Psy3120 - Comparison of two major counselling theories. This was a mandatory essay assignment. PDF

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Comparison of two major counselling theories. This was a mandatory essay assignment. The paper is a HD quality. ...

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A Critical Analysis of Two Counselling Theories This title is quite vague (e.g., which two counselling approaches are you comparing?). Rukshana Abeysinghe

Student ID 26368250 Please refer to APA guidelines regarding formatting (e.g., running header should be included, there should be page numbers).

Essay: Introduction to Counselling PSY 3120 Due Date: 11 October Tutor: Amanda Hurley

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Class: Monday, 8.00-10.00 Word Count: 2036

The emergence of counselling as a legitimate profession has greatly opened up to the role of theoretical knowledge in the modern counselling (Pilecki, Thoma, & Mckay, 2015). Most counselling practitioners view a solid theoretical approach as an effective foundation for the success of therapeutic practice. The baseline of each counselling theory derives from framework of assumptions and ideas of human nature (Maxwell, Eremie, & Kennedy, 2016). Since the complexity of human behaviour, each theoretical approach has different take of recognition about the human nature, and it is the unique view of human behaviour that differentiates one counselling theory from another (Pilecki, Thoma, & Mckay, 2015). While acknowledging the divergent structure of each theories, it is also believed that many of these theories share a mutual make-up (Maxwell, Eremie, & Kennedy, 2016). Thus, purpose of this paper is to compare and contrast of two such dominant theories in counselling: Cognitive behavioural theory (CBT) and psychoanalytic theory, with reference to their distinct theoretical rationale, therapeutic techniques and interventions. Remember that the introduction should also include the key points to be discussed throughout the essay. The psychoanalytic theory, which greatly emphasise on the unconsciousness and consciousness, can be traced back to Sigmund Freud, often known as the father of psychoanalysis; and his pioneered contribution. According to Freud, the human mind could explain in terms of three distinct segments; the unconscious mind, preconscious mind and conscious mind (Beystehner). The conscious mind engages reality with the physical world, preconscious mind mediates between the conscious and unconscious that is capable of becoming conscious, while the unconscious mind chiefly accounts for events, experiences and repressed memories that exist in the out of awareness realm (De Sousa, 2011). These

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inaccessible materials in the unconscious mind can be responsible for individual’s thoughts, feelings, and development of behaviour. Freud pinpoints two such unconscious forces that are the ultimate determinants of human behaviour; the sexual (Eros) and aggressive (death instinct) instincts (De Sousa, 2011). According to Freudian psychoanalytic approach, accurate comprehension of these forces of human mind holds the key to fathom of human behaviour and personality (Anand & Singh, 2017). Freud’s this classical view, that the human nature is largely rooted from unconscious impulses, considered as the mainstream theoretical assumption of the psychoanalytic theory. Unlike in psychoanalytic theory, the role of unconsciousness is less accentuated in cognitive behavioural theory (CBT). It is not that the idea of unconsciousness is refuted altogether; on the contrary, the experimental cognitive psychopathology has been emphasized the role of unconscious processes in “parallel distributed processing”, which is the fundamental principle of many clinical conditions including anxiety, depression, and psychosis (Williams, Watts, McLeod, & Mathews, 1997; Cohen, Dunbar, McClelland, 1990). Instead, more attention is rested upon the assumption that the human behaviour is a product of cognitive expression to the interaction of certain environmental cues (antecedents or reinforcements) (Dobson & Dozois, 2001). Moreover, behavioural component of the CBT grounded upon the theoretical assumption of that human behaviour is learned or conditioned through the environmental stimuli, hence by manipulating the individual’s environment can alter the “automated thinking” thus, modify the specific behaviour and subsequently his personality (Maxwell, Eremie, & Kennedy, 2016). As aforementioned, classical psychoanalytic approach based on the idea that the human nature stems primarily from the impulses lies deeply within the unconscious. To explain the idea, Freud introduced three forces of the psychical apparatus; the id, ego, and superego.

