Emotionally focused therapy is an approach used by psychiatrists in dealing with couples. Psychiatrists have also started applying it when dealing with families and other issues outside the couple. The work of counselors is in most cases to facilitate healing, growth, and wholeness of the human being (Hohenshil, 2010, p.5). Counseling can be done to an individual, a family, a couple, a group of individuals and others. The therapeutic goal of counseling is to restructure the personalities of individuals involved (Doss, Rhoades, Stanley & Markman, 2009, p.21). This will help them to uncover the unconscious, create social instrument, and help individuals to find some meaning in their lives. Therapeutic counseling also helps to cure emotional disturbance, reduce anxiety, develop trust, and become more self-actualizing. Through it, individuals are capable of examining old decisions and make new ones, shed maladaptive behaviors and learn adaptive patterns, and gain more control of their self (Whelton, 2004, para.4).
The principles of emotional theory and attachment theory are very useful in applying the therapy. It aims at changing the problematic emotional states or the experiences that some individuals go through. A psychiatrist achieves this by activating the emotions in a client so that the emotions in the client can adapt to the problem in hand. The emotions of an individual are connected to the essential needs of the specific individual (Greenberg & Goldman, 2008, 34). Whenever there is a chance for advancement, emotions alert an individual of the situation. The emotions also guide an individual when going through these situations that help meet his or her needs. Emotionally Focused Therapy is used to help individual manage their emotional experience.
As stated before, EFT arose from emotional theory and attachment theory (Crawley & Grant, 2005, para.6). Emotional theory has an argument that the experiences of an individual in the world make the nervous system top trigger some physiological events. Physiological changes in turn trigger emotions but do not case the emotions. On the other hand, attachment theory argues that if the attachment security is not certain, an individual may harass his or her spouse in response to the attachment cues. The individual does not even mind on the impact of his or her actions to the relationship. The therapy started being developed in the 1980s and is more humanistic but having less of the behavioral features. The methods developed are based on research that have taken place for over thirty years it explains how people change in therapy to know, express, and regulate their emotions. This helps individuals in a couple to avoid some emotions and assume other emotions that would better their relationship (Anker, Duncan & Sparks, 2009, p.697). As a matter of fact, emotion is a powerful and necessary agent of change. The model emphasizes on using emotion to change emotions. EFT entails reprocessing and reframing of emotions in order to repair the injuries caused by attachment. According to EFT, emotions are very important in the experience of self. Emotionally focused therapy is applied in both adaptive and maladaptive functioning and in therapeutic change. For change to take place, an individual must be aware of some experience and reflect on it. An individual undergoing EFT is therefore made to experience a maladaptive emotion which helps him transform it. The individual adapts another emotional state after experiencing a moment of fear and shame.
According to Compton (2008), when members of the American military return from war from Iraq and Afghanistan, they face many challenges and this may negatively affect their families and couples. He argues that EFT is very effective in dealing with such people. It is important in that it helps reduce interpersonal conflict; increases social support, and address experimental avoidance which maintaining the posttraumatic symptoms. Combat veterans and their partners are exposed to the emotional focused therapy that helps reduce conflict and increase intimacy through acceptance. The individuals are exposed to the therapy to emotions, interpersonal situations and activities that help them recover from the distress related to the combat. The therapy helps them relate with their couples just like they used to before going for the war.
The emotionally Focused therapy is well developed and tested top ensure effectiveness. It is empirically tested and has been proved to deal with problems experienced by couples effectively. The model integrates systems, experiential and attachment theories that help make it more effective (Church, Geronilla & Dinter, 2009, p.76). The integrated model addresses the roles of each partner in a couple. It also looks at emotional experiences of the partners using a systematic framework. These help in understanding the interactions of the couple. This model benefits practitioners by providing them with a relevant approach for addressing the issues and challenges that emerge from couples of different sexes. EFP focuses on the creation of a secure attachment that is effective for distressed couples. It is capable of dealing with one or both individuals in a couple in case of a trauma. Trauma in this case defines a wound. It occurs when an individual is confronted with a threat that overwhelms him or her. It evokes responses of helplessness, horror and intense terror (Mertens, 2009, p. 79). Relational trauma includes events such as miscarriage, childhood sexual abuse, combat and others. An individual experiencing trauma may develop other complications such as acute stress disorder, borderline personality disorder, posttraumatic stress disorder, and other disorders. The emotionally focused therapy will help an individual undergoing such experiences experience the situation and adapt to new emotions.
During the first few years of its discovery, emotionally focused therapy was seen as an evidence based method for treating depression and for conflicts experienced by couples (Johnson, 2004, p.76). Continued research led to advancements where it has now been found useful in treating trauma, interpersonal problems and eating disorders. The model will continue to advance and solve more problems facing not only couples but also other individuals. Its ability to focus on inner emotional experiences with interpersonal, systematic perspectives enables it to cover a wide range of issues.
The emotionally focused therapy takes place over a course of nine stages. It reprocesses emotion to help an individual adapt to new emotions. In the first three steps, the specialist aims at de-escalating the negative cycle (Christensen & Heavey, 1999, p. 167). The therapist in this case identifies secondary emotions that are hidden and comes up with a method of reframing them in terms of attachment. The therapist also shifts to some interaction patterns that contribute to the relationship distress. He or she widens the world of experience and acceptance of both partners by identifying the attachment needs that the partners have left behind them. He or she also helps them own up their underlying emotions. The couples learn to accept each other’s partner experiences and developing a new interaction pattern (Eastaugh & Sternal, 2010, para.4). The partners are required to nurture the new interaction patterns. They are encouraged to try new things and feel safe while doing it. The last processes of reprocessing the emotions using EFT involve consolidating new responses. Here, the couple and the therapist recognize new responses to the old problems that the couple experienced. The position of each partner and their attachment behaviors are also recognized.
When a therapist is attending to a couple that has experienced trauma, there are certain factors that he or she has to consider. The first factor is the fact that traumatized couples goes through higher level of distress that non-traumatized couples (Eastaugh & Sternal, 2010, para.11). The therapist will therefore conduct a slow therapy with a traumatized couple than non-traumatized couple. Instead of giving pathology, a pathologist works closely with the victims to find out how they define the criteria, names and codes for their experience. The therapist moves the attachment from the self to the other partner in a couple. The couples explain their boundaries to the therapist who helps them go about it. Emotionally focused therapy has been proved to be the most effective in dealing with cases of trauma and other differences between couples (Dandeneau, & Johnson, 1994, p. 18). The secondary effects of trauma on one partner may affect the other partner for the rest of his or her life. The therapist should be keen enough to help the couple get out of this condition. In general, many articles talk of emotional focused therapy as evidence based model that helps couples solve their differences even in the worst conditions.
Reference
Anker, G.M., Duncan, B.L., & Sparks, J.A. (2009). Using Client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77 (4), 693-704.
Christensen, A., & Heavey, C.L. (1999). Interventions for couples. Annual Review of Psychology 50, 165-190. Annual Reviews.
Church, D., Geronilla, L., & Dinter, I. (2009). Psychological Symptom Change in Veterans after Six Sessions of Emotional Freedom Techniques (EFT): An Observational Study. The International of Healing and Caring. 9(1).
Crawley, J. & Grant, J. (2005) Emotionally Focused Therapy for Couples and Attachment Theory. Web.
Dandeneau, M. L., & Johnson, S. M. (1994) Facilitating intimacy: Interventions and effects. Journal of Marital and Family Therapy 20 (1), 17-27.
Doss, B.D., Rhoades, G.K., Stanley, S.M., & Markman, H.J. (2009). Marital therapy, retreats, and books: The who, what, when and why of relationship seeking. Journal of Marital and Family Therapy. 35(1), 18-29.
Eastaugh, B. & Sternal, C. (2010) Treating Traumatized couples using Emotionally Focused Therapy. Web.
Hohenshil, T.H. (2010). International Counseling. Journal of Counseling and Development, 88(1) 3-15.
Johnson, S.M. (2004). The Practice of Emotionally Focused Couple Therapy (2nd Edition). New York, NY: Brunner-Routledge.
Mertens, D. (2009). Research and evaluation in education and psychology (3rd Ed.). Thousand Oaks, CA: SAGE Publications, Inc.
Whelton, J. W. (2004) Emotional Processes in Psychotherapy: evidence across Therapeutic Modalities. Clinical Psychology and psychotherapy Journal. Pp.58-71.
The main activities of the psychoeducational groups include “role playing, problem solving, decision making, and communication skills training” (DeLucia-Waack, 2006, p. 11). In this respect, psychoeducational groups have certain goals and topics to focus on regarding the common problems faced by members of this counseling group. Sessions are held in closed groups and do not admit new members after the beginning because there are several stages and each stage has a certain purpose. The major purpose of the current group counseling is to encourage those patients engaged into the weight loss programs and provide them with e certain feedback. Telephone counseling and computerized counseling can be used as well.
Objectives
The main group objectives include the following points:
Applying results of the literature review to the design of counseling sessions.
Group counseling sessions should be design with regard to ethical considerations.
Develop multicultural awareness of counselors.
Integrate different theories and methods into the structure of counseling sessions.
Incorporate knowledge of dynamics, member screening, group organization, and leadership competences in designing group counseling sessions.
Desired Outcome Goals
The major desired outcome goals include the following issues:
Knowledge on different theories and methods integrated by various researchers that should be retrieved while reviewing the literature.
Cultural awareness of possible reactions of representatives of various cultural groups.
Well-structured sessions aimed at educating group members.
Literature Review
The effectiveness of group counseling as well as of psychoeducational approach in general can be prejudiced in terms of lack of a standardized procedure or a system assessing the efforts of counseling group members and a counselor. It is natural that education and counseling are different forms of a cognitive method. However, it is necessary to establish a set of grades to be used while implementing information acquisition in counseling therapy groups. The study by Neuner et al. (2004) supports an idea that counseling can be used in refugee settlements with people that have received a certain trauma.
As you probably know, the refugees can be representatives of different countries. In this respect, the counseling therapy provides counselors with an opportunity to develop cultural awareness with people presenting different cultural layers from various parts of the world.
Trauma is a complicated issue that is claimed to be treated through specialized methods that have demonstrated effective results. Though the counseling approached does not have evidence supporting its effectiveness and cannot be treated as the universal method for refugees with trauma, it can be a part of therapy as well as psychoeducational component. People that are aware of their problems can easily cope with those.
A counseling therapy method helps in developing the awareness of people in terms of cultural diversity and problems encountered. Neuner et al. (2004) suggest that psychoeducation should be combined with other types of therapeutic interventions while dealing with refugees presenting different cultures. As trauma should be approached differently than the weight loss, it requires a different approach.
Different problems require different approaches. Some approaches are universal and can be applied to most individuals regardless of their age, status, background, education, ethnicity, or other parameters that help to define different formal groups for surveys and other types of researches. The study conducted by Lipton, Falkin & Wexler (1992) shows numerous approaches of therapeutic interventions in the form of individual counseling provided to drug abusing individuals during the week and group counseling in the form of small groups of individuals encountering the same problem. In this case, it is necessary to emphasize the issue of privacy as most individuals are concerned with their personal problems being discussed by other people. The issue of confidentiality should be of paramount importance for group counseling therapy with regard to the personal problems shared with other members of the same group.
