Developing a therapeutic orientation: comparing cognitive behavioral therapy to multicultural counseling approaches

Counseling

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.

Multicultural considerations

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 for a more direct process for enacting change in the patient.

Wellness and prevention

People maintain wellness through adhering to their belief system, and exhibiting moderation in all aspects of life. By having a predetermined set of beliefs, people are able to follow the core constructs and remain focused on maintaining a productive life of balance and order. Counseling strategies for preventing mental health issues, substance abuse, physical abuse, and relationship problems should emphasize assisting the patient in taking action and maintaining their own mental health. The therapist should emphasize the importance of maintaining core constructs, although they should refrain from attempting to impose their personal beliefs onto their patient, as this would reproduce the single-mindedness that is perhaps the foremost limitation of cognitive behavioral therapy. Using psychodynamic approaches, the therapist should identify the underlying principles that are most important to the patient, and help their client understand ways of promoting their own values. However, if the client's values are physically or mentally obstructive to either them or to others, the therapist should interject and explain why it is damaging.

In addition to using psychodynamic techniques, one of the most effective approaches to dealing with those who suffer from substance abuse is motivational enhancement therapy. As Lay and King (2007) attest, motivational enhancement therapy involves motivating the patient to take responsibility for their situation and overcome their difficulties on their own. For example, if someone was addicted to prescription drugs, the therapist would encourage their drug-addicted client by convincing the patient of the virtues they possess that could assist them in overcoming their affliction. For example, if the patient were a talented athlete, the therapist could encourage the patient by telling them to channel their energy into their athletics rather than focusing on their drug addiction and the withdrawal that accompanies one's attempt to end their dependence on the drug. Additionally, the therapist can employ techniques associated with psychodynamic therapy; they could draw from the patient's unconscious processes and past history in order to issue advice that is specifically formatted to the client's sensibility.

The nature of problems

People develop problems when their psychological makeup begins to obstruct their everyday routine. Everyone has a lifestyle that they need to maintain to remain productive in their job and personal life; while there does exist some variance to the exact routine, people generally have a job or responsibility to perform certain tasks on a regular basis. Therefore, problems occur when a person's ability to function becomes impaired. Ineffective functioning is characterized by a person's inability to perform their necessary responsibilities, and this can result from myriad causes. Therapeutic approaches must be sensitive to the specific causes and effects of the individual's problems, tailoring solutions that match both their mental makeup and their external situation. Someone who is lacks confidence, is depressed, and cannot summon the requisite energy needed to remain productive may benefit from motivational enhancement therapy, which could provide them with the confidence they need to overcome their problems. Someone who is traumatized by past events would likely benefit from psychodynamic therapy, with techniques such as hypnosis and talk therapy, since addressing the underlying causes for their problems would directly assist them in overcoming their afflictions.

The process of change

People change in the counseling process through their interplay with the therapist. The counselor should take an active, encouraging role, and the psychodynamic approach is particularly effective since it works to overcome the lingering problems that afflict the client. Change is also difficult to enact and sometimes painful; both therapist and patient should be sensitive to the fact that change can be a slow process. The therapeutic relationship should work closely within the patient's mindset in order to overcome the client's problems.

My theory in Practice

My theory incorporates elements of psychodynamic therapy, most notably talk therapy and hypnotherapy. I believe in the importance of respecting the client's individual sensibility, including their cultural viewpoints, and in this regard my orientation differs from cognitive behavioral therapy. Additionally, I would always offer encouragement and would employ motivational enhancement techniques that would assist the patient in adapting to their environment while retaining their core values. The patient may simply need extensive encouragement, and therapy should assist the patient to remain productive while not instructing them to discard their personal and cultural beliefs. The efficacy of my theory lies in its balance between being open-minded while at the same time operating in the best interests of the patient.