Term Stuckness - Essay Example

LITERATURE REVIEW: A QUALITATIVE EXPLORATION INTO THE PHENOMENON OF STUCKNESS FROM A PERSON CENTRED APPROACH and/or ID # Teacher Inreviewing the literature on ‘stuckness’ there are several topics which not only need to be discussed, but clarified in order to focus the approach of person-centred counselling and therapy as well as other disciplines appropriate to the topic. The term stuckness has evolved over time, but generally has the same impact and meaning. Freud discussed the topic many years ago when he noted that neurotics often have varying levels of progress, varying from either fast or slow and often devolving in what becomes a standstill in their therapy. Many therapists, including Freud, complained about their progress being stuck and the overall jargon of ‘stuckness’ became accepted. (Murdin and Errington 2005:56) A significant body of recent research has explored the processes associated with ruptures in the therapeutic alliance (Safran et al. 1990). In another, similar, piece of research, Hill et al. (1996) carried out a survey of counsellors concerning their experience of impasse in their work with clients. The findings of these studies are consistent with the view of Mearns (1994) that lack of therapeutic progress, or what he terms stuckness, is often associated with over- or under-involvement on the part of the counsellor. (McLeod 2003:335) This stuckness has also been often revealed as not so much the lack of apparent progress, but possibly a symptom of something else. Some therapist fell that it is an outcropping of anger and hurt emotions that often trigger the event. (Whelton and Greenberg 2004:117) This is something that the counsellor needs to put into perspective and it can often be the clinicians responsibly to find the cause for this anger and hurt. This mired down feeling is starting to wear on you. Stay with the stuck feeling for awhile and see what images come to mind. Whats the glue thats holding you and the client in place? Reflect on your discomfort with this ‘stuckness.’ What might this client be here to teach you? Just as a reality check, working with a chronically depressed client can be draining, and at times I have felt similarly tired and frustrated. (Pearson 2006) Maltreatment at an early age can also be the beginning of low self-esteem and could certainly be the early stages of a learned helplessness state from which it is perceived that is no apparent benefit in the given environment and therefore the client become stuck. This is the beginning of low self-esteem and poor self-concept. These assumptions and beliefs taken as fact over time create a situation of what psychologist term, learned helplessness. “When [past] experience with uncontrollable events leads to the expectation that future events will also be uncontrollable, disruption in motivation, emotion, and learning may occur” (Cemalcilar, Canbeyli, and Sunar 2003: 1). Stuckness must also be analysed in this light as well and given the due weight in a situation where learned helplessness might be a key culprit. Carl Rogers, one of the founders of humanism, states that we have difficulty in reconciling our ideal selves with our real selves and that what we perceive as ourselves is often clouded by past projections of others who doubted us. Rogers terms this as incongruity and this becomes the cause of all psychological problems for the individual. . His methods puts the client or person back in control and Rogerian Therapy is basically a person cantered non-directive approach whereby the therapist acts as a conduit for the client can view him or herself more clearly. This Rogers perceives as a required psychological adjustment, ‘...which is characterized by an openness to experience without defensiveness, congruence between self and experience, and living by an internal locus of evaluation rather than by externally determined conditions of worth.’ (Demorest 2005: 144) Humanistic psychology gave human development a very positive push, or motivation. The practitioners of this genre of psychology felt that as human beings the reasons we do anything, that we strive for any goal is because it is in out natures to seek the good and to be the best we can be. Rogers states that we have difficulty in reconciling our ideal selves with our real selves and that what we perceive as ourselves is often clouded by past projections of others who doubted us. Rogers terms this as incongruity and this becomes the cause of all psychological problems for the individual. During the development of the personality the primary caregiver must connect with positive regard to the child in order for his or her personality to develop correctly. This becomes the basis for congruence and the personality is more directly connected between the real self and the perceived self. His methods puts the clients back in control and Rogerian Therapy is basically a client cantered non-directive approach whereby the therapist acts as a conduit for the client can view him or herself more clearly. (Kail& Wicks 1993) As Rogers states, incongruence equals suffering of the psyche. The difference between the perceived Self, the actual Self and the ideal self is