Cognitive-behavioral therapy applications at Main Street Counseling Center

Main Street Counseling Center: Topic Selection

Advanced Counseling Theories

The Main Street Counseling Center provides counseling services to individuals experiencing a variety of psychological issues. The counselors at The Center employ numerous effective approaches in treatment. The following discussion will outline some of the theoretical approaches used for counseling at The Center, as well as evaluate strengths and limitations of the approaches. Examples of these approaches in practice will be described, and suggestions for methods of evaluating the counseling approaches will be discussed.
One of the therapeutic approaches commonly used by counselors to treat various clients experiencing a diverse array of symptoms and conditions is Cognitive-Behavioral Therapy (CBT). This approach addresses the way individuals think about themselves and people around them, as well as their worldview, and also looks at how behaviors affect thoughts and feelings (Carlson & Sperry, 2000). Essentially, this therapeutic approach aims to change clients' thoughts and behaviors in order to reduce negative symptoms and improve well-being. Furthermore, CBT does not focus on the past and potential causes of distress, but rather addresses problems and difficulties as they are in the present with the aim of improving clients' experiences in the here and now (Sharf, 2012). CBT proves effective by making overwhelming difficulties more manageable by breaking them down into smaller parts that can be addressed more readily by the client (2012). Also, CBT is based around the recognition of a cycle of altered thinking; feeling and behaviors, which when observed and understood clearly can be overcome through a change in thought (2012).
Cognitive Behavior Therapy can be effectively used in the treatment of post-traumatic stress disorder (PTSD) (Kar, 2011). For example, a client presented with symptoms of PTSD recently at The Center. The client was an adolescent who witnessed a car accident in which an erratic driver hit two of his friends. Symptoms now experienced by the client include nightmares, a lack of memory for some details of the event, uncontrollable crying, numbness, lack of concentration in class, avoidance of the front of the school where the accident took place, etc. Cognitive-behavioral therapy would approach this case with an assessment of how the environment is reinforcing the client's behavior. The school environment in which the client must function on a daily basis serves as a constant reminder of the accident witnessed by the client. This reminder causes certain thoughts to emerge that put the client into distress, and the client therefore avoids the environment in order to not feel distressed. CBT would recognize this avoidance as a result of dysfunctional behavior and would aim at changing the way the client thinks when exposed to the environment causing the distress. Research has demonstrated that CBT is an effective and safe intervention for the treatment of PTSD (Kar, 2011). The use of CBT for PTSD has been effective in adolescents with significant improvements observed in regards to avoidance behavior, depressive symptoms, and psychosocial functioning after therapeutic interventions (Kar, 2011).
A second therapeutic approach employed by counselors at The Center is Reality Therapy. This approach is a counseling modality that has been in practice since the 1960s and was pioneered by Dr. William Glasser, and it has a strong foundation in Choice Theory (The William Glasser Institute, 2010). This therapy views the source of the majority of all human problems as unsatisfactory or non-existent interpersonal connections. Furthermore, the primary aim of Reality Therapy is to aid people in reconnection with people they need. There are several principles counselors adhere to in order to ensure effectiveness of reality therapy. These principles include: focusing on the present, avoiding discussion of complaints and symptoms, focusing on direct behaviors that can positively change experience, avoidance of criticism or blaming, remaining non-judgmental, an understanding that excuses are barriers to reconnection, focusing on specific disconnections and establish concrete plans for reconnection (The William Glasser Institute, 2010).
An example of reality in practice is illustrated by a client at The Center that presented with anxiety especially in regard to appearance and body-image. This client was an 18-year old girl who has perfectionist tendencies, that recently was awarded a full university scholarship and will be the first person in her family to attend college. She was experiencing tremendous pressure and expressed feelings of anxiety and a need for perfection, especially in regards to her appearance and weight. A reality therapy approach would look at how the client is experiencing a need for belonging within her family, and that she may feel she will not be accepted if she is not "perfect". This results in an experienced disconnection from her family, or feelings that she will be accepted conditionally according to what she achieves, rather than being loved unconditionally. The counselor employing a Reality Therapy approach would devise a plan for the client to reconnect to family and friends on a level that would promote healthy self-expectations and decreased anxiety. Focus would especially be placed on specific actions that the client can take to foster reconnections and improve overall well-being.
