Theoretical Orientation

1 January 2017

In order to write this paper, the author had to consider two important questions in order to determine the most appropriate theoretical orientation for her. First, under what contexts and specific settings would the therapeutic process take place?

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Second, what does this particular client need most in order to heal, to grow, to be safe with him/herself and with others, to suffer less, to cope more effectively, and to behave in a way that will keep him or her from getting into trouble? It is very important to note that there is a significant amount of research that shows that different therapies work best with different clients regarding their level of functioning, existing pathologies and their severity, the clients’ socioeconomic statuses (SES), and their cultural background.

For the purpose of this paper and based on the answers to the questions previously stated, the author will write from the perspective of a therapist who works in a clinical setting with clients that are largely low to average functioning, are culturally diverse, and generally have a low SES, which means that they have limited time and resources to spend on their treatment. In response to the second question, the theory that comes closest to my worldview and serves as a foundation for constructing my theoretical orientation is the Cognitive Behavioral theory.

The author will discuss CBT as her “go to” primary approach in terms of techniques, goals, the therapist/client relationship, and the merits of the approach. The main concepts of Rogers’ person-centered approach will be infused into the author’s practice as a given, since clients are more likely to cooperate with the therapist’s cognitive and behavioral interventions, and most other interventions for that matter, if they feel the therapist is genuinely interested in their well-being. Cognitive Behavioral Therapy (CBT) Human nature Human beings are capable of change and are subject to determinants in their environments.

Negative and incorrect thinking patterns lead to maladaptive behaviors that somehow have been reinforced through emotions. We all have core belief systems of schemas that are formed early on through since our earliest experiences. Modern practitioners of CBT have opened up new ways of helping people by understanding that they are more than conditioned machines, but still victims or benefactors of the environment. Perception and experiencing in general are active processes which involve both inspected and introspective data.

The client’s thoughts represent these experiences and his or her appraisal of the situation is generally evident in his or her cognitions. These, in turn make up the persons “stream of consciousness”, which reflects the persons configuration of himself, his world, his past and future (Back, 1979). The Cognitive Behavioral perspective is somewhat pessimistic of human nature since it does not afford people the ability to get well on their own, and in some cases such as mental health institutions, the CB therapist exercises quite a bit of control over the patient and their environment. View of health and pathology

When people have negative experiences in their lives, certain core beliefs may result from that and these can lead to psychological dysfunction. Cognitive vulnerabilities develop early in a person’s life and when these beliefs are rigid, negative, and ingrained we are predisposed to pathology (Beck, 1979). Because of the high success rates that CBT has had in treating people with various pathologies as well as more common issues that are less complex but nevertheless need attention, CBT proves its point: if we can deal with and understand our thoughts, our behaviors will follow and our emotions will fall into place.

With the right tools and proper conditioning, there are few issues that CBT cannot correct. There seems to be a CBT technique for almost every occasion. According to CBT, pathology can present itself as a problematic or distorted thinking process if it is very catastrophic, idealistic, extreme, or confusing. Distorted information processing can be, for example, having obsessive thoughts. Other manifestations are skill deficits. Anxiety is the major cause of most behavioral disorders, but anxiety can be conditioned to any stimuli, so it’s not necessarily a bad thing.

When treating clients, CBT is symptom focused and acknowledges their underlying precursors while remaining in the present. In psychopathology from a CBS point of view, there are systematic biases toward selectively interpreting information in a certain manner which are disorder specific. This can be a potential pitfall of CBT since it appears to treat the disorder and not so much the whole person. That said, biology, emotions, behavior (and motivation) influence our thoughts in a very real and systematic way that can often be predicted.

For example, biological treatments (such as biofeedback) can change thoughts and CBT can change biological processes as well. This is especially helpful in stress management. CBT has been empirically proven as an effective therapy for treating other disorders besides those that are anxiety-based, such as depression and other mood disorders, borderline personality disorder, schizophrenia, PTSD, substance abuse, eating disorders, marital problems, and obsessive-compulsive disorder.

