Comparison of three models of psychotherapy

Psychotherapy

Social Work According to Three Models of Psychotherapy:

Cognitive Therapy, Dialectical Behavior Therapy and Behavior Therapy

Clinical psychology is a field constructed on the intent to treat disorders and dysfunctions and to promote mental health and stability in its subject. Therefore, it is centered on the processes of diagnosis and therapy, with the various disorders to which individuals are subject falling under a set of classifications discussed in greater detail in the following account. However, this is a process which cannot be pursued without the achievement of a sound and balanced patient/counselor relationship. Indeed, this relationship is at the center of the treatment process for the patient and in many ways, the success or stasis of treatment will depend on this relationship. The relationship between patient and therapist is an inherently sensitive one. In many instances, the degree of personal disclosure, the development of some level of personal dependency and the likelihood of emotional attachment will have the effect of making this a relationship due for careful treatment. This is a responsibility which falls upon the therapist, in whom is invested a significant amount of trust concerning ethical consistency, professional integrity and interpersonal sensitivity. This means that first and foremost, the qualified counselor, therapist, social worker or advocate will enter into a process of psychotherapy by choosing the correct model for treatment. As the discussion here will demonstrate, there are a great many models available to the therapist but it will fall upon this professional or a support group of professionals to select the proper treatment framework based upon the unique situation and needs of the patient in question. This account will evaluate the Cognitive Model, the Dialectical Behavior Model and the Behavior Model with the intent to explore both the variation of available models in the field and to fit these models to the particular needs and applications defined by different patient and treatment scenarios.

Basic Assumptions and Major Concepts:

The basic assumption of cognitive therapy is that a goal-oriented approach to treatment is required which projects basic the assumption that there are certain beliefs and perspectives present in the subject which are dysfunctional. The presence of these dysfunctional aspects of one's thinking promote negative emotional and behavioral responses which can be self-fulfilling. Therefore, cognitive therapy works to alter this dysfunctional thinking by setting goals for positive orientation and subsequently by attempting to locate the roots of the patient's negative cognitive orientation. Accordingly, Beck (1995) tells that "realistic evaluation and modification of thinking produce and improvement in mood and behavior. Enduring improvement results from modification of the patient's underlying dysfunctional beliefs." (Beck, 1) This is the overarching premise which drives the practice for the benefit of those with anxiety disorders and behavioral problems.

In a manner, this is also true of Dialectical Behavior Therapy, which incorporates certain elements of Cognitive Therapy. In particular, this school of thought is also driven by the interest in removing triggers to dysfunctional emotion. However, its methods of induction differ considerably and therefore make this a differently employed approach to psychotherapy. In Dialectical Behavior Therapy, these ideas of cognitive therapy are combined with the Buddhist principles of meditation. It is argued that this can help to induce comfort, relaxation and a willingness to explore possible triggers to dysfunctional in a way that reduces distress and other environmental obstacles to the penetration of psychotherapeutic investigation. According to the text by Jones & McDougall (2007), "DBT is most commonly used to help people with borderline personality disorder manage their self-harm and this is achieved by developing self-awareness and reducing impulsivity through emotional regulation and positive coping strategies." (Jones & McDougall, 13)

Our research refers to DBT as an offshoot of the Behavioral Approach. The introduction of the Behavioral Model of evaluation psychoanalysis, credited to the ingenuity of B.F. Skinner, would take into consideration the motives driving behaviors and the way that these behaviors tend to manifest into dysfunctional tendencies or complexes. According to Schimelpfenin (2009), behavioral therapy "is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. It is effective for the treatment of health problems which require some sort of behavior change, such as quitting smoking or losing weight. It is also effective for anxiety disorders and phobias." (Schimelpfening, 1) In all of these instances, it is intended that the behavioral model should help to promote a positive and sustained change in behavior such that the negative stimulants which will have caused a person to experience undue emotional anguish, self-destructive tendencies or negative habitual proclivities may be mitigated. The behavioral model is in many ways a formative basis to some of the other treatment models addressed in this discussion. Its emphasis on reconfigured self-induced negative patterns underscores the strategy denoted by some of these other approaches.

