.

Theoretical Concept of Mourning

Mourning is a mental procedure that is closely related to historical thinking, i.e. the ability to make sense of particular past events. It is one of the most common ways to draw connections between individuals and their past to identify one’s identity (Rüsen 1). According to Rüsen, mourning is helpful not only due to its value for personal re-establishment but also cope with trauma and improving one’s future (2-3). It can be explained by the fact that mourning helps understand how the past shapes one’s personality instead of ignoring it.

Speaking of mourning, there are two aspects of the concept. The first one is emotional that is directly associated with one’s mental activities and sensual involvement in the process. The second aspect is cultural (Rüsen 27). Mourning as a theoretical tool for addressing conflictual histories is commonly viewed as a nation- or communitywide specificity – an ability to cope with past trauma and regain identity (Zembylas 73). From this perspective, mourning is viewed as a collective tool for coping with conflictual histories. Its major strength is relatively high efficiency in overcoming traumas because the past is not ignored but reconsidered (Rüsen 1). On the other hand, it may be weak because, in some cases, it disappears either because there is nobody to mourn for the past events or mourning (for instance, silence marches) is prohibited or not supported by the state (Cobb 16; Zembylas 73). At the same time, it is deployed for addressing only those traumas that are related to collective self-esteem, not all significant conflictual histories (Rüsen 28).

Theoretical Concept of Hauntology

Hauntology is a peculiar theoretical tool for coping with conflictual histories. Just like mourning, it focuses on making sense of the past to improve the future. However, its specificity is in having conversations with the ghosts of this past so that there is an opportunity to craft a promising future (Zembylas 70). In this way, the idea is to create the tomorrow instead of fixing the yesterday. To obtain a better understanding of this theoretical tool, it is essential to pay special attention to the concept of ghosts. It is a broad phenomenon, incorporating different past traumas (for instance, dictatorship and victims of wars or genocides). The foundation of this concept is the collective memory and the search for social justice in the future (Zembylas 71).

Hauntology is about remembrance of the ghosts mentioned above. This remembrance may be demonstrated in the form of particular rituals (for instance, grandiose parades or silent marches) aimed at pointing to the criticality of particular past events and the necessity to avoid them in the future (Zembylas 71). The main strength of this tool is the chance of community reconciliation. On the other hand, it is associated with the challenges and weaknesses similar to those of mourning – governmental oppression and the inability to organize and complete the needed rituals due to political or ethical challenges (Zembylas 73). Moreover, the instrument is ambivalent because one can never predict the emergence of the new ghost and it is complicated to find the right balance between commemoration initiatives and adhering to social norms (Zembylas 84-85).

Theoretical Concept of Nostalgia

Nostalgia is another theoretical tool used for therapeutic aims in addressing conflictual histories. This concept was borrowed from the field of medicine and mental issues. Just like the first two instruments, nostalgia is a culture-based tool associated with collective memory. However, unlike hauntology, it is connected with the desire to return to the initial state of affairs and fix the past instead of creating a better tomorrow. Nostalgia is similar to mourning due to the powerful emotional aspect of this concept. From this perspective, it is the desire to return to happy (or any emotionally significant) times and prolong this feeling because it is associated with the sense of home. In this case, the main focus is made on personal criteria when it comes to grading particular past events (Denic-Grabic 156). Therefore, it is efficient because it may help make the influence of some events stronger while erasing the other.

Still, nostalgia is not always beneficial for overcoming the consequences of conflictual histories. For instance, it is not helpful in case when it is triggered due to political motifs. To prove this statement, think of the drive to establish the overall uniformity in the socialist society and the subsequent political references to the positive outcomes of the socialist uniformity after the collapse of the whole system. The problem is that the reality is distorted in such cases so that the community is manipulated because of the so-called installation of memory – demonstrating only positive aspects of a particular phenomenon or event and ignoring the negative ones (Denic-Grabic 159). This regulation can be conducted by different means – poems, photos, museums exhibitions, films, and other forms of art (Lesic 87).

