PSY20001: Theories of Counselling

Theories of Counselling

 Abstract

 Over the past decades, there has been an evolution of counseling theories. As such, this essay compares two counseling theory and their application in the treatment of depression. These include Psychoanalytic therapy and Cognitive Behavioural Theory.  First, a brief introduction is provided followed by a deep analysis of the two theories mentioned above separately and also explores their strengths and limitation. From the discussion, Psychoanalytic therapy has been found to be more suited in treating depression as it uncovers the unconscious thoughts and feeling to bring them into the patient awareness.

  1. Introduction

Major depressive disorder has been regarded as one of the most common mental disorders. This condition is typically characterised by persistent feeling of sadness as well as lack of interest in outside stimuli.  As such, there is substantial change of behavioural and physical symptoms among patients of major depressive disorder.  These include change in appetite, sleep, energy level, self-esteem, and concentration.  Fortunately, major depressive disorder is well understood in the medical arena. This implies that it is easily treatable particularly through counselling. Various scholars have established that there is a myriad of counselling theories that can be applied in the treatment of major depressive disorder. On this basis, this paper seeks to explore two major counselling theories that can be used in the treatment and management of major depressive disorder.  These are Psychoanalytic therapy and Cognitive behavioural therapy.

2.0 Psychoanalytic therapy

Psychoanalytic therapy is one of the widely-known treatment modalities. Founded by Sigmund Freud, Psychoanalytic therapy is a type of in-depth talking that focuses on bringing unconscious thoughts as well as feelings to the conscious mind. This is for the purpose of helping the patients to gain an insight of the unconscious forces that can contribute to their current emotions, thoughs, and behaviours (Milton et al. 2011). Psychoanalysis postulates that an individual behaviour is influenced by unconscious mind as well as past experiences. According to Freud,   unconscious stores memories, thoughts, and desires that are below the surface of conscious awareness of an individual.  Therefore, the unconscious plays a role in psychological disturbances and distress. Therefore, the main focus of this therapy is looking at childhood experiences to understand how they might have influenced and shaped the patient current disturbances (Luzzi et al. 2015).   In regard to treatment of depression, this therapy is based on the assumptions that depression occurs due to unresolved factors more so the unconscious that has origin from the childhood (Dekker et al. 2014).  Therefore in treatment of depression, it aims to ensure the patients gain awareness on their emotions, help them to bear with these feeling and put them in a perspective that is useful.

Also referred to us talking cure, a therapist treating a patient with major depression disorder spend most of the time listening to the patients. This is for the purpose of identifying events that may influence the patient current challenges or depression (Shedler 2010). First, establishing a therapeutic relationship between the therapist and the patience is of paramount importance to healing process more on the stage when the patient becomes overwhelmed by the release of repressed feelings and trying to avoid dealing with them. Therefore, this relationship will make the patient less resistance and comfortable in facing the issues and able to understand own motive which marks the start of the healing process.

Psychoanalytic is insight driven with an intense and open-ended exploration of the client’s feelings with multiple session.  As such, the patient with depression is encouraged to freely talk what is the mind and through this, the therapist can identify patterns of feelings and behaviour from the past which makes unrecognized feeling to be apparent.  This helps the patient to understand how these past experiences are influencing the present life.  

There are various techniques used in Psychoanalytic therapy that a therapist can use in treating depression. These include free association, dream analysis, transference an interpretation. In regard to free Association, the patient is encouraged to talk whatever comes in the mind.  Basically, a therapist read a list of the word for instance, “mother” and the patient responds with the first word that comes to mind without censoring.  In treating depression, this technique helps the repressed memories to be apparent or emerge during the free association. During this moment, the patient experience intense emotions, which a therapist uses to gain insight into the patient’s problem.

