Learning Task 4: Personal Position Paper Shelina Hassanali (00273150) EDPS 602 December 1 st , 2013 2 PERSONAL POSITION PAPER Introduction In this course thus far, we have explored various different counselling theories which are utilized in the practice of psychotherapy. For each theory, we have considered important aspects which are central to any sound theory, including philosophical, descriptive, prescriptive, and evaluative elements (The Nature of Theory, n.d.). While there are many aspects of these individual theories which overlap with or are similar to each other, each one is unique in the way that it approaches psychotherapy. This paper will discuss my position regarding my emerging personal counselling framework, which draws heavily from rational-emotive behavioural therapy (REBT), Adlerian theory, cognitive-behavioural therapies, and psychoanalytic theory. Various characteristics of my emerging framework will be discussed, including philosophical assumptions of human nature, the causes of healthy functioning versus impaired functioning, and the nature of change. I will also discuss my position regarding a number of factors related to the counselling experience, and will close with a discussion in which I will reflect on the strengths and weaknesses of my position. Philosophical Assumptions The philosophical element of a theory is that set of core assumptions which guide all other aspects of the theory (The Nature of Theory, n.d.). As such, it serves as the base of the theory and is an integral piece to consider. This element often includes assumptions related to the core nature of people, active versus passive tendencies, and implied assumptions about the cause of dysfunctional behaviour. The Nature of Humans 3 PERSONAL POSITION PAPER According to my personal framework, which draws heavily from REBT and Adlerian therapy, humans have the intrinsic drive to be happy (Ellis, 1976), to function optimally, and to be motivated towards self-growth and development rather than towards regression (Wedding & Corsini, 2014). Due to this natural drive, humans are aware when there is an imbalance or when something is wrong, and are inclined to work towards fixing it or restoring balance in their lives. However, during times when we are faced with uncomfortable situations for which we lack the skills to function optimally, I believe that humans tend to use various defense mechanisms to protect themselves, as suggested by psychoanalytic theory (Wedding & Corsini, 2014). These defenses are part of a larger group of behaviours which, according to both psychoanalytic and behavioural theory, always serve some sort of function and therefore must be examined in therapy (Perry & Bond, 2012). In terms of human decision making, a strong assumption of my personal counselling framework is aligned with the REBT principle that humans have the ability to be both rational and irrational, and that irrational beliefs may lead to emotional consequences and human disturbance (DiGiuseppe, 2009; Wedding & Corsini, 2014). I also suggest that these beliefs stem from the way we process information, and that we are directly impacted by the perceptions, goals, and previous learnings of our cognitive schemas, as discussed in cognitive theory (Wedding & Corsini, 2014). As recommended by REBT, it is important to consider how these perceptions, cognitions, emotions and behaviours work together to impact the functioning of an individual (Wedding & Corsini, 2014). The REBT and Adlerian principles of humans as constructivists and co-creators of their situations (Wedding & Corsini, 2014) is also a base of my framework because I strongly believe that change does not occur unless we utilize our ability to be active agents of change in our lives. 4 PERSONAL POSITION PAPER Relatedly, my framework assumes the Adlerian viewpoint which states that human nature is neutral, and that every individual has the ability to create positive change in their lives, no matter how dysfunctional their current status may be (Wedding & Corsini, 2014). The Nature of Healthy/Well-Adjusted Functioning It can be assumed that healthy, well-adjusted functioning is directly linked to the level of happiness and contentment in ones life. Healthy functioning does not involve conflict, discomfort, uncertainty and fear, as described by psychoanalytic theory (Wedding & Corsini, 2014). Healthy functioning in humans is also based on strong problem-solving and communication skills as well as a sense of agency; in other words, the perception that one has influence in their life and can take action to create positive outcomes (Cloninger & Zohar, 2010). My personal framework also includes assumptions which are present in Adlerian theory, including the idea that healthy functioning is linked to being successful in reaching ones goals as well as feeling a sense of belonging to a larger community (Wedding & Corsini, 2014). This framework places great importance on the role of belonging, as social connectedness has been shown to decrease depressive symptomology and increase perceived level of overall happiness (Mauss et al, 2011). The Major Causes of Problems My theory regarding the major causes of problems draws mainly from the assumptions of four established theories. First, I assume that problems are caused by the REBT principle