Theoretical Concept of Narrative Therapy

Narrative therapy has become the most popular tool for addressing conflictual histories. The foundation of the instrument is sharing one’s story. The range of addressed issues is wide which helps make the tool even more popular. The focus is made on narrations because they are associated with an individual’s identity and problems, not their feelings regarding identities or problems (Carr 487). To obtain a better understanding of this concept, it is imperative to be aware of the specificities of narrations, such as viewing each individual as one in need of help, paying attention to one’s perception of a particular event, and considering each individual within a broader frame – their surrounding and position in a community (Carr 491). All of the abovementioned details were proposed by Michael White – the founder of this theoretical tool.

Even though this method centers on an individual, it can be used as a collective tool for coping with conflictual histories due to the opportunity of initiating a public dialogue – either among members of a particular community or between people and legal authorities (Cobb 4). It is the primary strength of the tool. However, at the same time, narrative therapy is commonly associated with the creation of a they-us gap in the community. It may result in social fragmentation and increased risks of public conflicts, especially in cases of extremely important conflictual histories, such as genocides or victims of wars (Cobb 5, 8).

Works Cited

Carr, Alan. “Michael White’s Narrative Therapy.” Contemporary Family Therapy, vol. 20, no. 4, 1998, pp. 485-503.

Cobb, Sara. “Narrative ‘Braiding’ and the Role of Public Officials in Transforming the Public’s Conflicts.” Narrative and Conflict: Explorations in Theory and Practice, vol. 1, no. 1, 2013, pp. 4-30.

Denic-Grabic, Alma. “The Narrativisation of Memories. Trauma and Nostalgia in the Novels the Museum of Unconditional Surrender by Dubravka Ugresic and Frost and Ash by Jasna Samic.” Balkan Memories. Media Constructions of National and Transnational History, edited by Tanja Zimmerman, Bielefeld, 2012, pp. 155-162.

Lesic, Andrea. “Memory and Conceptual Tropes. Museums, Trade and Documents in Velickovic Konacari.” Balkan Memories. Media Constructions of National and Transnational History, edited by Tanja Zimmerman, Bielefeld, 2012, pp. 87-94.

Rüsen, Jörn. “Mourning by History – Ideas of a New Element in Historical Thinking.” Historiography East & West, vol. 1, no. 1, 2003, pp. 1-38.

Zembylas, Michalinos. “Pedagogies of Hauntology in History Education: Learning to Live with the Ghosts of Disappeared Victims of War and Dictatorship.” Educational Theory, vol. 63, no. 1, 2013, pp. 69-86.

Critical Appraisal of Studies and Reviews

A study of behavioral addictions conducted by Grant, Schreiber, and Odlaug (2013) provides insights into the process of the development of addictions. CBT and opioid antagonists are suggested as effective treatments for some addictions. These findings can be interpreted in the following ways: both pharmacotherapy and behavioral interventions are effective, but the underlining processes that connect different addictions (substance use and other dependencies) are not yet fully researched.

Lanza, Garcia, Lamelas, and González‐Menéndez (2014) compare the effectiveness of CBT and ACT (acceptance and commitment therapy). According to them, CBT was more effective when conducted posttreatment, while the ACT was effective at follow-up (Lanza et al., 2014). The following conclusions can be drawn from these results: depending on the phase of treatment, different strategies change in effectiveness; ACT might be more effective than CBT about long-term effects.

Carroll et al. (2014) examine the effect of computer-based training for cognitive-behavioral therapy (CBT4CBT) on cocaine-dependent individuals who are maintained on methadone. The authors argue that CBT4CBT can be an effective adjunction to the treatment of individuals addicted to cocaine, as participants who were assigned to this type of therapy were more likely to attain three weeks of abstinence from cocaine (Carroll et al., 2014). These results indicate that CBT4CBT is an effective intervention for individuals addicted to cocaine who are maintained on methadone, but they also show that the use of CBT4CBT needs to be supported by pharmacological intervention.