The effectiveness of cognitive approach is disputable for drug-using individuals. As suggested by Lipton, Falkin & Wexler (1992, p. 12), “Drug education and information programs are for basic support of other programs. Their cost is low and can be maintained by inmates in resource centers, but they do not constitute treatment”. However, cognitive approach can be considered rather effective taking into account the self-help groups and counseling therapy meetings.
It is obvious that a healthy lifestyle should be propagated among all people representing different social classes and age groups, groups of people according to their education and background or income rate. The study presented by Lipton, Falkin & Wexler (1992) dwells on the effectiveness of different approaches with drug addicts. It is possible to assume that the education is treated as an additional method for those who want to be healthy and do not need a feedback.
Counseling interventions can be considered one of the most effective elements of psychoeducational interventions in all cases relevant to the lack of knowledge on the concept, disease, or other issues. The status of citizens appeared to be exaggerated in the contemporary society as well as in the feudal country of the eighteenth century. Separations and divorces have become an integral part of the movement for rights of women that are claimed to be equal with those of men. Some women cease the valance in their families by means of a divorce or a separation, though children in such families with a single mother can become outcasts of the community regarding the norms of behavior established for the community members. The study by Smith & Smith (2000) demonstrated professional counseling interventions with parishioners from three different segregations and their attitudes towards separated or divorced people.
Divorce can be considered as a social phenomenon with some reasons and consequences that can affect other members of society, especially children from separated/divorced families. The counseling interventions in the case of Smith & Smith (2000) were aimed at developing awareness and understanding of the difficulties encountered by separated and divorced people with parishioners from different churches.
Recipients were asked to fill in questionnaires in accordance with their understanding of the divorced and separated people as well as their attitudes towards those being divorced or separated. In this respect, counseling interventions appeared to be effective in terms of developing the awareness of parishioners toward separated and divorced people and changing attitudes towards those people and some problems encountered by separated and divorced people. As you can see, psychoeducational component can be highlighted in case of developing awareness and changing attitudes.
Professional counseling can be considered effective in the most unexpected areas of human activities. As people tend to share their problems with their friends as well as with counselors, it is necessary to identify individuals that can be treated as trustworthy. In this respect, religion appears to be one of the most influential factors because most people that believe in god try to ask for some encouragement from clergymen or other people that can provide them with some confidence or soothing.
The study by Peterson (2002) demonstrates the effectiveness of church counseling in the corresponding establishments. As the professional counseling is aimed at helping people to cope with their problems and overcome certain difficulties existing in their lives via developing awareness, changing attitudes, or providing a feedback. The same measures are usually taken by preachers in churches of different segregations. When people have some problems, they should cope with those.
Some people appear to be unable to cope with their problems by themselves and need some moral help and encouragement. When a church priest advises parishioners on some activities and measures to be taken, this can be considered a psychoeducational component. The study by Peterson (2002) focuses on the professional counseling and a role of a professional counselor in church with regard to the professional approach to the issue of counseling taking into consideration separate individuals, families, and group interventions. In this respect, professional counseling at churches can be as effective as in all other areas with different people encountering different problems. Psychoeducational component is very important, especially with individuals who lack knowledge on certain issues and need a feedback from a counselor.
The importance of being aware of health problems and possible consequences of Pap smear results is vital. When you are not sure about something, you should require some additional counseling. The study by Miller et al. (1997) provides us with a definite evidence of effectiveness of counseling for Pap smear results. Abnormal Pap smear results and preliminary telephone counseling can help in developing awareness of possible consequences of the disease necessary therapies to prevent further development of the ill cells.
The counseling approach is performed via telephone calls; these interventions appeared to be effective in most cases and can be used to make women of different ages and social groups aware of measures to be taken and make them ready to many stages of painful procedures to prevent cancer tumors, though the research conducted for the study by Miller et al. (1997) was targeted at low-income minority women.
When a woman knows more about possible consequences of various therapies and interventions, she is ready for further procedures. Knowledge helps people to learn more about concepts and diseases that frighten them. Being aware of the real numbers of those who can fight the disease on the early stages, people start trusting therapeutic interventions and do not panic being diagnosed as those having cancer. Telephone counseling was used as a preventive measure for women that were going to the colposcopy in the study conducted by Miller et al. (1997). When a person is ready for other consequences than just a visit to a doctor, the patient can prepare herself to a complex of procedures to be taken as a preventive or medicinal therapy. In this respect, telephone counseling is a form of psychoeducational component.
Effectiveness of psychoeducational interventions can vary for patients facing different problems. When a person exaggerates the risk of having cancer, counseling interventions should focus on both the risk of having cancer and on the general information on the disease. Lack of knowledge can lead to exaggerated anxiety and inability to take appropriate measures or procedures necessary to overcome anxiety.
The study conducted by Lerman et al. (1995) demonstrates women who had first-degree relatives with the cancer disease and exaggerated their perception risk of it. The research was aimed at counseling these women on the real risk that they can have. The results of the research demonstrated that the counseling sessions appeared to be not very effective because of lack of knowledge on cancer with the counseling group members.
As the education on the most spread diseases can facilitate the reaction and help perceiving appropriate procedures, it is necessary to initiate counseling in medical centers and other establishments that can afford such interventions. Women with cancer were not targeted in the research conducted by Lerman et al. (1995), while the basic target group included women aged 35 years and older who had relatives of the first degree with cancer history.
If the closest relatives have cancers, patients start exaggerating their risk of perceiving this disease which should be ceased. Counseling interventions as a psychoeducational component can reduce the number of women with risk anxiety on breast cancer. First-degree relatives with cancer history can be considered the factor that causes the concerns of women on their risk of perception. Counselors should explain the essence of the disease and the real risk of perception, so should the relatives.
Telephone interventions can be used in many different ways to help people cope with their problems as a form of counseling sessions for separate individuals in the conditions of confidentiality. When some people do not want to talk about their problems in groups for some reasons, they do not refuse from receiving telephone counseling. In this respect, it is necessary to face different variants. The study by Zhu et al. (1996) shows that telephone counseling interventions can be considered from different ways, suchlike the initiative of the telephone intervention and the number of those. In this respect, the initiative may be from a patient or from his/her counselor; the number of telephone sessions ranged from one to four. The figures mean a lot in this case because it is necessary to focus on the effectiveness of single telephone interventions that can help smokers to take their first step on the way to the healthy lifestyle.
When people cannot cope with their problems by themselves, they can receive some encouragement or immediate feedback from counselors via group counseling sessions or telephone counseling as an alternative type of intervention which is more cost-effective, though appeared to be less effective for smokers willing to quit smoking. The telephone counseling interventions demonstrated in the study by Zhu et al. (1996) were aimed at facilitating ceasing attempts for smokers. The results demonstrated effectiveness of telephone counseling interventions that were initiated by patients but were preliminarily arranged. Single interventions can be considered the ones with low effectiveness. However, telephone counseling can be treated as an alternative type of counseling sessions with psychoeducational component.
Psychoeducational component can be considered one of the most powerful when people are afraid of something. People should be informed about all aspect both negative and positive of some measures or interventions. The study by Bertera & Bertera (1981) argues on the issue of cost-efficiency of telephone counseling compared to the group counseling sessions at clinic with hypertensive patients.
The experiment conducted shows that the effectiveness of telephone counseling was approximately equal to the one of group counseling. The study suggests the groups consisting of primarily aged Afro-Americans with low-income rate. As the sample size was not very sufficient, it is impossible to talk about recommendations, rather it is reasonable to mention that “…telephone counseling is at least as effective as face-to-face counseling in helping patients to achieve and maintain blood pressure control; telephone counseling is about twice as cost-effective as clinic visit counseling as a patient tracking technique…” (Bertera & Bertera, 1981, p. 628).
Regardless the number of sample groups it is necessary to conduct further researches in order to define the appropriate measures with people who should control their high blood pressure. If people cannot afford group-counseling, it is necessary to provide them with the intervention that is as effective as group counseling but is two times more cost-effective than the abovementioned intervention. Cost-effectiveness of interventions should be of paramount importance while working with low-income rate patients regarding the financial situation in the contemporary society.
The study by Bertera & Bertera (1981) focuses on psychoeducational component of interventions, whereas others emphasize medicinal component. In this respect, the telephone counseling sessions can facilitate education of hypertensive patients about their high blood pressure and some measures that should be taken.
The importance of modern technologies can scarcely be overestimated. We use telephones and internet to get a feedback and purchase a book. It is necessary to use technological progress in psychoeducational counseling therapy because we can make group sessions more effective through the internet and via using online databases to share experience, knowledge, and innovative methods. As suggested in the study conducted by Tate, Jackvony, & Wing (2006), the Internet counseling appeared to be very effective for those who tried to lose some weight. This can be presented as a new method for group counselors who can support the group members even outside the group sessions.
This technique can be rather effective regarding the increased number of Internet users and computer-friendly people that develop their communication skills via Internet chats and other types of messages.
The role of feedbacks received by group members is important, especially if the group members lack communication skills and need some encouragement and appraisal to increase their self-confidence. The research conducted by Tate, Jackvony, & Wing (2006) has demonstrated effectiveness of “automated computer-tailored feedback in an Internet weight loss program” (p. 1625). The effectiveness of feedback and encouragement is as important as human counseling groups.
However, some issues do not require automated feedbacks or other types of feedback. If a group member requires a feedback, he/she is not likely to be self-reliable and needs permanent encouragement. You can provide such members with the Internet-based support every time a group member needs it. You can also be sure that not only people concerned with weight loss require counseling therapy in the form of immediate feedback on the phone or via the Internet connection.
As counseling can be performed via telephone as well as via the Internet, it is necessary to emphasize the effectiveness of interventions relevant to the use of modern communication and information technologies. Some counseling interventions can appear to be ineffective for some problems, while other demonstrate a high level of effectiveness compared to the results of the control groups that received neither group counseling nor telephone/Internet counseling interventions.
The study by Tate, Jackvony, & Wing (2003) appeared to demonstrate high effectiveness of Internet counseling provided for patients that were engaged into the Internet weight loss program and had some risk of type 2 diabetes. The main difficulty was that patients were engaged in a different activity and were asked to participate in the counseling sessions. However, the interventions of weight loss that were supported with Internet counseling on the issue demonstrated better results that those without any counseling.
The type 2 diabetes was considered as an obligatory parameter for those participating in the experiment conducted by Tate, Jackvony, & Wing (2003). Preliminary loss of weight as well as pregnancy excluded patients from the potential participants. The loss of weight is a burning issue of the modern global society. Researcher from all countries attempt to find a way not only to lose weight but also to fix the result without any probability to gain overweight again after the experiment or a set of procedures. In this respect, the Internet counseling demonstrated effective results with most patients regarding the risk of the type 2 diabetes. Education played a role of psychoeducational component and facilitated the weight loss as well as fixing the results at one level.
Theoretical Approach
The most appropriate method that should be used by psychoeducational groups is the cognitive one because the counselors should acquire more information in order to be able to teach the members of counseling groups. As psychoeducational groups are aimed at developing the awareness of some aspects, rules, or basic requirements, cognition is the best way to learn something. A psychoeducational component is present in different types of counseling interventions. Telephone counseling is suggested to be a cost-effective type of counseling interventions, though group counseling interventions often appear to be more effective in terms of long-lasting results.