certainly one of the primary causes of all psychosis and suffering for the human being. As human beings we have an ‘idea’ or concept of who we are and what we really should be, hence we create an Ideal Self that we constantly strive for, often in vain. If the perceived self, our own self-image, is not aligned with the actual self, how we really are, there will always be personality problems and dysfunction as one relates to ones self and the rest of the world. (Kail& Wicks 1993) In some sense if a human being grows in a very healthy and psychological and socially secure and protected environment, congruence should naturally be achieved. If he or she has felt the unconditional positive reinforcement that Rogers advocates, than congruence should be an outcome of certainty. (Vander Zanden 2003) However, even with the best of growth comes change and the self you are today may be different that the self you will be tomorrow, with perhaps different plans and goals. The human beings ability to adapt and change is one of the species greatest strength, but may also keep total congruence just a little out of reach. Self-actualization is the Rogerian goal of finding your actual self and discovering no differences between that self and the perceived self. This is congruence. It is hard to believe that no incongruence can ever exist in the human psyche, but there are certainly levels of development that can lead one to a more congruent life. Stuckness may be a reflection of incongruence and certainly needs to be explored in that respect. In this capacity the therapist need to allow the client to explore their own subjective world more fully. This world, also known as a person’s internal frame of reference consists of all experiences such as sensations, personal meanings and beliefs that have developed over a lifetime, and memories, both conscious and unconscious. Rogers believed that this world can only be fully known and realized by the client and never fully to an outsider, even the therapist. Here is where the term ‘person-cantered’ is in its fullest meaning. The term person-cantered reflects this emphasis on the subjective view of individuals. In order to understand the behaviour of another person it is necessary to get as close as possible to seeing the world through that persons eyes, through their frame of reference. (Dryden and Mytton 1999:69) Since Carl Rogerss death interest has continued to grow regarding person-centred therapy. This interest has expanded beyond the United States. In Europe, the person-centred approach has become one of the leading counselling and therapeutic approaches of the twenty-first century, with major organizations and centres for person-centred research and practice throughout Western and Central Europe. Equally significant, there has also been a great deal of interest in the person-centred approach in emerging democracies in Eastern Europe, Russia, and Latin America. (Kirschenbaum 2004) In fact as early as the 1960s a Japanese counsellor speaking to Rogers explained that person centred counselling helped,‘teach me ... to be democratic and not authoritative.’ Rogers (1977) Cognitive-behavioural therapy (CBT)is also a central tool in assisting a client who is stuck, to become unstuck by using certain very tactile and practical techniques. The principles of CBT include the influence of negative thinking patterns upon individuals feelings and behaviours. By recognizing negative thoughts, they can then be challenged and compared to reality. Replacing critical, unhelpful and damning negative thoughts about events and situations can lead to more effective ways of behaving, living and experiencing according to two major influences on CBT: Albert Ellis and Aaron Beck. (Coles 2003:43) Both learning and cognition are processes that are of primary importance of almost any organism. In general terms learning is a process by which an organism, human being, etc. experiences something in the environment and sets up a new order of principles or rules to deal with that situation. This may involve memory, recognition, emotional, and psychological responses, which become the learned or acquired behaviour. Cognition is the actual process of thought, the reasoning that sets up the process of learning behaviour. While these are highly generalized definitions, both terms are often interchanging and interchangeable, between what is learning behaviour and what is cognitive behaviour. Either the counsellor or the person seeking help may suggest or devise activities or routines that can be applied to resolving the issue. Within the counselling world, cognitive behavioural therapy in particular represents a rich resource of activities, such as relaxation training, homework assignments, initiating rewards for preferred behaviour, identifying and challenging irrational beliefs, and much else. (McLeod 2007:56) Cognition can be conceived as the way individuals’ processes information. Some people make lists, some create pictures in the mind, and some do not really know how they remember information or learn, but they all use some cognitive process by which to view, retain and analyse information so that learning becomes possible. For instance, in learning