Filges and Jorgensen (2016) conducted a systematic review of randomized trials that compared CBT to other interventions to evaluate its effectiveness. The results show that CBT performs neither better nor worse than other interventions (e.g., Motivational Enhancement Treatment, Functional Family Therapy (FFT), etc.). Thus, other interventions can be used as effective substitutions of CBT. At the same time, CBT is more common in interventions that target individuals who suffer from substance abuse, and to make such interventions more effective, other types of treatment can be used together with CBT.

Carroll and Smethells (2016) study sex differences that influence drug seeking and drug abuse. According to them, hormonal conditions can increase or decrease (estrogen and progesterone respectively) cocaine and nicotine-seeking behavior (Carroll & Smethells, 2016). Using these results, one can conclude that hormonal conditions need to be taken into consideration when treating drug abuse. At the same time, as these treatments also target specific behaviors such as impulsivity, anxiety, depression, etc., it is possible to assume that interventions should focus on these behaviors to reduce the chance of recurrent drug abuse in patients.

Mohr et al. (2012) research the influence of telephone-administered vs. face-to-face CBT on patients of primary care. The study aimed to determine which type of CBT was more effective. According to the authors, both of these interventions were effective, but T-CBT was more effective in adherence, while face-to-face CBT provided better maintenance. Thus, it can be seen that in patients with poor adherence, T-CBT can be an option, but the recurrence of the condition or illness (depression, in this case) will also be more likely, which is unsuitable for Emilia and her goals.

McHugh, Hearon, and Otto (2010) examined the use of CBT and other supporting interventions in people with substance use disorders (SUDs). The authors found out that CBT and other interventions (such as pharmacotherapy) can provide better results than CBT alone (McHugh et al., 2010). Although these findings support the use of CBT, it can also be concluded from them that not all services are capable of providing combined interventions. Furthermore, not all interventions are tested thoroughly to support their effectiveness. Nevertheless, CBT is actively researched and tested currently, which makes its use more reliable.

DeVito et al. (2012) conducted a study about the neural influences of behavioral therapy among patients with substance abuse. The study indicated that improved task performance and cognitive control were present; the subthalamic nucleus (STN) was seen as a part that plays an important role in cognitive control. Thus, further research might find that medical interventions directed at STN will be effective in treating substance abuse in individuals. At the same time, as behavioral therapy is a basis for this research, its influence on changes in behavior is also high.

Witkiewitz, Bowen, Douglas, and Hsu (2013) suggest that mindfulness-based relapse prevention (MBRP) can be used for the treatment of drug craving among substance abusers. According to the authors, MBRP is effective because it focuses on creating awareness of the experiences and acceptance of them (Witkiewitz et al., 2013). Thus, the results of this study show that a different approach to drug abuse experiences can emerge in patients, helping them to cope with drug craving. At the same time, it is unlikely that MBRP will be effective in eliminating drug addiction in individuals with SUDs (i.e., Emilia), and thus other interventions that treat biological and affective symptoms are necessary.

Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) review a set of meta-analyses that focus on measuring and evaluating the effectiveness of CBT about different disorders (e.g., SUDs, anxiety disorders, personality disorders, etc.). The study identified that CBT was effective in individuals with nicotine and cannabis addiction, but less effective in those who were treated due to alcohol or opioid dependence. On the one hand, these results can be interpreted as supporting the use of CBT in individuals with different types of addiction, as CBT was not proven to be completely ineffective in alcohol/opioid dependence. On the other hand, if the addiction is accompanied by other comorbid conditions such as depression, anxiety, panic attacks, etc., CBT will be highly effective as it is used for the treatment of these conditions as well.

