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Develop your theoretical orientation to the counseling process and identify how this approach compares to Cognitive Behavioral theory
Since its inception nearly fifty years ago, Cognitive Behavioral Therapy (CBT) has become recognized as perhaps the most effective therapeutic approach. Indeed, CBT has myriad uses, and is applied in a number of situations, including depression, personality disorders, and wellness and rehabilitation. However, there also exist limitations to cognitive behavioral therapy, mainly surrounding treatment with patients from diverse cultures. This paper develops appropriate therapeutic orientations, discussing different therapeutic concerns and approaches. First, attention is paid to the nature of people; next, the role of the individual in families and other systems is addressed. Then, multicultural considerations, wellness and prevention, and the nature of problems are discussed. Finally, the paper addresses the process of change and how the orientations enacted are successful in practice.
The nature of people
People are diverse, not only with regard to their race, ethnicity, and socioeconomic status but also their psychological makeup. For example, two people who were raised in the same household could hold vastly different perspectives concerning their background. Although most people likely agree on certain accepted truths regarding morality and upstanding conduct, different cultures still have widely contrasting and even antithetical views toward how people should conduct themselves and the goals to which they should aspire. For example, some cultures stress that people should be as ambitious and competitive as possible, while other cultural viewpoints contend that people should work more cooperatively with one another. To this end, effective conduct entails the ability to coexist with different cultural viewpoints while maintaining their personal beliefs. Mental health is also fluid and a person's mental status can change over time. Effective functioning involves the ability to adapt to their environment. Accordingly, mental health refers to the interplay between a person's neurological profile and their external environment. It is also important to note that just because someone's external situation thrives, this does not ensure that their mental health is in good standing. Indeed, news headlines are constantly filled with reports of wealthy individuals who have become addicted to drugs, or people who have gone into rehab for substance abuse, depression, or eating disorders. Given the immense diversity of the human population, it is imperative that therapists recognize the singular sensibility of each patient they work with, tailoring their therapeutic approach to the particular needs of the individual. A 'one size fits all' approach will never accommodate the immense diversity of belief systems.
Cognitive behavioral therapy is now perhaps the most widely accepted therapeutic approach. According to Beck and Tompkins, "Cognitive therapy is based on the premise that psychological disorders are based on the meanings individuals give to events (rather than to the events themselves)" (Beck and Tompkins). As such, the approach seeks to distinguish between people's external and internal realities, and therapy sessions attempt to endow the patient with the ability to recognize their 'objective reality.' Cognitive behavioral therapy thoroughly examines the sensibility of the individual, and then attempts to 'correct' this sensibility so that it will be able to more accurately perceive their environment as it objectively exists.
Despite its popularity, cognitive behavioral therapy has a number of limitations and it is not the most effective therapeutic approach. Specifically, it operates with the objective that everyone should perceive the world in a uniform way. Indeed, cognitive behavioral therapy attempts to deny many aspects of the individual's personality, and it also privileges a Western, goal-oriented sensibility predicated on the principles of personal advancement and individual autonomy. This can be limiting because many people may not desire to relinquish aspects of their sensibility. Accordingly, the most effective approach must acknowledge one's cultural viewpoint and not attempt to change fundamental aspects of a person's sensibility.
The most effective counseling theory involves psychodynamic therapy, a relatively recent approach that draws from a number of psychological discourses, including Freudian psychoanalysis. Although it can exist as a form of therapy in its own right, psychodynamic therapy is also effectively used in conjunction with other approaches, and can improve behavioral or cognitive behavioral therapy. Indeed, in his description of psychodynamic therapy, Shedler states (2010):
"Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings"
Psychodynamic therapy is particularly effective because it acknowledges the singular sensibility of the patient and does not attempt to 'correct' fundamental aspects of the individual's existence. Instead of changing their cultural viewpoint, the emphasis is instead placed on assisting the individual with adapting to their environment.
The individual in families and other systems
Family systems have a crucial impact on the physical and psychological evolution of the individual. This is particularly true because different cultures involve varying (and often contrasting) perceptions of the 'proper' family structure. In the United States, the nuclear family is the privileged family structure; it is characterized by two parents and children, and this family dynamic can be particularly obstructive to individuals from cultures with differing family structures. In the nuclear family, the members interact in a less intimate manner from other cultures; the adults are typically married, and the children are generally biological. This promotes a heteronormative lifestyle and can be particularly polarizing to gay, lesbian, bisexual, or transgender individuals. Additionally, the nuclear family can be quite alienating to individuals from ethnic cultures, such as Hispanic culture. Specifically, the Hispanic family is much closer and intimate than the nuclear family, and the extended family (in particular, the grandparents) often lives with the family. It is imperative that forms of family therapy acknowledge the validity of different family structures. To this end, the autonomously-motivated cognitive behavioral therapy is not the most effective theory for treating families.
The most successful family theory is one that accepts the sensibility of the constituent family members and acknowledges the richness of different cultures. The Bowen Family Systems Theory, developed by Murray Bowen in the late 1960s, is the most effective family theory because it is sensitive to the needs of the nuclear family structure as well as alternate family dynamics. Brown (1999) describes the fundamental attributes of Bowen Family Systems Theory, stating that it not only analyzes the family as a single system but also acknowledges the personality of the different family members. The Bowen theory acknowledges the impact that different members of the family have on each other, and encourages family members to refrain from attempting to change the other family members. It is also important for therapists to acknowledge that family members of different ages may necessitate divergent therapeutic approaches. For example, adolescents require an approach that is sensitive to the specific issues of teenagers, with less admonishment and a respect for their personal space. Similarly, with young children who have not yet developed strong attention spans and may not be receptive to talk therapy, play therapy may be an effective approach. In play therapy, the child's behavior is analyzed, and the therapist interprets the implications of their behavior and how they relate to the relationship with the other family members (Wittenborn, 2006).
Perhaps the foremost limitation to cognitive behavioral therapy is its disregard for other cultural viewpoints. Cognitive behavioral therapy promotes Western values of competition, personal autonomy, and advancement. However, this does not cohere with other cultural perspectives, such as Buddhist or Hispanic cultures in which certain family members have responsibilities distinct from being as economically successful as possible. For example, in Hispanic culture, the wife is expected to prepare meals and raise children, while the husband provides the money for the family. A Latina housewife undergoing cognitive behavioral therapy might find the approach to be at odds with her cultural viewpoint since it may be against her cultural beliefs to work in a job setting. Cultural differences also affect the way in which people view others people and their problems, and can complicate the process of change. It is necessary to adopt a more culturally sensitive approach when dealing with individuals from different cultures. When treating someone, it is necessary for the therapist to refrain from denigrating the patient's culture. Psychodynamic theory is especially useful for dealing with multicultural considerations because it is not culturally biased and works directly with the individual psychology of the patient. As Sue and Zane (2009) assert, it is also crucial that therapists do not brand everyone from a given culture with certain characteristics. Psychodynamic theory, which analyzes the (often repressed or unconscious) desires of the patient, is particularly effective in targeting the goals of the patient, allowing…[continue]
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