The second technique used to uncover the unconscious is dream analysis.  Typically, people do not always dream what they wish for in actual sense but rather, dreams are considered to be disguised in one form or another. Dream analysis seeks to explore repressed feelings that can be expressed in the dreams. According to this theory, repressed feeling is also manifested in the dreams because a person defenses are lowered when asleep (Lees 2005).  Dreams are considered to be of two levels namely latent content such as wishes or fear and manifest content which is the dream as it appears.  Therefore, a therapist uncovers the latent content and manifest content of the dream, or simply identifying the symbolic meaning of the dream. In the treatment of depression, a therapist may ask the client to write down a dream that he or she has ever had and through this, a therapist can gain insight on repressed materials.

Transference technique may be used to uncover the repressed feeling of the patient.  This is when the patient transfers feeling or thoughts about another person such as a spouse to the therapist (Wallerstein 2014).  This enables the patient and therapist to discuss perception about the other person.  Through this, the depressed patient experiences the feeling that ought to be resolved again.

Lastly, the interpretation technique is where the therapist helps the patient to explore personal narratives and memories in detail while analysing them (Taylor 2008). Through this, a therapist can identify common themes and patterns and through the Freudian slip, a patient my reveal important aspects that may further provide insight. In this technique, a therapist provides interpretation of the patient’s words.

2.1 Strengths and limitation

One of the main strength of this theory is that it provides a framework that clearly describes human personality. As such,   it addresses the imperative of the unconscious, aggressive and sexual drives, that makes up most of the human being personality.  Also, its argument on childhood trauma as the origin of abnormal behaviour makes it stand out as most of the individuals with psychological disturbances recollect childhood traumas (De Maat et al. 2009).  This method is thus provides an optimistic view of mental illness such as depression. In addition, psychoanalytic therapy is tailored according to the needs and history of a person. Impliedly, the patient is not put in the pre-determined diagnostic category but instead appreciated according to his challenges and needs. More so, it references childhood to the abnormality of an individual.  This is because each individual is born into a “normal home” but childhood set an individual experience of the world.

One of the limitations of this theory is that depends on the subjective interpretation of the therapist. Take an example of dream analysis technique, a therapist subjectively interprets a dream and the patient accepts the interpretation. Secondly, this theory is determinist because there is an assumption that childhood experiences are the major contributors of abnormal behaviour or mental disorder in adulthood. As such it ignores other influencing factors such as genes.  Thirdly, psychoanalytic therapy is expensive and time-consuming, which makes it have value of middle and upper income earners.  This therapy requires on-going sessions that may extend to years so as a therapist can better understand the patient (Jones 2000).  Lastly, this theory focus on uncovering repressed feelings and some of the patients may find it painful as well as unpleasant these feelings and memories.

3.0 Cognitive behavioural therapy

Cognitive Behavioural Therapy (CBT) is a form of psychotherapy, which is a blend of cognitive and behavioural therapy. As such, cognitive therapy focuses on thoughts while behavioural therapy focuses on actions and behaviours. On this understanding, CBT   seeks to help the patients to gain a better understanding on the thoughts that influence the behaviours (Lambert 2013). Put simply, it seeks to modify dysfunctional and biased thoughts in cognitive functioning. CBT is a short-term approach in which current life situations that may be causing depression are identified. On this understanding a therapist aims to help a depressed patient to understand the reciprocal relationship between thoughts, feeling, and behaviour and also give an insight on the automatic thoughts that occur in response to events or situations.

CBT is based on the notion that feelings, thoughts, physical sensations, as well as actions, are interconnected and negative feeling and thoughts have the ability to trap an individual into a vicious trap.  Based on this a therapist work with depression patients to change the patients thought patterns and modifying the behaviour (Beck 2011).  Therefore, a therapist helps the patient to identify negative thoughts and replace them with more realistic and positive thoughts.  First, the use of CBT helps the patient understands that she or he has negative thoughts. Then the patient is taught how to replace them with healthier thoughts and the change in the patient attitude lea to change in the behaviour, which helps in easing depression.