Selecting and Implementing the Intervention

The CBT was chosen as the primary intervention for the following reasons:

1. It aligns with Emilia’s goals and desires about her drug addiction, i.e., she wants to start treatment, avoid using drugs, and overcome her addiction but cannot do it due to the reinforcing nature of drug use and resulting adherence to cocaine.
2. The CBT will be accompanied by family therapy (home-based multidimensional family therapy) to support Emilia’s wish to improve and reconstruct her relationships with and ties to her family. Due to her decision to terminate a previous pregnancy, relationships with her family deteriorated significantly. MDFT will be effective in building cooperation between Emily and her family, improving relationships between relatives via behavioral changes (Filges, Andersen, & Jorgensen, 2015).
3. Job education to ensure that Emilia can acquire skills (both practical and social) to find a suitable position and support abstinence from drugs.

Quantitative researches conducted by Carroll et al. (2014), Mohr et al. (2012), and DeVito et al. (2012) indicate moderate-to-high effectiveness of CBT in patients with SUDs. It should be noted that CBT that used a face-to-face approach or was conducted through different means (the Internet, telephone) was proven to be effective either way. The research conducted by DeVito et al. (2012) is especially significant as it indicates how the behavioral therapies influence patients’ behaviors by affecting parts of the brain (the subthalamic nucleus (STN) and midbrain and surrounding regions), thus indicating that these interventions are effective not only at psychological but also at physiological levels. The results of the study provided by Carroll et al. (2014) are significant because they show how CBT can serve as an adjunct to methadone maintenance therapy, thus emphasizing a pharmacotherapy + behavioral therapy approach. Mohr et al. (2012) notice that the medical professional’s decision to choose a type of CBT therapy (face-to-face or telephone-administered) will influence both the adherence and effect of the therapy, thus providing different opportunities that depend on patient’s and physician’s/nurse’s goals in treatment.

Qualitative research supports my decision to use CBT as a basis for treatment. Grant et al. (2013) indicate that the use of CBT is justified because it targets the underlying processes standard for many types of addictions, and its ability to change patient’s behavior aligns with Emilia’s goals to stop using drugs. The comparison of CBT and ACT by Lanza et al. (2014) is useful because it provides a critical view of CBT, at the same time pointing out why it might be effective in this case. The authors agree that CBT is effective at posttreatment, but argue that ACT is more effective at follow-up (Lanza et al., 2014). The effectiveness of CBT in this study supports the author’s decision to use it, but, at the same time, ACT can be considered as an option too if the use of CBT will be less effective than expected. Carroll and Smethells (2016) provide a thorough and detailed study about sex differences and their impact on behavioral dysfunctions, indicating that early exposure to alcohol or drugs can predict the development of drug abuse, which is relevant to Emilia’s case, as she was diagnosed with a SUD at an early age (<25 years old). Carroll and Smethells (2016) prove that behavioral dyscontrol is a factor common for different addictions (including substance and drug a), which supports my decision to choose CBT and other supporting implementations for Emilia’s treatment.

Interventions that I found unsuitable include pharmacotherapy only or behavioral therapy only approaches, as several studies indicate that if these ways of treatment are used separately, they are unlikely to be effective (Carroll & Smethells, 2016; Grant et al., 2013; Mohr et al., 2012). Brief interventions (<25 days) were also excluded as possible variations of treatment as both the 12-step program and CBT chose for the intervention require more time to provide the full effect.