It is important to note that a cognitive behavioral therapist is not interested in etiology, but rather focuses on the reasons that the problem continues to persist. CBT techniques have been extended to more areas of human functioning than any other therapeutic approach, making it useful in a variety of situations and clients, which is important to her given her work setting. Role assessment CBT somewhat relies on assessments. The therapist “takes the client’s temperature” and records the client’s mood.

Then client and the therapist go over the homework and assess where to go from there after noting the client’s feedback. Other assessments that measure emotion or personality traits are not widely used in CBT. Certain evaluations that measure cognitive reasoning are of value as well as empirical and valid ones that can observably measure progress or regression. As far as the information gathered, CB therapists want to know some history to establish a baseline of cognitive and behavioral functioning, but don’t expect them to go very deep. Counseling goals

The therapeutic goal in a nutshell is to use patterns to alter moods and behavior of identifying the maladaptive or distorted perceptions that the client has with as much brevity as possible. Once the negative ways of thinking have been identified, the therapist and her client can work collaboratively towards replacing them with new, more effective ones that will include the client’s quality of life. CBT aims to arm clients with and arsenal of tools like coping skills, cognitive awareness, and practical “tips” to help the person literally change his or her mind.

The counseling goals depend from client to client and issue to issue, but in the author’s opinion, addressing immediate thoughts that can cause the client of those around him or her to behave in maladaptive, dangerous, and even deadly behavior is of paramount importance. Therapist/client roles/functions The behavioral perspective is more properly an educational experience in which individuals are involved in a collaborative teaching/learning process between the therapist and the client, respectively.

The therapist is a psycho-educator who is an active enforcer and a guide for the client and his treatment plan. The client must be a willing and active participant who monitors his or her behavior, does the homework according to the treatment plan, and provides the therapist with valuable feedback. In this collaborative relationship, the goals of therapy are very transparent. A valuable feature of CBT is the demystification of the therapy process. Both the client and the therapist take an active role in monitoring the results and efficacy of the treatment.

In The CBT approach, clients are active, informed, and responsible for the direction of therapy because they are partners in the process of getting well. Although having a warm and fuzzy relationship with the client is inconsequential in most cases, giving the client a sense of trust and credibility is. Again, the author works with the assumption that every client needs to be treated with positive and unconditional regard. Counseling skills/techniques Out of a number of therapies that the author has read, it seems that the behavioral therapies have the most to offer in terms of counseling skills and techniques.

Some of these techniques might include biofeedback, self-instructional training, and stress management skills, mindfulness approaches, internal dialogues, as well as closed and open-ended questions, to name a few. Unlearning responses happens in and throughout the therapeutic process and is often achieved through desensitization, assertiveness training, role-playing, and stimulus control. Socratic questioning or Socratic dialogue is a concept in which questioning is used to help clients come to their own conclusions about their thoughts and behaviors.

The author believes that this is technique is the most useful in terms of getting insight from the client by allowing him or her to observe where their faulty thoughts, assumptions, behaviors, and emotions are taking place. It is very important that CB therapists continue their training and stay abreast of what new developments and treatments are constantly being practiced. In this way, CBT is extremely demanding on the therapist. Homework assignments are an important part of CBT, allowing the client to do a substantial amount of therapeutic work in practice outside of the session.

The homework exercises are cognitive in nature and help the client self-monitor, collect data, and test cognitive changes, this often brings more than just a change in behavior – it also brings insight. Through the process of guided discovery, clients develop behavioral experiments to test hypotheses with the help of their therapist and they make adjustments to the treatment plan as needed. Role playing is an important technique because it helps the client become aware of their automatic thoughts and resulting emotions.

The intricacies and the extensive repertoire of CBT techniques will not be discussed in depth in the present paper. Mechanism of healing – the process of change These action-based approaches encourage self-help, and provide for continuous feedback from the client on how well treatment strategies are working, as stated before. In this kind of therapy, the client is able to set the pace, in a way, by allowing the evaluation of outcomes and then collaboratively make the appropriate adjustments to the treatment plan to maximize the tempo and efficacy of the therapy.