As previously stated, CBT is a blend of cognitive and behavioural therapy. In reference to a cognitive aspect, a therapist helps the patient to identify negative thinking that results in negative emotions.  The patient and therapist then examine the validity of the identified thoughts and explore healthier thoughts.   The patient uncovers negative beliefs and discusses how they influence him or her.  Beck (2011) contemplates that this step is critical in CBT because negative thoughts lead to lack of focus, energy, and motivation, thereby influencing the treatment negatively.  When t comes to behavioural therapy component of CBT, a therapist helps the patient to identify how daily activities impact mood. The patient is then encourage to explore how own behaviour can help ease depression.  This may be followed by a proposed list of activities by therapist ranging from simple to difficult one and achieving these activities help in alleviating depression (Benjamin et al. 2011).  Therefore, CBT   aims to change negative thoughts that can lead to depressions. This is given that these thoughts tend to be accepted as true, which influence an individual’s mood.   This helps the patient to be objective when examining the feelings that lead to depression and hence engage in healthy thinking pattern.

There are different CBT techniques that can be used in treating depression. First, writing a journal is a common CBT technique used in treating depression.  In this light, a client keeps a diary on different situation encountered in day-to-day life. The thoughts associated with these situations and the behaviours shown in response to these situations are captured in the journal (Wenzel et al. 2016) A therapist then review the though pattern and then explore alternative behaviours with the patient.  The other effective technique is validity testing where a therapist tests the validity of the patient’s thoughts. For instance, a patient with depression may be asked to list examples that prove negative thoughts are true.  The faulty beliefs held by the patient are exposed and therapist tries to normalize the patient’s thoughts. Guided discovery technique is also effective in treating depression. In particular, it helps the patient to understand the root cause of depression (In Thoma & In McKay 2014). The therapist asks specific questions relating to the patient’s thoughts, feelings, and behaviour regarding a certain issue. This help the patient discover how he or he process the information and also give an insight into the patient needs to work on feeling so as to cure the depression having identified the root cause.

3.1 Strengths and limitations

One of the strengths of   CBT is that patients are actively involved in their own treatment.   As such, CBT helps the patients to identify negative thoughts, recognize them and explore new and alternative thoughts that reflect reality through cognitive restructuring.  In addition, CBT helps in relieving depression because it changes thoughts that increases vicious cycles of negative thinking and feelings.  This is supported by Butler et al. (2006) that CBT is one of the most effective treatments of depression with the broadest evidence base.

 Secondly, CBT is instructive because once the patients understand how to counsel themselves after being taught rational counselling skills, they gain the confidence they can excel in recovering. This is supported by Baardseth et al. (2013) argument that strategies and skills learnt in CBT can be applied in everyday life to cope with challenging situations.  This is because CBT emphasizes on getting better as opposed to feeling better.  Put simply, once the problem is corrected, the results are long-time as the problem is identified and corrected.  The other strength of CBT is that it takes a relatively short period of time (Barth et al. 2016).  This is unlike psychoanalytic therapy, which requires many sessions to ensure a therapist gain an understanding about the clients.

Thirdly, CBT is highly structured in which therapist and patient collaborate in achieving specific, measurable, achievable, realistic as well as time-limited goals. This makes it possible to for BT to be offered in different formats such as through self-help books or in groups.  Also, its structured nature reduces the chances of the session becoming chat sessions, meaning much can be accomplished within each session.

One of the limitations of CBT is that it does not explore past experiences that may be an underlying cause of the present difficulties. Put simply, CBT only focuses on the current problems and overlook other possible causes such as trauma in childhood.  Also, a therapist may misuse power when giving their perspective of what comprises rational thinking especially the one from the different cultural background.  This means that the counsellor may influence the client and hence there is a need to remain neutral as well as non-judgemental.  Another limitation of CBT is that it requires the patient to commit to the process. This is supported by Beck (2011), who espouses that a therapist only help and advice the patient and hence, the patient should cooperate to ensure the problem is solved.  This is because; the patient ought to identify negative thinking and behaviour that may be contributing to depression so as to recover. In addition, CBT emphasizes the client to bring change to themselves. This means that depressed patients who may be feeling low may not be motivated to take an active role in their recovery.