Ethical Practice
Ethics of counseling interventions include the risk of breaches of confidentiality that can happen because of different people learning personal information about each other with regard to not meeting before interventions. If a counselor learns some personal information about the patient, he/she should not distribute it; neither should other members of the counseling group. In this respect, some people may prefer individual counseling interventions rather than the group counseling because of the risk of being discussed in public. Many people are ashamed of their problems and prefer not to be defined as those having some problems.
Besides, as suggested in the study by Tate, Jackvony, & Wing (2003), the patients should be informed about the confidentiality and prohibited about the violation of this rule. As soon as a counselor finds an appropriate approach to ensure safe and confidential sessions, the group counseling interventions can be considered effective in terms of results.
Group Organization
It is necessary to state that the main target group of counseling interventions in the current research paper includes people engaged into the weight loss programs. The research addresses other groups relevant to counseling interventions in groups, though the current paper regards the weight loss as a topic to be aimed. The group should be organized in the manner of at least two groups: a research group and a control group. The research conducted by Basseches & Mascolo (2009) proves that psychoeducational therapy should be approached regarding four stages. The first stage includes the knowledge on the nature of sessions and necessity of its implementation into practise.
As soon as a person realizes what is happening now and anticipated results of sessions, he/she is sure to attain greater success in learning the techniques that can be used to cope with his/her problems and help others to cope with similar problems (as psychoeducational therapy is created for people to be able to help others). The second stage is aimed at reducing the effect of some problems. The third stage is aimed at reaching goals established for every person individually. The fourth stage deals with general acceptance of techniques introduced during sessions. Moreover, “core mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance” are modules existing within the psychoeducational therapies (Basseches & Mascolo, 2009, pp. 90-91).
Member Screening
The group should include people that did not have recent experience of weight loss; also, it is necessary to exclude people with pregnancy or some problems with high blood pressure, diabetes, and other factors that can influence the course of counseling interventions. It is necessary to take all possible measures to avoid group members quitting sessions and the project in general. The groups should be organized in the way of at least two groups: the first group should be engaged into group counseling session, while the second group should be excluded from counseling interventions (this would be a check group) and be engaged into weight loss program only.
Consent Form
As a rule, a consent form includes consent from parents or guardians, or other people that take care of the patients. The current research is aimed at developing awareness of pros and cons of diets with regard to weight loss and possible consequences of unwise measures taken by patients regardless of the doctor’s prescriptions or prohibitions. The weight loss may include the right to use personal data while conducting a research and an obligation to check the results and share these results with researchers and a counselor as violation of some rules and regimes can influence the results of the whole research.
Location, Materials, and Other Considerations
The location of group counseling should be a comfortable place, though it is necessary to exclude any mentioning of food or other factors that would distract patients from a counseling session. It is necessary to avoid public places or places where many people can appear to be witnesses of counseling interventions. The most appropriate choice in this case seems to be a clinic or a medical center. The materials necessary for counseling sessions include handouts because this should be a part of the first-stage sessions. Moreover,
Group Session and Activities
As sessions are integral parts of all types of group therapies, it is necessary to consider the way and importance of planning sessions for psychoeducational therapies. As you cannot predict the reactions of all group members, you should do everything possible to foresee the reactions of different people with regard to their social status, background, age, ethnical diversity, and other factors that can help you anticipate certain results of the sessions.
As suggested by Brown (2003), it is necessary to outline the objectives for each session; compose a list of materials that may be useful for the current session; a minilecture or a monologue that would introduce the information you want to present at the current session; and a certain set of activities or exercises aimed at acquiring information and integrating it into practise (p. 94). You should plan both the content of the session and the sequence of exercises and time that every set of activities may take.
DeLucia-Waack (2004) suggests some activities to be used in different stages of the group counseling therapies. The first type of activities includes initiating focus and establishing interaction. In this regard, this activity is important to learn about the peculiarities of every patient and problems encountered by each person (being aware means being ready to prevent certain difficulties and foresee problems).
The second type of activities is used after the interaction has been established; it includes facilitating the interactions. As suggested by Trotzer (1999, p. 396), facilitating “activities should be derived from or suggested in response to a situation or dynamic that has emerged in the group” (as cited in DeLucia-Waack, 2004, p. 80). And the third type of activity introduced by DeLucia-Waack (2004, p. 81) is integrating activity used in the end of sessions to consolidate the effects reached during the sessions.
Evaluating the Group
As a rule, the assessment of group counseling appears to be not very effective because of the nature of these interventions. As claimed by Neuner et al. (2004), it is impossible to use counseling sessions for all types of disorders and guarantee good results because the effectiveness of these results is difficult to assess. Thus, the results of the members of a counseling group engaged into the weight loss program should be assessed according to the results of the major program (the loss of weight) and its effectiveness. If the average weight of the patents participating in counseling sessions is less than that of non-members of counseling sessions, we can talk about the effectiveness of sessions.
Leadership Development
The leadership development is an important part of counseling sessions, especially while talking about people with equal possibilities and primary data. When people feel the competition, for instance, in the weight loss programs, they are likely to make every effort to surpass the results of their group members.
Conclusion and Recommendations
The main conclusion concerns the effectiveness of counseling interventions with people engaged into the weight loss programs. The counseling sessions can take place in groups or via telephone and Internet interventions. Counseling interventions appear to be an integral part of psychoeducational therapy and are required be people who seek feedback and encouragement.
Reference List
Basseches, M., & Mascolo, M. F. (2009). Psychotherapy as a developmental process. New York: CRC Press.
Bertera, E. M., & Bertera, R. L. (1981). The cost-effectiveness of telephone vs. clinic counseling for hypertensive patients: A pilot study. AJPH, 71 (6), 626-629.
Brown, N. W. (2003). Psychoeducational groups: process and practice (2nd ed.). New York: Routledge.
DeLucia-Waack, J. L. (2004). Handbook of group counseling and psychotherapy. Thousand Oaks, California: SAGE.
DeLucia-Waack, J. L. (2006). Leading psychoeducational groups for children and adolescents. Thousand Oaks, California: SAGE.
Lerman, C., Lustbader, E., Rimer, B., Daly, M., Miller, S., Sands, C., Balshem, A. (1995). Effects of individualized breast cancer risk counseling: A randomized trial. Journal of the National Cancer Institute, 87 (4), 286-292.
Lipton, D. S., Falkin, G. P., & Wexler, H. K. (1992). Correctional Drug Abuse Treatment in the United States: An Overview. In C. G. Leukefeld & F. M. Tims (Eds.). Drug Abuse Treatment in Prisons and Jails. NIDA Research Monograph, 118, 8-30.
Miller, S. M., Siejak, K. K., Schroeder, C. M., Lerman, C., Hernandez, E., & Helm, C. W. (1997). Enhancing adherence following abnormal pap smears among low-income minority women: A preventive telephone counseling strategy. Journal of the National Cancer Institute, 89 (10), 703-708.
Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72 (4), 579-587.
Peterson, J. (2002). Nonsectarian counseling in churches: A delicate balance. Counseling and Values, 46 (3), 226-236.
Smith, J. A., & Smith, A. H. (2000). Parishioner attitudes toward the divorced/separated: Awareness seminars as counseling interventions. Counseling and Values, 45 (1), 17-27.
Tate, D. F., Jackvony, E. H., & Wing, R. R. (2003). Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: A randomized trial. JAMA, 289 (14), 1833-1836.
Tate, D. F., Jackvony, E. H., & Wing, R. R. (2006). A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an internet weight loss program. Archives of Internal Medicine, 166, 1620-1625.
Zhu, S. H., Stretch, V., Balabanis, M., Rosbrook, B., Sadler, G., & Pierce, J. P. (1996). Telephone counseling for smoking cessation: Effects of single-session and multiple-session interventions. Journal of Consulting and Clinical Psychology, 64 (1), 202-211.
Buddha’s teachings analyze that mindfulness is an awareness of a spiritual faculty that is of great significance to enlightening. Mindfulness is the reality of things, especially at the present moment. This psychological aspect becomes power when one understands his or her life. Buddha advocates that individuals should establish mindfulness in their daily lives while trying their best to maintain calm awareness in their bodily functions, feelings, objects of sensations, and consciousness (Herbert & Evan, 2011). The western psychologists borrowed this practice from Buddhists so as to use it in the alleviation of depression, drug addiction, and relapses among other conditions; which might be mental or physical in nature. Depression is the feeling of sadness or blueness, and while these feelings are short-lived, it takes many days for an individual to heal.
The condition comes with a lot of pain to the affected individual and those around him hence causing a lot of inconveniences for many people. According to my observation, this is a common serious illness, but many people living with it do not seek medical attention (Piet & Hougaard, 2011). The condition is curable when medical attention is sought, especially for intensely affected patients. This illness can be treated by; psychotherapies such as acceptance and commitment therapy (ACT) and mindfulness-based cognitive behaviour therapy (MCBT). This is a reflective essay comparing, contrasting, and critiquing, two of the cognitive approaches to therapy. The approaches to be explored are acceptance and commitment therapy and mindfulness cognitive-based therapy. I will consider these approaches in my own professional practice. I will critique each therapy through a discussion of the strengths and weaknesses, and I will give reasons for concluding that one is better than the other. I will further discuss each therapy outlining the strengths and weaknesses of each which will be supported by relevant literature.
Acceptance and Commitment Therapy (ACT)
This is a type of psychotherapy that can help in accepting life difficulties. The therapy needs the participant to accept his or her condition and be mindful. These two components will lead to behaviour change and enhance the chances of ensuring that psychological flexibility is successful. This approach, developed by Steven Hayes, was first called comprehensive distancing before it was renamed acceptance and commitment therapy (Hayes, Luoma, Bond, Masuda & Lillis, 2006). Under this therapy, the wellbeing of an individual can be attained by overcoming negative thoughts and feelings. I find this therapy useful because it focuses on character traits of a person and his or her behaviour, and it assists the person to reduce coping styles that are avoidant (Hayes, Luoma, Bond, Masuda & Lillis, 2006). Moreover, the therapy addresses an individual’s commitment to propose changes, and I have seen it useful in providing solutions, especially to challenges of sticking to set goals.
The Six Core Processes of ACT
There are six core processes of acceptance and commitment therapy, and they include;
Connection; this means being in the present moment while connecting fully with what is happening wherever one is at that particular moment. This is commonly referred to in the therapy as “contacting the present moment” (Harris, 2006, p. 6).
Defusion; I ensure that my clients do not remain in worries or memories that destruct them. He or she should learn how to let go thoughts and worries, which are not useful, instead of allowing these memories to overcome one. I encourage my participants to hold back and keenly observe their thinking so that they are ready to handle the condition when it comes instead of getting lost in unhelpful thoughts (Harris, 2006).
Expansion; this is where a client is encouraged to open up and create room for sensations and feeling, which are painful. I advise my clients to by dropping struggles within themselves, allowing some breathing space and not interfering with their lives. Under this phrase, the more patients open up and give room to their struggles, the easier struggles will come and go without affecting their lives (Harris, 2006).
