Personal Theory in Family Systems Therapy, Essay Example

Model of Therapeutic Change: How does change occur? What is the interplay between affect, behaviour, and cognition in effecting change? What techniques or methods will you use? Will you focus on the past, or future with you client?

The main way change occurs is first through clients wanting to change, and then this desire for change is followed by intervention. The core theories utilized are structural theory which utilizes cognitive behavioral learning as a tool to implement change and experiential theory which utilizes motivational interviewing as a method for change. The intervention entails integrating motivational interviewing and cognitive behavioral therapy in collaboration standard care of the client or clients, which was compared to standard care alone. Phase one of therapy “motivation building”—concerns engaging the patient, then exploring and resolving ambivalence for change in certain unwanted behavior. Phase two—“action”—supports and facilitates change using cognitive behavior. An example of unwanted behavior can be seen in situation like substance abuse, where one family member might have an addiction, but it can also be seen in habitual acts of violence or mistreatment in the household. Often violent behavior within a household can also be attributed to substance abuse. Cognitive behavior learning as well as the motivational interviewing process, both focus on assisting the client of clients to attain deeper knowledge of self in their pursuit genuine change.

Once it’s clear that the client or clients want genuine change in their lives, they must be put on the path towards reducing their addiction through motivational interviewing or cognitive behavioral learning methods. The main focus of these methods will be to prevent lapses and relapses of unwanted behavior while offering treatment. The main difference between a lapse and a relapse is the aspect of control. When an addict lapses they use their substance of addiction once or twice but then they choose whether they are going to continue with their treatment. A relapse is a complete loss of control and halt in treatment all together, usually with very little chance of recovery, due to substance abuse at levels near or even beyond the addict’s original frequency of use. The most important part of relapse prevention is controlling lapses through minimization and interruption. In many sever cases of addiction, it’s unrealistic to assume a client can quit cold turkey, but a lapse can easily turn into a relapse if it’s not monitored efficiently.

I would explore the client’s reasons for wanting to change his/her behaviour. For example, if they originally wanted to seek treatment, we would evaluate that reason and reinvest our interests in why the client initiated action to receive treatment. I would help the client return to this mindset through asking the 5 key questions of the D.A.R.N. system. This would allow me to find the client’s desire, ability, reason, and need for the change, as well as reinitiate the client into understanding the importance of change in their life, as well as what they think is the type of commitment they need to make to get them on their path.  The most significant counter to depression is being surrounded by family, loved ones and other forms of social support. I would get the client’s family involved in the hopes that they could help the client overcome this time of need.

Role of the Therapist and Role of the Client: What is your role as therapist? Who are your clients? To what degree will you work with families? Individuals?

The role of a therapist is to be a licensed mental health practitioner, educated with a masters or doctoral degree. A therapist should be trained for at least two years in regards to having clinical experience. My role as a therapist is to be a family-focused provider of psychotherapy and mental health. It is also an implied expectation of my services to also have access to providers of one of the five core professions of mental health for my clients, these being social workers, psychiatric nurses, psychologists, psychiatry. As a family therapist, I will provide services like offering diagnosis for and treatment of emotional disorders and mental disorders. This usually entails treating 15 percent individual children, 47 percent adult psychotherapy, and 38 percent couples, group therapy and family therapy. Treatment planning is also an essential aspect of marriage and relationship counseling, premarital counseling and education, marital enrichment and life coaching. The disorders most commonly treated by Family therapists are : Childhood Behavioral and Emotional Disorders, Depression and other Affective Disorders, Marital and Relationship Problems, Conduct Disorder and Delinquency, Substance Abuse, Alcoholism, Domestic Violence, Severe Mental Illness, and Physical Illnesses.

The American Association for Marriage and Family Therapy, clients of family therapists tend to be “6.1 Million People are seen Annually by Family Therapists (2.1% of Population), 2,294,728 Individuals Per Year, 808,798 Children Per Year, 752,370 Couples Per Year, 526,659 Families Per Year, 3.4% of Households have seen a MFT” (AAMFT, 2013). As addiction and substance abuses tends to play a significant role in many of the disorders and dysfunctional relationship shared by many patients of Family therapy, most of those individuals being treated are addicts, drug or alcohol abusers or they are the family of these individuals. Therapy, in this regards, is often implemented with the goal of creating a change of behavior in the life and practices of the addict often those negative of regressive practices of the family which reinforce the addiction. Many individuals who are diagnosed as having mental illness also show signs of dual diagnosis due to drug and alcohol abuse playing a significant role in enhancing the symptoms of their disorder.

