Therapy

Anchored on Carl Rogers’ theory on the person-centered approach of understanding behavior and applying such an understanding to the “healing” process, the concept of congruence is among the highlights of this renowned theorist’s perspective. It is understood as a concept which usually starts or initiated by the therapist or practitioner and modelled to the client whereby the former displays more of the real person that he/she is and reducing denial of the real struggles or feelings that tend to be kept inside (Smith, 1997; Rogers, 1951).

In the process, the client learns to unveil the real self rather than assume a facade which not only masks the real problems, make the therapeutic relationship increasingly difficult (Rogers, 1959). Rogers probably in his long years of exposure to different clients or patients, found commonality in his interactions that help facilitate better recovery and congruence as modelled by a therapist eventually gained its place in his approach. My list (Roman numeral #I) reflects specifically what I am like and readily present a sketch on my person. There are obvious similarities and the differences are there as well.

I have many characteristics that I wish I have such as what I had just enumerated in the second set of list (II). The reason that there are differences especially the yearning on my part, for instance, to be “less temperamental” spring from the fact that because I am too tired from being dedicated and serious which are manifested in the works I do, I tend to be short-tempered or easily get irritated. In order for this to be attained, the legitimate need to be less serious or work-aholic and have more fun then, is easily understood or acceptable.

This actually portrays a healthy tug of being real and aspiring to be more real to others in more ways than I am at present. Sufficient to say, basing on the idealization of the self by Rogers, I appear to be a congruent person because I gain more insights of who I am. IV. Include an action point that provides details on how you will strive for more congruency between your actual and ideal self. Action Point: There are some “steps” that had been coined by Rogers to put the theory in “action, so to speak. To elaborate, the following are some of the most important things that I will be doing or implementing for a targeted schedule.

– Step 1: I will examine my values; what I cherish and make me thrills are among the things that are found under this step. – Step 2: Start to honour the values that I know are my treasures. – Step 3: I would probably pay attention to my body – such as my physical reaction to the things I don’t want to do but was just forced to do because of what people might think – increases incongruence. Every time I do this, I begin to enhance and increase my ability to say no, or being real especially. Sensing the inner peace and – Step 4.

As much as possible, I will start to remove or minimize encounters or activities leading to incongruence. The more I listen to the inner prodding that the most important things are given priority, and this vantage point becomes a pathway within the person to experience more confidence in expressing the real issues inside of him. The more I check whether what my actions are, no matter how seemingly trivial they may be, the more I’d realize whether the discrepancies do exist and there are perhaps few improvements to narrow the dividing line.

This results to being a contented person, able to fully accept inner failings and realizing that people eventually tend to follow suit. Reference: Rogers, Carl . R. 1951. Client-Centered Counseling, Boston: Houghton-Mifflin. Rogers, Carl . R. 1959. A theory of therapy, personality and interpersonal relationships, as developed in the client-centered framework. In S. Koch (ed. ). Psychology: A study of science. (pp. 184-256). N. Y. : McGraw Hill. Smith, M. K. (1997, 2004) ‘Carl Rogers and informal education’, the Encyclopaedia of informal education. [www. infed. org/thinkers/et-rogers. htm

Behavioral approach is based on the principle of explaining one’s behavior through observation. Through observation an individual is able to mimic the behaviors of others – a process more commonly known as learning. It is further believed that behavior is affected by our environment. Since behavior is learned, it can also be unlearned. This is one of the benefits of the behavioral approach.

Therefore, behavior which is harmful to the society or runs against socially accepted norms may still be unlearned. As for behavior which serves to improve the state of the person, such behavior can be enhanced.

The process of learning and changing a person’s environment are strong tools of behavioral therapists enabling them to address the particular needs of their clients. There are four major aspects of behavior therapy – (1) classical conditioning, (2) operant conditioning, (3) social learning theory, and (4) cognitive behavior therapy. Classical conditioning is the use of significant associations to moderate behavior. Operant conditioning is the use of consequences to alter the condition and form of behavior. Cognitive behavior therapy is based on altering mental processes and behaviors, with the aim of influencing disturbed emotions.

These can be applied in the work because these methods are not culture-specific. In a culturally diverse population, all except the social learning approach can be used for counseling. Social learning theory gives prominence to the reciprocal interactions between an individual’s behavior and the environment. This theory requires that individuals mimic observed actions after undergoing a process of understanding and internalizing the observed behavior. Since people coming from different cultures are exposed to different kinds of accepted behaviors, their internalization and understanding of social norms are also different.

When counseling multi-racial individuals therefore, a view as to the particular culture from which the individuals came from must be taken. References Dayan, P. , Kakade, S. , & Montague, P. R. (2000). Learning and selective attention. Nature Neuroscience 3, 1218 – 1223. Kirsch, I. , Lynn, S. J. , Vigorito, M. & Miller, R. R. (2004). The role of cognition in classical and operant conditioning. Journal of Clinical Psychology 60, 369 – 392. McSweeney, F. K. , Hinson, J. M, & Cannon, C. B. (1996). Sensitization-habituation may occur during op

ADHD is Attention-deficit Hyperactivity Disorder which is a biopsychosocial disorder or neurobehavioral problem characterized by numerous problems including hyperactivity, inattention and impulsivity. These problems pose a lot of difficulties in learning at school, home, at work and in relationships. About 3%-5% of children are affected by this problem out of which 30%-70% continue to show symptoms even to adulthood (Curtis, 2008).

