Psychotherapy Approaches Used in The Sessions - Research Paper Example

Psychotherapy Approaches Used in The Sessions Introduction The word Psychotherapy is a derivative of two Greek words Psyche meaning breath and therapeia meaning to cure. The term therefore means to relieve distress or mental disability in another person using a particular theory or paradigm in which one is trained. Psychotherapy is therefore different from counseling which is a generic term for all types of psychological treatments that can be offered by any person merely from experience and, at times, not based on any particular theoretical framework. However, the two terms are sometimes used interchangeably (Stolorow, & Atwood, 1992, 5). Most forms of psychotherapy use conversation as the main way of accessing the subconscious mind of the patient. In this manner, the patient can be helped to his problem and find solutions to it. But there are other methods of communication that can be employed as well. These include the use of writing, drawings, drama, narratives or music (Stolorow, & Atwood, 1992, 5). This paper sets out to identify different types of psychotherapy approaches used in the sessions with a particular patient, who I named Jacinta for confidentiality purposes; and identifying the theories on which they are based. It explores her experiences of retraumatization and the restoration of hope in her. In order to isolate the particular theories used in this case, a rundown of the theories available is done in the next chapter. Theoretical Approaches of Psychotherapy Psychoanalysis This was the first kind of psychological treatment approach grounded on a theoretical framework. First employed in the late19th century, it was based on a theory developed by Sigmund Freud. A neurologist, Freud realized that there were certain neurological problems that cold not be explained based on discernible organic basis. He, therefore, theorized that their causes were psychological and originated in childhood experiences and the subconscious mind. The practice of psychoanalysis employed techniques like dream interpretation, transference and free association. It also involved the analysis of the id, ego and superego. The id is the basic animal drive to achieve human desires; the ego is the pride of the individual that controls opposes such drives; while the superego is the balance between the two representing the conscience of the person (Stolorow & Atwood, 1992, 4). Rogerian Developed by Carl Rogers, this approach involves allowing the client to express himself through constant encouragement by the therapist. It is grounded on the theory that every individual has a cure to his own psychological condition provided that he learns to express himself freely and generate self respect. Like psychoanalysis, the approach posits that individual problems arise out of previous experiences that affected one in earlier life. The success of the therapy depends on three crucial characteristics of the counselor. He must be congruent, positive and empathetic in handling the client, without having too much sympathy (Rogers, 1951, 1-2). Cognitive Behavioral Approach This approach seeks to identify and transcend poorly adapted cognition, appraisal, beliefs and reactions in order to influence negative emotions that are destructive and antisocial troublesome behavior (Stolorow, & Atwood, 1992, 5). Psychodynamic This is a kind of depth psychology that is primarily focused on revealing the content of the subconscious of the psyche of the client with the aim of alleviating psychic tension. Though it is deeply rooted in psychoanalysis, it is usually briefer and less intensive than the latter. Existential This approach is founded on the existential belief that individuals are on their own, alone in their existence. Isolation inevitably leads to the feeling that life is meaningless. Such a feeling can only be overcome through creating individual values and meanings (Stolorow, & Atwood, 1992, 7). Humanistic This approached emerged as a reaction to both behaviorism and psychoanalysis. It has subsequently come to be known as the Third Force in development of psychology. It is purely concerned with the issue of the development of the individual in the human context. It consequently emphasizes individual development with emphasis on subjective meaning. This in a nutshell is a total rejection of determinism. The concern is therefore focused on positive growth and not pathology. It posits that humans have an inherent capacity to achieve their maximal potential. This has come to be known as 'the self-actualizing tendency'. So the Humanistic therapist aims at creating a relational environment in which this tendency is best placed to flourish (Anderson, 1997, 12). Brief This is a generic term for a number of psychotherapy approaches. It differs from the other approaches with its distinct emphasis on specific problem focus and direct intervention on the problem. Its approach is therefore oriented towards solutions rather than problem. How the problem arose in the first place is of little concern here, what matters is the factors sustaining the problem by preventing change (Hycner, & Jacobs, 1995, 5). Systemic This approach focuses more on the group than the individual. It recognizes a person only as a part of wider society operation within the confines of its beliefs, values and cultural systems. People are therefore seen as