Evaluation of both theories

In experiential psychotherapy, clients engages in creating and organizing the meaning of their environment. This is different from structural theory in which the therapist restructures the world of the client through engaging with the family and limiting influencing factors feeding into the client’s disorder.  Experiential psychotherapy take account for the way individuals behaves, react, perceive and construct their world. The potential for experiencing are closer to the surface compared to other potentials which are deeper. Focus is primarily on ways  people develop the foundation of their lives as it relates to their environment. Meaning is applied to the external world by the person perceiving it   Experiential theory teaches that the  external world is a resource that can be utilized  to identify what is relevant to the person perceiving it.  The person also plays an active role in developing the world that is most important for them to experience. The fact that people play an active role in creating their external world, means they essentially build and organize the resource from which they extract experiences. Experiential theory follows that the external world represents  externalization of the person’s own deeper potential and interests.  One’s healthy and balanced existence hedges on their ability to create an external world that  provides and equal  degree of experiences and relationship s that are both integrative-good and disintegrative-bad but not too much of either. One fundamental treatment method common of experiential theory is motivational interviewing.

Motivational Interviewing involves motivation as a core step to a successful change process: The short term goal of Motivational Interviewing is to identify discrepancies between objectives or desires of individuals and their behavior. This process is often referred to as the “5 A’s” model. It’s a brief framework for counseling developed specifically for practitioners to create behavioral change in patients. The “5 A’s are 1) Assess for a problem, 2) Advise making a change 3) Agree on action to be taken, 4) Assist with self-care support to make the change and finally 5) Arrange follow-up to support the change. Through these five approaches, patients can be motivated to seek change in their behavior for themselves.  Motivational Interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The result technique was described in a textbook co-written with Steve Rollnick, a South African psychologist working in Wales” (Miller & Rollnick, 1991).The core principle of the approach is negotiation rather than conflict. In Treasure’s 2004 review the historical development of Motivational Interviewing and gave some of the theoretical underpinnings of this approach. Treasure summarized the available evidence on its usefulness and discussed practical details of its implementation, using vignettes to illustrate particular techniques. Motivational Interviewing is noted by USA and Norwegian psychologists as a key therapy method to assist individuals with changing their behavior patterns. Specifically in regards to the method used for people trying to reduce their alcohol use. Janet Treasure note the method entails a process of discovery which “may have been like the technique itself” as it includes “gradual process of listening, reflecting to check understanding, and clarification. Once the form was crystallised it was subjected to a detailed academic analysis. Authors further explained that, “questions concerning what, how, when, why and for whom have been studied”. The approach has been fitted with various theoretical models relating to interpersonal processes and behavior change.  International training has meant that this approach has been widely disseminated and evaluated in a variety of settings.

Motivational interviewing is an example of experiential theory in action because it allows the patient, or patients, to extract value from their own world experiences and essentially initiate their own treatment. Through this method the therapist works more as a guide than an actual participant in the process.  Motivational interviewing incorporates skills like gradual listening, reflection and academic analysis. Patients can be informed of studies on their condition and motivated to question their environment, but for the most part they are in the driver seat of their treatment in regards to interacting with their own world. Engaging patients through ‘questioning, interactive discussion and posing problems where patients can practice role playing in hypothetical clinical scenarios will enhance the thinking and problem solving skills of students (Kan & Stabler-Haas, 2009). The way this fosters problem solving is by putting the students in an environment where they can think outside of the box and visualize situations where they might have to make challenging decisions. These are things that might not come up through textbook reading instruction. This is very different from structural theory or treatment methods commonly utilized within a structural theory therapy method like cognitive behavioral learning.

Structural Theory

On the topic of Structural Theory as it relates to Family Therapy, Arthur, Home, Merle, and Ohlsen note that, “Structural family therapy is a model of treatment based on systems theory that was developed primarily at the Philadelphia Child Guidance Clinic, under the leadership of Salvador Minuchin, over the last 15 years. The model’s distinctive fea­tures are its emphasis on structural change as the main goal of therapy, which ac­quires preeminence over the details of individual change, and the attention paid to the therapist as an active agent in the pro­cess of restructuring the family (Arthur, Home, Merle, and Ohlsen, 1982). The key difference between structural theory and experiential theory can be seen in the fact that structural theory is instructor based and relied primarily on the ability of the instructor or therapist to restructure the family or patient’s environment, while experiential leaves the responsibility to the patient to restructure his own environment and extract meaning. In Beck’s study on cognitive therapy, he notes that cognitive therapy has been supplemented by structural theory “cognitive therapy has been influenced by a variety of theories of psychopathology and the process of therapy. At the theoretical level, it has been primarily influenced by three sources: (1) the phenomenological approach to psychology, (2) structural theory and depth psychology, and (3) cognitive psychology. The “phenomenological” approach to psychology is rooted in Greek Stoic philosophy. It maintains that one’s view of self and one’s personal world largely determine behavior” (Beck, 1989). Cognitive-experiential self-theory (CEST), being a core aspect of structural theory is a psychodynamic theory of personality. The primary focus of CEST is to attain a high level of integration through the combination of the emotional unconscious factors of psychoanalysis, principals of learning theory, the affect-free unconscious of cognitive science, and psycho-dynamic factors. According to CEST, individuals function through two distinct information-processing methods, “a predominantly conscious, verbal, rational system and a predominantly precocious, automatic, experiential, learning system” (Beck, 1989). The two systems are interactive but work based on their own set of rules.