Measurable Treatment Goals

The identified treatment goals for Emilia concerned her abstinence from drug use, improvements in her relationships with the family, and socialization through education and acquisition of skills necessary for a job. They were chosen based on her objectives and goals. Perse, these concepts are unmeasurable; that is why I have created specific treatment goals that are easier to calculate, evaluate, and measure:

1. Abstinence from drugs. At least three-week abstinence from drug use is expected during the first phase of the intervention (one month after the beginning of the treatment). A long-term goal, related to this one, is drug abstinence for one to two years after the full completion of the intervention cycle (12 months). As Emilia has a son, the disruptions in her abstinence from drugs will have negative consequences for her and her family. A calculated goal will be easier to follow and check.
2. Rebuilt ties to the family. As the chosen CBT and family therapies rely on the participation of Emilia and her loved ones, the number of therapies attended (e.g., twenty out of twenty or three out of twenty) will be measured to see whether the goal was achieved. As the current number of therapies necessary for Emilia is yet unknown, it is estimated that if 60 to 75% of sessions are attended, the objective is completed. Is less than 60% of sessions are attended by Emilia and/or her relatives, the goal will not be achieved.
3. Job education. Job education targets Emilia’s desire to gain social skills and find a job to support herself and her son. This goal relies on Emilia’s ability to attend educational training or workshops related to the occupation she is interested in. If Emilia chooses one or several training courses and attends them appropriately (e.g., visits 65-80% of the provided training sessions), the goal will be achieved. If less than 65-80% of the sessions/lessons are attended, the goal will be considered unachieved.

As can be seen, these treatment goals align with Emilia’s desires and are constructed in a way to ensure that both Emilia and I can measure them accurately.

Collaboration

To provide services effectively, a social worker needs to collaborate with different professionals who might be occupied in the area of public health, legal communities, faith-based institutions, education, etc. In the case of Emilia, a social worker will address her different needs by working with her family (relatives and the son), her supervisors in the public health (e.g., physicians and nursing professionals) who will monitor her detox program, and psychologists/psychotherapists who will provide CBT sessions to Emilia. It is also possible that a social worker will need to maintain contact with Emilia’s supervisors or manager in the job education area as her outcomes in this training will directly relate to her educational successes. The involvement of a faith-based institution is also likely.

A social worker will collaborate with public health, represented by a public health professional. In this case, both the social worker and the public health professional will be working on ensuring that Emilia’s detox program is completed effectively and on time. The public health professional might discuss specifics of the detox program and medication used with the social worker to outline their effects on Emilia.

A social worker might collaborate with a religious representative. If Emilia seeks spiritual counseling during her rehabilitation, a religious representative will be involved together with the social worker to monitor Emilia’s progress. The social worker can discuss Emilia’s goals with the religious representative to understand how faith-based institutions can influence them.

A social worker is likely to collaborate with Emilia’s supervisor or manager in job education. The educator will help the social worker track Emilia’s progress and point out areas of concern if any are detected. The social worker can also provide counseling to Emilia about her potential successes and failures at job education, discussing steps for active learning.

Practice Informed Research

The collected information can be used in research in several ways. First, it is important to conduct research that will compare the use of CBT in individuals with different forms of drug addiction (e.g., heroin, cocaine, methamphetamine, etc.). The results of such a study will indicate the possible effectiveness of CBT on different drug users. Second, the information collected in this research can be used in further research to understand how the treatment that consists of several (three, in this case) interventions affects the drug user’s abstinence from drugs. Further research can focus on the number of interventions preferred for treatment and rehabilitation of former drug abusers and use the results of this research as a starting point. Third, the patient’s desire to overcome the problem and reintegrate into society can also be useful for future research when evaluating the influence of motivation on therapy and medication adherence.

Practice can be informed by the research if the implications of this research are considered in other treatments involving CBT as well. For example, if professionals will apply CBT and family therapy with other patients who have a similar medical history, their practice will be informed by this research. The use of face-to-face and/or telephone-administered CBT can also be considered by other professionals when using CBT in their practice, as these methods provide different adherence and maintenance of the therapy. If other researchers and medical professionals are unsure whether they should implement CBT and family therapy simultaneously when treating individuals with drug addiction, they can rely on the information from this research to determine the effectiveness of such a combined technique.