Another therapeutic approach used by some counselors at The Center is Psychoanalytic Therapy. This approach is centered on evaluating unconscious past forces that affect present emotions and behaviors of clients (Schimelpfening, 2009). Psychoanalytic therapy is based in theories established by Sigmund Freud in the late nineteenth century. These theories were primarily based in an understanding of the unconscious as a vast personal reservoir of thoughts, feelings, urges and memories that individuals cannot consciously access (Schimelpfening, 2009). Deep feelings of anxiety, pain and conflict within the unconscious affect experience and behavior, but without therapy, conscious awareness of this connection cannot be made. Furthermore, the primary aim of psychoanalytic therapy is to aid the client in gaining meaningful insights into unconscious processes so that positive change in behavior can be experienced (Schimelpfening, 2009). In regards to scientific research addressing the effectiveness of psychoanalytic therapy, it has been demonstrated that Psychoanalytic therapy is more effective than no treatment and that it is also more effective than shorter forms of Psychodynamic therapy (Leichsenring, 2005).
An example of Psychoanalytic therapy in practice could be illustrated by a client at The Center who was experiencing marital difficulties including experiences of detachment, growing apart, differences in desires regarding having children and financial priorities, and recent feelings of anger and hurt due to knowledge of an affair. This client expressed not wanting to divorce, and wanting to fix the situation. Psychoanalytic therapy would examine the client's unconscious conflicts. What experiences in the recent and distant past have contributed to the distress felt by the client in the present? How can these past unconscious experiences be understood in order to change thoughts, feelings and behaviors in the present? Psychoanalytic therapy would also assess defense mechanisms, and look at what thoughts or behaviors are being used in the present in order to avoid feelings of anxiety or discomfort. The counselor utilizing this approach would focus on ways that present thoughts and behaviors could be understood in order to illuminate underlying unconscious conflicts.
It is important that any therapeutic approaches for treatment be adequately assessed and evaluated in order to determine their effectiveness. There are currently two methods under consideration. The first method would focus on evaluating short-term effectiveness of therapeutic interventions immediately following a course of treatment. This evaluation would consist of the measurement of client's experiences before the onset of counseling, during the course of counseling, and immediately following the end of the course of treatment. The measure used for this evaluation would be a Likert Scale that would fully assess severity of symptoms experienced by clients. This would allow for a clear and concise means for comparing individual's experiences before, during and after therapeutic intervention, and would allow for statistical analysis of data regarding effectiveness of different therapeutic counseling approaches.
A second method that could be used to evaluate effectiveness of different counseling approaches is a personal structured interview conducted several months after the cessation of treatment. This method would allow for assessment of long-term effectiveness of different therapeutic approaches and would provide a more qualitative evaluation. Although statistical analysis with this method would not be as possible as with the former method, it could provide a more personal, in-depth view of clients' experiences as a result of different counseling approaches.
Introduction
In order to deal with the large number of patients who exhibit various forms of psychological conditions in our clinics today, effective counseling theories must be engaged (Bernes,2005). The specific techniques that are employed are largely dependent on the nature of trauma that the patients are exposed to. In this section however, we present the main ideas about the effectiveness of counseling theories as applied to working with diverse clients and issues in our clinics. The effectiveness of counseling theories translates to effective techniques and interventions. The counseling techniques that are employed must be effective as well as consistent with the expectations of the client. Bernes (2005) pointed out the techniques employed account for between 12-15 % success level in counseling The success of the techniques are dependent on the level of sense of alliance that the patient has with a healer which may be actual or symbolic. The implication of this assertion is that basically the therapists should ensure that they select for their patients the therapy that can best address the patient's personal characteristics as well as their view of the problem.