The Observing Self; this is whereby, one accounts for his or her awareness and attention. The process involves the two parts of the mind. The first is the self, which is responsible for thinking, feel and do at a particular moment and accounts for all beliefs and judgments. The second one is the observing self, which is always aware of what one is thinking, feeling, or doing at a particular moment. I always warn my clients that without this part, one cannot develop mindfulness skills (Harris, 2006).
Values; this is the fifth process, and it involves what one wants his life to be as deep inside his heart. Values involve what one stands for; how he wants to spend his time, what he wants to do with his time while living and what it will be like to be remembered by those he loves when he or she dies (Harris, 2006).
Committed action; in this stage, the action is taken by the guide of one’s values by doing the right thing regardless of the challenges.
The combination of these six steps leads to the development of psychological therapy, which enables one to open up, present himself, and concentrate on matters that are of importance to him. If one is in a good position to do this, he is in a good position to live a quality life. The participant can effectively deal with the situation when it comes along (Harris, 2006).
Strengths of ACT
Some ideas have been borrowed from ACT to create acceptance and commitment training, which are non-therapy in version. For example, in my professional practice, I use ACT to train patients because it enables the development of mindfulness values and even acceptance away from medical centres like in businesses and schools. ACT training and application is similar to awareness management movement where techniques such as cognitive shifting and mindfulness are applied as in business (Blackledge, 2007). The therapy is a wonderful tool to deal with stress because of its ability to have the participant regains a rich and meaningful life.
While I am dealing with my clients, I also teach them psychological skills, which enable them to deal with their painful thoughts and feelings. That way, the painful thoughts will have less effect and influence on their lives (Blackledge, 2007). I ensure my clients get important skills of the therapy, which can assist them in differentiating good and bad. They are required to use that knowledge to guide and inspire them to brighten their future. Most of my clients, whom I have given this therapy, have recovered from various illnesses. This therapy does not cure every illness or make it perfect, but it reduces upsurges in patients hormones, elevate mood, and upsurge chemicals produced in large volumes when one is stressed.
This therapy introduces positive thinking, which is a recovery process from mental illnesses. This therapy prevents a person from thinking negatively because it changes the way one perceives situations by evaluating motivations, which can drive other people. I have also discovered that this therapy is not important to the sick only, but it can also assist other people like athletes. For instance, students can focus on achieving high test scores, and by reduction of test anxiety and focusing on studies. This therapy assists many people to adopt optimism even in difficult moments of life (Blackledge, 2007). My clients try to find solutions to their problems or use these hard times to help others reduce test anxiety by studying the therapy. ACT is effective in executive coaching of life (Blackledge, 2007). There are tactics that I apply in my practice such as cultivating acceptance, openness and mindfulness, which help in treating depression, substance abuse, chronic pain and anorexia, among other complications. I usually teach my clients that this therapy has its disadvantages. First, people who have adopted it can become too optimistic about a condition called optimist bias. At this point, they tend to think that they are immune to moments of life or believe that greater things in life have a high chance of occurring as compared to negative things. If this happens, cases like smokers believing that they cannot get cancer can occur (Blackledge, 2007). I teach my clients to know that optimism is usually tempered with realism, which is not negative.
Limitations of ACT
ACT utilises mindfulness strategy similar to mystical aspects of Buddhism and other religions. At times I received complains that after applying the ACT therapy, some of my clients have had experiences of confusion between psychological experiences and the proposed mechanisms of change in the ACT. I understand that some critics argue that both of them are intervention methods; which has pressurized the proponents of the therapy to seek more evidence to differentiate the therapy from psychological experiences. However, the therapy is based on the assumption that other mindfulness-based treatments are similar to that of Morita therapy (Forsyth & Georg, 2007). Therefore, I usually advocate for an alternative when confusion occurs because there is no object therapy for clients.
Mindfulness-Based Cognitive Therapy
Mindfulness-based cognitive therapy can be defined as a psychological therapy used to prevent the relapse of depression on those people with major depressive disorder (MDD). This therapy uses traditional cognitive behavioural therapy (CBT) methods and complements with new psychological strategies, such as mindfulness meditation and mindfulness (Hofmann, Sawyer & Fang, 2010). Cognitive methods comprise of educating the participant on depression while mindfulness and mindfulness meditation usually focuses on one being informed of all insight feelings, thoughts and accepting themselves as they are: rather than reacting to them in a strange or unacceptable way (Hofmann, Sawyer & Fang, 2010). The main objective of mindfulness-based cognitive therapy targets at interrupting the normal life in the participant and make him or her not to concentrate on stimuli from outside. These stimuli are better observed without any judgment for a better outcome.
This is because it is possible for participants to realise when automatic processes are in action, and therefore acquire skills of altering them. Most researches carried out to check on the effectiveness of MBCT have found it to be effective, especially on those people suffering from depression (Hofmann, Sawyer & Fang, 2010). This is believable because the mindfulness-based approach is meant to deliberately focus on an individual’s present experiences without judging him or her. This therapy has its roots in Buddhism. The approach was developed by Segal Zinde, Mark Williams, and John Teasdale (Hofmann, Sawyer & Fang, 2010). Under this therapy, the participant must direct and focus his or her mind away from thoughts that are external. In this case, it is advisable for any participant to observe and accept the current situation with all its offerings; whether good or bad.
Phases of Mindfulness-Based Cognitive Therapy
Recognition; the phase informs the participants on how to recognise his actions and the best responsibility to take at that particular moment. It also informs participants on how to carry their burdens without blaming them on other people. At this point, I advise my clients that what we do is very different from the source of suffering. For instance, pain exists, but suffering is a subjective process conditioned by thinking that is usually attached to the pain (Leahy, 2006).
MT; at this point, one should know how to handle relationship together with his problems. Transformation and healing take place during this phase. I teach my clients to learn to recognize their reactivity so as to transform it because if they do not feed this anxiety, it will weaken, and eventually die out (Leahy, 2006).
Relationship; my clients make informed and flexible decisions at this point, according to the teachings of Buddha, compassion which is allowing pain to prevail safely while at the same time ensuring that the ego is at control.
Resolution; at this point, the participant enters into another phase of inner thoughts and feelings. The road to resolution presents itself naturally, and it enables the exploration of details of what brings about the resolution of the emotion (Leahy, 2006).
Strengths of Mindfulness-Based Cognitive Therapy
Mindfulness-based cognitive therapy focuses on thoughts, beliefs, and feelings which are just on the surface. This is because participants close their eyes most of the time. This enables them to explore their inner structures with full concentration, explore their anxieties and depression, anger, and traumatic memories. The therapy focuses on the inner sensory structure of anxieties and other emotional imbalances instead of concentrating on the surface of thoughts or personal story (Leahy, 2006). MBCT concentrates on unhelpful thoughts which allow stress and depression due to un-compulsive force.
The therapy works from general to specific, which makes the therapy effective because it is easier working from general to specific than the other way round. For instance, worrying is a proliferate thinking that can change a little anxiety into a large nightmare. If this is dealt with early, large anxieties of worry can be avoided (Leahy, 2006). In this therapy, information about cognitive therapies such as depression and exercise are available. These therapies combine thinking and the way the results affect the feelings. The therapy has a formula of guiding participants to work with thoughts of depression, and the way skills negative moods and thought patterns are recognised.
This therapy can be molded to address a variety of symptoms as well as circumstances. My profession requires me to make follow up on the progress of my client and advise him or her to be fully dedicated to the participation. After sometime, the client gets some mindfulness skills, which can assist him or her deal with the situation wherever and whenever even in the absence of professional personnel. Those who regularly practice this therapy gain emotional healing fast than those who do not practice it. Mindfulness based therapy is mostly delivered through the practice of mindfulness approach. I encourage my clients to consider their thoughts, their past, their present, and their future anticipations when they seem to deviate from the present. This way, I win back their attention to the present moment (Shapiro, Carlson, Astin & Freedman, 2006). In my working with the client, I ensure that he or she gets to know the negative thoughts, which can be caused by these types of emotions and advice them to be alert so that when they come, he or she can recognise them.
This therapy aims at relieving the signs of psychological stress, physical pain as well as negative mental states (Shapiro, Carlson, Astin & Freedman, 2006). Meditation and yoga movements are very useful in reminding the participants their physical sensations, and reminding them to maintain deep breath and straight movements during the period of taking exercises. This should continue outside the therapeutic process session to allow him the opportunity of serving, exploring, and experiencing mindfulness in an environment that is not clinical (Shapiro, Carlson, Astin & Freedman, 2006). It is important to examine and evaluate the results and obstacles one gets in his life and use these results to alter his behaviors and thoughts.
Limitations of Mindfulness Based Cognitive Therapy
During times of stress, I encourage my clients to pause for sometime and be in their current status. I do this because the mindfulness based cognitive therapy is into people’s behavioral pattern in a way that they are always trying ways of combating stress and improving the quality of their lives (Leahy, 2006). According to my professional teachings, mindfulness meditation is effective in both health and performance. Finally researches carried out on mindfulness based cognitive therapy have argued that people suffering from chronic depression have not been benefiting from this type of therapy. Therefore, they are advocating for deeper research to be done on this therapy to assist people with chronic depression (Leahy, 2006).
Comparing and Contrasting ACT and MBCT
Acceptance and commitment therapy is a branch of the mindfulness based approaches just as mindfulness based therapy. Mindfulness is a powerful therapeutic intervention aimed at increasing emotional intelligence (Lau, & McMain, 2005). ACT has proved to be an effective therapy in most researches. Mindfulness requires one to be focused, open, and aware in one’s daily activities. In my professional practice, I find this useful not only to the sick, but also to athletes and business people (Lau, & McMain, 2005). ACT is a branch of MCBT and presents a new form of psychotherapy. ACT is method of treating conditions like depression, stress, post-trauma and anxiety among others. Both ACT and MBCT rely on the philosophy of contextualism school of thought. The school advises people to be in a context so as to understand ideas and words well. MBCT on the other hand concentrates on identification of hot thoughts (Lau & McMain, 2005). These thoughts are throes of depression or anxiety.
The therapy evaluates the thought and list evidence to show why it is not true. Many who think about this process come to know that what they are thinking is not the truth. They learn skills of easily dismissing those thoughts when they occur. ACT differs from MCBT in accepting the thought immediately. Participants of ACT do not actively dismiss previous unwanted thoughts (Lau & McMain, 2005). This is also the case with MCBT because MCBT aims at the reduction of unwanted thoughts. ACT has so many ways of learning its skills and some of them take a short period of time. Acceptance, defusion and contact with the present moment are the components of ACT. These three aspects require participants to be uninterrupted by external thoughts and feelings (Lau, & McMain, 2005). Sometimes the ACT therapists have claimed that the ACT therapy takes long as compared to MCBT. This is because ACT helps people accept situations the way they come, live life the way it is, and take appropriate action where necessary. As a result of this, I find ACT to be more effective than MCBT.