As research on the use of CBT indicates that it might be ineffective in centers where the personnel is unqualified for providing such services, policymakers need to create a policy that will regulate the diffusion of CBT and rehabilitation-based services in metropolitan and rural areas. Another aspect of the research essential for policymaking is the collaboration between different professionals and their influence on treatment. Future policies can regulate the cooperation among social workers, educators, medical professionals, legal advisors, etc. that targets individuals with drug addiction and treatment provided to them. A research-informed policy will emphasize the necessity of such collaborations and their effectiveness compared to interventions led by one professional instead of a group. Emilia’s desire to reintegrate is a factor that needs to be taken into consideration by policymakers. In this case, her motivation can be used as proof that people with drug addiction need to be protected from stigmatization legally, via specific policies that regulate opportunities (occupational, educational, etc.) available for such people who want to stop using drugs.

Social service delivery can use the collected information to understand what measures can be used to prevent drug use in communities. First, interventions based on the methods proposed in this research can be used by social workers to reduce the recurrence of drug use in their communities. Second, social workers can evaluate the use of other techniques depending on an individual case, using comparisons of CBT to other therapies presented in this paper. Third, social service delivery can use this information to improve communication with current drug users, pointing out opportunities that can help them overcome their addiction.

References

Carroll, K. M., Kiluk, B. D., Nich, C., Gordon, M. A., Portnoy, G. A., Marino, D. R., & Ball, S. A. (2014). Computer-assisted delivery of cognitive-behavioral therapy: Efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. American Journal of Psychiatry, 171(4), 436-444.

Carroll, M. E., & Smethells, J. R. (2016). Sex differences in behavioral dyscontrol: Role in drug addiction and novel treatments. Frontiers in Psychiatry, 6(175), 1-20.

DeVito, E. E., Worhunsky, P. D., Carroll, K. M., Rounsaville, B. J., Kober, H., & Potenza, M. N. (2012). A preliminary study of the neural effects of behavioral therapy for substance use disorders. Drug and Alcohol Dependence, 122(3), 228-235.

Filges, T., Andersen, D., & Jorgensen, A.M. (2015). Effects of multidimensional family therapy (MDFT) on nonopioid drug abuse: A Systematic review and meta-analysis. Research on Social Work Practice, 2(4), 1-11.

Filges, T., & Jorgensen, A. M. K. (2016). Cognitive–behavioral therapies for young people in outpatient treatment for nonopioid drug use. Research on Social Work Practice, 3(2), 1-23.

Grant, J. E., Schreiber, L. R., & Odlaug, B. L. (2013). Phenomenology and treatment of behavioural addictions. The Canadian Journal of Psychiatry, 58(5), 252-259.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

Lanza, P. V., Garcia, P. F., Lamelas, F. R., & González‐Menéndez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. Journal of Clinical Psychology, 70(7), 644-657.

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511-525.

Mohr, D. C., Ho, J., Duffecy, J., Reifler, D., Sokol, L., Burns, M. N., & Siddique, J. (2012). Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA, 307(21), 2278-2285.

Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2013). Mindfulness-based relapse prevention for substance craving. Addictive Behaviors, 38(2), 1563-1571.

Abstract

This paper looks at the possible methods of solving problems that couples go through in their marriages. It uses Robert and Sophia’s situation to contextualize issues that couples face and their possible solutions. In addition to the case study, the paper uses eight sources to back the arguments. The study shows that most problems that couples face are a result of OCD, and goes further to advocate the Accommodation Therapy and the Exposure Therapy as the best solutions to problems among couples.

Introduction

The Family System proposes the division of the mind into three sub-categories. The founders of this theory called these parts, the managers, exiles, and firefighters. Each of these parts plays a role in the formation of the self. The most problematic part is the exile, which entails traumas, pains, and humiliations from an individuals’ childhood. The firefighters and managers prevent exile problems from disturbing an individual (Yahav, 2002).

In the case of Robert and Sophia, they both have burdens from their childhood. Robert is antisocial because of the alienation he underwent while growing up while Sophia experiences a trauma because her uncle raped her.

