Theories of Counseling and Psychotherapy

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Book Analysis

Session I

David Sue and Diane M. Sue discuss the Cognitive – Behavioral Theory and Techniques in chapter 11. Theories of classical conditioning, operant conditioning, social learning, and cognitive – behavior are discussed in particular. Several therapies have been developed using the concept of classical conditioning which include exposure or extinction therapy and desensitization (Sue & Sue, 2007). Classical conditioning can be contrasted with Operant Conditioning which requires the subject to act voluntarily. In operant conditioning, positive reinforcers are usually used to increase the desired response while negative reinforcer “increases the frequency the frequency of a behavior by removing an aversive event” (Sue & Sue, 2007, p. 183).

On the other hand, punishment is used to eliminate unwanted behavior. Peter Lewinsohn developed a Therapeutic Intervention for depression using the Operant Model, in which he identified some variables that may cause depression in an individual. Other types of training mentioned in the book include social learning training that teaches individuals with schizophrenia, ADHD, and conduct disorder to function properly in a social environment; Assertive training, which mainly “teaches the difference between nonassertive behaviors, aggression, and assertive responses” (Sue & Sue, 2007, p. 186); and REBT, which assumes that it is the thoughts of an individual that lead to anxiety and not the situations. Since I want to become a school social worker, I believe all these techniques and therapies will help me get started in my career and help the individuals perform better in their environment. I believe that the theories of operant conditioning will help me in particular as children tend to respond better to the technique. However, individual behavior varies, and the same technique may not work for everyone.

Session II

Aaron Beck’s research and clinical work on depression apply much to my career because it identifies the core beliefs of an individual that are causing the problem and also suggests some ways in which these beliefs can be dealt with. It is very common for children to be diagnosed with depression today. Beck’s work provides a detailed account of depression in individuals and suggests ways in which it can be tracked down to its roots. Beck’s work is also very practical as it begins with the identification of distortions on the surface level and then guides the clinician through which the core beliefs of the client can be identified. The three components of Cognitive – Behavioral Therapy for depression include Therapist – Client Alliance, Collaborative Empiricism, and Guided Discovery.

Since school social workers work closely with school children, these components can be of great help. The step-by-step instructions that are suggested to treat the client can be used to develop a more productive relationship with the children and make the task enjoyable for them. It can be a little difficult for a social worker to keep the client interested in a task as children tend to lose interest easily, however “guided discover” can be used to tackle such situations. Working with school children requires a lot of determination as it can be hard to make children understand and recognize the relationship between thoughts, emotions, and behaviors, which is an important part of cognitive-behavioral therapy. However, the assessment and evaluation of cognitive-behavioral therapy can be used to overcome these hurdles.

Session III

Chapter 14 discusses the Dialectical Behavior Therapy which was specifically developed by Marsha Linehan to treat persons with Borderline Personality Disorder. Since it is believed that Borderline Personality Disorder begins in childhood, this topic is of great importance for me as my profession will require me to work with children in particular. Diagnosing a child with Borderline Personality Disorder can be very confusing because the symptoms of the disorder are very common, such as moodiness, jumping to wrong conclusions, impulsiveness, etc. Many children demonstrate the symptoms of Borderline Personality Disorder but it does not necessarily mean that they have it. Moreover, it can be very difficult to work with children who demonstrate such behavior, and they may resist and find it hard to develop a trustworthy relationship with the therapist.

Dialectical Behavioral Therapy can be of great help as it is a combination of several techniques that can be used by a school social worker to get through to a child with Borderline Personality Disorder. The cognitive and behavioral intervention strategies mentioned in the chapter can be used not only by a school social worker, but any clinician to improve the quality of life of the client. Moreover, Dialectical Behavioral Therapy has been experimentally proved to be effective not only for people suffering from Borderline Personality Disorder but also for individuals that may show symptoms of spectrum mood disorders and the survivors of sexual abuse. I find this therapy to be of great importance since many children are vulnerable to sexual abuse and it can be very hard for them to cope with their traumatic experience alone. Dialectical Behavioral Therapy can help me get through to these children and help them overcome their problems.

Session IV

School children come from different cultural and social backgrounds. It would be wrong to assume that all the children will respond similarly to a particular situation or that a single method of therapy will work similarly on children belonging to different cultures and backgrounds. Different cultures have different concepts of family and individuality. One behavior that is accepted in one culture may be considered to be a sign of disrespect in another. All clinicians need to identify the cultural differences in their clients and accept the fact that psychotherapies theories in the United States are based only on the “European or Western standards, values, and beliefs” (Sue & Sue, 2007, p. 246). Since therapies are based on the Western perspective of life, conflict may arise between a therapist and client from a different cultural background and the therapist may become a victim of misinterpretation in the process.