directions to get to another location there are certain cognitive steps to acquire and use the information, yet they may vary in style. Some people will use a map, other would prefer street directions turn by turn, and other may prefer landmark references to remember how to get there. Cognition is process by which we do something for the first time and learning is when the process itself seems to disappear and the directions, in this case, become second nature and you do not even have to think, or cognate, in order to get there. The cognitive psychotherapist will give her patient tasks to perform as homework which will usually involve concentrating the mind on aspects of patterns of thought and behaviour. This may be a matter of noting when an unpleasant or conflictual situation arises and registering how one reacts to it. The patient must be willing to experience the unpleasant situation yet again, with no promise that anything will ever feel better. The only way in which such a situation can be bearable for the patient is where there is a strong belief that the therapist has a plan which will lead in the end to improvement. In other words, there is trust in the wisdom and therapeutic skill of the clinician. (Murdin and Errington 2005:117) Cognition and learning appear to be an innate function of humans. Perception and memory are important survival instincts and are present even in the youngest child. . Not only does the infant perceive and has to ability to finely distinguish between the sounds of words, but shows the ability to retain and remember that sound over a period of time, such as the sound of his or her mother’s voice. (Fanzen, 2001) In theory, cognitive modification has been successful with the general population with average intelligence having no need for special assistance in educational objective. This area of therapy has been quite successful in maintaining long term result by changing the way one thinks about him or herself, and their beliefs about the world at large. It has helped to improve self- efficacy and self-esteem in individuals with emotional of psychological impairments as well as those undergoing treatment for substance abuse and addictions. It accomplishes this through several methods that help to change Negative Automatic Thoughts (NATS) so that there is developed a more positive attitude and outcome for an individual. (Neenan& Dryden, 2004) Much of it is used in imagery exercises that take the client through the worst scenarios, but then leads to a greater realization: The client’s imaginal journey through the worst and beyond demonstrates to him that he will not be stuck in that ‘awful’ moment for ever. The client practiced this imagery exercise as a homework assignment and later declared: ‘I dont think it would be a big deal any longer if it did happen to me. To be honest I’m getting bored with it. So what if I spill water over myself?’ The general thrust of imagery modification in CT is to help clients change the negative direction of their imagery towards positive and more successful coping scenes (Neenan& Dryden, 2004, p. 134) Jean Piaget was one of the first to present the importance of the Cognitive Stages of development in the human child. The ability to comprehend how ones mental capacity develops over time is of crucial importance. This new understanding will aid in the ability to communicate in a manner that is age appropriate. Jean Piagets constructivist theory outlines the manifestation of cognitive motivation and intelligence. According to Piaget’s theory, there are four components that are directly responsible for the motivational sequence: The sensorimotor - birth to 2 yrs., preoperational - 2 to 7 yrs., the concrete operational -7 to 11 yrs., and the formal operational period – 11yrs to adulthood. Again, these are stages of development that must be completed fully and cannot be it skipped or bypassed. In order to progress from one stage to the next, the infant must first move for example, from sensorimotor to preoperational; therefore, the sequence of stages is constant and predictable. (Vander Zanden 2003) It is important to keep this history of the client in mind when dealing with stuckness. …the process of self-re-evaluation tends to be most prevalent for individuals when attempting to change with or without therapy interventions. Rational-emotive behaviour therapy, cognitive therapy, transactional analysis, and existential therapy are leading therapies that have been identified as fitting most appropriately with the respective process of TTM [Transtheoretical Model of Change] at the contemplation stage (Petrocelli 2002: 28) The Transtheoretical Model of Change is not really a counselling theory or method per se, but is derived from a multistage sequential model regarding general change. It is in effect a multi-modal approach to counselling and is inherently interested in the processes and the many stages of change and development that are central to all counselling theories. TTM was designed to provide an integrative structure to counselling and therapy. ‘The structure of TTM acknowledges the importance of a developmental perspective of change, rather than for example a theoretical approach that mainly focuses on personality characteristics or behaviours as predictors of change.’ (Petrocelli 2002:22) Transactional analysis is another area that needs to be explored in the realm of stuckness. This mode of therapy is particularly useful when the therapist believes that the stuckness is occurring due to client sabotage his own personal growth. This occurs when a particular script is in place in the client’s internal frame of reference that is telling them not to success or to avoid success and the like. In this sense people can create tragic outcomes and certainly become stuck in their own therapy so it does not succeed and prove to themselves that there is no hope for them. Clients have numerous ways of presenting obstacles, excuses, evasions, psychosomatic complaints, and so on. Dont run away with the idea that progress will be or has to be smooth - it is more likely to be an obstacle course - but go over the terrain with the client, mapping out what bumps and ravines you both think could stand in the way. (Feltham and Dryden 2006:80) During the course of therapy using transactional analysis, ‘clients are encouraged to establish respectful and dialogic relationships between their parent, adult and child ego states.’ (Cooper 2004:68) These mature transactions are hoped to gain communication with others as well as with the self. In the workplace, transactional analysis of the environment found between the counsellor, therapist and company can be simply represented by the following: Figure 1: Workplace Transactional analysis. (Coles 2003:98) This transactional analysis model can be used to describe the agreement that a counsellor may have with a client and organization. Here it is represented as a simple triangular figure. ‘It is useful as a visual description of the distance between client, counsellor and the organization.’ (Coles 2003:98) While transactional analysis is a very powerful tool one must be aware of the more complex language and jargon associated with it. This can be counterproductive under some circumstances. Most therapist feel that too much technical jargon can be overwhelming and in transactional analysis, where counselling depends on teaching basic concepts from models like the one above, some technical language will be necessary. However these jargons must be explained to the client well in advance and then checked and rechecked for appropriate understanding. Misunderstanding can often create a, ‘… misalliance or negative transference-countertransference kind of battle.’ (Feltham and Dryden 2006:59) Transference, the projection a client’s past emotional experience onto their therapist (Callahan, Corey & Corey 2003), takes training and experience to utilize as a therapeutic tool. Most pointedly in a client’s transfer of racist hatred or aggression from a past experience would certainly be a difficult situation, especially if the counsellor’s background were of a minority status. However, the door on this swings both ways, one is either dealing with the emotions from a victim of racism or of a perpetrator of the bias. Trying to get one’s client to see that the transfer of this emotion is something they need to talk through may be a most demanding endeavour. Conversely, counter-transference, the conveyance of emotions or feelings from the therapist onto the client, may also be either destructive or constructive (Callahan, Corey & Corey 2003). An example of a potentially destructive counter-transference trait in a therapist would be perfectionism. This quality, left unchecked, is certain to ruin any productive client-counsellor relationship. By its very nature this trait’s existence leads to criticism and control. Both these values can certainly undermine a client’s self-esteem at any sensitive juncture. Constructively, there may be subconscious responses resonating in the therapist that have been activated by some aspect of the client’s situation. Recognized, these reactions may lead the therapist to a deeper understanding of the client’s condition (Callahan, Corey &Corey 2003). As any therapist or counsellor knows, change is always difficult and daunting. Furthermore, making the change from stuckness to flow is perhaps even more so. However, most in the therapy and counselling professions have to believe that if the client has enough insight and can be guided with some understanding of their situation, relationship or whatever issue they encounter that is creating this dysfunctional state, they may be able to realize their negative script and begin to cultivate behaviours for a more productive and positive lifestyle. This ideal has long been held in many forms of counselling and psychotherapy, and especially in person-centred counselling The key idea is to focus not on the problem behaviour, but on the person who is engaging in that behaviour. For example, someone who abuses alcohol may have a history of emotional neglect and abuse, and may have low self-esteem. From this perspective, binge drinking may be viewed as almost emotionally and interpersonally necessary for the person as a means of assuaging emotional pain and living up to other peoples views that they are no good. In this approach, counselling