of irrational beliefs. That is, emotional consequences are caused by irrational beliefs regarding an activating event, and not necessarily by the event itself (Wedding & Corsini, 2014). It is assumed that rational thinking aids in reaching client goals and irrational thinking functions to block 5 PERSONAL POSITION PAPER success in reaching goals (Ellis, 1976). Second, my framework also adopts the assumptions of Adlerian theory which state that psychopathology is caused by faulty motivations, feelings of inferiority, self-centeredness, competition, and discouragement (Wedding & Corsini, 2014). If an individual is unsuccessful in reaching personal goals, they will feel a sense of failure which could be problematic if left unresolved. Third, my theory assumes the behavioural stance that many problem behaviours serve some sort of function for the individual. Based on this assumption, one of the goals of therapy would be to determine the function of the behaviour and to replace it with one that is more adaptive. Finally, the fourth assumption regarding the major causes of problems is that certain behaviours can be described by the psychoanalytic principle of defense mechanisms; that is, the client is engaging in some sort of problematic pattern because it is protecting them from some undesirable circumstance (Wedding & Corsini, 2014). As stated above, my personal counselling framework utilizes assumptions proposed by four main theories. The reason for drawing from more than one theory is because causes of problems can be different for each client, and therefore, it would be difficult to pinpoint one particular cause. However, I do feel that the assumptions listed above capture the most prominent causes of many human issues. The Nature of Change My personal position regarding the nature of change is that change is a gradual process which requires time and active effort. An individual must be ready for change, and must have accepted that an issue exists. The amount of progress a client makes and the amount of success they experience at any given time is partly a function of the stage of change which they are in (Norcross, Krebs & Prochaska, 2010). The stages of change have been described as pre- 6 PERSONAL POSITION PAPER contemplation, contemplation, preparation, action and maintenance (Prochaska, DiClemente & Norcross, 1992 as cited in Renninger, 2013). My personal framework allows for flexibility in the choice of certain methods or techniques due to the fact that certain stages of change may require varying theoretical approaches. For example, it has been suggested that clients who are in the first two stages may benefit more from psychoanalytic and cognitive approaches whereas clients in the latter three stages may experience more success with behavioural strategies (Renninger, 2013). Therefore, I would support flexibility in the approach to therapy based on the clients stage of change. Regardless of the therapeutic approach and stage of change, this theory assumes that change will be unsuccessful or only temporary at best if the individual doesnt buy into and take responsibility for the process. Finally, given the relationship between perceptions, cognitions, emotions and behaviours (discussed later), the last assumption of my theory is that all of these aspects must be focused on equally in order to create change. The Counselling Experience The process of counselling involves many aspects, including the definition of counselling that is utilized; views related to the change process; the emphasis placed on the relationship between beliefs, emotions and behaviours; particular interventions which are employed; and other factors including the criteria for success and contextual factors such as culture. These are discussed below. Definition of Counselling The definition used in my personal theory of counseling is as follows: counselling is defined as assisting an individual to bring awareness to various factors which have contributed to 7 PERSONAL POSITION PAPER a particular issue, utilizing interventions to build client skills and agency, and facilitating the change process as needed to help the client meet their goals and create positive change. Counselling Process Beliefs One of the main factors which affects the counselling process is the relationship between the client and the therapist. The most basic aspect of this relationship should be a non- judgemental, open and honest partnership between therapist and client. The relationship should be one where the therapist guides and coaches the client, but also one in which the client is an active participant in the change process. Also, my personal framework aligns with the REBT principle that while a warm relationship is desirable, it is not always necessary for change to occur (Wedding & Corsini, 2014). I also think that it is important, as suggested by the literature, that the therapist determines characteristics of the client-therapist alliance which are of importance to the client, including areas of collaboration, active commitment, therapeutic bonds, and views on client-therapist disagreement (Bachelor, 2011). The counselling process is also impacted by the therapists view on how long sessions should be and how many sessions the client should participate in. As my personal framework is solution-focused