always operating within relationships. This is markedly different from the other approaches that seek to deal with the individual as a singular entity independent entity. A good example of the systemic approach is family therapy (Winnicott, 1971, 12). Transpersonal This approach views the client within the context of their spirituality. It is on this basis that an understanding of the consciousness is established (Stolorow, & Atwood, 1992, 5). Integrative This method is really a combination of all or some of the methods above to achieve a more effective result. Many practitioners of psychotherapy actually combine different schools of thought or theories with the intention of getting the best out of all such approaches as can suit a particular situation (Winnicott, 1971,12). Case Study of the Counseling of Jacinta Background Jacinta Lucas is an 18 year old girl who just graduated from high school. She lives in Chicago Illinois in the US. Though she completed school, there were so many incidents she was involved in that were adjudged by the school authorities to be antisocial. This included pinching other students’ belongings and fighting regularly with fellow girls and boys. Her parents were called to school several times to try and establish the rot cause of her behavior, but nothing out of the ordinary was found out from them. The parents insisted that their daughter was not a problem at all at home. Teachers found it difficult to believe this and, according to them, the parents were hiding information about Jacinta. The parents however admitted that Jacinta was a pathological liar who told untruths even for no particular purpose. Other students indicated that she would occasionally scare other girls by screaming all over a sudden for no apparent reason. On one occasion she took an overdose of tablets and became unconscious. Though it was not established which tablets they were- all she said was that they were small yellow tablets she had found at home-school authorities strongly suspected that she was attempting suicide. She strongly denied these allegations. Her parents became very scared and decided to send her to me for counseling. Approach Used To help decipher what Jacinta’s problem was, it was necessary to use an integrative therapeutic approach. This was because her problem had a unique complexity to it. The information I had from the school suggested an individual with a deeply troubled personality who however tried her best to hide her suffering from her parents. This gave her a kind of Jekyll and Hyde personality; the perfect girl at home (except for her lies) and the devil in school. This dual personality was puzzling and in such situations it is best to keep an open mind and apply whatever approach, or approaches, that prove to be appropriate to the situation (Anderson, 1997, 48). I would however concentrate on Gestalt Therapy which is concerned with the present situation of the client rather than the past and which gains insights through dialogue (Hycner & Jacobs, 1995, 5). The Interview I carried out the first interview with Jacinta in my office in the presence of her parents. The main gist of the discussion was simply for my introduction to her and for her to express if she understood why she had been brought to see me. She simply said yes, and that she believed she was having problems coping with other people, especially former fellow students. However, she felt that she did not have any particular problem on her mind and thought that she would do her best and everything would be OK. The Rogerian approach stipulates that the interviewer should be open minded (Rogers, 1951, 2). I proposed to her that we would arrange sessions to hold discussions twice every week, and if it turned out that nothing was really wrong with her after three weeks, then we would call off the sessions. She readily agreed to this arrangement and we went ahead to arrange time for the first session. Her mother insisted that she would drop her to every session and pick her up afterwards. Jacinta agreed to this too. She looked quite encouraged by the fact that I had made it clear to her mother that the sessions would be strictly between Jacinta and me; and that all the discussions would remain confidential. Confidentiality is very important to a client, more so to one in an impressionable age like Jacinta (Stolorow & Atwood, 1992, 14). Secondly, I took sometime to explain to her what would happen during each session. The gist of it was that I would ask her questions and she would respond to them in as detailed a manner as possible. Meanwhile, she should feel free to talk about anything she felt was important. The First Session The very first session we had with Jacinta was as dramatic as it was revealing. As soon as she was sure that her mother was out of the vicinity, she opened up herself. It is usually difficult to for any tow strangers to establish a rapport, leave alone a counselor and a client. In most cases, clients will not open up until the fourth or fifth session. Given her cagey and reserved responses on the first day in the presence of her parents, I suspected that Jacinta would even take longer than that. I was proved wrong. She went straight ahead to tell me what she believed bothered her. I record all interviews on video since it is more reliable for analysis than a mere voice on tape. The reactions and gestures of the person speaking can be analyzed