Conclusion
ACT is more explored and researched as compared to mindfulness based cognitive therapy, which has almost all the skills in ACT. However, ACT is a powerful therapy when integrated well with the mindfulness based approach. Mindfulness based approach is widely used in ACT in research, application, and analysis of results. The therapy applies all the skills involved and other new specialised skills in the therapy. These skills are not found in mindfulness based approach. This is what makes ACT more preferable or effective as compared to mindfulness based therapy. ACT uses traditional and modern skills in assisting people get out of stress, depression, and other disturbing aspects of life. If these skills are practiced daily, unhelpful thoughts and painful feelings will find no room to influence or affect the participants. ACT is an effective therapy in doing away with depression, worrisome thoughts, and stress among others. Although both approaches can be applied separately, they can be combined to make a strong therapy for participants.
References
Blackledge, J.T. (2007). Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. The Psychological Record, 57, 555-576.
Forsyth, J. P., & Georg, H. E. (2007). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy. Oakland, CA: New Harbinger.
Harris, R. (2006). Embracing your demons: an overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4), 2–8.
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. New York: Nova Science Publishers.
Herbert, J. D., & Evan M. F. (2011). Acceptance and mindfulness in cognitive behavior therapy: Understanding and applying new theories. Hoboken: John Wiley & Sons.
Hofmann, S. G., Sawyer, A. T., & Fang, A. (2010). The empirical status of the “New Wave” of cognitive behavioral therapy. Psychiatric Clinics of North America, 33 (3), 701–710.
Lau, M.A., & McMain, S.F. (2005). Integrating mindfulness mediation with cognitive and behavioral therapies: The challenge of combining acceptance-and-change-based strategies. The Canadian Journal of Psychiatry, 50(13), 863-869.
Leahy, R.L. (Ed). (2006). Contemporary cognitive therapy: Theory, research, and practice. New York: The Guilford Press.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31 (6), 1032–1040.
Shapiro, S.L., Carlson, L.E., Astin, J.A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62 (3), 373-386.
Counselors and psychology practitioners provide therapeutic services to clients who need full information about the nature and the consequences of such services. It is because the clients have legal and ethical rights to be informed about the underlying potential results of any therapeutic service. Therefore, mental health professionals are responsible for providing accurate information to clients because therapeutic services often affect the client’s emotional, social, and mental operation.
Providing full information to clients during therapeutic sessions is crucial because it shows respect for the client’s rights to autonomy, human dignity, and freedom. Therefore, informed consent is defined as the process of disclosing to the client relevant information about the client’s needs so that he or she can make reasonable decisions. Informed consent empowers the clients to make free consent in a free society.
A list of the Elements that are needed for Informed Consent
Several elements are required for informed consent. These elements vary from each other. They depend on the type of clients that psychotherapists engage with for informed consent. They include the following:
The kind of decisions the client makes: This element focuses on the ability of the client to make consent freely without coercion.
Available options to proposed intervention: The alternatives provide a backup intervention i.e. if the proposed intervention fails another intervention replaces it.
Evaluation of the client’s understandings: This element requires the psychotherapists to assess the extent to which the client comprehends the information that he/she needs to make informed decisions.
The client’s approval of the intervention: The client must accept the intervention before the therapist proceeds to implement it.
Possible risks, benefits, and uncertainties associated with each intervention option: This element requires the practitioner to know all the risks and/or benefits the client is likely to face during the process of informed consent.
The client’s knowledge: This element focuses on the knowledge an average mental-health client needs to be an informed participant in the context of therapy.
The client’s competency: Adults who cannot provide their consent are represented by legal representatives. On the other hand, children who cannot provide their consent are represented by parents or legally bound guardians.
A script on how you will explain the various things in Informed Consent
Informed consent entails various aspects that need explanations for the client to understand. Unfortunately, there are no particular guidelines to explain these things. However, practitioners follow general instructions to explain those aspects so that informed consent becomes effective.
To begin with, the therapists ensure that the clients under therapy understand the language used for communication. Therefore, they give the clients information about informed consent, either orally or in writing. An example of written work is the client information brochure. This document outlines all the fundamental details of the things that informed consent needs to be conducted successfully.
The second step is to prepare a list of questions. This list will contain relevant questions that will help the client to participate actively in the discussion. The questions will primarily focus on the client’s needs and perceptions.
The third step entails the identification and definition of the client’s rights. It makes the client feel a sense of self-worth and respect. Moreover, the elements are clearly explained to ensure that information is provided efficiently and interestingly to shorten the informed consent process.
The next step involves the presentation of the guidelines explaining the informed consent to the client. The guidelines will elaborate on the purpose, procedures, risks, and possible alternatives. Also, the client is issued a summary of the study information that everyone understands.
The last step involves allowing the subjects to read the contents of the study information so that they can understand for themselves. The therapist answers all the arising questions appropriately to facilitate clients’ free consent.
How you will explain Informed Consent to an Intoxicated Client
Explaining informed consent to an intoxicated client is difficult because the client’s mental abilities are impaired. However, intoxicated clients also need informed consent before offering them therapeutic or treatment services. The procedure provided below is used to help the therapist to explain informed consent to an intoxicated client.
Assess the level of intoxication, by the policies and procedures of the organization, before providing any information to the intoxicated client. Treat the client with respect and provide him/her with clear information regardless of the level of intoxication. Wait until the client becomes sober before giving informed consent in cases of severe intoxication, or the client cannot consent. Moreover, use clear messages that are aimed at changing the intoxicated client’s impaired impulse and cognitive control.
Introduce yourself to the client. It will stimulate the client’s reasoning about where he/she is and help in measuring his/her level of intoxication. Besides, this will help in foretelling the kind of response, or behavior that is likely to prevail throughout the counseling process. Therefore, continue to explain informed consent if you notice that the client can consent.
Prepare the client for the discussion by asking him/her to tell you his/her name. After knowing the name, inform the client about his or her responsibility to provide informed consent and why he/she is under therapy. As a practitioner, think, and guide the informed consent session because highly intoxicated clients may lack cognitive ability. It will bring about control and reduce repulsive behavior from the client.
Finally, explain informed consent by using short sentences to enable the client to understand it efficiently. Remind the clients to ask questions if they encounter any misunderstandings.
How you will explain Informed Consent to a Mandated Client by the Authorities
When the client has been mandated by authorities to seek informed consent from mental professionals, the professionals must observe several ethical and legal principles to effectively explain informed consent. You should handle the process of explaining informed consent carefully because voluntariness is non-existent in mandated informed consent. Therefore, observe general ethics such as maintaining the client’s human dignity and welfare.
Inform the client of your role and obligation to the authorities that required informed consent from the client. Moreover, consider the clients as people who are willing to receive directives and participate in the exercise of therapy.
Furthermore, explain to the client the services they are going to receive according to the court order, and the level of confidentiality to be observed in the scenario. Mandated clients have a feeling that they are coerced to participate in counseling or therapy, thus for informed consent to occur, ensure that a non-coercive relationship with the client exists. It will assure the client of his/her confidentiality and reporting of the consent. Finally, inform the client that some degree of information will be shared according to the third party’s request, but it will be done in a limited manner.
My therapeutic perspective is the client-centered approach, which Carl Rodgers suggested. I believe in the inherent ability of human beings to improve themselves. Certain therapeutic approaches tend to use a paternalistic strategy in which it is assumed that the therapist knows everything. As such, the client develops a dependence on the expert whose presence may not be sustainable in their lives. I believe that the client has a capacity to understand his situation, and thus develop a course of improvement. As Rogers explained, all individuals have resources to direct their behaviors, so these should be utilized as much as possible (Rogers, 2003). For instance, a person who has just lost a close relative may have difficulty in coping with the issue at the beginning but will have improved greatly after several months or years. This does not, in any way, prove that a therapist is irrelevant. The counselor’s role is to direct or facilitate this self-actualization.
Discussion
I adopted a humanistic school of thought because I believe that therapists should be as genuine and as open as possible. Rather than trying to hide one’s identity, it would be more effective to use one’s humanity as a tool in therapy. I was particularly drawn to the manner in which therapists in this school perceive their clients. This attitude is respectful and unpretentious. I liked the idea of treating the client like one would treat a friend; therapeutic sessions would involve listening and nudging the person as he decides what to do with himself. This concept of relationship-building is quite authentic to me. It seems that a lot of progress can be made when the client-therapist association is personal in nature. Further, a focus on relationships appears to be more sustainable than skills. This is because skills are too technical and only work in certain circumstances. However, if one alters one’s attitude, then this can apply to almost any situation (Cooper et. al., 2010).
References
Cooper, M., Watson, J. & Hoeldampf, D. (2010). Person-centered and experiential therapies work: A review of the research on counseling, psychotherapy and related practices. Ross-on-Wye, UK: PCCS Books.
Rogers, C. (2003). Client centered therapy: Its current practice, implications and theory. New York: Constable Publishers.
Art therapy is based on the idea that the productive procedure of art making is healing, making life better or attractive and it is also a form of gestural activity of transmitting information of individual thoughts and feelings. Like other forms of psychiatry concerned with psychological methods and counselling, it is used to encourage individual growth, gain self understanding, and helps in emotional reparation and has been used in a comprehensive range of circumstances with children, adults, families, and groups.
It is a classification of propositions on the basis of whether they claim necessity, possibility or impossibility that can assist individuals of all ages create message that is intended, expressed or signified and achieve clear (and often sudden) understanding of a complex situation, find assistance from intense emotions or emotional wound or shock often having long-lasting effects, settle open clash and problems, improve the quality of daily life, and attain an increased sense of well being (Malchiodi,1998).
Art therapy supports the cognitive content that all individuals have the ability to express themselves in a creative manner and that the product is insignificant than the therapeutic process connected by participation. The therapist’s centre of attention is not specifically on the aesthetic admirable quality or attribute of art making but on the therapeutic needs of the individual to express.
Consequently, the most important thing is the person’s participation in the work, selecting and smoothing the progress of art activities that are useful to the being, helping the individual to fully understand the creative method, and making it easier to share in the experience of image making with the person skilled in a particular type of therapy.
While other types of therapy are in an effective manner, art therapy is progressively being utilized by therapists with individuals of different ethnic groups and of all ages. Furthermore, art expression for therapy is not only used by art therapists, but also counsellors, psychologists, social workers, psychiatrists, and physicians.
With the introduction of short forms of therapy and the increasing forces to complete treatment in specific number of sessions, and the research carried out by therapists they discovered that art activities help individuals to transmit thoughts or feelings about relevant issues and problems quickly, as a result, to speed up the progress of assessment and interference. Even the simplest task in the representation of forms or objects on a surface by means of lines presents radically distinctive possibilities for expression that complements and often, assists a child or adult to communicate what words cannot.
The field of art therapy is an acknowledged form of treatment, which is still to some extent a mystery to several professionals. However, the professional therapists who use art with their clients understand that art therapy is an effective form of intervention, but most do not know its rich history, why it works, and what its benefits and limitations are as a form of therapy and evaluation. Regarding this, some therapists distinguish art therapy as modality that helps individuals to express their thoughts and feelings, beliefs, problems, and world views.
By this definition, art therapy is an addition to the branch of psychiatry concerned with psychological methods, which facilitates the process through both image making and verbal exchange with the therapist. In reality, both distinct features chip in to art therapy’s efficiency as a form of care provided to improve a situation and most art therapists pledge to both explanations in their work. Making of representations is of assistance for people to transmit thoughts or feelings both through image and words and, with the direction of a therapist, can help individuals in conveying that which cannot be said by words alone. Artistic expression is any behaviour that engages the brain in a manner that can be used to improve therapeutic treatment and evaluation.