Effectiveness of therapies/interventions
The effective therapies have been noted to seek to disrupt or even remove the symptoms altogether; enhance the level of agency as well as competence of the clients; increase the level of tolerance for the patient's emotional experience; provide a form of dramatic relief as well as a restoration of certain level of self-efficacy. The problematic arousal might also be rendered extinct (Bentler, 2000; Walmpold, 2001).
In regard to the outcome of the counseling interventions, Walmpold (2001) pointed out that the proponents recognize the existence of a relationship between the client and the therapists as a critical factor but one that is insufficient. The relationship has been indicated to account more in terms of the variability in regard to outcome than to the cumulative effects of the specific ingredients (Walmpold ,2001,p.158). The work of Walmpold further indicate that about 8 percent of the outcome can be attributed to the model employed while 70 percent is attributed to the general features that are common to all other good therapies.
Literature review
Extant literature has been dedicated to the effectiveness of counseling theories. Abramson (2010) carried out a study on the treatment of psychoses using principles that are applicable in real world situations. In his work, he explained that the treatment of psychoses should be tailored to include the psychological treatment of the patient's mind in conjunction with the conventional treatment of the brain. He pointed out that several schools of psychotherapy exist but the psychoanalytic treatment is the only one that is classified as a Western principle that is devoted to the comprehensive exploration of the subjective mind. Abramson (2010) further indicated in his work that the existing psychoanalytic authorities have extensively explored the psychodynamics that are in action in the treatment of psychoses. The approaches of which are constrained by the realities of resource limitation as well as the smaller number of trained therapists. It has also been pointed out in Abramson's (2010) work that therapist who lack broad theoretical background can never effectively implement the techniques as well as comprehend the strategies advanced by distinguished authors. According to Abramson (2010), there are five main principles that are necessary for the effective treatment of patients with psychotic problems. The principles include; the level of safety that exists in therapeutic situations, the existence of empathy as a way of effectively understanding the patient as well as avoidance of problems associated with counter-transference. The other factors include the validation in situations that are therapeutic and this includes the enhancement of safety, bolstering of ego in those with fragile egos. Anthony (2011) on the other hand discussed the latest advancements in Anxiety Disorders therapy. His work provided some backgrounds on various advancements that have been made in Anxiety Disorder therapeutics. In regard to the effectiveness of counseling therapies , Anthony (2011) indicated that despite the fact that there are evidence-based interventions for all forms of anxiety disorders, several patients only receive partial relief from these interventions. Some patients on the other hand don't benefit at all. It is therefore necessary for researchers to come up with improved and better interventions that have sound theoretical backings in order for the to comprehend the factors that can assist in the prediction as well as determination of who is most likely to respond to the interventions.
Berghout and Zevalkink(2009) on other hand have studied the significance of the long-term psychoanalytic interventions. Their work evaluated the level of clinical significance of the long-term psychoanalytic treatment in 4 groups of sixty patients in various phases of treatment (prior to, during, after as well as follow up stages). This was done with highly normative comparisons of a total of four symptom questionnaires (SCL-90, STAI, BDI-II, IIP-64) as well as 2 personality assessment instruments (Rorschach-CS, MMPI-2). In each of the groups, the percentage of patients having clinically elevated scores was effectively evaluated through the comparison of their scores with the clinical and the nonclinical reference groups for all of the instruments that were used. The combined percentage for the clinically elevated scores was calculated on the basis of six instruments. This was done as a conservative estimate of the level of improvement that was observed on the nonclinical levels post-psychoanalytic treatment. In comparison to the pretreatment levels, it was found that there was a significant decrease in the proportion of clinical cases post-treatment. This study served to indicate that in the evaluation of the degree of clinical significance at a group level, an examination of level of changes must be conducted at an individual level.