together with the words. The opening of the discussion went like this: Therapist: Hallo Jacinta, did you have a good weekend. Jacinta: No really. I spent most of the time at home doing chores and thinking about this talk with you. T: Why? J: I dunno, it’s like totally new to me, you know. I never had this kind of thing before. T: So how do you feel about it? J: Its kind a hard you know. Telling someone everything that is bothering you? Do you find it easy? T: What? J: Telling others your problems? T: No, its not easy. But problems must be told to someone you trust. Otherwise they keep bothering you all alone. Do you trust me? J: I guess, coz you are a shrink and all that. T: So feel free and talk. What else were you thinking about this session, apart from it being hard to tell your problems? J: Stuff you know. T: What stuff? J: Like my dad. He is not my real dad you know. My mum tries to make me think so but it is not true. And he just behaves queer sometimes which makes me realize that he really isn’t my dad. That bothers me a lot. From that first session I was able to gather so many facts from Jacinta. She was the eldest child in a family of three children: two girls and a boy. The boy Ted is the youngest while her follower is called Iris. She revealed that she suspected she had been born out of wedlock and that her father did not treat her fairly compared to the other two children. He is a civil engineer working for the government in Chicago while her mother is an administrative assistant in a local blue chip company. She cited the fact that her father had completely refused to buy her a car even after she worked hard and got a driving license. She also quoted the fact that she always spent her birthday at home whereas her siblings got the additional bonus of being taken out after the party. I sought her permission to question her mother about these issues, but at first she strongly refused saying that it would make the parents more cross with her. However, when I promised to respect her wishes she went silent for a while and I thought I had lost her confidence. This particular request was likely to subject her to retraumatization ( Hycner & Jacobs, 1995, 20). Quite on the contrary, she asked me if I thought they would be angry with her if I told them and I frankly told her I did not know how they would react. She the shrugged and decided that I should ask her mother. I did talk to her mother after the first session to confirm some of these statements since I was apprehensive about the allegation that Jacinta was a pathological liar. However, to my amazement, she confirmed everything Jacinta had said but insisted that she was not born out of wedlock as she suspected. The mother said that Jacinta’s mind had been poisoned by her drunken aunt, the father’s sister, who did not like marriage of Jacinta’s parents. Everything that was done differently to Jacinta was actually an attempt to punish her for behaving badly at school in order to correct her behavior. This was therefore a classic case of punishment gone wrong. I cautioned her not to ask Jacinta about what we had discussed unless Jacinta was the one who approached her. The Second Session The second session revealed that Jacinta was always told the reasons she had been punished, but insisted that they were just excuses to treat her wrong. She concurred that it was her aunt who had planted the idea in her mind that she was illegitimate in her mind. However, she insisted that her aunt was right. When I asked why she had not confronted her parents with the issue; she said that she loved her parents and thought the issue would offend them. Jacinta listened keenly to what her mother had said, and in a moment of confusion, asked me if I thought it was really true that she was indeed her father’s true child. I told her it was quite likely though only a paternity test could confirm the fact for sure and put her mind to rest. She asked me how that worked and I told her she would need to have a sample taken from her and her father to confirm if the genes matched. She sounded fascinated and after explaining to her in a little more detail I told her that it was very important to work hard in school in order to understand such issues. The Third Session During the third session I asked her about her screaming. Jacinta told me that she had once agreed to have sex with a boy, for the very first time in her life, and she was afraid she might get pregnant. The thought scared her very much that her child might be illegitimate and thus be mistreated in future. While thinking about it she sometimes just screamed. She also explained that she had taken a drug overdose, not to kill herself as her teachers said, but to get rid of the pregnancy. I asked her if she was pregnant at the time and she told me she had no idea. I asked if she had taken a pregnancy test and she told me she had no idea how it was done. When I asked her if she had a friend with whom she shared her secrets, she simply remarked that her friends always revealed her secrets to others who used them the ridicule her. She had therefore learned not to trust anyone. I the asked her again if she trusted me and she affirmed it. She said talking to was easy and it made her feel better about herself. Her remarks were so sincere that I had to control myself from being emotionally involved. Nevertheless, I was really moved. Since I was afraid that her screaming might