The symptoms associated with ADHD are of three types. One is having attention deficiencies in that the affected person is distracted very easily and also exhibits difficulties focusing on a given task.

Secondly, the patient is prone to doing things before thinking about the consequences or the impacts they would have on themselves and the people around them. For instance, becoming too angry than the situation calls for, laughing or talking too loud, teens and adults may hurriedly make decisions that would impact the rest of their lives negatively like spending money recklessly. The third type of symptom is hyperactivity in which affected children may fidget, run around at inappropriate times or squirm while adults and teens are restless and are unable to enjoy their quiet times or studying (Curtis, 2008).

ADHD causes can be attributed to biological, social, experiential and strong genetic factors. The use of medication for treating this condition is not without serious side effects. By adopting behavioral approaches, the myriad of challenges faced by the affected children such as school failure, school drop out, behavioral disorders, depression, relationship and vocational problems can be significantly reduced and eventually overcome instead of relying on medications which only add more problems by causing serious side effects and whose long term outcome poses a threat to the life of the patient.

Moreover, whether a child is affected by ADHD or not, such problems associated with ADHD may still be evident in psychologically healthy children. This paper will discuss how lack of adequately monitoring and controlling behavioral patterns at early childhood has resulted in many parents branding their children ADHD affected. It will show how behavioral strategies can be used extensively to deal with behavioral problems which may be mistakenly associated ADHD.

Instead of using medications which cause more harm to the children to whom they are prescribed, the paper will justify by use of real and practical examples of other approaches which if well applied would eliminate the harms of relying on medicine. 2. 0 Why medication is not a remedy for treating ADHD Though there are several documented benefits associated with using stimulant medication for treating ADHD, it has not offered a complete remedy due to a number of reasons.

It is first of all worth noting that the side effects caused by this medication impedes its administration on a prolonged basis and secondly no real benefits are accrued from medication for up to 20% of children claimed to be affected by ADHD (Rabiner, 2009). Another thing is that ADHD has primary symptoms in addition to other associated problems which cannot be alleviated by medication and therefore the need for employing other means. In addition, some children and many teenagers are strongly opposed to taking medicine which creates more problems when they are forced to take the medication.

Moreover, management of children behavior can be effectively done even without the use of medication especially when the symptoms are relatively mild. This can be done through strategies such as positive reinforcement and punishment. 2. 1 Side effects of stimulant medications A stimulant is the commonly used type of medication whose action produces a calming effect on the patient. Other medications are non-stimulants and their mode of action differs from that of the stimulants. There are several side effects caused by the use of stimulants in treating ADHD.

The common ones are sleep problems, decreased appetite, irritability, and anxiety in addition to few cases of headaches and stomachaches. There are also other side effects which are less common including some children developing sudden sounds or repetitive movements known as tics and change in personality in which some children appear to be without emotions (nimh. nih. gov, 2009). The US Food and Drug Administration have also warned against possible side effects which though rare may cause fatal consequences. It has pointed that the use of ADHD medication may cause psychiatric or possible cardiovascular problems.

The medication-related psychiatric problems include becoming suspicious without any reason, hallucinations, hearing voices and becoming manic even among patients with no history of psychiatric complications. In addition, atomoxetine as one of ADHD medication has been found to cause increased suicidal thoughts in teenagers and children who take the medication than those who do not take it (nimh. nih. gov, 2009). Other non-medical treatment measures are therefore no doubt necessary to combat ADHD in a more safe, effective and easy way. 3. 0 Behavioral treatment for ADHD

This is also referred to as behavior management or behavior therapy whose basis of operation is pegged to the simple understanding of why children would want to behave or act in a socially acceptable manner. There are three reasons for this one being that children are inclined towards pleasing their parents by doing the right things and through this they feel good about themselves when the parents commend and applaud their positive behavior. This is because children are strongly motivated when the relationship with their parents is positive.

Another reason is that children want to behave well so as to benefit from the positive consequences that rewards and privileges associated with good behavior. The last basic reason is that children would want to avoid the repercussions of acting inappropriately such as being punished. Therefore, behavior therapy endeavors in enhancing the desire to embrace commendable behavior by all children whether affected with ADHD or not in order to please their parents and also to get positive consequences by behaving correctly.

At the same time, inappropriate behavior is suppressed and highly discouraged by creating an environment which guarantees negative consequences after displaying undesirable behavior (Rabiner, 2009). Lack of understanding of this important concept has resulted in many parents making incorrect decisions such as taking their children to psychiatrists who may prescribe medicine for ADHD only to cause health problems to the children who are absolutely normal.

Through the efforts of parents and their children, the tools of this approach can be effectively applied to do away with such predicaments and unwarranted over reliance on medicine since the practicability of the method carries no doubt. There are different tools that are essential for positive behavior outcome to be achieved. 3. 1 Positive Reinforcement This is based on the understanding that children would be motivated to behave positively if by doing this there is a reward or positive consequences to be gained.

This therefore calls for the parent to devise means of increasing the frequency of good behavior by simply offering a reward when the child displays good behavior. The parent ought to be keen on noticing the desired behavior such as putting away toys or playing quietly and not hesitating to comment on the behavior. This approach also entails helping the child to understand what the parent wants him or her to do and ensuring that positive comments or praise is directed to the child every time the behavior occurs.