that concentrates on programmes to encourage alternatives to drinking is missing the point: it is the sense that the person has of who they are that needs to change. (McLeod 2007:201) Personal change during the course of counselling or therapy is normally a complex and multi-dimensional process that requires more than one approach, especially if the client is stuck and making no progress. The therapeutic change process can commonly include elements of hesitancy, enthusiasm, sustained commitment, conversion, stuckness, peak experiences, disappointments, incidental learning, crises, relapses and stable maintenance. The reality is that counselling can be a rough ride, with ups, downs, moments of uncertainty and doubt, and times of backsliding. (Feltham and Dryden 2006:159) Maslow’s hierarchy of needs come into play here, although Maslow’s theory stems from the branch of Humanistic Psychology, the overall framework is aligned somewhat with human development. Maslow’s postulated that in order for one to develop, basic needs must be met, if one is to continue to evolve psychically, psychologically and socially. According to Maslow, there are five basic needs: Physiological, safety, belonging/love, esteem, and self-actualization. One cannot ascend to the next level of the hierarchical pyramid without having successfully completed the prior one (Frager& Fadiman, 1998). Furthermore, as Maslow states: Capacities clamour to be used, and cease their clamour only when they are well used…Not only is it fun to use our capacities, but it is necessary for growth. The unused skill or capacity or organ can become a disease centre or else atrophy or disappear, thus diminishing the person. (Maslow 1968: 132) While the literature for this subject is vast, the particular focus here on person centred counselling, transactional analysis and cognitive behaviour therapy as well as the Transtheoretical Model of Change can be helpful in regards to the concept of stuckness in the therapeutic situation. Furthermore, by attempting to use various techniques that act alone may jostle the client out of his or her stuckness. Presenting alternative techniques to the ones that have led to stuckness is certainly a viable and positive approach to creating change in the therapeutic setting and open the flow of treatment back up. List of References Callahan, P., Corey, G. & Schneider-Corey, M. 2003.Issues & Ethics in the Healing Professions.Brooks/Cole, Pacific Grove, CA. Cemalcilar, Z., Canbeyli, R., and Sunar, D. 2003. ‘“Learned Helplessness, Therapy, and Personality Traits: An Experimental Study. Journal of Social Psychology.143: 1 Coles, Adrian. 2003. Counselling in the Workplace. Maidenhead, England: Open University Press. Cooper, Mick. 2004. ‘Chapter 4 Encountering Self-Otherness.’ pp. 60-73 in The Dialogical Self in Psychotherapy, edited by Hermans, Hubert J. M. and Giancarlo Dimaggio. New York: Brunner-Routledge Demorest, Amy. 2005. Psychologys Grand Theorists: How Personal Experiences Shaped Professional Ideas. Mahwah, NJ: Lawrence Erlbaum Associates. Dryden, Windy, and Jill Mytton. 1999. Four Approaches to Counselling and Psychotherapy. London: Routledge Fanzen, Harald. 2001. Babies Know Early on Where Words Begin and End. Scientific American Online. June 2001. Feltham, Colin, and Windy Dryden. 2006. Brief Counselling: A Practical, Integrative Approach. 2nd ed. Maidenhead, England: Open University Press. Frager, R.& Fadiman, J. 1998. Personality and Personal Growth. (4th ed.). New York: Longman Hermans, Hubert J. M. and Giancarlo Dimaggio, eds. 2004.The Dialogical Self in Psychotherapy. New York: Brunner-Routledge. Kail, RV, & Wicks-Nelson, R. 1993. Developmental Psychology. 5th ed. Englewood Cliffs, New Jersey: Prentice Hall. Kirschenbaum, Howard. 2004. ‘Carl Rogerss Life and Work: An Assessment on the 100th Anniversary of His Birth.’Journal of Counseling and Development 82:116-127 Maslow, A. H. 1968.Toward a psychology of being 2d ed. Princeton, NJ: Van Nostrand. McLeod, John, ed. 2003. An Introduction to Counselling 3rd ed. Philadelphia: Open University Press McLeod, John. 2007. Counselling Skill. Maidenhead, England: Open University Press. Murdin, Lesley, and Meg Errington. 2005. Setting out: The Importance of the Beginning in Psychotherapy and Counselling. London: Brunner-Routledge. Neenan, M., & Dryden, W. 2004.Cognitive Therapy: 100 Key Points. New York: Brunner-Routledge. Pearson, Quinn M. 2006.‘Psychotherapy-Driven Supervision: Integrating Counselling Theories into Role-Based Supervision.’Journal of Mental Health Counselling 28:241-257 Petrocelli, John V. 2002. ‘Processes and Stages of Change: Counseling with the Transtheoretical Model of Change.’Journal of Counseling and Development 80:22-29 Rogers, C. R. 1977. Carl Rogers on Personal Power: Inner Strength and Its Revolutionary Impact. New York: Delacorte Press. Vander Zanden, James W. 2003. Human Development. Crandell, L. T. & C.H. Crandell& Thomas L., Eds.. New York: McGraw Hill. Whelton, William J., and Leslie S. Greenberg. 2004. ‘Chapter 7 From Discord to Dialogue.’ pp. 108-123 in The Dialogical Self in Psychotherapy, edited by Hermans, Hubert J. M. and Giancarlo Dimaggio. New York: Brunner-Routledge. Read More