Dowd (2010) on the other hand conducted a study on the specialty practice of both the cognitive and behavioral therapies. In their work, they indicated that cognitive and behavioral psychology is a very distinct area of practice within the larger profession of psychology. The discipline is however based on the counseling theories that explain basic learning as well as developmental principles, social and cognitive theoretical principles as well as psychotherapeutic treatment. The most important and widely applied elements of the specialty are; the use of interventions that have undergone further scholarly inquiry, the application of specialized treatment strategies that are formulated to aid in the modification of cognition as well as behaviors; the employment of empirical outcome indicators that are formulated to aid in the tracking of the impact of client treatment. This study therefore supports the fact that counseling theories are effective in the correction of cognitive as well as behavioral psychology.
Hart and Hart (2010) explored the future of the now popular cognitive behavioral interventions within the context of behavioral medicine. Their work cast some element of doubt on the effectiveness of certain counseling theories. His specific doubt was directed towards the effectiveness of Cognitive Behavioral Therapy (CBT) in the treatment of cognitive and behavioral deficits.
Newman et al (2011) o the other hand conducted a randomized controlled trial of the concept cognitive-behavioral therapy for a population that had generalized anxiety disorder using integrated techniques that ranged from emotion-focused to and interpersonal therapies. Their work indicated the potency of CBT as an intervention having both long-term as well as short-term impacts on a large number of clients suffering from with generalized anxiety disorder (GAD). This work indicated that for the counseling theories to work the prescribed interventions must be intertwined with experiential and/or interpersonal interventions.
Salzer et al., (2010) studied the patterns of interpersonal unrests /problems as well as their improvement in patients who are both depressed and anxious. The patients in their study were subjected to psychoanalytic therapy. This work indicated the effectiveness of counseling theories (psychoanalytic therapy) in solving the dissatisfaction that is experienced within the interpersonal relationships among mental disorder patients.
Tizón (2010) in his work on the psychoanalytic perspective of mourning and psychosis attempted to come up with a conceptual framework/model as well as concepts that relate directly and indirectly to the process of mourning in patients who are psychotic. In his work, he indicated that the situations of morning as well as loss are integral moments for psychotherapy, psychoanalysis as well as therapeutic approaches. His work therefore excelled in differentiating the roles of various counseling theories as well as their interrelatedness.
Witkiewitz & Marlatt (2010) conducted a study on behavioral therapy that explored a wide range of subjects. His study indicated that there are several instances in which behavioral therapies have been effectively used in bringing treatment to the patient as opposed to taking the patient to the treatment. The evaluated behavioral therapy techniques can provide effective treatment for a wide spectrum of conditions including but not limited to alcohol abuse disorders, couple and family therapy, individual therapies as well as in contingency management. This work indicated the effectiveness of counseling therapies in the management and treatment of various psychological conditions.
Wubbolding et al (2004) on the other hand provided an overview of Reality Therapy with a global perspective. Their work evaluated the employment of Reality Therapy with persons as well as groups from dissimilar/multiple cultures. The work explained the misconception that the concept of Reality Therapy is one that can never be applied on non-Western cultures. This work therefore discussed the universality and effectiveness of some of the counseling theories that are noted to be very important for correcting some of the most common cases of psychological disorders/conditions.
Methodology
The process of evaluating the effectiveness of the counseling theories in use at the Main Street Counseling Center involved interviewing of clients after treatment in order to find out their experience before the beginning of counseling, during the period of counseling as well as immediately after the end of the treatment regime.
Participants
The evaluation took place at the Main Street Counseling Center clinics. A total of 150 patients took part in the survey. The participants were all undergoing different therapies in order to cure various conditions. In regard to age group, 80 percent were more than 25 years old while the rest were younger. More than 75 percent of the participants were Caucasian while 3 percent were African-American. Two percent were Asian-Americans while about 1 percent were Hispanic.
Instruments
In order to measure the effectiveness of the effectiveness of counseling theories as applied to working with diverse clients and issues. We employed the measure-Meaning in Life Questionnaire (MLQ) (Steger,2006).The Meaning in Life Questionnaire is used in the assessment of the meaning of life by means of 10 items that are rated on a 7-point scale that ranges from "Absolutely True" up to "Absolutely Untrue." The Presence of Meaning subscales are used in the measure of how the respondents fell about their lives meaning.