Many therapists question if art therapy is strictly about translating the content of art expressions and clinicians new to the field often question what exactly art expression can tell them about the patients who makes them. Images are types of being other than verbal communication and therapists are frequently inquisitive if it is possible to interpret their client’s artwork. To a large extent, art therapists are worried with understanding the importance of client-created artworks and research is presently being carried out in the area of art based classifications. Art therapy is an interesting, changing field, one which continues to develop in terms of depth and applications.
For the art therapist’s professional, it is a modality that is central to their work and is the foundation of their global view of therapy in general. For counsellors, social workers, psychologists, psychiatrists, it is a modality that is essential to their work and is the base of their world view of therapy in general. Furthermore, for counsellors, social workers, psychologists, psychiatrists, and others, art may also be a tool that is employed as an addition to verbal therapy.
Art therapy is a crossbred discipline primarily founded on the fields of art and psychology, drawing characteristics from each parent to change a unique new entity. But the twisting of arts and healing is hardly a new remarkable development.
It seems clear that this combination is as old as human extended social group having a distinctive cultural and economic organization itself, having repeatedly taken place throughout the history across place and time (Malchiodi, 1998). The development of the profession of art therapy can be seen as the formal application of an established human specific practice of long standing shaped by the intellectual and social trends of the present millennium (Junge & Asawa, 1994).
The Aims of Art Therapy
Art therapy involves both the process and products of image making and the provision of a healing relationship. It is within the supportive totality of surrounding conditions, furthered by therapist-client relationship that it becomes possible for individuals to create images and objects with the clear plan of exploring and sharing the significance these may have for them. It is by these means that the customer may gain a better understanding of themselves and the essential qualities or characteristics of their problems or suffering.
The aims of art therapy repeatedly vary according to the exacting needs of the individuals with whom the art therapist works. These needs will have to change as the therapeutic relationship build up. The process of art therapy might entail the art therapist encouraging the clients to share and search an emotional difficulty through the creation of images and conversation; whereas to others it may be focussed towards enabling them to hold a crayon and make it mark, by this means developing new ways of giving form to previously unexpressed feelings.
Medicine, Health, and Rehabilitation
Hospitals have long served as important incubators for the field of art therapy. For better or worse, medical model concepts such as diagnosis, disease, and treatment have had a strong influence on the development of most schools of thought within western psychotherapy, including art therapy. While psychiatry has always been the medical speciality most closely allied with the field, art therapists have worked with patients being treated for AIDS, asthma, burns, cancer, chemical dependency, trauma, tuberculosis, and other medical and rehabilitation needs (Malchiodi, 1998).
All these seem to suggest that art therapy will continue to have a role in exploring the connections between body and mind. For much of human history mental illness was regarded with fear and misunderstanding as a manifestation of either divine or demonic forces. Reformers such as Rush in the United States and Pinel in France made great strides in creating a more humane environment for their patients. Freud, Kris, and others contributed to this rehumanization by theorizing that rather than being random nonsense, the productions of fantasy revealed significant information about the unique inner world of their maker (MacGregor, 1998; Rubin, 1999).
The term art therapy began to be used to describe a form of psychotherapy that placed art practices and interventions alongside talk as the central modality of treatment (Naumburg, 1950/1973). Psychoanalytic writers placed on early childhood experiences made the crossover of these theories into education an easy one (Junge & Asawa 1994). Some progressive educators placed particular emphasis on the role art played in the overall development of children. In addition to psychoanalysis and the rehumanization of people with mental illness, one of the strongest trends to emerge within modern psychology has been the focus on standardized methods of diagnostic assessment and research. Whether discussing the work of a studio artist or the productions of a mentally ill individual, (Kris 1952) argues that they both engage in the same psychic process that is ‘the placing of an inner experience, an inner image, into the outside world. This method of projection became the conceptual foundation for a dazzling array of so-called projective drawing assessments that evolved in psychology during the 20th century (Hammer, 1958).
Art Therapy and Occupational Therapy
One profession with which art therapy has been mistaken with respect to the therapeutic application of art is occupational therapy. There appear to be two main reasons for this. Firstly, the respective histories of the art therapy and occupational therapy are inextricably linked. Many art therapists were based in occupational therapy departments and their work was part of the overall service provided by them.
Although the use of art mental health settings by occupational therapists appears to have declined since the mid 1980s, a trend, in part, influenced by the development of art therapy as a profession, their work in this area is nevertheless frequently confused with that undertaken by art therapists. It may, therefore, be helpful to examine the areas of commonality and difference between the two professions in order to clarify further what art therapy is as well as what it is not. Research identified four main areas of difference between are therapy and the use of art in occupational therapy. These they distinguish as, education and training, the use of single arts based medium, the importance attached to the artwork, and the level of direction evident within the therapeutic approach.
Art therapy has historically resisted an association with science and has favoured a more art-based stance in its philosophy and practice. However, recent scientific findings about how images influence emotion, thoughts, and well-being and how the brain and body react to the experience of drawing, painting, or other art activities are clarifying why art therapy may be effective with a form of populations. As science learns more about the connection between emotions and health, stress and diseases, and the brain and immune systems, art therapy is discovering new frontiers for the use of imagery and art expression in treatment.
Neuroscience, the study of the brain and its function, is rapidly influencing both the scope and practice of psychotherapy and mind and body approaches. As new technologies allow researchers to scan brain and other neurological and physiological activity in the body, we are learning more about the relationship between mind and body. However, researchers have described the neurological and physiological phenomena related to memory and how images conceptualized and how they affect the brain and body. Hammer, (1958) have broadened the understanding of how the brain, human physiology, and emotions are intricately intertwined, the importance of early attachment on neurological functions throughout life, and the impact of trauma on memory.
Nonetheless, the relationship between neuroscience and art therapy is an important one that influences every area of practice. Ultimately, science will be central to understanding and defining how art therapy actually works and why it is a powerful therapeutic modality.
Neuroscience and art therapy
How the brain functions and how it influences emotions, cognition, and behaviour are important in the treatment of most problems people bring to therapist, including mood disorders, posttraumatic stress, additions, and physical illness. Although many areas of research are relevant to the practice of psychotherapy, several areas are particularly important to art therapy. These areas include images and image formation, physiology of emotion, attachment theory, and the placebo effect.
As regards this, neuroscience continues to provide an ever widening understanding of how the brain and body react to stress, trauma, illness, and other events. It also is central to understanding how images influence emotions, thoughts, as well-being and how the visual, sensory, and expressive language of art are best integrated into treatment.
Humanistic approach to art therapy
Psychology of pertaining to or concerned with the humanities is considered the third strength of psychology and came out as an option to incorporation of methods and theories of psychiatric treatment and approaches relating to behaviour. The following models, among others, encompass humanistic psychology: existential therapy, person-centred therapy, and Gestalt therapy. Maslow was also instrumental in developing the humanistic trend in psychology, proposing the ideas of self actualization and personal potential. The humanistic approaches to art therapy developed both in reaction to psychoanalytic approaches to art therapy and as a result of the human potential movement of the 1960s and 1970s.
In conclusion art therapists conceived an overarching humanistic approach to the practice of art therapy based on three principles:
emphasis on life-problem solving;
encouragement of self-actualization through creative expression;
emphasis on relating self-actualization to intimacy and trust in interpersonal relations and the search for self-transcendent life goals.
Reference List
Hammer, E. F. (Ed.). (1958). The clinical application of projective drawings. Springfield, IL: Charles C Thomas.
Junge, M. B., & Asawa, P.P (1994). A history of art therapy in the United States. Mundelein, IL: American Art Therapy Association.
Kris, E. (1952). Psychoanalystic explorations in arts. Durham, NC: Duke University Press.
Malchiodi, C.A. (1998). The art therapy sourcebook. Los Angeles: Lowell House.
MacGregor, J.M. (1989). The discovery of the art of the insane. Princeton, NJ: Princeton University Press.
Naumburg M. (1950/1973). Introduction to Art therapy: studies of the “free” art expression of behaviour problem children and adolescents as a means of diagnosis and therapy. New York: Teachers College Press/Chicago: Magnolia Street.
Rubin, J.A. (1999). Art Therapy: An introduction. Philadelphia: Brunner/Mazel.
Jay1 was my client in crisis. He was a soldier during the Iraq war and had a traumatic experience. He lost his brother, cousin, and best friend, who were also soldiers in the war. Jay also had a near-death experience because he escaped a grenade bomb that exploded several meters from him. He had a self-denial crisis because he believed that any soldier who portrayed any post-war psychological problem was weak or disloyal. He also had a hard time coping with his marriage and family because of the duration of time and distance he was away from his wife and children. Apart from the distress he experienced, Jay was a normal person who wanted to get rid of his awful memories and did not exhibit any major psychological abnormalities.
Assessing the Situation
I actively listened to Jay’s predicaments about the war. He seemed troubled and vulnerable when he explained his near-death experience and the demise of these two family members and best friend. He also tried to act tough several times especially when he talked about his life as a soldier. I asked him several questions concerning whether he ever regretted serving in the army, how he thought about the war in general, and how he thought of his own family.
He answered that he did not regret serving his country in the armed forces but did not anticipate that his life would have a negative transition after doing so. He stated that ex-soldiers were not supposed to portray any psychological disorders after their experiences because they would be considered weak or disloyal. He also said that his family meant a lot to him though he felt that there was a great detachment between them and considering himself a part of them was difficult because of being very far away from them for a long time.
I assessed Jay’s situation to be a post-traumatic stress experience. He lost three important people in his life after doing a worthy cause for their country and also escaped death himself. He was a troubled person who was on self-denial because he had a hard time accepting that he suffered from psychological and emotional stress. I also assessed Jay to be a normal person who was afraid of taking the initiative to accept being part of his own family.
The Solution Focused Brief Therapy
I practiced the Solution Focused Brief Therapy approach on Jay due to the nature of his predicament and psychological turmoil. His experiences were in the past and he was an ex-soldier who needed to move on with his life. This goal-oriented methodology made Jay move from the crises in his past and progress into a fulfilling future. This treatment therapy helped him concentrate on the solutions to his trauma instead of the problems.
The Solution Focuses Brief Therapy is a crisis intervention technique that helped curtail Jay’s post-traumatic stress from the war. I offered emotional support and developed his coping techniques for the crisis. This crisis therapy and counseling involved specific assessment, planning, and treatment. It is a solution based pragmatic approach that helped Jay to deal with the psychological hurdles of the personal and family aspects of his life. I defined Jay’s problem to him to help him accept his situation to move forward while at the same time being empathetic and supportive to ensure his safety psychologically (Wiger & Harowski, 2003).
I counseled Jay and helped him accept that he suffered from post-traumatic stress and self-denial. I helped him to know that the condition was normal but temporal. He was encouraged that it was a typical reaction from any normal human being. This helped him accept his situation and it reassured him that he was eventually able to recover and stabilize his life back to being normal.