The multicultural theory provides the basis for the assessment of clients on different dimensions to help the therapist overcome the cultural differences. The multicultural Theory is much applicable in the profession of school social work as the therapist comes in contact with people belonging to different cultures. Not only does this theory highlight the differences between people belonging to different cultures, but it also identifies the differences in minorities belonging to the same culture. The multicultural theory highlights the importance of social, environmental, and cultural issues that are to be considered by a therapist. Therapy that works on one child may not necessarily work for another child and a school social worker needs to maintain a comfort level so that the child does not feel distant from the therapist.

Session V

Chapter 15 identifies the multicultural and diversity issues that may arise between a therapist and a client during counseling and psychotherapy. Several issues that are faced by the therapists during counseling are discussed in this chapter providing a deep understanding of the topic. The problem issues identified in this chapter include the perception of the client and the possible biases of the therapist. One important issue identified in the chapter is the age difference between the client and the therapist. Just like an older client may doubt the ability of a young therapist to understand and help the client, a child may uncomfortable discussing his or her issue with an adult therapist.

It is therefore important to have prior knowledge and understanding of this kind of behavior of the client so that the gap between the therapist and the client can be bridged. This chapter highlights the need to understand cultural differences and adopt an appropriate strategy for treatment. It is also important for the therapist to maintain his or her body language and way of interaction with the client as it plays an important role in influencing the perception of the client. When dealing with a child belonging to a different culture, it is important that the therapist maintains a friendly relationship with the child and makes sure that the child is comfortable with the therapist to help the client. Altering the techniques of therapy to make them fit the cultural beliefs of a child will show better results.

Session VI

Chapter sixteen discusses the different crises that may arise during therapy and the response of the therapist to that situation. It is hard for any therapist to predict the next move of the client and since the client is already going through emotional problems, at times even the client may not know what s/he is doing and the consequences of his or her actions. The situation is more complex with younger clients who may still not be aware of the concept of the consequences of their actions. For instance, children who indulge in self-injury may not even know what that injury can do to their bodies. Working as a school social worker means dealing with all kinds of children, some children may be shy and reserved, while others may be loud and destructive.

When a child demonstrates wild behavior, such as shouting, jumping around the room, throwing things, it can be very difficult for the therapist to control that situation. It is therefore important to have an emergency plan depending on the work setting of the therapist. An important factor in the client-therapist alliance is that of validation. It is important to validate the feelings of a client. The chapter also provides the criteria to assess and manage a potentially violent or angry client which can be used by the social workers to handle the aggressive behavior of a child. The chapter identifies how a violent client can be controlled and provides a way of connecting with the client without agitating him and minimizing the threat. An important factor that contributes to the violent behavior of the client is domestic violence, it is, therefore, important the therapist has prior background knowledge of the client to overcome a threatening or suicidal situation.

Session VII

The therapist needs to have a deep understanding of Psychopharmacology since drugs can significantly change and influence the behavior of the client. A client may show the symptoms of a particular mental disorder when in reality the symptoms may not be a result of the mental disorder, but a reaction to a particular drug used by the client. The abuse of drugs by children is now very common, especially if the parents of a child take regular medication. A high percentage of school-going children experiment with drugs and many of them do it again. School going children are more vulnerable to drug abuse because they find these drugs very attractive. Some may experiment with drugs against their will under peer pressure.

The children who frequently abuse drugs start revealing symptoms of a mental disorder that may not be there. A school social worker needs to have adequate knowledge of Psychopharmacology to identify such patterns. The top three substances that are abused by children include alcohol, tobacco, and marijuana. Therapists everywhere are expected to have adequate knowledge of the biochemical processes to differentiate the behaviors induced by medication from that of the individual. Since special care is to be used when medicating children, a school social worker must be fully aware of the impact of a particular drug on the patient. Since school children are more likely to abuse drugs, the therapists are required to carefully supervise the whole process.

Session VIII

The last chapter discusses the medications that are used with Psychological disorders. Even though it is better to treat the client without using a medication, at times it is required that the therapist prescribe some medication to the client to keep the client more hopeful. Mediation is usually given for depression, anxiety disorders, psychotic disorders, bipolar disorder, and Attention-Deficit/Hyperactivity Disorder (ADHD) (Sue & Sue, 2007). It is important to make sure that the client does not become addicted to the prescribed medication and that the amount of drugs prescribed is not more than the needed amount.

It is necessary for any clinician, especially a school social worker, to have adequate knowledge of the medications that are to be given for a particular disorder since special care is to be given to children. The chapter also suggests some herbal remedies that can be used by the clinician to replace drugs. The therapist should avoid giving drugs to children under the age group of six and only give a limited dose to children at the age of six if needed. The school social worker should follow the recommended amount of drug per day and should avoid exceeding that amount as it can be harmful to the child. Moreover, herbal therapies are better since they do not have the same side effects that drugs may have. The opinion about drugs varies from therapist to therapist, but biases should be avoided when treating a client the priority should be the well-being of the client and not the personal beliefs of the therapist.

References

Sue, D., & Sue, D. M. (2012). Foundations of counseling and psychotherapy: Evidence-based practices for a diverse society. John Wiley & Sons.

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