The influence of the experiential system on the rational system can account for everything that the psychoanalytic unconscious can and, unlike the latter, to do so in a manner consistent with evolutionary principles and cognitive science. An extensive research program is described that provides support for many of the assumptions in CEST, including the operating principles of the experiential system and the interaction of the two systems. The implications of the theory are discussed for psychotherapy and psychological research. According to CEST, there are three basic ways in which psychotherapeutic change can occur: by using the rational system to correct the experiential system, by learning directly from emotionally significant experience, and by communicating with the experiential system in its own medium (e.g., fantasy, imagery, metaphor). It is important in research to take into account the two processing systems and their influence on each other, rather than following the more customary procedure of assuming there is a single, unified system.

In the article “CBT & Schizophrenia Special Section: Who Does Not Get Cognitive-Behavioral Therapy for Schizophrenia When Therapy Is Readily Available?” (2006), Kingdon and Kirschen notes on the objective of a study on Cognitive-Behavioral Therapy and its practical use to treat Schizophrenia. The author’s illustrate that there is a well-established evidence base for the practical use of cognitive-behavioral therapy on schizophrenia and its use is recommended in guidelines by the Schizophrenia Patient Outcomes Research Team  based in West Southampton (England) (Kingdon & Kirschen, 2006). The methodology of the study centred on examining data was assessed regarding referral patterns for patients with schizophrenia. The study was set in West Southampton. Each patient in the study evaluated by one of four psychiatrists at the mental health censer providing services to West Southampton (England). Results of Kingdon and Kirschen’s study concluded that out of the 142 patients identified, 69 were referred to a cognitive behavioral therapist program and 73 were not. Patients weren’t referred if they seemed unlikely to engage within the program or they had no clear diagnosis of severe issues related to schizophrenia. The author’s concluded that “in a location where cognitive-behavioral therapy for schizophrenia was readily available, half of all patients were considered appropriate for referral. The author’s further pointed out that CBT was noted to have improved engagement skills and created a more assertive outreach by therapists. He recommends that broader considerations need to be made to bring CBT to a larger group of people.

Conclusion

In sum, the main way I would go about structuring a treatment for patients in a family therapy setting would be to first utilize experiential theory as a form of therapy, through utilizing motivational interviewing methods. I believe this method is superior to structural theory as it has the ability to allow patients to seek their own answers without force-feeding them treatment. As a secondary method I would use structural theory, incorporating cognitive behavioral theory to have more hands on control of severe cases. In regards to very sever cases where addiction and relapse are prevalent, I believe structural theory is essential at providing therapists with more control from the diagnostic stage on through the transition towards actual change. Since those patients suffering from addiction are always at risk of relapse, it would be false to identify either method as a true cure for negative or unwanted behavior in a Family Therapy treatment environment.

References

Arthur M. Horne and Merle M. Ohlsen (1982). Family counseling and Therapy. Itasca, Illinois: F .E .Peacock,.

Beck, A. T., & Weishaar, M. (1989). Cognitive therapy (pp. 21-36). Springer US.

Epstein, S. (2003). Cognitive?experiential self?theory of personality. Handbook of psychology.

J. Sternberg and L. F. Zhang (Eds.) (2000). Perspectives on cognitive, learning, and thinking styles. NJ: Lawrence Erlbaum,.

Shojania, K. G., & Grimshaw, J. M. (2005). Evidence-based quality improvement: the state of the science. Health affairs, 24(1), 138-150.

Kan, E.Z. & Stabler-Haas (2008 ). Fast facts for the clinical nursing instructor. Singer Publishing Company. Retrieved from

Kingdon, D. G., & Kirschen, H. (2006). Special Section: A Memorial Tribute: Who Does Not Get Cognitive-Behavioral Therapy for Schizophrenia When Therapy Is Readily Available?.Psychiatric Services, 57(12), 1792-1794.

Miller, W. & Rollnick, S. (1991) Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York: Guilford Press.

Rector, N. A., & Beck, A. T. (2001). Cognitive behavioral therapy for schizophrenia: an empirical review. The Journal of nervous and mental disease, 189(5), 278-287.

Treasure, J. (2004). Motivational interviewing.Advances in Psychiatric Treatment, 10(5), 331-337.