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According to this, many impulses of the id, which is largely unconscious conflict with the ego (connects to reality), and superego and these internal conflicts are the genesis of many psychological disorders including, Anxiety (Compton, 1972). Freud believed these intrapsychic conflicts play an essential role in personality development through the childhood and continue to influence in adulthood. This personality development occurred through a series of stages (psychosexual stages) in childhood: oral, anal, phallic, latent, and genital stages, and failure to meet the progress through a stage will result in a fixation. For instance, when a child’s needs at the oral stage are not adequately met, he may become “fixated” and overly dependent on others or seek stimulation through abnormality behaviour such as excessive drinking, smoking, or binge eating (Knight, 2014). It would have been better to discuss both CBT and psychoanalytic approaches within the same paragraph, so that they can be directly compared and contrasted. Even though, both theories are seen to be deterministic, CBT model focuses on maladaptive thinking patterns or cognitive distortions resulting from “schemas” (Beck, 2011). For example, if person’s cognitive thinking is irrational (cognitive distortions), it can lead to psychological disorders, hence altering these thinking into rational beliefs will improve emotion regulation. In their research on PTSD and CBT by Careaga, Giardi, and Suchecki (2016), demonstrated that patients re-evaluated their cognitive distortions (such as overgeneralizations, catastrophizing, personalization, polarized thinking) were able to reconceptualize their understanding of traumatic event and enhance coping abilities. Prominent behaviourists such as B.F. Skinner, Albert Bandura; the founder of Social learning theory, Albert Ellis; the founder of Rational emotional behavioural theory (REBT) and Richard Lazarus were contributed immensely to such theoretical orientations exist in CBT. In the psychoanalytic theory, psychological disorders assumed to be rooted from inner

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conflicts hidden in the unconscious. The symptoms are then considered as expressions of this conflict and the ultimate goal of the therapy is focused upon the reduction of negative expressions and resolution of the conflict (McWilliams, 2004). The concept of “free association” whereby the client is encouraged to voice freely without any inhibitions, is one of the fundamental techniques in CBT (Bornstein, 2005). This intended to help discover the unconscious wishes, fantasies, and intra conflicts of the patients. Then, therapist would attempt to correctly interpret and analyse the repressed materials, through therapeutic interpretations; analysis of resistance, and transference analysis (Bornstein, 2005). Interpretations are provided either by patients or therapist, are explanations of unconscious content (dreams, symptoms, fantasies). Whilst analysis of resistance involves the explanation of oppositional behaviour exhibited by the clients during the therapy setting, resistance is theorized to be the unconscious defensive mechanism to protect the ego by the client (Pilecki, Thoma, & Mckay, 2015). Psychoanalytic therapists are generally trained to look out, and analyse such behaviour. Another vestige of Freudian therapy; the analysis of transference, whereby a client’s unconscious redirection of feelings, desirers, and attitudes retrained from childhood toward a therapist, is considered as important to therapeutic process because transference allows the client to re-experience the conflict that need to be resolved (Pilecki, Thoma, & Mckay, 2015). While the Psychoanalytic therapy is mostly “insight oriented”, where the “unconscious” is seen as the cause of the behaviour, CBT is a systematic “problem focused”, therefore use “symptoms” as a revenue to look into the problematic behaviour. Clients are usually encouraged to identify the problematic behaviour through the homework and maintaining a journal, then through the necessary assistance, guidance, and role playing (modelling), patient

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is asked to rehearse positive thoughts which helps in making appropriate adjustments in their behaviour (Robinson, 2008). Techniques as, systematic desensitization, aversion conditioning, reinforcement, and dissuasion are incorporated in CBT, and found most effective in treating specific phobias, anxiety disorders, and PTSD (Robinson,2008). Another commonly observed difference between CBT and psychodynamic therapies is the therapeutic alliance, or the strength of the relationship between therapist and the clients. The cognitive therapist builds a warm empathic atmosphere, and recognises the process as a joint voyage of recovery ((Pilecki, Thoma, & Mckay, 2015). Transparency is valued, system of guided discovery is acknowledged, and collaborative empiricism is expected (Robinson, 2008). In contrast, psychoanalytic relationship emphasizes the anonymous stance or blank screen approach as the therapist tends to maintain neutrality to enhance a transference relationship, and strict analytic framework (Orlinsky, Schofield, Schroder, & Kazantzis, 2011). However, modern psychoanalysis has evolved a long way since Freudian approach, and most therapists are interactive and embraces “even out attentive” approach today (Anand & Singh, 2017). Although modified, the length of treatment for psychotherapy and efficacy are still widely criticised. One land mark study by Stulz, Lutz, Kopta, Minami, and Saunders (2013), found that longer treatment is associated with the less rate of treatment outcomes. A metaanalysis on a depression study also found that extensive treatment related to limited benefits (Cuijpers, Huibers, Evert, Koole, & Anderson, 2013). Unlike psychoanalytic treatments, CBT tends to be short-term, goal oriented and many treatments may last anywhere from 5-20 sessions. A recent study compared 20 weeks of CBT treatments in patients diagnosed with Bulimia nervosa, and found the treatment were more effective and beneficial towards the