and relatively short term, I believe that the client should participate in an average of 12-15 sessions and that each session should be 60-90 minutes in duration. Of course, these guidelines will vary depending on the unique needs and presenting concern of each client, the stage of change in which they are referred, and many other influences. However, as a general guiding principle, I believe that therapy should be short term. Finally, the amount of focus a therapist is willing to give to the past versus the present/future also heavily guides the counselling process. For example, a psychoanalytic 8 PERSONAL POSITION PAPER therapist may spend the bulk of counselling time examining and interpreting past events, memories, and experiences, while a therapist practicing REBT may focus more on the present (Wedding & Corsini, 2014). Of course, this doesnt mean that one theory focuses exclusively on either the past or the present, but that there is a strong focus on one or the other. In my personal counselling framework, historical events which may be impacting the current situation would be explored to an extent, as they may be part of the underlying cause. However, the focus of therapy would be on the present, because it is that which will lay the new foundation for the future. In other words, while the client would be encouraged to explore historical underpinnings, more emphasis would be given to behavioural, Adlerian and REBT approaches which concentrate on what the client can do currently to change their situation (Wedding & Corsini, 2014). Emphasis on and Relationship between Beliefs, Emotions and Behaviours My personal framework holds a strong emphasis on the relationship between beliefs, emotions and behaviours of individuals. As stated by REBT, these three factors as well as perceptions must be considered equally as they influence one another (Wedding & Corsini, 2014). The relationship between all of these is that our irrational beliefs regarding certain antecedents lead to certain emotional reactions which then trigger certain behaviours (Wedding & Corsini, 2014). I also draw from the behavioural therapy view which posits that changed beliefs lead to changed behaviours. Our behaviours are driven by our perceptions, beliefs, and emotions, and therefore each one of these must be considered individually and as a larger construct in order to create positive change. My personal framework draws heavily from the REBT position on the relationship between these factors, which states that people engage in perceptions, thoughts, emotions, and 9 PERSONAL POSITION PAPER behaviours simultaneously. According to Wedding and Corsini (2014), People seldom emote without thinking because their feelings include and are usually triggered by an appraisal of a given situation (pg. 152). In other words, our cognitions are a direct result of our feelings. The authors also state that, People rarely act without simultaneously perceiving, thinking, and emoting because these processes provide reasons for acting (Wedding & Corsini, 2014, pg. 152). We can see then, that there is a complex and direct relationship between beliefs, emotions and behaviours and therefore this theory places a strong emphasis on client exploration of each factor and its impact on the others. The Change Process and Resistance As discussed in the above section on the nature of change, the three main factors of my personal framework related to the change process are that the client must be ready for change, they must buy into the change process, and they must be active participants in creating change for themselves. From this framework, resistance to change is seen as a natural reaction to an uncomfortable and unfamiliar situation (Wedding & Corsini, 2014); however, clients must become aware of dysfunctional patterns (conducted via the behavioural therapy technique of functional behavioural analysis) so that they can create the necessary change. I believe that when the client becomes aware of how dysfunctional or irrational certain behaviours and thoughts are, their level of resistance may decrease as they open themselves up to exploring other options. For this to occur, my personal framework would suggest that early positive relationship building between therapist and client is essential, and that client feelings of helplessness be replaced with a sense of agency, as these have been shown to aid in the reduction of client resistance (Westra et al, 2012). 10 PERSONAL POSITION PAPER In this framework, aspects of psychoanalytic theory are also employed as client resistance is not seen as a client trying to be difficult, but as a defense mechanism which the client is unconsciously using to protect themselves from emotional pain and uncomfortable change (Wedding & Corsini, 2014). It is important to examine these defense mechanisms and encourage gradual decrease of defenses so that the client is less resistant to change and open to therapist coaching. Interventions During the initial stages of therapy, I believe that it is important to utilize various interventions which draw from the psychoanalytic principle of making the unconscious conscious (Wedding & Corsini, 2014). This is because before attempting to teach the client new skills and before attempting to practice desired behaviours, the client must