The logic behind these social rewards is that the desire of the child to behave well is enhanced by realizing that the parents are keen to notice and appreciate them (Rabiner, 2009). This keeps at bay defiant or undesirable behavior for which most may be tempted to contemplate using medicine. Apart from social rewards, tangible rewards are a form of positive reinforcement. Parents should be enthusiastic to give tokens or privileges to children whether affected with ADHD or not every time positive behavior occurs. This enhances compliance and obedience to requests made by parents.

For instance, a parent can explain to a child that each time a request is obeyed, a point is earned. The accumulated points can then be used to obtain a privilege such as access to computer time. 3. 2 Punishing appropriately Punishment is an appropriate strategy to use especially when the behavior is as a result of direct non-compliance or violation of rules. However, punishment cannot be done in solidarity and expect that it will change the long term behavior of children whether ADHD affected or not. Rather, it should always be accompanied with a managing strategy so as to precipitate the anticipated results.

The logic behind punishment is that every time a certain behavior is accompanied with consistent negative consequences, the frequency and intensity with which it will occur over time will diminish and eventually disappear. The child should be made to understand that every time the behavioral expectations are not met, negative consequences are always the result and that bad behavior has absolutely no pay-off. Many parents have failed to apply this important approach resulting in a rise in inappropriate behavior and poor performance in academics by many children.

Due to this kind of reluctance on the side of the parent, many normal children have continuously displayed defiance and many have resulted into using antipsychotic medicine on these children in an effort to curb the problem. Punishment is critical in stopping negative behavior and can take many forms such as reprimands, detention, criticism, extra work, and corporal punishment (kidscoinsproductions. com, n. d). The different forms of punishment should be used interchangeably so that if one fails to give the expected change, a different one is employed.

3. 3 Response cost techniques This refers to different forms of punishment in which the likelihood of losing what has already been earned is determined entirely by the mode of behavior or conduct of a child. Parents with children displaying inappropriate behavior can apply this practical approach to influence their behavior instead of making the conclusion that ADHD is the problem. Its effectiveness is as good as those of giving social and tangible rewards but is especially suitable when used in older children and teens.

An example would be to start by giving the whole token say $5 at the start of the week instead of giving it at the end of the week after the child has behaved as expected. This allowance may be placed somewhere in a transparent vessel and a promise made to the child that as long appropriate behavior is maintained throughout the agreed time period, all the $5. 00 belongs to the child. Whenever the child violates the agreed upon set of rules, a dollar is removed from the vessel and this continues to the end of the week upon which the child gets whatever is remaining (Goldstein, 1999).

This is a good way of making the child work hard to maintain appropriate behavior so as not to lose the already available reward. 3. 4 Special time Children sometimes find themselves having frustrations caused different challenges they face at school or even at home which can easily jeopardize the good relationship between them and their parents. The frustrations can also be caused by mood swings or being disappointed with friends which thus does not mean that they are having ADHD.

These frustrations can create feelings of anger and trigger conflicts which only put the children-parent relationship at risk with the good times completely dwindling if the situation is not strategically contained. With the understanding of how behavior therapy works, parents can capitalize on the natural inclination of children to please their parents when relationships are positive. This calls for the creation of a special time program whose entire focus is mending the badly affected feelings between parent and child.

The parent can allocate at least 30 minutes everyday which is designated “special time” for the child during which the child can choose the desirable activity which must be commensurate with the purpose of the program (Rabiner, 2009). The parent ought not to give commands or ask a lot of questions during this time and the whole focus should be having quality time with the child. The parent should tune into the activity of the child in a complementary and interested manner such that the child will become more motivated to carry on with the activity.

The parent should express the feelings of being pleased by for instance commenting positively on the efforts of the child. With time, the natural inclination to please the parent will find its way in and the child will now focus on doing it right and avoiding anything that would displease the parent. Through this, limit setting and discipline is done with ease. 3. 5 Non-Compliance vs. Incompetence Children whether having ADHD or not may display non-compliance to given rules or instructions and therefore there needs to be effective means of dealing with this problem as early as possible in the life of the child.

The best way to overcome non-compliance is through manipulating and applying different consequences with the most effective being that of negative consequences through different forms of punishment. On the other hand, children who display incompetence for instance in understanding academic concepts in school should be helped through intensive skill building and educational training. Such children should also be allowed to make choices of what activity they feel they are capable of excelling in. This calls for the parents and teachers to be highly observant and assist the children to make the appropriate choices.

This will eliminate the misplaced thoughts in such children that they are incapable of performing which is a source of depression and hopelessness which creates more defiant behavior. Instead of hastening to use medicine with the notion that ADHD has clipped in, such practical approaches are the best since they help avoid the harms associated with using drugs. 4. 0 Conclusion ADHD may be a disorder which is in existence or not but either way, lack of proper use of practical means to ensure sustainable appropriate behavior has resulted in many kids in the US being labeled ADHD-affected.

The consequences of using medication to improve behavior and school performance have only created more problems than solutions which indicate that the right approaches are not yet exploited. Behavioral therapy as opposed to chemotherapy ought to be upheld and strategies like punishment properly used by parents and teachers. Assumptions that all behavioral problems emanate from a mental disorder should not be made. References Curtis, J. (2008). Attention Deficit Hyperactivity Disorder: What It Is and Who Is Affected. Retrieved July 22, 2010, from http://www. health. com/health/condition-article/0,,20251884,00. html Goldstein, S.