4.0 Conclusion

This essay has analysed different theories that are used for treating major depression.  These include Psychoanalytic therapy and Cognitive Behavioural Therapy (CBT).  Psychoanalytic therapy focuses on bringing unconscious thoughts as well as feelings to the conscious mind while CBT aims to change seeks to modify dysfunctional and biased thoughts in cognitive functioning by helping the patient to gain a better understanding on the thoughts that influence the behaviours.  From the arguments, one of the strengths of psychoanalytic therapy is that it addresses childhood trauma as the origin of abnormal behaviour makes as most of the individuals with psychological disturbances recollect childhood traumas. The limitation discussed include lengthy session and cost extensive reflecting middle and upper- class values. Also, the subjective nature of this theory increases chances of bias during interpretation by the therapist. On the other hand, CBT theory has a wide evidence base and the client is extensively involved in their treatment.  One of the limitations is that it CBT only focuses on the current problems and overlook other possible causes such as trauma in childhood.  Also, the therapist may misuse power when giving their view on what rational thinking is when encouraging the client to change thoughts that influence the behaviour.  From the discussion, Psychoanalytic therapy is more suited to treatment of depression because it focuses on uncovering unconscious to the conscious mind.  In addition, it focuses on childhood trauma as the cause of abnormal behaviour, which most people can relate with.

References

Beck, J. S. (2011) Cognitive behavior therapy: Basics and beyond. Guilford press.

Benjamin, C. L., Puleo, C. M., Settipani, C. A., Brodman, D. M., Edmunds, J. M., Cummings, C. M., & Kendall, P. C. (2011) History of cognitive-behavioral therapy in youth. Child and Adolescent Psychiatric Clinics20(2), 179-189.

Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., … & Minami, T. (2013) Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review33(3), 395-405.

Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … & Cuijpers, P. (2016) Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus14(2), 229-243.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006) The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review26(1), 17-31.

Dekker, J. J., Hendriksen, M., Kool, S., Bakker, L., Driessen, E., De Jonghe, F., … & Van, H. L. (2014) Growing evidence for psychodynamic therapy for depression. Contemporary Psychoanalysis50(1-2), 131-155.

De Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J. (2009) The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry17(1), 1-23.

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In Thoma, N. C., & In McKay, D. (2014) Working with emotion in cognitive-behavioral therapy: Techniques for clinical practice.

Jones, E. E. (2000) Therapeutic action: A guide to psychoanalytic therapy. Rowman & Littlefield.

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Lambert, M. J. (Ed.). (2013) Bergin and Garfield’s handbook of psychotherapy and behavior change (p. 864). New York, NY: John Wiley & Sons.

Luzzi, A. M., Bardi, D., Ramos, L., & Slapak, S. (2015) A study of process in psychoanalytic psychotherapy with children: the development of a method. Research in Psychotherapy: Psychopathology, Process and Outcome18(2).

Lees, J. (2005) A history of psychoanalytic research. Psychodynamic practice11(2), 117-131.

Milton, J., Polmear, C., & Fabricius, J. (2011) A short introduction to psychoanalysis. Sage.

Shedler, J. (2010) The efficacy of psychodynamic psychotherapy. American psychologist65(2), 98.

Taylor, D. (2008) Psychoanalytic and psychodynamic therapies for depression: The evidence base. Advances in Psychiatric Treatment14(6), 401-413.

Wenzel, A., Dobson, K. S., Hays, P. A., & American Psychological Association,. (2016) Cognitive behavioral therapy techniques and strategies.

Wallerstein, R. S. (2014) Psychoanalytic therapy research: A commentary. Contemporary Psychoanalysis50(1-2), 259-269.

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