Relevance of Models:

The cognitive behavior method is useful in the community mental health center context because it has the capacity to be used in situations of situational depression or anxiety. That is to say that where individuals might visit a community center with emotional issues closely correlated to stress at home, financial insecurity, familial strife or health ailment, this method can be employed to help alter the subject's perspective. In many ways, this shows that the cognitive approach is centered on achieving effective coping mechanisms. Accordingly, Beck remarks that this approach "is orderly and rational and that patients get better because they understand themselves better, solve problems, and learn tools they can apply themselves." (Beck, 37) That said, this method is not recommended for confrontation of addiction issues.

The model is useful in the context of a child welfare agency, where behavioral issues produced by childhood discontent can be seized early. The behavioral challenges which are often found in children from dysfunctional, poor or broken homes may be addressed through this intent to help the subject alter his or her way of thinking. In the private practice, cognitive therapy is perhaps among the most commonly employed of psychotherapy avenues. Its importance in private one-on-one sessions is founded in its emphasis on the maintenance of core beliefs which it argues can be altered in most subjects seeking support for genera depression or anxiety disorders. For those in psychiatric hospitals by contrast, cognitive therapy may not be aggressive or invasive enough to constitute an effective level of treatment.

Indeed, the Dialectical Behavior Model suggests itself as more readily suited to those in psychiatric hospital contexts, who may be there due to personality disorders or evidence that such individuals may threaten harm to themselves. According to Harved et al. (2006), "borderline personality disorder (BPD) is a severe and complex psychological disorder characterized by pervasive dysregulation of emotions, behavior, and cognition. Due to the nature and severity of BPD criterion behaviors, individuals meeting criteria for its diagnosis are generally viewed as among the most challenging clients for clinicians to treat." (Harned et al., 67) This is because such subjects will often become guarded and obstruct prying methods of psychotherapeutic investigation. The mollifying aspects of DBT are a response to that particular need.

The Behavioral approach, by contrast, seems best suited to the Community Mental Health Center context, where the frequent confrontation of addiction or negative lifestyle orientation serves this discussion well. To this end, chemical addictions, compulsive eating habits or sexual addiction, to name a few conditions, may be intervened upon by attacking the behaviors underlying these habits. As the Madison (2009) text denotes though, behavioral therapy is a form which can generally apply to any psychological ailment where it appears that there has been a short-coming in taking responsibility for the behavioral stimulants to a psychological dysfunction. Accordingly, Madison indicates that "behavior therapy can be used to treat a wide range of psychological conditions including, but not limited to, depression, Attention Deficit Disorder (ADD), Attention Deficit Hyperactive Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and certain addictions. Behavior therapy may also be used to treat insomnia, chronic fatigue, and phobic behavior. This type of therapy may require fewer treatment sessions than cognitive therapy. However, the length of therapeutic treatment varies with each individual patient." (Madison, 1)

Social Work Values and Ethics:

With respect to the field of Social Work, each of the methods described has its own distinct value. As alluded to at the outset of this discussion, the field of therapy is largely splintered in this way, with the onus falling on such professionals as social workers to make ethically-driven decisions about the most appropriate way to channel treatment. As noted above, the Behavior Model is especially well-suited to the needs implicated by drug addiction, which is a primary issue in the field of social work.

Social work also frequently involves the counseling of children from dysfunctional homes, foster homes or juvenile institutions. For this aspect of the job, Cognitive Therapy is a highly recommended method of intervention. According to Beck, this is a primary avenue to intervening where behavioral problems are evident.

The Dialectical Behavior Model has a place in social work where the most pressing of disorders are evidenced. 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.

Research-Based Knowledge:

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.