Change comes about by shifting cognitive schemas and distortions in a measurable way. Then the environment and its contingencies shape, maintain, and/or extinguish behavior. So if we change the contingencies, the behavior will change also. A good motto for behavioral therapies in general would be “fake it ‘till you make it”, since the assumption is that behavior and cognition precede emotion and that once aligned and cognitively aware, the person’s new behavior and perspective will change for the better. Sensitivity to human differences

Currently, there are many cognitive behavioral therapists that don’t feel comfortable working with clients who have lower levels of cognitive functioning, for example those with certain types of learning disabilities or mental retardation. The author notes that people with those disabilities certainly do think, although they may have trouble articulating their thoughts. For this reason, CBT is not currently a standard treatment for this population. There are some adaptations that therapists can make to help these clients.

For example, they can use simpler vocabulary to ensure the client is accurately receiving the information that is given to him or her. There are many disabled people (and many able people too) that struggle differentiating between a thought in the feeling. This presents a problem since CBT depends on a very discrete distinction between affect, behavior, and cognition. From a multicultural perspective, the author finds that one of the strengths of CBT is that it works extremely well with diverse ethnic populations.

Possibly because some cultures are not interested in delving into the past, but rather want to go straight to the point and fix whatever is wrong. JC Norcross said it well when he stated that “a major challenge for the field of psychotherapy will be to discover creative ways to integrate the values and worldviews of multiple cultures within the discourse of efficacy and evidence that currently dominate health care. ” (Norcross, Hedges, & Castle, 2002). Comparison and contrast of CBT approach with other existing theories CBT label stocks as “dysfunctional” while REBT label stocks as “irrational”.

Also, CBT’s view of the problem is functional; pathology arises from multiple cognitive distortions while REBT’s view of the problem is philosophical; pathology arises from shoulds, musts, and oughts. CBT is more collaborative while are REBT is more confrontative but both of these therapies place equal stock on the power of thought. Psychodynamic therapies differ from CBT approaches in that psychoanalytic theories focus on deterministic and irrational forces, biological and instinctual drives, and unconscious motivation.

A CBT therapist would disagree in almost every one of those points. The post-modern characteristic of an emphasis on playing on the clients’ strengths and resources, as well as the thought of a subjective reality are not consistent with the basic assumptions of CBT but they are both generally brief. Existential approaches are much too vague for CBT and take much more time to process. These approaches are based on a similar concept of the person as purposive and self-determining and a striving for growth and meaning in life. Analysis: rationale for the author’s choice

The theory of CBT was chosen based on the author’s worldview, personal life experiences, observations, and congruence with her basic beliefs and personality. The author is a “fixer,” someone who gets right to the point and tries to reason things out as to figure out the quickest and safest way to deal with an issue and hopes for a lasting effect, although she is ware that CBT tends to be a “Band-Aid” approach. The practical and immediate implications of undesirable or even destructive behaviors are meaningful and significant to the author.

In many occasions, CBT interventions have prevented her from getting caught in downward spirals of erratic and dangerous behaviors. The author’s therapists took control of her environment and once she was stable, she and the therapists began working on the significance of automatic and intermediate thoughts and how they affected her feelings and behaviors. This process was long and tedious (because much of it was work done outside of session) and it has changed and saved her life.

There is no way that the author could have “talked her way out” of such significantly pathological episodes with such little time, support, and resources. The author also strongly believes in the power of choice and in being a part of a collaborative effort that involves the therapist, a physician, and a solid support system. All of these people know the treatment plan and hold the author accountable for her part in staying well. The importance of having a solid, attainable, and clear treatment plan is paramount.

The author has tried numerous other therapies without any success, such as Gestalt and psychoanalytic. Many emotive and behavioral issues that the author, close friends, and her family have struggled with have improved because changes were made in their cognitive processes, specifically, identifying automatic thoughts and understanding the core beliefs from which they stem. Overall, even with its limitations, the author believes that this type of therapy is useful in a variety of settings, and that its transparency and efficacy is attractive to people in similar situations.