(1999). The Facts About ADHD. Retrieved July 22, 2010, from http://www. samgoldstein. com/node/21 kidscoinsproductions. com. (n. d). Designing a Behavioural Modification Program. Retrieved July 22, 2010, from http://www. kidscoinsproductions. com/Research/Behavioural_mgt. htm nimh. nih. gov. (2009). Attention Deficit Hyperactivity Disorder (ADHD). Retrieved July 22, 2010, from http://www. nimh. nih. gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index. shtml Rabiner, D. (2009). Behavioral Treatment for ADHD: An Overview. Retrieved July 22, 2010, from http://www. athealth. com/Consumer/farticles/Rabiner. html

In the essay, “Basic concepts of psychodynamic psychotherapy” I have delved deep into the concept psychodynamic psychotherapists. Who are they? What is their role and how they help emotionally disturbed patients. Freud was the first to formulate the concept psychodynamic psychotherapy and then with the passage of time, many types of therapies have been conceived.

It is based on the simple concept that we all are emotionally related to each other and these emotions may from time to time create disturbances in our daily lives, which we are unable to find out.

Therapists help us to find these problems and give the solutions. But there are certain problems too in the treatment process in the various concepts of Psychodynamic psychotherapy. These problems can arise due to transference, counter-transference, defense and resistance. All in all, this essay will be beneficial for all the people concerned and students of psychotherapy. Introduction: Psychodynamic psychotherapy involves patients to understand their emotional turmoil and effectively deals with them.

It is a therapy provided to the young adults to help them deal with the emotional problems arising out of the depression and anxiety caused due to the relationship problems either with family, peers, friends, or professors. It is a method of verbal communication enabling patients to get relief from emotional pains. People go for psychodynamic psychotherapy for number of reasons like prolonged sadness, anxiety, sexual frustration, physical symptoms without any basis, continuous feelings of isolation and loneliness, and an ardent desire to achieve more success in work and love.

People ask for therapist, as they cannot solve the resolution in the time of their difficulties in their own way. The roots of the concepts psychodynamic psychotherapy had arisen out of the theories and techniques of psychoanalysis. As said by Nancy McWilliams, “Psychoanalytic therapists, including psychoanalysis, are approaches to helping people that derive ultimately from the ideas of Sigmund Freud and his collaborators and his followers”. (McWilliams, 2004, p. 1)

The overall theme of the psychodynamic approach of helping people is based on the simpler premises that the more we are honest with ourselves, the more we have chances of living a better, satisfied and useful life. Psychoanalytical and clinical writing espouses from within our unconscious level those aspects that we have not realized or are not evident and if we are aware of these disavowed aspects, we will get relief from emotional pain and also from the time and energy spent to keep ourselves at unconscious level.

Michael Guy Thompson and the inheritors of Rieff argued that psychoanalysis as a field has adorned an ethic of honesty as a means to achieve therapeutic goals. Thomas Szasz in 2003 defined psychoanalysis as a “moral dialogue, not a medical treatment. ” (McWilliams, 2004, p. 2) Since decades therapists have personified themselves as most honest in their personal analysis with the patients and also fostering the achievements as a result of the same. (McWilliams, 2004) There are differences in the goals of therapy depending on the methods of treatment that could be either expressive or supportive.

Expressive therapy enables the patients to relieve themselves from symptoms through the development of awareness of feelings and thoughts. The therapy is based on the concept that difficulties, which are experienced by the adults have their emergence in childhood; children neither possess the ability of making suitable choices for themselves nor they have an independence to follow the same and the methods that are developed in the childhood are no longer effective during adulthood.

With counselling, adults get to know the ineffective ways they had been adopting and today’s ways of adoption to come out of the various problems and hurdles. Another is supportive therapy, more relevant to give patient immediate relief. Therapist adopts this approach with the previous level of functioning of a person and helps him to strengthen the ways already been adopted by him. While many patients can get benefited from one treatment but in several cases, other therapies may also be involved like family therapy, couple therapy, or group therapy, which could be separately given and also in combination.

Concepts of Psychodynamic psychotherapy Psychodynamic psychotherapy provides a unique model for the mental functioning involving five key concepts, and these are: “Unconscious processes in the mental level; Transference; Counter-transference; Defense and resistance; and the past repeating itself in the present. ” (Yager, Mellman & Rubin, 2005, p. 340) 1. Unconscious processes in the mental level “Unconscious is an adjectival description of areas of mental experience not available to normal awareness”. (McGrath & Margison, 2000) It is the part of the mental process about which we are not aware of.

There could be different levels of unconscious mental activity including our inability to realize what is going on in our mind and secondly partial awareness. Most of the Freud’s writings were based on this unconscious level of mind, which is “a reservoir that contained dynamically repressed contents that were kept out of awareness because they created conflict. ” (Gabbard, 2004, p. 3) Freud’s earlier attempts were his efforts to bring out to surface the unconscious part of our mind for easily identifying the problem and understanding it in a better way.

Freud formulated what is known as the topographical model and the structural model. The topographical model describes the parts of the mind that functions at various levels of consciousness and creates awareness of the same. It reveals and studies the quality that is playing its part in the mental processes rather than function it is playing. On the other hand is the structural model, which delves into the three important parts of the personality i. e.

id, ego and superego and they perform motivational, interactive and executive functions. In the structural model, ego is shown as different from aggressive and sexual drives. Freud explains that, “The conscious part of the ego involves that part of the mind, which performs the function of decision making, integration of perceptual data, and the mental calculation whereas the unconscious part of the ego involves defense mechanisms that are designed to counteract the power instinctual derives harbored in the id”. (Gabbard, 2004, p.