first become conscious of certain perceptions, beliefs, and patterns which are causing the undesired outcomes. It is only after the creation of this awareness that I would venture into the use of other interventions. As part of this process, I would also use the behavioural intervention of functional behavioural analysis and the REBT intervention of directly challenging the clients illogical and irrational beliefs while providing suggestions and advice as to how these may be changed (Wedding & Corsini, 2014). Various aspects of cognitive behavioural therapy fit well here, as helping the client to change their thoughts will inevitably lead to a change in behaviour. During this stage, it is important to encourage the ideas to come directly from the client before the therapist provides his/her own input. In other words, the client should be encouraged to provide their own ideas as to what the function of certain behaviours is, or what the illogical/irrational aspects of certain thoughts are. This approach flows well with the overarching position of this 11 PERSONAL POSITION PAPER framework that clients should be active in therapy and should experience a sense of agency in their change. When the ideas come from the client themselves, they will experience a sense of having more control over their situation and the therapy itself rather than being told what is wrong with them. After making the unconscious conscious and challenging their beliefs, I would move into the next stage. This would involve Adlerian principles of bringing new choices to light, educating the client, and providing learning opportunities for new skills (Wedding & Corsini, 2014). In this stage, I would also spend some time on the topics of goal-setting, belonging, and behavioural motivations as a pre-cursor to practicing new skills. The remainder of my interventions would stem from behavioural therapy, and would include operant conditioning (reinforcing target behaviour), psycho-education, social skills and problem solving training, modeling, and homework tasks to allow the client to practice the required skills and transfer them out of the therapy setting (Wedding & Corsini, 2014). These interventions would be heavily tailored to fit the needs of the client and the target behaviour, as each will present with a unique situation. I would also provide opportunities for the client to be involved in the process of determining specific intervention details in hopes to give them the opportunity to be active agents of the change process. Definition and Criteria for Success In my personal counselling theory, success is defined as when the when the client, by virtue of their own self-growth and determination, has met his/her current goals in a sustainable way and therefore has created positive change in some aspect of his/her life. 12 PERSONAL POSITION PAPER The criteria for success are captured in the definition. A client is truly successful when they have experienced self-growth, determination, and agency as opposed to having change created for them. Also, the client must have developed the awareness and skills required to sustain the change long-term, beyond discharge from therapy. Finally, a client is successful when they have met the goals which they had initially set out for themselves and/or when they have created positive change. This framework also stresses the importance of celebrating small successes as many clients will require more time and effort than others to reach their goals and others may not completely reach them at all. Therefore, it is important to motivate the client by celebrating smaller milestones with them rather than focusing only on the end-goal.
Contextual Factors My personal counselling theory takes client diversity into consideration during all steps of therapy. Diversity in the areas of culture, religion, and many other areas will often play a role in the clients perceptions, cognitions, emotions and behaviour, and therefore need to be considered by the therapist (DiGiuseppe, 2009). These areas of diversity may also impact the clients willingness to participate in certain interventions, as well as the likelihood that certain interventions will be carried out outside of the therapy setting. This framework posits that the context within which client change is to occur is not only considered and respected, but embraced. It has been suggested that therapists should move away from value-free or value-neutral practice and should instead move towards value-informed practice (Worthington Jr, 2011). Contextual considerations such as ethnicity, culture, religion, gender, etc. can be tolerated by the therapist, or they can be purposely included, and this framework suggests the latter. For example, a therapist who is considering a particular 13 PERSONAL POSITION PAPER intervention may avoid it because they are aware that the client will be resistant to participate due to religious restrictions, but a therapist who is embracing this contextual factor may choose to propose an intervention strategy which is actually based in that individuals religion, thereby using it as a strength to therapy rather than a barrier. Reflection Upon reflection of my personal counselling framework, I feel that the philosophical assumptions and the various elements of the counselling process align