Sunday, 15 July 2012

Therapeutic Models

Because I've been a bit under the weather, I haven't had the time to think and write as much as I would like, so this Sunday's offering is a piece by Annie Parmeter, written when she was studying counselling.

The fundamental idea that crops up in her thinking, which is one taken from co-counselling, is that of "patterns". Harvey Jackins, the founder of co-counselling, saw "patterns" as fixed reactions to hurt and pain, that were almost recorded like tape recordings, and would be replayed at other times of hurt and pain. It can be seen that this comes from a very old idea of memory, that memories themselves are like tape recordings. The notion that they can be replayed under hypnosis with "regression" also comes into this.

But we now know that human memory is not like that of a tape recorder or a computer, but is much more fluid and complex. Past lives, and alien abductions, are not examples of events recorded on an organic  tape recorder but how the human mind behaves when charged with creating events that did not exist. The work of Elizabeth Loftus shows that memories can be strong, but wholly false, and can even be implanted either by accident or by design.

And I think the same is true of "patterns" - just because we have reacted in similar situations, doesn't mean that we will simply react in the same way in future situations, like a robot programmed to react that way, because it must. The tape recorder idea of the psyche is not true either.

Yet it is true that unless we follow the Socratic ideal, and seek to "know thyself", we are also likely to be prone to follow set patterns of behaviour. This is not because they are like a tape recording which must play back exactly, or a robot programmed to react, but because they have become automatic responses. Just as when driving a car, we may take a wrong turning because we are not concentrating on where we are going, or have been distracted, and so follow the turning we usually take, so too, I suspect that our behaviour can follow learned patterns where we are not sufficiently critical and introspective. This is where therapy can be helpful, to provide a means to enable us to see our own behaviour more objectively, especially if we are not naturally introspective - and this is the subject of this piece by Annie:

Therapeutic Models
by Annie Parmeter

This week we have been asked to make an exploration of our preferred therapeutic model.

I cannot honestly say that I have any one favourite, firstly as a trainee counsellor I am still learning about a variety of different models and until I gain more experience in the practice of them I would like to keep an open mind; secondly, my experience so far has been as client and the effectiveness of a therapeutic model (if that is the criteria by which we should judge it favourite) may therefore only be indicative of my own individual needs and modes of learning, for example I value the trust, sense of safety and unconditional positive regard engendered by a humanistic style of counselling, but the more logic-based practical style of the cognitive approach appeals to the pragmatist in me and my rational need for beauty and order.

These may not be the needs or preferred learning styles of other clients and as counsellor it behoves me to remember this and act accordingly. For the purposes of this exercise I will focus on the humanistic person centred and cognitive approaches as I have found from my own experience that they can complement each other very well.

How we come to experience suffering;

Cognitive therapies (including those of Beck and Ellis) support the belief that human beings are prone to learning erroneous and self-defeating thoughts and that these thoughts are the cause of our subsequent feelings of distress, but the cognitive message is one of hope as it is believed that we can challenge these negative thoughts and relearn a more positive/rational (although we must beware of assuming that there is a universal definition of 'rational') view of the world and come to enjoy more upbeat feelings as a result. The cognitive approach recognises the degree to which negative thinking has the power to set a client on the road to self-destruction.

The person-centred approach of Rogers is constructed around the idea that human beings are motivated by the drive to 'self-actualise' and that at a very young age we begin to develop a concept of our 'self' as an individual. We also find within us a deep need for positive regard of this 'self', tailoring our behaviour in order to receive approval, we learn about the effects of our behaviour and how acceptance can be conditional upon it, if we internalise this the result can be feelings of alienation as we come to feel bad about ourselves as if we were the cause of others' perception of us.

The aim of therapy;

The cognitive approach has a present time focus and suggests that the painful 'symptoms' (the result of faulty learning) with which the client presents are the real issue to be tackled, the goal therefore is to help the client change their behaviour by unlearning destructive patterns of thinking (and ensuing behaviour) and replace it with life-enhancing skills, the therapist is seen very much as a teacher of effective behaviour.

Change-goals are set up to be limited, specific and measurable in order that client and therapist can both easily evaluate the effectiveness of the treatment.

The aim of Rogers' person-centred approach is to create for the client an environment conducive to personal growth, that is to say one of congruence, unconditional positive regard and accurate empathic understanding. Rogers believed it was from this nurturing position that clients could feel safe to examine those patterns that may be inhibiting their growth thus enabling them to change their self-concept.

How does therapeutic change come about?

The cognitive approach brings about change when the client is confronted by the therapist about their irrational notions and begins the practice of unlearning destructive or counter-productive patterns of thinking and takes on board more useful and effective ways of thinking about their life and their difficulties. This process usually involves homework.

The Rogerian humanistic counsellor/client relationship is an egalitarian one where the counsellor declining the role of 'expert' proceeds from the assumption that the best person to find the most effective way forward is the client. In a therapeutic environment that is free from blame, criticism and judgement the client can feel safe to explore the full potential of their path to self-actualisation, the resolution or working through of difficulties is deemed to be something that will occur quite naturally along the way. There is a way of looking at this type of process that we may borrow from gestalt therapy, 'The curious paradox is that when I accept myself as I am, then I change'. Rogers also played down the usefulness of intellectualising about problems in favour of a more intuitive/emotional slant that he felt was more conducive to 'whole-person learning'.

Where it became useful for me to run these therapies side by side, was when I could discharge on and clarify ideas within the safety of the humanistic 'talking therapy' then check in with a more cognitive approach in order to more swiftly and effectively set up goals for change.

There can be valuable lessons to be learned from a more confrontational approach, sometimes, additional information or an outside viewpoint can help to open up new angles on a given problem. I do however value the space afforded by a humanistic approach to explore the origins of some of my distress recordings, often this process of unravelling, recognition and understanding of the patterns currently running can be sufficient motivation to alter my thinking and behaviour, without which the cognitive restructuring approach can seem slightly like brainwashing and more definitely like trying to use a sledgehammer to crack a nut.

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