4) Sexuality and aggression are drives requiring deep level defensive efforts from the ego to prevent them from becoming intrusive to the person’s functioning. According to Freud, unconsciousness continues to create an influence on our behavior even though we are unaware about it. For e. g. during one of the clinical trials, I studied the patient’s problem on his communication process. I assumed that the patient’s verbal and nonverbal communication to us was unconsciously organized, and consciously as well as unconsciously had certain meaning.

This meant from his speech and non-verbal behavior, I had to find out the central conflict patient was undergoing through unwillingly organized thoughts, feelings and behaviors in his relation to the persons he was concerned. When I listened to the patient, certain portion of this conflicting tendency in his mental power was quite visible. This could be in the form of phrases, images, nonverbal behaviors etc. These signs help in interpreting the root cause of the problem. After the thorough investigation of the verbal phrase, I interpreted that his focal conflict was related to his phallic competitive wishes.

But it was not clear whether his phallic conflicts were regressive arising from his struggle or he went to an extent of powerful regression towards the sadistic tendency. In other words, it was not clear that his difficulty with phallic competitive feelings toward males had arisen from his feeling of jealousy or looking at them as rivals or his anxiety had arisen due to the sad feelings and his impulses. But one thing that I found was he often felt very anxious and often had a great feeling of anxiety over the affects and that could be created on his impulses by the people he thinks to be rivals.

Psychotherapeutic acts like a friend, and as said by must act like a therapeutic distance or therapeutic neutrality; never treating with any personal desires yet always maintaining the relationship with the patient focusing on the treatment process. 2. Transference Second concept is transference, involving the relationship client feels towards his psychotherapist. It is very natural for the client to experience the feeling of transference, also known as the transference reactions. These feelings are no less than in-depth feelings of love or hate.

Jacques Lacan, a psychoanalyst explains that this love means having a belief or faith in the other, in other words, the other person has knowledge you don’t have. (Wright, 1998) This intense belief on the part of the client can cause problem that should be solved during the process psychotherapeutic treatment. For e. g. these feelings could be mixed feelings of love and hate that can arise out of the relationship problems with parents and they look at therapist with these mixed feelings. In such a situation, there is a need to realize that psychotherapist is only trying to reduce these feelings.

A patient also begins to feel that the psychotherapist has a personal ability to come out of the sense of inner worthlessness and there can be fondness and even sexual attraction with the psychotherapist. This happens as the therapeutic cure comes from the emotional feeling and removes emotional emptiness. It is said if transference is not handled carefully it can lead to disaster consequence. For e. g. many patients have their lives ruined because psychotherapists play with the patients erotic feelings in a personal way and fail to make the client understand that it is the medical treatment.

In many cases transference can also make you frighten putting a stop to the treatment prematurely. For e. g. it was October 18th 2000, I had one patient in my clinic that most of the time got into the fits of anxiety and depression. I lovingly asked him several questions and during the process, I found he had an odd problem with his parents. He acknowledged the fact that his parents loved him but at the same time was always had a feeling of insecurity, anger and confusion towards his parents thinking they didn’t love him as much as they loved their other children.

The first thing about him that came to my mind was he had a craving for love and it was love he needed the most. He was fourteen years old boy with smart and innocent boyish look in his face, with black and blonde hair. So my initial step of treatment started by getting emotionally close to the patient, and I initiated to give the parental care he craved for, understand his differences with his parents and try not to repeat the same mistakes what he felt his parents were doing.

Slowly, his signs of depression began to reduce and he felt more relaxed and tension free. My more and more closeness with him created a situation of transference, as I soon realized he was not able to spend even few minutes of his time without calling me or having a talk with me. He was now looking at me as his saviour and parents. I soon realized this would create a more problem if I leave him, as he could feel sadder and get into more depression. I then called his parents, discussed problem with them and explained them the importance and real meaning of love.

Love means not just fulfilling the responsibilities but also coming close to your child, keeping your hands on his head and saying, “I am with you. ” These are magical words best than the medicine that can reduce the emotional pains and can trigger the self-confidence and faith in others and oneself. I gave his parents some tips to follow and soon they realized it. This was the beginning of new life for my patient as he felt more relaxed, happy and relieved from all the pains and I slowly and slowly made him realize I was only his doctor and had to go.

3. Counter-transference Counter transference is a reverse of the transference. This is described for the reactions and the emotional and unconscious reactions that can be felt by psychotherapist for his client. If these feelings are taken personally then psychotherapist can get into angry bout, abusive, spiteful, indifferent, or even seductive and if the counter-transference gets very deep and intense, then psychotherapist has to stop the treatment himself and get his patient referred to someone else for client’s protection.

Counter-transference should be distinguished from the feelings he generated during the process of treatment, because these feeling are used for treatment. At this point we can say that feelings generated by psychotherapists could be good as well as bad as both the extremity of the emotional feelings can have adverse effect on both the psychotherapist as well as on the part of patient. With the patient I mentioned above, I also began to feel emotional closeness but I controlled my emotions and with some careful analysis of the situation and adopting the balanced approach I dealt with him.