very well with my personal and professional values and beliefs. Personally and professionally, I am drawn to this theory for many reasons. First, I believe that change occurs with both internal and external motivation, which is why I place strong emphasis on the partnership between a clients engagement/participation and therapists active coaching. Second, I feel that individuals often require exposure to opposing viewpoints which challenge their beliefs in order to become aware of dysfunctional patterns, and therefore I am drawn to the direct style and active confrontation/challenge which this theory affords to the therapist. Finally, I am drawn to this theory because of its focus on the present and future rather than the past. While I do believe that it is important to examine the past because, for many reasons, the past influences present and future behaviour, I also believe that change can only occur in the present, and therefore, this is where most of the focus should be placed. While there are many strengths to this theory, certain aspects could also be viewed as weaknesses. Some may assume a traditional psychoanalysis perspective which would state that more attention needs to be paid to exploration and interpretation of past experiences, as well as less advice/suggestions provided by the therapist (Wedding & Corsini, 2014). Others may 14 PERSONAL POSITION PAPER suggest that a weakness of this theory is the idea that confrontation and direct challenges of the clients beliefs could potentially reduce rapport and cause a rift in the relationship, thus reducing the level of success for the client. Another potential weakness which could be suggested is that there is not enough time spent on discussions and long narratives regarding the clients feelings in this particular framework. Of course, weaknesses will always be proposed in those theories which are different than an individuals personal theory of counselling; however, it is my belief that the strengths of my theory outweigh any weaknesses. Conclusion This paper outlined details of my personal theory of counselling which, as mentioned earlier, draws primarily from certain aspects of Adlerian, behavioural and psychoanalytic theories as well as many aspects of rational-emotive behavioural therapy. The framework is based on numerous assumptions about the nature of humans and their well-being, as well as why issues exist and the process used to change them. The relationship between beliefs, thoughts, and emotions is strongly emphasized in this framework. It is also based on the idea that the counselling experience must involve active work by the client, the idea that the client must be challenged and coached, and that interventions must be based in psycho-education and skill- building both in and outside of the therapy setting. Overall, I believe that my personal counselling framework is one that is effective in facilitating client change and is based on various aspects of existing theories as well as on my personal values and beliefs. While varying client needs may require me to draw on aspects of other theories, the base from which I see myself practicing most often is the counselling framework discussed in this paper.
15 PERSONAL POSITION PAPER References Bachelor, A. (2011). Clients' and therapists' views of the therapeutic alliance: Similarities, differences and relationship to therapy outcome. Clinical Psychology & Psychotherapy, 20(2), p. 118-135. Cloninger, C.R. & Zohar, A.H. (2010). Personality and the perception of health and happiness. Journal of Affective Disorders, 128(1), p. 24-32. DOI: 10.1016/j.jad.2010.06.012 DiGiuseppe, R. A. (2009). Rational-emotive behavior therapy. In Kazantzis, N., Reinecke, M.A., & Freeman, A. (Eds.), Cognitive and behavioral theories in clinical practice (pp. 115-147). Guilford Press. Ellis, A. (1976). Answering a critique of rational-emotive therapy. Canadian Journal of Counselling and Psychotherapy, 10(2). Retrieved from http://cjc.synergiesprairies.ca/cjc/index.php/rcc/article/view/1721 Mauss, I. B., Shallcross, A. J., Troy, A. S., John, O. P., Ferrer, E., Wilhelm, F. H., & Gross, J. J. (2011). Don't hide your happiness! Positive emotion dissociation, social connectedness, and psychological functioning. Journal of personality and social psychology, 100(4), 738. Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011). Stages of change. Journal of Clinical Psychology, 67(2), 143-154. Perry, J.C. & Bond, M. (2012). Change in defense mechanisms during long-term dynamic psychotherapy and five-year outcome. American Journal of Psychiatry, 169, p. 916-925. DOI:10.1176/appi.ajp.2012.11091403 Renninger, S. M. (2013). Clinical application of meta-concepts that are essential to client change. Psychotherapy, 50(3), 302. 16 PERSONAL POSITION PAPER Wedding, D., & Corsini, R.J. (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. Westra, H. A., Aviram, A., Connors, L., Kertes, A., & Ahmed, M. (2012). Therapist emotional reactions and client resistance in cognitive behavioral therapy. Psychotherapy, 49(2), 163. Worthington Jr, E.L. (2011). Integration of spirituality and religion into psychotherapy. In Norcross, J.C., VandenBos, G.R. & Freedheim, D.K (Eds.), History of psychotherapy: continuity and change (pp. 533-543). Washington: American Psychological Association.