During my first interaction with the couple, I will ask them to talk about their past lives. I will create an environment that will make them talk freely. Talking about themselves will enable me to detect their tones and moods when they mention certain events about their past lives. These elements of their will expose their burdens. I will then talk to them and convince them to stop keeping their painful experiences within themselves. An intensive talk will serve to make their protectors release the exiles they hold and take up new and better responsibilities.

Using the DSM-5 diagnostic system

In handling Robert and Sophia’s case, I will apply the Relationship Distress with Spouse or Intimate Partner approach. The two have poor conflict resolution skills and exhibit dysfunction in behavior, cognitive, and emotional faculties. They frequently quarrel and even fight. In addition, Robert’s behavior has changed drastically. He has an extra-marital affair and does not talk openly to his wife. Sophia, on the other hand, experiences stress due to her husband’s infidelity. The DSM-5 proposes the use of the Relationship Distress with Spouse or Intimate Partner approach in dealing with such symptoms (APA, 2013).

Assessment, Diagnosis, and Treatment of a Couple or Family

Socio-cultural factors

Robert’s unsatisfied childhood needs are responsible for his status. The lack of brothers or sisters and his alienation caused him social problems. He grew up with the fear of socializing with other people. In addition, he experiences fear that is natural and common among most men. According to Harmon et al., men naturally fear failure, criticism, and medication (Harmon, Audra, & Ginsburg, 2006).

He is afraid of talking about his problems because of his socialization. His culture has different expectations for men and women. Men do not talk about their problems with their wives. Robert is afraid that his wife will consider him a failure, and his colleagues will criticize him. Living in different countries has exposed him to different cultures. His new culture requires him to discuss issues with his wife. This acculturation causes him confusion.

His wife, on the other hand, is experiencing trauma because of her childhood experience. The trauma makes her oversensitive and hyperactive to Robert’s infidelity. She reacts violently because of her mental disorder. According to Abramowitz et al. (2013), Sophia’s obsession with her molestation causes anxiety, doubt, and avoidance. Sophia expects Robert to reassure him that he is ready to stay in the marriage. The need for reassurance is due to the compulsion that arises from the obsession with her childhood experience.

My social background, biases, and values might cause me problems in understanding the couple’s situation. The socio-cultural history of America has put women and men in almost the same rank. There is no clear difference between feminine and masculine roles. Therefore, I might find myself forcing Robert to abandon his patriarchal disposition and talk to his wife about his problems. I also do not believe in cheating on one’s partner. This belief may make me subjective during the treatment. Worse still, I may find it difficult to understand why Robert does not share his problems with his wife because I believe in openness in marriage.

Ethical issues in assessing and diagnosing a couple

Counselors need to observe ethical standards while handling their clients. The American Counseling Association, ACA, and the American Association for Marriage and Family Therapy propose some ethical standards for counselors to observe.

According to ACA, counselors should be ready to give back to their communities. Giving back refers to the readiness to serve their people without expecting payment. Sometimes, their clients may lack money to pay for the services. In such cases, the counselors should be ready to offer services to them and not harass them for not paying for the services (ACA, 2014).

Sometimes, due to poor romantic relationships with their partners, clients can show readiness to have sex with their counselors. In the case of Robert and Sophia, both clients have no time for each other. They work for long hours and do not find time to be with each other. In addition, Sophia may want to revenge Robert’s infidelity by having sex with somebody else. The counselor should always avoid the temptation of having a sexual relationship with clients (ACA, 2014).

The AAMFT proposes a two-year avoidance period before engaging in any romantic relationship with former clients. The avoidance prevents either of the parties from taking advantage of their professional relationship (AAMFT, 2012).