4. Defense and resistance Yet another therapeutic concept needs to be undertaken is defense and resistance. Freud defines resistance as “whatever interrupts the progress of analytic work, like getting late, missing a session, or avoiding a particular issue”. (Fink, 1997, 230) Simply defense and resistance occurs owing to the fear and fear we have to face and relinquish from the anger of the victim. In other words, the treatment task is very complex and frightening and there is often the fear of facing the anger of a patient and overcoming an inclination to lie to yourself.

Nonetheless Lacan said resistance should be distinguished from defense, and gave the statement that “there is no other resistance to analysis than that of the analyst himself. ” (Fink, 1997, p. 225) For e. g. if the psychotherapist makes interpretation or makes intervention, which seemed to be not proper clinically, the client can be defensive and that can cause interruption in the work of therapists. In other words client will only get into the process of treatment when he himself feels comfortable about. The psychotherapist must feel the awareness of the fact that to what extent of the treatment process client is willing to go.

Attempts to forcefully get client deep into the treatment process without getting him emotionally prepared can result in the client getting away from the treatment itself. In my case during the initial visit of the client, he showed reluctance in the treatment process. He often came late from the time schedule and felt hesitant in disclosing. I assured him the best of my treatment and with great patience and slight conversations slowly yet steadily made him come closer to the treatment process. Then I was comfortable with me and he too was finding comfort in the treatment.

5. The past repeating itself in the present In the psychodynamic language, it implies the past experiences of the patient continue to haunt him in the present. This happens with most of the suicidal patients – the past horrible experiences of the patients may continue to haunt him in his unconscious level. This may cause resistance on the part of the patient and treatment may suffer. In the clinical words, the transference to the clinician may have a major impact on the treatment, and counter – transference may also occur in subsequent time duration.

(Gabbard & Allison, 2006) During the treatment period, practitioners have to face this situation and have to look into the patient’s past to bring out the root cause of his present situation and formulate this phase also. This process of integration of the past with the present is very painful thing for patients and in severe cases they can get emotionally disturbed, more depressive, anxious and can be aggressive, but nonetheless it is a temporary phase. I still remember she was nineteen years old and had gone into deep depression.

When I asked about her past life, she entered into deeper state of depression and got completely silent and saddened and scared. I tried to relive her and promised not to ask about her past. She then slowly recovered herself, came back to normal and then after few days told me about her past. The treatment psychodynamic psychotherapy is all about the treatment of caring and love. In number of upheavals in our life, we need someone who can listen to us and care for us and here psychotherapist role starts. They listen to us and strive to give us good hearing and relieve us from emotional pains.

But, finally it is you only who is a healer and psychotherapist is only a guide who can take you on a self-guiding path. . Reference List Busch, F. N. & Milrod,B. L. 2008. Panic-Focused Psychodynamic Psychotherapy. Psychiatric Times. 25 (2). Corradi, R. B. (2006). Psychodynamic Psychotherapy: A Core Conceptual Model and Its Application. Journal of American Academy of Psychoanalysis, 34:93-116. Fink, B. 1997. A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique Harvard University Press. Gabard, G. O. & Allison, S. (2006). Psychodynamic Treatment.

In Robert I. Simon, Robert E. Hales (Eds. ) The American Psychiatric Publishing Textbook of Suicide Assessment and Management: assessing the unpredictable. Arlington, VA: American Psychiatric Publishing, Inc. , 221-234. Gabbard, G. O. (2004) Long-Term Psychodynamic Psychotherapy: A Basic Text. Arlington, VA: American Psychiatric Publishing, Inc. McGrath, G. & Margison, F. (2000) An Introduction to Psychodynamic Psychotherapy: BASIC PSYCHODYNAMIC CONCEPTS I. Retrieved on September 25, 2008 from W. W. W: http://www. geocities. com/nwidp/course/basic1. htm

McWilliams, N. (2004) Psychoanalytic Psychotherapy: A Practitioner’s Guide. New York: Guilford Press. Shervin, H. , Bond, J. A. & Brakel, L. A. W. 1996. Conscious and Unconscious Processes: Psychodynamic, Cognitive, and Neurophysiological Convergences. New York: Guilford Press Wright, Elizabeth. 1998. Psychoanalytic Criticism: A Reappraisal. London & New York: Routledge. Yager,J. Mellman,L. & Rubin, E. 2005. The RRC Mandate for Residency Programs to Demonstrate Psychodynamic Psychotherapy Competency Among Residents: A Debate. Academic Psychiatry, 29:4, p. 339-349.

In the book “Bad Therapy: Master Therapists Share Their Worst Failures” by Jeffrey A Kottler it shows how other therapists use psychotherapy and how the therapists deem certain sessions as bad therapy. When the authors began this work their aim was to create an opportunity by which some of the most prominent therapists in the field could talk about what they considered to be their worst work in order to encourage other practitioners to be more open to admitting their mistakes. The authors are among the 22 therapists who agreed to participate in the project.

The result of the interviews, all conducted over the telephone is this collection of short and very readable accounts. The credentials of the list of contributors to the book are impressive. In the preface the authors explained that they selected the participants because all were prominent and influential, had a body of published work and years of clinical experience. Arnold A. Lazarus, a pioneer of Behavior Therapy is among the writers. Between them, the authors alone have written over 70 books on counseling and psychotherapy. The majority of these therapists are working in a public professional life.

They write books, run training courses, lecture and demonstrate their techniques to large professional audiences. They produce tapes and videos of their work. Throughout the text there are many references to the anxiety stirred by the nature of the subject on which these therapists were asked to reflect this because of the possibility of a lawsuit and laws. Each chapter is a narrative account of the conversation the authors had with the therapist who was asked to talk about incidences in his or her clinical practice which evoked uncomfortable memories, feelings of regret or guilt, or a sense of failure.