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outcome (Poulsen et al., 2014). However, the recognition of the efficacy of both two therapies are important for further conclusion. A meta-analysis on efficacy of psychoanalytic therapy for somatic disorders by Abbas, Kisely, and Kroenke (2009), reported improved somatic symptoms in patients. Another methodological meta-analysis study compared patients with common mental disorders and psychodynamic therapy, found improvement of general symptoms while in the therapy and even after therapy (Abbas, Hancock, Henderson, & Kisely, 2006). Similarly, many comprehensive reviews examined the efficacy of CBT in number of psychological disorders. The strongest support is a recent meta-analysis of 332 clinical trials covering 16 different disorders, founded beneficial effect of CBT on positive symptoms (Butler et al. 2006). Other separate studies also indicated that CBT could be useful for treating depression, anxiety, and Schizophrenia (Beynon et al., 2008, & Ghahramanlou, et al, 2003). In general, CBT is considered as an effective approach for treatment of many psychological disorders, this is largely based on the abundance of empirical evidence on CBT in literature. The lack of empirical support is the strongest criticism psychoanalytic therapy faces today, which lead to believe that the other forms of treatments are more effective. However, some argue this is due to biases and “overlook” against the empirical findings that supported the psychodynamic therapy (Shedler, 2010). Regardless, considerable research and scientific evidence supports the efficacy and effectiveness of both CBT and psychoanalytic therapies. In summary, what are the known efficacy rates of these therapies? Where and when should these be used? The complexity of the human nature is nearly understood. Psychoanalytic theory explained the human nature in terms of conscious/unconscious minds, whereby CBT relied on changing irrational cognitive and behaviours. Though CBT and psychoanalytic theories have many differences in their therapeutic techniques and theoretical principles, considerate

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empirical evidences support, both therapies are effective in treatment of various psychological disorders. Well done in discussing in broad terms the main points you have covered in this essay, however, this could have been more specific (e.g., what are the core differences in theories?). Remember that you still need to cite here.

Personal Reflection I believe CBT is more effective approach that deal with helping people to clarify their thoughts through the work. In the CBT, the therapy involves working with patients or clients to help them change or alter the way they think and their behaviour, with the goal of improving the way they feel. As CBT today considered client focused, short term approach compared to psychoanalytic therapy. Psychoanalytic therapy is not a quick fix but requires a longer-term commitment, and due the nature of transference and interpretation from the therapist, it lacks the objectivity towards the patient. Because of the lengthy treatment time, it is possible that condition might return. Particularly, for people whom diagnosed with chronic mental disorders, or with long standing, and severe conditions, a short-term approach, such as CBT is more likely to work. There are excellent points, and relay the potential perspective of the client. Remember that you also need to discuss your own values and perspectives. According to my knowledge, certain principle that use in psychoanalytic approach fail to answer modern day issues. For an example, dream interpretation and the reliability of such source in therapeutic intervention is personally questionable for me. I also believe the inadequacy of empirical evidence may act as a disadvantage, since the there are many literatures support the efficacy of CBT in various psychological disorders. We need to

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consider the integrative meta-analysis to assimilate and integrate these two approaches in coherent manner, and I find CBT outweigh the psychoanalytic by its efficacy. As we learned in PSY 3120, the emergence of “Third wave”, which is relatively new to CBT, is promising according to many studies. The classic CBT is the way of seeing, third wave therapists, on the other hand, are interested in focusing on context over just identifying the problem. I feel as its a more compassionate based approach and integrates mindfulness and acceptance. The therapeutic alliance is one of the major factors differentiates the CBT from psychoanalytic therapy. CBT therapist is holistic, compassionate and non-judgemental compared its counterpart which is what I expect in a therapy session. I anticipate my therapy session to be more interactive, more engaging and guided. As we all are capable of producing cognitive distortions times to time (filters, overgeneralization, personalization, catastrophizing), the active participation of the therapist is essential to solve the problem and enhance the emotional wellbeing.