It is worth saying that modern CB therapies are becoming more amenable to counting emotional and historical factors into the great thought/action equation. Theoretical integration However, working strictly within the framework of a single theory may not provide counselors and therapists with the therapeutic flexibility to account for the complexities of human behavior, especially when the range of client types and this was the problems are taken into consideration One reason for integration is the recognition that no single theory is comprehensive enough to cover it all.

She contends that individuals can only be truly understood by taking into consideration all the aspects of human functioning. It’s important to present the advantages of constructing a systematic, consistent, personal, and disciplined approach to integrating various elements into a therapist’s practice and to be careful not to haphazardly pick and choose from this theory and that one, as that may harm the client instead of doing good.

After much consideration, the author has chosen theoretical integration which “refers to a conceptual or theoretical creation beyond a mere blending of techniques that has the goal of producing a conceptual framework that synthesizes the best of two or more theoretical approaches under the assumption that the outcome will be richer than either of the theories alone” (Lazarus & Lazarus, 1991) and looks at the person more holistically than CBT alone.

The author would like to be theoretically consistent but technically eclectic. Within this integrated approach, she prefers multimodal assessments, whose underlying principle is tailoring the treatment to the individual’s needs. By asking “who or what is best for this particular individual? ” we can get a better, bigger picture of what theories (or parts of them) to carefully employ. Sample questions in a MM assessment might be How active are you? How emotional are you?

Do you have a vivid imagination? How much of a thinker are you? How social are you? Do you take good care of your body and physical health? (Lazarus & Lazarus, 1991). Arnold Lazarus wrote in 1958 that “humans are the product of genetic endowment, the environment and social learning… humans respond to perceptions rather than to reality” (Lazarus & Lazarus, 1991, p. 8). This struck a chord with the author, who fully subscribes to this view of perception.

The author also draws from the post-modern solution-focused approach because she believes that it useful to consider the client’s strengths and potential. This therapy is based on the optimistic assumption that people are healthy, competent, resourceful, and possess the ability to construct solutions It also acknowledges that certain societal constructs and expectations can limit the person’s full potential (Corey, 2009). She also likes the concept of externalizing problems.

This preference is probably due to her cultural upbringing. As someone who is multicultural, this therapy seems cohesive with the philosophy of multiculturalism therapists can learn from their clients about their experiential world, rather than approaching clients with a preconceived notion about their experience. The author also believes that the past informs our present and even our future. It’s difficult to wrap one’s head completely around the “here and now” when much of that may have happened last week or in childhood.

From the psychodynamic and Adlerian perspectives, the author considers the value of family and personal history, past relationships, and Freudian concepts such as ego defense mechanisms. Furthermore, the author appreciates the take that feminism offers on education, multiculturalism, and advocacy. The author posed a question at the beginning of this paper: what does this particular client need most in order to heal, to grow, to be safe with him/herself and with others, to suffer less, to cope more effectively, and to behave in a way that will keep him or her from getting into trouble?

Truthfully, there is something positive to be said about every theory. Each one attempts to help the client albeit in different ways, and although right now the author’s inclination is toward CBT, there are other schools from which she would like to learn more; she recognizes that the complexities of being human very simply demand a multi-dimensional understanding of people. Ideally, the triad of affect, behavior, and cognition should be addressed, although the order in which they are addressed is the main difference between the most popular theories.

In the author’s opinion, it’s a matter of what came first – the chicken or the egg. We can only make educated guesses. Therapists cannot integrate what they don’t know, so they have to be familiar with and well-educated in a lot of different therapies in order to appropriately and thoughtfully integrate, if that is what they choose to do. In the end, this therapist’s objective is to help clients think about their beliefs and assumptions, to experience at the feeling level their conflicts and struggles, and to actually translate their insights into action programs by behaving in new and productive ways in their everyday lives. The entire point is to be an efficient, caring, knowledgeable, and compassionate helper.

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