Strong emphasis is laid upon what can be learned from the mistakes. I found this and the more general reflections on the theme of what makes therapy bad helpful to me considering a career in the clinical practice. The refreshing honesty of the therapist’s accounts that gave me a sense of the tensions that arise during these sessions, “projecting an image of perfection”, and “stories of miraculous successes” (p. 189) or the “stunning failures” (p. ix). These words made me reflect on the nature of idealization and its opposite, devaluation on what success and failure means in therapy.

It also helped me to reflect on the high expectations we put on ourselves as therapist to train well and to be viewed as doing a good job in the eyes of our clients, peers, trainers and supervisors. There is an uncertainty to what we view as good and what is bad in therapy. Good and bad can become intertwined with emotionally charged meaning along the success-failure road and their use is dependent upon expectations of good techniques or good interpretations. The value of the ordinary human contact with the client can get caught up in an anxiety ridden preoccupation with the right way of doing things.

At the beginning of the book, the authors state that they “tried for a cross section of representative styles and theoretical orientations” (p. x). But none of the 22 contributing therapist practices in the psychodynamic tradition. The therapeutic relationship is known as being important and the interaction between therapist and client is very much the basis of what happens in these accounts but the term “transference” is used only once or twice and not explained.

The term “countertransference” is used in several places and in the context of some exploration of interpersonal dynamics but this is not explained either as a concept or as a useful frame within which to understand what happens in the emotional field between therapist and client. One of the few exceptions occurs in the discussion between the authors and Richard Schwartz (p. 51-52) in which the therapist talks about the importance of noting countertransference thoughts or behaviors, commenting that many therapists do not think about their own emotional responses to their clients.

In several accounts, the therapist was left with a hangover of guilt or regret as a result of the bad therapy practiced. If a detailed exploration of the transference and countertransference dynamics had been possible then I suspect the focus of what was bad might have been shifted from it being a bad technique or an unfortunate intervention or maybe strategy to the kind of understanding that psychoanalytic psychotherapists are more familiar with.

Also the impact of unconscious projection and introjections upon ourselves and our client’s behavior or emotional response, an example was given of this occurrence in the first chapter when the therapist, Kottler, briefly describes how he got mad at a client who would not dump her abusive boyfriend, and told her not to come back because he could not help her and then hoped she received better care elsewhere from another therapist.

If a way of attempting to unravel what happened in this session were to think about the repetitive actions of an explosive situation in the client’s life during the session, the conclusion that this was bad therapy would be different. The kind of understanding that a psychodynamically trained therapist or counselor brings on some of these accounts made gave me a sense of what could happen during a session, such as Jeffrey Kottlers confession to sometimes feeling invisible and irrelevant as part of the personal process he encountered in interviewing the contributors (p.

195). Both authors remarked that the contributors did not “go deeper” (pgs. 195, 197). Neither really explains what they meant by this and I suspect a similar sentiment is felt by many therapists. I felt there was a certain lack of depth and substance to the book because of the absence of consideration of the workings of the unconscious mind. The meaning of “bad therapy” must be deemed by individuals reading the book.

But in the book bad therapy means “In summary, bad therapy occurs when either the client or the therapist is not satisfied with the result and when that outcome can be traced to the therapist’s repeated miscalculations, misjudgments, or mistakes” (p. 198). It would be very interesting to extend this question of what makes for bad therapy by opening a clinically orientated debate among psychodynamic counselors and psychotherapists. What is the difference between bad practice and bad experience in psychotherapy and counseling would be a good question to pose.

Both the therapists and clients may from time to time have a bad experience of each other or of the effects of our words or of feelings which cannot be thought about or adequately contained in a single moment. If we are open enough to be available to receive our client’s projections and be affected by emotions unconsciously intended to be a communication, we will no doubt feel the bad emotions or the mental state being projected. It will be enough to call this countertransference.

If a bad experience is not able to be recognized then transforming the experience into something understandable in terms of the need of the client or even the mental state of the therapist it could become an example of bad therapy. What makes for bad therapy cannot be limited to doubtful strategies or mistimed interpretations or the wrong techniques. We are human in relationship to another and constantly affected by the emotional impact the other has on us if we are not really emotionally present to the client for some reason or if the client is using the therapist to communicate his or her experience of not being responded to emotionally.

The point is that therapists need to find ways of transcending the experience so that it can be understood or changed by being given the benefit of thoughtful reflection. This may be a result of consulting our internal supervisor or of talking with a trusted peer group or external supervisor or consultant. Another related question has to do with the responsibility we take upon ourselves for monitoring and understanding what we call countertransference. In the book the point is made, several times, which we can all too easily label or blame our clients for their bad behavior or resistance or ability to make us feel tired, angry or irritable.

Are we so focused on what the client does to us and on using this as a helpful therapeutic tool that the therapist will lose sight of their own state of mind or emotion which Freud cautions in relation to countertransference may be interfering with therapist’s ability? We need our peer colleagues and supervisors to help monitor therapists state of mind and reactions to their clients so that the ability to enter into the experience of the encounter with the client does not turn into a case of bad practice due to the absence of reflective thinking or insightful monitoring.

