Table of Contents
Cognitive Behaviour Therapy
Family Systems Therapy
Counselling with Ethics
This paper will focus on the theories and the techniques involved in counselling as well as the ethical issues related to counselling. I propose to discuss each therapy style individually in an attempt to supply a user-friendly approach to the similarities and differences in relation to each style of therapy.
The buzz term at the moment in counselling is Cognitive Behavioural Therapy, and while this technique of counselling has its merits it is important for us to open ourselves to the vast array of therapeutic styles. It is my opinion that a competent counsellor utilises a combination of counselling techniques to best serve the needs of the client. Having a thorough understanding of how each technique can add value to the counselling environment makes for a more productive and successful practice.
While each individual technique has its own application, it also has its own limitations in the counselling realm; these will be discussed in turn along with the implications and applications for multicultural counselling. In the South African field of counselling, along with numerous other countries in the world, the concept of multicultural sensitivity is of huge importance. Counsellors or therapists in this country will be exposed to clientele from many different cultural backgrounds and sensitivity to the application of a particular therapeutic approach to multicultural counselling is paramount.
Another important component of therapy is ethical practice. This concept goes beyond informed consent and client confidentiality and will be discussed later in this paper.
Sigmund Freud (1856 – 1939) is still viewed as the father of modern day psychology. His therapeutic approach, Psychoanalytic Therapy, is a theory revolving around the development of the personality. It is deemed a philosophy and relates to the strength and weakness of the human nature. The relevance of unconscious factors is pivotal to this approach. His premise was based on the idea that experiences from birth up to the sixth year of a child’s life have profound significance for their later development and the generation of their individual personality.
The basic philosophy of this type of therapy lies in the belief that the client, at his current point, is basically a result of the interplay of his experiences from a young age. The manifestation of his unconscious motives and the subsequent conflicting experiences that have brought him to the point of seeking therapy, are rooted in his irrational thought processes.
Freud reduced all unconscious motivation to the result of two extremely strong ‘driving’ factors; that of sexual and aggressive impulses. These impulses are believed to stem from the conflicts experienced during ones’ childhood. Unresolved conflicts continue to manifest in later life until they have been addressed at the root cause. The sexual and aggressive drives have the ability to determine later personality development.
It would be remise to mention the work of Freud without an outline of his psychosexual stages of development, the key component of his work was based on successful resolution of each stage of development. Conflict in the client is a direct result of unresolved ‘troubles’ at one or more of his stages of development. He proposed five stages of development in the life of an individual:
- The oral stage (1st year) revolves around the sense of satisfaction that the young child experiences as it suckles at the mother’s breast. The need for both sustenance and pleasure. If an infant is prevented from satisfaction of this need, this stage of development is unresolved and the child becomes fixated in this stage of development, with manifestations of greed later in life. Freud believed that adult manifestations of inability to form intimate relationships and essentially mistrust in others was a direct result of this stage of development.
- The anal stage (1st – 3rd year) when the child begins the process of potty-training was significant for Freud as it lead to the learning of independence and the idea that the child has the ‘power’ to control the movement of the bowels and thus withhold from the parent. The habits of the parents in toilet training are of significance as they can influence the development of both rage and aggression in later life. Unresolved issues around this period of development in the child’s life create fixation in this stage and impact on the personality development of later life.
- The phallic stage (3rd – 6th year) was believed to be centred around unconscious incestuous desires of the child. It is this stage of development that has given rise to both the Oedipus and Electra complex, the child is believed to generate desire for the affection of the opposite sex parent. This need for affection is perceived by the child as inappropriate and creates a threatening environment, thus leading to repression of this desire. The male child sees the mother figure as his object of love and the female child to the father figure. The child seeks to replace the affection gained by the same sex parent and hence a ‘power struggle’ between the child and the same sex parent ensues. The parent’s sensitivity to this stage of development and the manner in which they handle the child’s emerging sexuality can impact on the child’s own sexual attitudes as he/she matures.
- The latent stage (6th – 12th year) is characterised by the child’s involvement in more social activities when the child begins to form new social interactions and relationships, replacing the sexual interests for the opposite sex parent.