be due to Schizophrenia, which may not be easily cured by simple psychotherapy since it is more of a biological than psychological condition, I had to find out more about it. I asked if she still screamed and she said no, since her menses had returned confirming that she was not pregnant. Admittedly, I was visibly relieved to hear that and she noticed it. She told me she was not crazy, just disturbed. The Fourth Session There were no further revelations from this session onwards. Instead we delved more deeply into the problems that we had discussed earlier. Jacinta said that before meeting her boyfriend who worked at a gas station where she fuelled her father’s car, she had always steadfastly remained a virgin. She dumped him soon after having sex with him due to the fear of getting pregnant. She said they had not used any contraceptive protection as the act had been impulsive. When I asked her if she would have another boyfriend, she remarked that the boys she knew only wanted sex. From this point on she became more the questioner than the questioned. She wanted to know what to do in order to make her life better. We considered a number of options open to her. The first option I based on the Transpersonal Approach focusing on her spiritual wellbeing. This was to go to church regularly. She told me that she was a marginal Christian of Pentecostal extraction. I did warn her that the church did not solve all the problems that face a person, but that to some extent it gave people peace of mind (Friedman, 2002, 201). The second option was to pursue her education further. The Humanist Approach centralizes its theme on the issue of self actualization (Teichoiz, 1999, 112). This was important in the case of Jacinta since many of her problems were founded on ignorance of concepts as simply as the need for taking a pregnancy test. She told me that her grades were very low and I assured her that there were bridging programs that could help her improve her grades enough to pursue her education further. I however insisted that she should not resort to online programs since they would deny her the one component she needed most: human company. Through meeting people she would find persons to trust and even a boyfriend who was willing to wait to have sex later. This was based on the Existential Approach, since she had a deeply rooted sense of isolation that was affecting her gravely ( Hycner, & Jacobs, 1995, 21). On the third issue, we also agreed that there was no option but to go for the paternity test. In my opinion this was the key to her cure. Everything else that affected her negatively seemed to revolve around the paternity issue. I told her that not taking the test would only leave room for doubts in future. This was also based on both the Existential and Systemic approaches, answering the need for her to have a sense of belonging ( Hycner & Jacobs, 1995, 21). She was, however, apprehensive about what might happen if it turned out that she was not her father’s biological child. I told her that such an eventuality would not change the fact that she was his daughter. Biological origin is not the only basis for parentage. The Systemic approach stipulates that the individual is a sum total of the values and belief systems one grows up in and is thus not simply a biological organism. The love and care that she had received from childhood to her present age was the true basis (Buber, 1922, 26). Though this suggestion traumatized her, I made it easier for her when I promised to talk to her parents and make the arrangements. Conclusion I did manage to record impressive progress with Jacinta after as few as eight sessions. Most therapies take much longer than that to record any tangible results (Hobson, 1985, 17). I attribute this to the seriousness with which she took the sessions from the very beginning. She obviously wanted a way out and got it in me (Stolorow & Atwood, 1992, 14). She was a very changed person with restored hope and faith, especially after her paternity test dispelled all her fears about her parentage proving she was indeed her father’s biological daughter. She went for the bridging course and ultimately joined college to study, guess what; Psychiatry. Psychotherapy may not always work this well. But even when it doesn’t, it does change a client to some extent, even if not to the desired level. In this case, the approach I used actually worked, thanks to the cooperation of the patient. References Hycner, R. & Jacobs, L. (1995). The Healing Relationship in Gestalt Therapy -A Dialogic/Self psychology approach. London: Oxford. pp 5-21. Hobson R.F. (1985). Forms of Feeling: The Heart of Psychotherapy. New York: Tavistock. p17. Stolorow, R. & Atwood, G. (1992). Contexts of Being: Intersubjective Foundations of Psychological Life. New York: Routledge. pp 4-14. Anderson, H. (1997). Conversation, Language and Possibilities: A Postmodern Approach To Therapy. New York: Basic Books. pp 22- 48. Friedman, M.F. (2002). Martin Buber: The life of Dialogue. 4th edition. chapter 21. New York: Hesperides Press. p 201. Buber, M. (1922). I and Thou. New York: Hesperides Press. p 26. Teichoiz, J. G. (1999). Kohut, Loewald, and the Postmoderns: A comparative study of self and relationship. New Jersey: The Analytic Press. p112. Rogers, C. (1951) Client-Centred Therapy. New York: Routledge. pp 1-2 Winnicott, D. (1971). Playing and Reality. New York Roultedge. p 12. Read More