I helped him understand that the war was the cause of his brother, cousin, and best friend’s death and not him. I assisted him to understand that he did not cause the tragedy and could not do anything to prevent their demise at that time. I made him know that the consequences of every war could either be positive whenever there was victory or negative whenever there was defeat or loss of lives. I encouraged him to mourn over their demise and let out the pain from his heart.
However, this was not to tie him down to a long-term bereavement crisis. He mourned but it was aimed at helping him feel better and not worse after the process. I also encouraged him to counter his emotions by celebrating their lives and being happy whenever he remembered the good times he had with them. This helped Jay to be strong and have coping skills towards the loss of these three people in his life.
I assisted Jay to view his near-death experience positively and not negatively. The power of positive thinking helped him acknowledge the importance of his life after surviving such a traumatizing experience. He would only be grateful to be alive if he recognized that it was a life-changing experience. It facilitated him to embark on making his life more meaningful because of such a narrow escape. I gave him soul searching techniques such as helping him know that he came a long way and helped him appreciate his own life. This was beneficial to Jay to know that he survived from that experience unhurt and had to do more fulfilling things to make his life worthwhile again.
I assisted Jay to accept being a member of his own family. By acknowledging how his family was important, he became actively involved with them. I made him know that neither time nor distance should affect the relationship with his family. The fact that he said his family meant a lot to him was the first step to also make him mean the same to them by making them his priority. I encouraged him to consider recreational and outdoor activities with his wife and children and have plenty of fun and laughter with them. This helped him catch up on old times and made him recover from their absence.
Conclusion
The Solution Focused Brief Therapy approach on Jay was an emotional and psychological first aid process. It helped Jay and other clients who go through similar experiences to heal emotionally and psychologically. This therapy helps the client explore different solutions to their traumatic experiences. It is a therapeutic initiative and decreases the level of the client’s emotional and psychological reactions to trauma. It offers positive solutions towards moving on to the future. This approach is innovative, pragmatic, and produces positive results when implemented well by the client (Seligman & Reichenberg, 2009).
References
Seligman, L. W., & Reichenberg, L. W. (2009). Theories of counseling and psychotherapy: Systems, strategies, and skills. 3rd ed. Boston: Pearson.
Wiger, D. E., & Harowski, K. J. (2003). Essentials of crisis counseling and intervention. Hoboken, New Jersey: John Wiley & Sons.
Footnotes
This is a fictitious name of the client in crisis.
Many psychologists believe that conscience is the foundation of dignity and respect amongst human beings. Sociopathy is a mental disorder that results in development of weird behaviors such as negative attitude towards other people and urge to distress colleagues and/or friends.
Sociopaths are primarily motivated through self-centeredness. They have a tendency to compete with other people for goals that they cannot achieve. This essay provides an analysis of Doreen’s case with a view of illustrating how the psychodynamic theory relates to other therapeutic theories that are used in therapy.
The Case of Doreen
Dr. Doreen Littlefield, a psychologist who works in a hospital has a covetous sociopathic mannerism that is revealed through her jealousness and incessant behavior of imitating the character of other people (Segal, Coolidge, & Rosowsky, 2006). In the context of this case, Doreen has a friend, Dr. Jackie Rubenstein, a star psychologist staff whom she loves outwardly. However, she hates her inwardly because of her beauty and brilliance.
Indeed, Doreen hates her friend so much that she wants to terminate her life. However, killing her friend is a difficult task to comprehend because she knows that the action will attract public’s attention.
As a result, she resolves to destroy Dr. Rubenstein’s reputation. She interferes with Dr. Rubenstein’s patient whom she perceives as handsome by deliberately assaulting him to embarrass Dr. Rubenstein. Nonetheless, Doreen is not worried about her immoral actions. This situation makes her a sociopath because such people lack humane characteristics (Rutan, Stone, & Shay, 2007).
Provide an assessment/diagnosis for Doreen Based on DSM-V
The diagnosis of sociopathic traits comprises a checklist of behaviors that are provided in the DSM-V manual (American Psychiatric Association, 2000).
Pervasive Behavior and Infringement of the Rights of Other People
Pervasiveness and infringement of the rights of other people is the first step towards diagnosis of sociopathic behavior based on the DSM-V (American Psychiatric Association (2000). At the outset, the patients who are sociopaths defy laws and norms that are stipulated by different institutions. In most cases, such patients commit criminal activities that warrant arrests. For example, Dr. Doreen kicks a patient at some point.
This situation drives the patient into an acute paranoid state. According to the American Psychiatric Association (2000), it is clear that Doreen’s action towards the patient is violent. Therefore, it can warrant an arrest. Furthermore, an attempt that was made to investigate the case exposed that she kicked the patient as a way of revenging against her fellow acquitted staff. This scenario is an act of crime that violates the hospital regulations.
Doreen’s behavior is an act of jealously since her colleagues have value-added attitudes towards patients. Doreen practiced psychiatry without authorization. Instead, she has obtained various counterfeit recommendations to convince other people that she has the obligation to handle psychiatry patients. In addition, she has committed many unsubstantiated assaults. Doreen’s actions reveal the various traits that a sociopath possesses (Krueger, Markon, Patrick, & Iacono, 2005).
Secondly, most sociopaths indulge in deceptive and manipulative activities. For example, Doreen is an unqualified doctor. However, she pretends to be a medical professional irrespective of her colleagues’ knowledge that she is incompetent and has no certification that grants her permission to deal with psychiatry cases.
Sometimes she assaults patients, as realized in the case of Dennis. The case analysis unveils that Doreen manipulates Jackie because she realizes her bad actions towards Dennis. As a result, Jackie gets worried about her reputation since it remains at the stake of Doreen’s cruelty in case she spills the beans (Krueger et al., 2005).
Furthermore, sociopaths are impulsiveness and fail to plan (American Psychiatric Association, 2000). The case of Doreen brings about a realization that sociopaths lack the ability to plan. In ability to plan is realized when Doreen sees a customer advocate whose wife suffers from depression during a local television show known as the ‘Buyer Beware’.
On realizing that Doreen is his wife’s therapist, the customer threatens to uncover Doreen’s behavior and even emphasizes that he will kick her out of the room if the hospital fails to assign a new therapist to his wife.This situation clearly shows Doreen’s inability to take heed of the consequences of her cruelty (Segal et al., 2006).
Moreover, they are irritable and highly aggressive. In most cases, sociopaths are aggressive and irritable. The case analysis reveals numerous incidences where Doreen gets annoyed due to unsubstantiated reasons. On the day of her expulsion, she turns to the directors and warns them of the mistake they have made to fire her.
She also shows a similar behavior to Jackie over the issue of Dennis, who was a customer, through their cellphone communication. Sociopaths always look for a weak point to hit back as a way of seeking security to their bad behavior. However, the possession of knowledge about the negative secrets of their friends or colleagues provides a basis of instilling fear in them (Kruegeret al., 2005).
Finally yet importantly, they also exhibit recklessness and disregard for the safety of self and/or others. Doreen, being a sociopath, is remorseless and never feels guilty for her wrong actions towards other people. As a result, she does not care about her friends, patients, and/or colleagues.
At some instances, she thinks of driving over other people with her vehicle. This case is evident where she attempts to drive over Jackie. Although her ill intentions are not fulfilled in most cases, she compliments the achievement of her goals by damaging the reputation of other people. Such behaviors are regarded as sociopathic (Segal et al., 2006).
Minimum age of 18 years
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), individuals who exhibit sociopathic behavior should be above the age of 18 years (American Psychiatric Association, 2000).
The fact that Doreen has been employed in a health institution as a doctor is an indication that she is over 18 years old. Therefore, her antisocial behavior can be said to be sociopathic. Individuals who are eligible for the DSM-V diagnosis criteria should be at least 18 years.
Conduct Disorder Characteristics at the age of 15 years
However, despite the aforementioned criteria B above, a sociopath may exhibit a conduct disorder prior to their fifteenth birthday (American Psychiatric Association, 2000). Before this age, sociopaths begin showing deviant behavior and lack of respect, which is perceived as conduct disorder. In the case of Doreen, there is no evidence that she experienced any mental illnesses that could have resulted in her antisocial behaviors. Nonetheless, she is adamant to the rules and regulations of the hospital.
Sociopathic Symptoms not caused by other Mental Disorders
According to the American Psychiatric Association (2000), the last criteria involve checking whether the patient has other mental disorders that can lead to maladaptive behaviors. However, the case analysis reveals that Doreen does not have any other mental disorders that resulted in her sociopathic behavior.
List and describe the ethical violations that are demonstrated by Doreen and provide evidence from NASW Code of Ethics
Ethical Responsibility to Clients
Doreen does not show ethical responsibility to her clients. At the outset, she fails to take her work seriously. Furthermore, she goes ahead and assaults her clients. This state of events is evident where Doreen assaults Dennis who later communicates the incidence to Jackie.
Therefore, Doreen never committed herself to serving her clients as required by the NASW code of ethics, which seeks to promote the wellbeing of clients (Waldman, Vazsonyi, & Flannery, 2007).
Doreen’s state of professional incompetence is also a violation of the NASW code of ethics. She lacks certification to handle psychiatric patients.
She is only an administrator in the organization and the reference letters that she possesses were acquired through sexual means from her supervisors. This behavior infringes the NASW code of ethics that requires professionals to be competent within the boundaries of education, training, and certification. Doreen was only an administrator (Gibelman & Schervish, 1993).
Ethical Responsibility to Fellow Workers
Doreen violates the code of conduct by disrespecting her colleagues. For instance, she aggressively addresses Jackie on phone after she is questioned about her attendance to a client. Furthermore, she does not respect the management.
In fact, she warns them on the impending risks that will accompany her dismissal from work (Gibelman & Schervish, 1993).Doreen is always irrational and aggressive to her colleagues. At one point, she went to an extent of disliking Jackie so inwardly that she even wished to kill her.
Nonetheless, Doreen understood her incompetence as a self-proclaimed professional. Instead of referring a client to a qualified professional, she insisted on attending to the patients. The case study reveals that she assaults her client, Dennis, after she fails to handle his situation.
When her colleague realizes the situation, she gets irritated and poses a threat to Jackie’s reputation. The Referral for Services code of ethics requires that a worker should refer clients to other professionals who are specialized in handling difficult cases (Gibelman & Schervish, 1993).
They should discourage and prevent unethical conduct. Otherwise, workers should strive to seek resolutions to conflicts that arise. Nevertheless, the case study reveals that Doreen remains adamant to such regulations. She strives to destroy the reputation of Jackie and other employees.
Ethical responsibility to Professionals
Social workers should accept responsibility based on existing competencies (Gibelman & Schervish, 1993). However, Doreen lacks this virtue. She acquires recommendation letters corruptly by seducing her supervisors. Her incompetency is realizable where she handles clients poorly.
At one instance, a client who realizes that she is his wife’s doctor threatens to inform the management to expel her. Doreen’s deceptiveness and dishonesty also violates the code of ethics. Since she was a mere administrator, her pretentiousness as a psychologist portrays her incompetence. She also deceives Ivy by shedding crocodile tears after mishandling her client, Dennis, whose condition had significantly deteriorated.