- The genital stage (12th – 60+ years) engulfs the remainder of the person’s life according to Freud. This stage sees the phallic stage interests revisited as the child commences and moves through puberty and Freud proposed that this stage is predominant right through into old age. The sexual desires of the young adult may be manifest in socially acceptable circumstances and manners, while any other sexual desire is believed to be sublimated into other non-sexual activities such as sport. The sexual energy, characteristic of this stage needs to be dealt with in an acceptable manner. Suppression of these sexual desires and again the responses of the parent figure can create conflict in the child. As the child grows into adolescence is it presumed that more independence and freedom is gained?
These key concepts in Psychoanalytic Therapy form the basis of Freud’s work. All first year psychology students have a good understanding of the relationships between the Id, Ego and Superego as the basis of the development of the personality and hence discussion here would be redundant. The repression of desires grounded in each stage of development lead to anxiety in the client, and the unconscious nature of these desires have the power to influence the current behaviour and personality of the client.
The primary goal then of Psychoanalytic Therapy is to bring to light the unconscious desires of the client that they may become conscious of them and hence work towards change. The therapeutic process focuses on re-visiting the repressed conflicts of that stage or numerous stages of development in order to work through the conflict towards changing the current personality.
The therapeutic relationship between therapist and client remains rather distant for want of a better expression. The process of therapy is designed to be lengthy; there are no short-term fixes with psychoanalytic therapy. Primarily the client is taken through a free-association programme in order to identify the conflicts that underlie the problem behaviour. The therapist will use dream analysis in conjunction with free-association to identify and discuss the conflicts that have arisen during one or more developmental stage. This process allows for the creation of new ways of thinking about the conflict and thus assimilation of this new cognition into the realm of the ego.
This therapeutic style is not deemed appropriate for clients with psychoses or particularly self-centred or impulsive clients. It does indeed form the basis of good training for current and future psychologists and can be utilised in part with numerous clients. The sense of distance between the therapist and client can be attractive to certain clients but may be a ‘problem’ for other more sensitive clients who need a strong connection with their therapist.
One of the strongest criticisms of this therapeutic style is its lengthy process, many clients have a limited budget and seek a much shorter process to identify the problem thinking and focus on mechanisms to alleviate the ‘suffering’ or development of coping skills to bring them more happiness in their lives.
There has been much criticism for Psychoanalytic Therapy across the years but it may still have value in the South African context. The strength of the family unit and the connection to the ancestors is a norm that continues in the greater majority of the population. Making a connection between the younger years of the client, the will of the ancestors and current behaviour may have significant therapeutic benefit. Admittedly, this style is expensive and time consuming and deemed inappropriate for the vast majority of the population in the typical counselling setting, but it is not a therapeutic style that does not still have merit. Unresolved issues as a source of conflict and cognitive strife remains a useful, sound approach to therapy.
Alfred Adler (1870 – 1937) moved as far away from the teachings of Freud as he could. The ultimate proponent of his therapy revolved around the idea of creating one’s own destiny. Clients were encouraged to take ownership of their lives, taking responsibility for their actions, while being driven to look at life in moments of meaning and making and striving towards goals that would give the client impetus to move forwards and upwards.
The basic philosophy of Adlerian Therapy is based on the belief that each individual has a vested interest in his social interactions. His life is driven by a course of goals that he has for his life and the striving towards the fulfilment of these goals. The client is encouraged to add value to the community in which he lives and the world at large. The client’s ability to evaluate events in his life, adjust his behaviour and thus become the master of his own destiny by creating opportunities in his life is encouraged and a key component of the therapeutic process.
In addition to setting goals for the client, the therapist aims to encourage the client to create their own unique path in the world. Providing encouragement to the client is the key to Adlerian Therapy, encouraging them to assess their goals to ensure that they are challenged until they emulate the type of goals that are of value and use to the greater society. This encouragement enhances the client’s sense of belonging in the world.
The therapeutic relationship has to be grounded in trust and mutual respect. The goals are evaluated and set as a ‘team’, the client and therapist working together to create the type of goals that will give the client a profound significance in the world. Having moved away from the Freudian stance on therapy, there is still room to delve into the experiences of the client in their youth but not to dwell on them; key to change is sharing evaluations between client and therapist and assisting the client to find new ways of goal directed forward movement with new possibilities in their life.