AAMFT encourages marriage and family therapists to refer to cases that are beyond them to other experts. They discourage them from struggling with difficult cases or deliberate refusal to refer them. Both ACA and AAMFT propose that marriage and family therapists should seek consent from their clients before referring them to other experts. The therapist should write down the consent or record it to serve as evidence of the client’s involvement. In addition, they advise therapists to come up with ways of helping their clients continue with the treatment before they stop working with them (AAMFT, 2012).

Therapists should also provide services to their clients without discrimination. They should not reject or give unsatisfactory services to clients because of their color, ethnicity, age, or religion. Experts discovered that acculturation is one of the main causes of OCD. Therefore, most of the couples who seek therapy are likely to be of different races, ethnicity, and religions. Therapists should not compromise their services because of these factors (Harmon, Audra & Ginsburg, 2006).

Treatment plan

Focus of therapy

The therapy for the couple should mainly focus on their obsessions. Robert’s obsession is the fear that their relationship may not work, while Sophia’s obsession is Robert’s infidelity. The best therapies for this couple are exposure therapy and accommodation therapy. Exposure therapy helps them realize the lack of logic in their obsessions (Nolen-Hoeksema, 2014). Each of them will ignore the urge for compulsive responses to the obsessions. Accommodation Therapy, on the other hand, helps the affected people to assistance from relatives, spouses, and friends (Abramowitz et al., 2013).

Treatment goals for the couple

The major goals for this couple are faithfulness, finding time to talk about their problems, and for intimacy and openness to each other. When Robert starts to talk about his problems with his wife freely, the therapy will have worked. He is not satisfied with the relationship but does not talk about the cause of his dissatisfaction. Accommodation therapy will be very effective in handling this situation. He should make deliberate efforts to involve his wife in his problems. The exposure therapy may also help him realize that it is not helpful to cheat on his wife because of not having time for him (Yahav, 2002).

Sophia is very observant due to her lack of trust for men. Her uncle molested her when she was growing up, and this incident caused anxiety in her. Exposure Therapy is the best for handling her problem. The therapist should help her confront her obsession by avoiding situations that may trigger compulsions. The attainment of this goal is when she stops spying on what Robert does with other people.

Intervention methods

Susie Scot argues that therapists must help suppress or eliminate irrational characteristics in their clients. This philosophy is very important in coming up with methods of intervening in a situation similar to Robert and Sophia’s. Scott argues that the responsibility of therapists is regulating rationality (Scot, 2006). Therefore, in the case of Robert and Sophia, the therapist will have to prevent their clients’ emotions from going beyond their normal working conditions.

As Scot (2006) proposes, the therapist should help Robert realize that getting another woman was an overreaction. He should go through the CBT and be in an environment that allows him to recover on his own. The therapist should also allow Robert and Sophia to interact with anxiety triggers repeatedly. They will realize that the triggers are not important, and will eventually stop worrying about them.

References

Abramowitz J. S., Baucom D. H., Wheaton M. G., Boeding S., Fabricant L. E., Paprocki C., Fischer M. S. (2013). Enhancing Exposure and Response Prevention for OCD a Couple-Based Approach. Behavior modification, 37(2), 189-210.

American Association for Marriage and Family Therapy. (2012). Code of Ethics. Alexandria, VA: Author.

American Counselling Association. (2014).Code of Ethics. Alexandria, VA: Author.

American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM 5. Arlington, VA: American Psychiatric Publishers.

Harmon, H., & Audra, L. (2006). The Role of Gender and Culture in Treating Youth with Anxiety Disorders. Journal of Cognitive Psychotherapy, 20(3), 301-310.

Nolen-Hoeksema, S. (2014). Abnormal Psychology. (6th ed.). Boston: McGraw-Hill.

Scott, S. (2006). The Medicalization of Shyness: From Social Misfits to Social Fitness. Sociology of Health & Illness, 28(2), 133-153.

Yahav, R. (2002). External and Internal Symptoms in Children and Characteristics of the Family System: A Comparison of the Linear and Circumflex Models. American Journal of Family Therapy, 30(1), 39-56.