The Value of Affective Therapy

¶ … Change Pathways There are multiple theories for effecting change in therapeutic settings; it is largely advantageous for practitioners to become well versed in all of these. Nonetheless, it is necessary for therapists to decide what sort of theory of change pathways is most natural for him or her to deploy. In deciding which one is most efficacious in this regard, it is necessary to consider a plethora of factors that can potentially impact the way change theory is utilized by the potential therapist.

Firstly, he or she should understand that the most commonly used theories for change pathways involve affective, behavioral, and cognitive mechanisms of change. Significantly, these approaches are not necessarily mutually exclusive; it very well could be beneficial to utilize combinations of these approaches while working with various clients. Moreover, it is also essential to consider the patient's input in which sort of mechanism is used. Based on the patient's goals and his or her various skills and experiences, one change pathway could be more beneficial than another.

After giving this matter the grave consideration that it is due, this particular student believes that the most consistently useful theory of change pathways -- and the one that creates the most lasting sort of change -- is the affective one. The basis for this belief lies in the way that "emotion-focused therapy" (Paivio and Shimp, 1998, p. 211), the basis of the affective approach, relates to the behavioral and cognitive foundations that are central to the other two approaches.

Quite simply, if a patient is feeling better about himself or herself, he or she is more likely to behave better and to think or reason better about himself. Therefore, there is a causal relationship between an affective mechanism of change and the desired reactions of the other two change pathways; getting patients to feel better can help them to act differently and to develop improved thought processes about themselves. The relationship between the other two approaches and the affective theory of change pathways is much more dubious.

It is more difficult to first learn new behaviors if one still feels the same way about something. Similarly, it is not easy to think about something in a different manner and to foster some sort of insight about it if one has yet to change one's feelings about the subject. Thus, it is advantageous to utilize the affective theory of change pathways as the primary foundation for treating patients, and to moderate its use based on additional factors that are germane to the patient.

Nonetheless, there is a fair amount of merit in the other two mechanisms for change. In fact, there are several fascinating points in regards to behavioral change mechanisms that are of use when initially implementing the affective approach. As previously mentioned the relationship between these two approaches is largely causal -- a change in feeling can help to initiate a change in behavior, or "spillover" (Cohen et al., 2008, p. 955) in this regard.

There are some cogent reasons why it is desirable to first strive to implement therapeutic change through an affective methodology, and then to further or expand that sense of change through behavioral mechanisms. The crux of those reasons is that people can make themselves do right -- to act accordingly, in line with both social and personal standards of behavior -- despite their thoughts and feelings.

However, it is much easier for a person to effect positive change when he or she has undergone an affective experience that makes him or her feel like initiating change. Once a person is feeling like they are capable of change, they can utilize that feeling as the impetus to modify their behavior: regardless if they have yet to alter their perceptions and cognition on the subject.

People can begrudgingly do the right thing, even if they do not fully agree with what is they are doing on an intellectual level. As such, it is important to augment an affective change mechanism with behavioral mechanisms for change, in order to supplement the former approach. Another extremely important consideration when determining how to best treat a patient involves the clinician's assessment of the patient's needs. This assessment is a standard part of treatment, and provides an opportunity for patients to inform the clinician of their goals from therapy.

Considering the patient's needs in this regard is a critical component of differentiation that can significantly affect the mechanism of change deployed. Moreover, it substantially affects how the change mechanism is implemented by the therapist and how he or she chooses to deploy it. There are some patients who might actually prefer to focus on their cognitive issues, in which case the clinician is almost required to adjust his or her theory of change pathway accordingly.

The same notion applies to patients who want to focus on facets of their behavior as well. Still, even in these instances in which patients necessitate a focus that is seemingly at variance with an affective theory of change pathway, the clinician still can -- and is likely best suited to -- utilize an affective theory as the foundation for his or her treatment.

The critical aspect of this statement and the ensuing treatment is that the practitioner should only utilize the affective change mechanism as a foundation for his or her treatment. The practitioner is still obligated to tailor that treatment to the particular needs of his or her patient -- which may involve manifestations of either behavioral or cognitive goals, or possibly both. The way that the practitioner is obligated to tailor his or her treatment is largely predicated on the therapeutic alliance between the clinician and the patient.

This alliance is three-fold: it involves not only a positive emotional bond between these two parties (Feller and Cottone, 2003, p. 53), but also shared treatment objectives and a shared plan for reaching those objectives. In this respect the clinician must support the treatment goals of the patients, and also agree with the patient about how to reach them. Therefore, the patient's desires are somewhat mitigated by those of the clinician in that they must come to an.