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References References have been well done in accordance with APA guidelines. Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 4. doi:10.1002/14651858.CD004687 Abbass, A., Kisely, S., & Kroenke, K. (2009). Short-term psychodynamic psychotherapy for somatic disorders: Systematic review and metanalysis of clinical trials. Psychotherapy and Psychosomatics, 78, 265– 274. doi:10.1159/000228247 Anand, A., & Singh, K. (2017). The practice of psychodynamic psychotherapy in contemporary clinical psychology. International Journal of Innovative Research in Science, Engineering and Technology, 6(9). doi: 10.15680/IJIRSET.2017.0609101 Beck, J. S. (2011). Cognitive behaviour therapy: Basics and beyond. 2. New York. Guilford. Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. (2008). Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. The British Journal of Psychiatry, 11, 192-195. Bornstein, R. F. (2011). Reconnecting psychoanalysis to mainstream psychology: Challenges and opportunities. Psychoanalytic Psychology, 22(3), 323–340. doi: 10.1037/07369735.22.3.323 Careaga, M. B., Giardi, C. E. N., & Suchecki, D. (2016). Understanding post-traumatic stress disorder through fear conditioning, extinction, and reconsolidation, Neuroscience and Biobehavioural reviews, 71, 48-57. doi: 10.1016/j.neubiorev.2016.08.023. Cohen, J. D., Dunbar, K., & McClelland, J. L. (1990). On the control of automatic processes: A parallel distributed processing account of the Stroop effect. Psychological Review, 97, 332-361. doi.org/10.1037/0033-295X.97.3.332

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Compton, A. (1972). A study of the psychoanalytic theory of anxiety. I. The development of Freud’s theory of anxiety. Journal of the American psychoanalytic association, 1. doi:10.1177/0003065172000101 Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioural activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318–326. doi:10.1016/j.cpr.2006.11.001 De Sousa, A. (2011). Freudian theory and consciousness: A conceptual analysis. Mena Sana Monograph, 9(1), 210-217. Doi: 10.4103/0973-1229.77437 Dobson, K., & Dozois, D. (2001). Historical and philosophical basis of cognitive behavioural therapy. Handbook of cognitive-behavioural therapies, 3-39. New York: Guilford. Ghahramanlou M. (2003). Cognitive behavioural treatment efficacy for anxiety disorders: A meta-analytic review. Unpublished Dissertation. Fairleigh Dickinson University. Kramer, U. (2010). Coping and defence mechanisms: What’s the difference? Psychology and Psychotherapy, 83, 207–221. doi:10.1348/147608309X475989. Knight, R. (2014). A hundred years of latency: From Freudian psychosexual theory to dynamic systems nonlinear development in middle childhood. Journal of Psychoanal Association, 62(2), 203-235. doi: 10.1177/0003065114531044 Orlinsky, D. E., Schofield, M. J., Schroder, T., & Kazantzis, N. (2011). Utilization of personal therapy by psychotherapists: A practice-friendly review and a new study. Journal of Clinical Psychology, 67(8), 828-842. doi: 10.1002/jclp.20821 Maxwell, D., Eremie, D., & Kennedy, G. (2016). Review of selected counselling theories and

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assumptions of human nature. International Journal of Innovative Psychology and Social Development, 4(4), 1-5. McWilliams, N. (2004). Psychoanalytic psychotherapy, a practitioner’s guide. 67-70. New York. Guilford. Pilecki, B., Thomas, N., & Mckay, D. (2015). Cognitive behaviour oral and psychodynamic therapies: Points of intersection and divergence. Psychodynamic Psychiatry, 43(3), 463-490. doi: 10.1521/pdps.2015.43.3.463 Poulsen, S., Lunn, S., Daniel, S. I., Folke, S., Mathiesen, B. B., Karznelson, H., & Fairbum, G. (2014). A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioural therapy for bulimia nervosa. Am J Psychiatry, 171(1), 109-16. doi: 10.1176/appi.ajp.2013.12121511. Robinson, P. (2008). Putting it on the street: Homework in cognitive behavioural therapy. In W. T. O’Donohue, & J. E. Fisher (Eds.), Cognitive behaviour therapy: Applying empirically supported techniques in your practice, 260271). Hoboken, NJ: John Wiley & Sons. Shedler, J. (2010). The efficacy of psychodynamic therapy. American Psychologist, 65, 98109. Stulz, N., Lutz, W., Kopta, S. M., Minami, T., & Saunders, S. M. (2013). Dose-effect relationship in routine outpatient psychotherapy: does treatment duration matter? Journal of Counselling Psychology, 60(4), 593-600. . doi: 10.1037/a003...