If you were Dr. Jackie Rubenstein and your supervisor brushed off your accusation, would you or would you not have taken additional step to report Doreen? Explain your response
The best way to handle Doreen’s case is to report the issue to the appropriate authority. The core value of administering therapy treatments should be client-driven. Dennis, who has a deteriorating condition, notes that Doreen, his medical attendant, has done a mistake. To maintain the client’s reputation to the hospital, Jackie should have solved Dennis’ problem as soon as possible and then try to make Doreen understand the situation in a manner that does not create a rift based on the lines of duty.
A. Why, in the psychiatric hospital, was it so hard for people to discover and understand Doreen’s diagnosis based on her behavior?
Many people fail to realize that sociopaths lack proper emotional functions. They fail to recognize that sociopaths can kill or destroy somebody’s property without feeling guilty or apologetic. This state of confusion makes people vulnerable to the consequences of sociopathic behaviors, as in the case of Doreen (Waldman et al., 2007). Doreen has an exceptional character that she uses to silence everyone who realizes her mistakes and incompetence in the psychiatric hospital.
B. Most of the people at the hospital had vast quantities of ethics and conscience, so why, when they finally found out about Doreen, did they let her go without a fight, so that Doreen might most likely strike out again somewhere else?
The hospital directors and other staff were not able fight Doreen because of her bizarre manipulations that she staged to destructthe hospital’s reputation. The hospital fraternity also dreads the impending public embarrassment in case they fire Doreen. She a sociopathic ability to manipulate the enterprise; hence, they cannot pursue criminal actions that she committed earlier. She also had the capacity to advertise them negatively by spreading propaganda to the public.
If you were asked to treat Doreen, would you use CBT or a psychodynamic theoretical framework? Explain your choice of a theoretical perspective and why you feel this choice of TX will work best for treating Doreen
The psychodynamic theoretical framework is the best therapy for treating Doreen. This method focuses on internal processes that pertain to needs, mental activities, and emotions that motivate human behavior. Overwhelming of internal and external demands by human requires management of all these factors.
Being a sociopath, Doreen lacks compassion. Therefore, the psychodynamic therapy is suitable to boost her senses and feelings towards others. Relationships are enhanced through the psychodynamic components. As a result, this theory will improve Doreen’s relationship with her clients and colleagues (Rutanet al., 2007).
Conclusion
The workability of the psychodynamic theoretical framework in treatment of sociopathic cases depends on its ability to trigger emotions in a patient. This therapy seeks enhancement of the factors that lead to improvement of a sociopath’s interactions with other people in a manner that creates positive relations. In many cases, psychologists have suggested the CBT mechanism can be applied in cases where other features, apart from the aforementioned, trigger the patient’s behavior (Rutanet al., 2007).
Reference List
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: Text Revision (DSM-IV-TR). New York, NY: American Psychiatric Association.
Gibelman, M., & Schervish, P. (1993). Who we are: The social work labor force as reflected in the NASW membership. Washington, DC: NASW Press.
Krueger, R.F., Markon, K.E., Patrick, C.J., & Iacono, W.G. (2005). Externalizing psychopathology in adulthood: A dimensional-spectrum conceptualization and its implications forDSM-V. Journal of abnormal psychology, 114(4), 537.
Rutan, J.S., Stone, W.N., & Shay, J.J. (2007). Psychodynamic group psychotherapy, New York, NY: Guilford Press.
Segal, D.L., Coolidge, F.L., & Rosowsky, E. (2006). Personality disorders and older adults: Diagnosis, assessment, and treatment. Hoboken, NJ: John Wiley & Sons.
Waldman, I., Vazsonyi, A., & Flannery, D. (2007). The Cambridge Handbook of Violent Behavior and Aggression. Cambridge: Cambridge University Press.
Solution Focused Brief Therapy (SFBT) is a therapeutic approach that majors on helping people to construct solutions rather than solve problems. It facilitates an individual’s ability to find a solution to a situation he or she is facing. SFBT is useful for counseling in schools, prisons, public, social and family services. It is also an important tool within child welfare and mental health sectors. SFBT’s main objective is to help victims to imagine how they would like to change their situation and the input required to achieve success. There are no considerations for diagnosis, history taking, or examination of the problem.
Solution-focused therapists consider aspects such as the client’s resolve to change and his or her input in the change process. Other assumptions include that the solution or part of it has already started. Treatment is brief and usually lasts for a couple of sessions. From the description above, there is an indication that the therapy is applicable in every situation, and a client can use the same steps to overcome a problem regardless of its nature. The main procedure of SFBT entails a search for pre-session change, goal-setting, use of the miracle question, use of scaling questions, a search for exceptions, a consulting break and a message including compliments and task at the end of a session (Jong & Berg, 2002).
The client who came with a problem of losing a job will have to go through the same approach in order to help him construct a solution to the new problem of a relationship ending. His scenario introduces various aspects that characterized the previous case. However, the steps in the previous case will not be followed strictly. For example, it is inappropriate to include the search for a pre-session change and a consulting break. This is because SFBT’s objective is to equip clients with skills to help them address an ensuing depression due to the different problems they face from day to day. Repeating the steps and procedure will assist the client to entrench the steps in his system so that he can easily overcome a depression in future. SFBT works in different ways depending on the client since there are procedures for prison populations, antisocial adolescent offenders, high school students, family setup for couples, public social services, outpatient mental health and orthopedic patients. In order to be consistent and achieve results in the short run as purposed by SFBT, it is necessary to recommend the steps that achieved results in the first instance for the same client. This will facilitate faster recovery for the client while still ensuring that the therapy constitutes all the necessary procedures. Integrating various aspects in two cases will create a comprehensive therapeutic process.
Two of the most used techniques in SFBT are the miracle question and the scaling question. Steve de Shazer and other parties developed these techniques in the 1980s. The miracle question technique involves the therapist guiding the client in assuming a miracle and visualizing the solution to the problem in question. On the other hand, the scaling question technique entails the evaluation of a client’s day based on a 10-point scale. These two techniques are crucial in establishing a solution to a problem. Towards the end of a therapy session, the therapist introduces aspects such as well wishing the client and various follow-up procedures.
Reference
Jong, P., & Berg, I. K. (2002). Interviewing for solutions (2nd ed.). Pacific Grove, CA: Brooks/Cole.
The two interviews took place on 6th October 2012 and 16th October respectively. The first interview was done in order to analyze the client’s problem and then establish a path for dealing with the issue. The second session was a follow up on the early progress of the intervention. Successful outcomes were reported in both instances.
Patient information
Javier is a 39 year-old, Hispanic male who, prior to the two sessions, had never seen a psychology professional. It only dawned on him that he could get psychological assistance for his problem through suggestions from friends. He has been married for eleven years and has two children of school-going age. Javier works in Chicago as a mechanical engineer, and has a bachelor’s degree.
The problem
In the first interview, Javier explained that he was having trouble at work as he could not concentrate and felt constantly fatigued. His productivity went down, and this had not gone unnoticed by his supervisors. Javier’s colleagues also detected the change in behavior, and suggested psychotherapy. His only source of income would be in danger if this pattern of disengagement persisted. Additionally, he dreaded time at home because he was now the primary caregiver. It was necessary to do so after his wife, Nina, was diagnosed with breast cancer. He didn’t spend as much time as he should with his children and was distant from Nina. Javier also felt trapped because he had lost control of almost every part of his life. As a result, he started smoking again, yet this was a habit that he had quit seven years ago.
During the second interview, it was evident that Javier was not feeling as downtrodden as he appeared in the first interview. His level of engagement at work was improving, but the situation at home was not where he wanted it to be. Javier still stated concerns about communication issues and his smoking habit.
Theoretical orientation
Cognitive Behavior Therapy (CBT) is an approach used to treat a myriad of psychological conditions, including stress or depression among patients. Each cognitive therapy session should be precise and result-oriented. Normally, most therapists prefer having an hour-long session once a week, for 16 weeks. For great outcomes, one ought to have training in CBT and possibly some experience on the same. In this approach, one must focus on identifying negative thought triggers. Cognitive behavior therapists believe that the way patients react depends on the way they think. Therefore, by developing the right thought patterns, a client can reverse some of the issues that led to his current psychological problem.
One must apply a structured strategy to challenge the patient’s beliefs and then work with them to create new beliefs and behavior systems. The main goal is to teach patients how to react to undesirable situations. They must realize that although they have no control over their surroundings, they can control how they react to them. Rationality is also a vital component of this form of therapy. Patients need to base their reactions on facts rather than imaginary conceptions. They need to be ready to do practical work on matters that they discussed in therapy. Psychotherapists should develop a collaborative relationship with the patient in order to enhance positive outcomes. In essence, the therapist should not prescribe actions to patients, but should teach them how to act.
Reflective summary
In the first interview, it was evident that the client was in a low mood. He did not care much for his appearance as there was a big stain on his shirt. Additionally, Javier felt fatigued and immediately slouched on the couch. He often seemed detached and I had to ask him questions more than once for him to give appropriate responses. Therefore, his body language corresponded to his verbal expressions. When Javier described his symptoms, there were some clear sources of stress in his life; the most obvious was his wife’s illness. However, in line with cognitive behavior therapy principles, one must work with the patient in order to establish these triggers of stress. After asking Javier what he thought was the main trigger, he replied that it was the unavailability of his spouse. All his problems started after she was diagnosed with breast cancer.
Javier also pointed out that the quality of his marital relationship had deteriorated. Instead of focusing on the unchangeable condition of cancer as the cause of his problem, it was wiser to dwell on things that he could change. It became evident that his communication patterns with Nina had contributed to this problem so he needed to work on them. The client also noted that he was under increased strain to assume the role of primary caregiver. Javier had to prepare food for the children, feed Nina when home and cater to her health needs. He explained that these responsibilities were overwhelming. After asking Javier about how he could work around the many care giving tasks, he suggested the use of a hired helper.
Additionally, the client was anxious about becoming a single father after the death of his wife. After asking Javier about how he could deal with these challenges, he stated that he needed to accept the fact and prepare for it. It was decided that the issue of smoking was a cover for Javier’s fears, stresses and insecurities. If we dealt with them, then he would slowly refrain from the habit. This case was symptomatic of depression as Javier reported having issues with sleep. Fatigue is was also an important indicator of the condition. DSM IV criteria indicate that a depressed person should report decreased interest in work. He or she may have a depressed mood and will report feelings of worthlessness. High levels of indecisiveness and a reduced ability to concentrate also prove that depression exists. Javier had all these qualities, so treatment approaches included challenging negative thinking and making lifestyle adjustments. He joined a Zumba class and promised to identify these negative-thought triggers.
In the second interview, Javier appeared more engaged as he had practiced some of the things discussed. For instance, he had already hired a helper and joined the dance class. He was adjusting to the Zumba class since it takes time to learn the routines. He made a list of some sources of negative thoughts and suggested ways in which he could challenge those thoughts. However, he did not report very positive outcomes about his marital relationship. It was clear that he had reservations about talking openly to his wife about his doubts and fears. Communication was still a big problem, and he needed to challenge it. Nonetheless, Javier still slipped into periods of disengagement and depression. This indicates that he is yet to challenge the negative thoughts he experiences. It is also necessary to address his anxieties about a future without his terminally-ill wife.