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As our research demonstrates, there is a close correlation between the presence of emotional disorder and the encounter of negative life circumstances. These are circumstances which can place an individual in a social work context, where he or she must address both personality disorder and practical living obstacles.
Sensitivity to Cultural Differences:
Cultural differences are also significant in the way that a social worker channels specific aspects of the treatment. For instance, Cognitive Therapy is a constructive way to address the likelihood of unique individual realities based on characteristics such as race, gender, sexual orientation or income. These individualities mean that no one treatment course is right for all individuals. Cognitive Therapy respects this condition, proceeding from the logic that "the way people feel is associated with the way in which they interpret and think about a situation. The situation itself does not directly determine how they feel; their emotional response is mediated by their perception of the situation." (Beck, 14)
This is a perspective which is echoed by the emphasis on individuality in Dialectic Behavior Therapy, which indicates that "the relationship between the client and therapist in DBT is thought to be highly influence in the success of therapy. Linehan goes as far as to suggest that this therapeutic relationship is sometimes the only thing that keeps the client alive." (Jones & McDougall, 14)
In terms of the cultural versatility of the Behavior model, it too will depend heavily on the capacity of the therapist to relate to and facilitate comfort in a patient. In order to attack those behaviors which have stimulated a negative pattern in the patient's life, it is necessary to first identify these. The nature of the Behavior Therapy model is such that the therapist will be a determinant force in making these identifications. In order to achieve the type of comfort which would allow such disclosure, the patient must feel that he or she is in a sensitive and non-judgmental context. Thus, Madison denotes, "behavior therapy typically begins with the analysis of a trained therapist. The therapist analyzes the behaviors of the patient that cause stress, reduce the patient's quality of life, or otherwise have a negative impact on the life of the patient. Once this analysis is complete, the therapist chooses appropriate treatment techniques." (Madison, 1) This means that the treatment approach is not predetermined by is instead selected according to the unique needs and outlook of the individual. This denotes an opportunity for sensitivity to individual needs that extends to culture, ethnicity and personal orientation in any number of categories.
Value to the Social Worker:
The Cognitive Therapy model presents a constructive framework for collecting and interpreting client-data. This is an approach with is centered on encouraging the client to speak and disclose, to the point that Beck tells that "the final element of every therapy session is feedback." (Beck, 41) Beck also contends that the Cognitive approach is important to assessing client strengths and limitations, with the latter of those being defining the by the dysfunction of thought central to cognition based theories. Also central is the Cognitive model's emphasis on achieving goals that have been designed by client and counselor in concert. By helping to alter dysfunctional thinking to this end, Cognitive Therapy can be important in helping to implant measures preventing future emotional discord.
The Dialectic Method is somewhat more intensive upon the therapist's taking the lead role. For the attending social worker, there are distinct risks affiliated with the borderline personality disorders which often invoked the use of DBT. Thus, this field is central in helping the social worker initiate actions to achieve therapeutic goals. More than any of the other areas of focus, this model is geared toward therapeutic intervention first. Concsequently, the therapist also becomes an important channel for treatment, taking a lead role in negotiating, mediating and advocating for clients who may lack the emotional stability to do so for themselves.
The Behavioral method, contrary to the cognitive approach, is a less self-directed approach to recovery for many. This is because, according to Barlow et al. (1989), "it has been used with positive results in patients with developmental disabilities and with severely disturbed psychotic patients. It is the treatment of choice for severely ill patients who can't participate in insight-oriented or cognitive therapies." (Barlow et al., 262) Thus, for the social worker who must reach a person demonstrating levels of disturbance deep enough to prevent self-directed recovery, the behavior model can be a way to construct strategies that actually can be self-direct in the aftermath of the therapeutic process.
In terms of the existing research and consensus on the three separate streams of psychotherapy, Dialectical Behavior Model seems to have strongest empirical underpinning. This accounts for its use in the most serious of cases discussed here within. Namely, Harned et al. contend that "understanding dialectical theory is essential to the proposed view of BPD as a disorder of emotion regulation and its treatment as an emotion-focused one. According to the Encyclopedia of Marxism, 'dialectics is the method of reasoning which aims to understand things concretely in all their movement, change and interconnection, with their opposite and contradictory sides in unity.'" (Harned et al., 68) This definition underscores the prevailing knowledge of BDP as requiring a therapeutic approach which attempts to remove emotional obstructions to rational self-regulation.
Knowledge in the Behavior Field is centered on the notion of instituting a wide range of health behavior changes in treatment subjects, both relating to the conditions specifically in question and seemingly independent from these conditions. Thus, the relationship which our research establishes between individual orientation and the behavioral perspective illuminates one aspect of its usefulness to our discussion, denoting that a treatment mode for the intercession of bipolarity and drug addiction must encourage a lifestyle habit change across all of these fronts which is to manifest as a distinctly new chapter in the life span.
Absent of the conditions of addiction, Cognitive Therapy proceeds from a similar base of knowledge which contends that individual behaviors are impacted directly by an intervention which targets belief and perspective. Beck reports that "core beliefs are the most fundamental level of belief; they are global, rigid, and overgeneralized." (Beck, 16) It is ironic then that these formulate so significant a portion of one's perspective on one's self, on others and on the world at large. Cognitive Therapy proceeds from the knowledge that this irony can be corrected by provoking an examination of one's core beliefs.
Personal Knowledge and Practice Wisdom:
Personal knowledge is a central aspect of any course of therapy, with the ability of the therapist to channel observations into constructive avenues of emotional exploration. However, among the disciplines discussed, it seems most appropriate to consider the value of personal knowledge in the Dialectical Behavior Model, given the grave dangers reflected in this approach. The therapist in this case must be armed with a combination of established clinical research and the experiential basis for intervention where necessary.
This also speaks to the specific value of this approach as a way of evaluating patient or client needs. For those suffering from borderline personality disorder, the capacity of the social work to construct meaningful intervention methods is proven and reinforced by available literature. Both the sources by Harned et al. And by Jones & McDougall refer to this as the only method with proven success in helping to resolve BDP.
Ultimately, the model which one selects here will depend heavily on the type of patients which one expects to encounter. That said, I would favor the BehavioralTherapy model where appropriate. My expectation and interest in helping clients resolve drug addiction through comprehensive lifestyle, social and emotional change denotes this to be the most suitable avenue. When faced with more severe personality disorder challenges, DBT would be a more appropriate way for me to channel my skills.
Barlow, DH; Cranske, M.G.; Cerny, J.A.; Klosko, J.S. (1989). Behavioral Treatment of Panic Disorder. Behavior Therapy, 20(2), 261-282.
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. Guilford Press.
Gabbard M.D., Glen O. & Jerald Kay M.D. (2001). The Fate of Integrated Treatment: Whatever Happened to the Biopsychosocial Psychiatrist. American Journal of Psychiatry, Vol. 158, p. 1956-1963.
Harned, M.S.; Banawan, S.F. & Lynch, T.R. (2006). Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder. Journal of Contemporary Psychotherapy, 36, 67-75.
Jones, C. & McDougall, T. (2007). Dialectical Behaviour Therapy for People Who Self-Harm. Mental Health Practice, 11(1).
Madison, N. (2009). What is Behavior Therapy? Wisegeek.com
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