I would recommend “Bad Therapy” to both trainees and the more experienced counselors and psychotherapists for its very thought provoking and interesting content as well as the unusual opportunity to gain insight into the mind and emotions of the practitioner at work. Reference: Kottler, J. A. , & Carlson, J. (2003). Bad therapy: Master therapists share their worst failures. New York: Brunner-Routledge.

This assignment is a personal reflective account on the use of solution focused brief therapy (SFBT) carried out during a practice placement within a Crisis and Home Treatment Team (CRHT). This assignment aims to discuss the importance of the 10 Essential Shared Capabilities, introduce clear definitions of SFBT, evaluate current research of SFBT, and provide an evaluation of the key principles of SFBT. I will make a brief comparison of SFBT and traditional psychotherapy.

I will utilise aspects of Gibb’s Model of Reflection (1988) when discussing my own thoughts and feelings in order to critically analyse and evaluate two key features of SFBT interventions used in practice. This will allow me to identify positive aspects of my practice as well as highlighting aspects which need further development. Finally, I will evaluate the theoretical framework underpinning its relevance in current and future practice. De Shazer & Dolan (2007) defined SFBT as “a future focused, goal orientated approach to brief therapy”. Iveson (2002) proposes that SFBT focuses on “solution building rather than problem solving”.

As such, SFBT does not require a detailed history of the past or problem due to its solution focused nature. The client is believed to have the necessary resources to implement changes. Furthermore, Macdonald (2007, p. 7) stipulates that the client has the capacity to use these resources to set their own goals for therapy. In a general sense, psychotherapy aims to aid clients to reach their full potential or to develop better coping mechanisms to deal with their problems. During psychotherapy a client will develop skills to become self aware, change their unhelpful cognitive schemas, and develop insight and empathy (O’Connell, 2005).

Additionally, psychotherapy assumes that, with guidance, each client has the capacity to overcome their discomfort or distress. There is considerable agreement in literature regarding the main characteristics of SFBT (De Shazer & Dolan, 2007; O’Connell, 2005; Lethem, 2002; George, Iveson & Ratner, 1990; Sharry, Darmody & Madden, 2002). It is believed that therapy must convert from focusing on the presenting problem and move towards looking for solutions (O’Connell, 2005). Therefore, the therapist must consider the client’s subjective, individual interpretations of the given problem.

O’Connell (2005) reports that this phenomenon is a result of social constructionism. Social constructionism proposes that client’s theories are created as a result of social interaction and negotiations with peers. As result these theories are fluid, constantly changing with knowledge, and therefore move away from any certainty (McNamee, 2010). For example, Walter & Peller (1994, p. 14) reported that if a therapist was to lead from behind, by allowing a client to talk about their experiences, this would encourage the client to become increasingly aware of aspects of the perceived problem that had previously been disregarded.

Rosenbaum, Hoyt & Talmon (1990) theorised that improvements can be achieved by the change of the smallest aspect in the client’s life, and that it is this smallest, positive, initial step that will inevitably lead to greater improvements for the client. Furthermore, Sharry et al (2002) highlight that it is not possible for a client to experience one emotion all of the time, and that there must be times when the problematic emotion is more or less intense. They stipulate that it is the therapists’ role to determine when the emotion is less severe and encourage the client to do more of these behaviours.

In addition to this, Sharry et al (2002) advise that the therapist should not focus failed solutions or advise the client to continue with behaviours that are problematic. Clients are advocated to actualize their preferred future by implementing small changes that have proved to be positive solutions. The idea of a preferred future is dominant with the SFBT approach. This is seen throughout a SFBT session, from the initial clarification of the client’s goals for therapy to the client being encouraged to describe in detail what their future without their problem would look like by use of the miracle question (De Shazer & Dolan, 2007).

De Shazer & Molnar (1984) advise that is important to be mindful that clients may think they have to do something which they feel is expected of them by the therapist, even though this may not necessarily be right for them. As such, I feel that asking about the client’s preferred future can be a high risk strategy for vulnerable clients as it may initiate a negative response and prolong feelings of hopelessness. There are many similarities of the underlying assumptions of SFBT and other psychotherapies.

For example, the goals for therapy are chosen by the client (O’Connell, 2005). In addition to this, all psychotherapy assumes that the client has the resources they need to implement change (Macdonald, 2007, p. 7). However, the main differences between SFBT and other psychotherapies are that a detailed history is not needed, the perceived problem is not analysed, the treatment process begins within the first session of therapy and that SFBT does not believe a person’s perception is maladjusted or in need of change (O’Connell, 2005).

It is evident that SFBT draws upon numerous therapeutic approaches. I believe SFBT shared a number of theoretical principals with person-centred therapy. Rogers (1951) hypothesised that human’s have an intrinsic ability to self-actualise, which can be seen explicitly in SFBT in identifying the clients strengths and resources (Saunders 1998). In terms of person-centred counselling, the way SFBT highlights these factors is directly facilitating the self- actualization of the client. Furthermore, both theories take an eclectic approach to the client’s situation.

For example, the importance of the whole person in person-centred counselling is associated with the interest in the whole context of a person’s life in SFBT (Iveson, 2002). Hales (1999) describes how person-centred therapy believes that the client is in control of the counselling process and makes judgements about their decisions and experiences; this is seen much more overtly in SFBT as the clients are asked directly their goals for therapy and how they would know that therapy had been worthwhile.

Both approaches provide client-orientated counselling which aims to promote self esteem and coping strategies for the client (Hales, 1999). By employing the underlying principals of SFBT into future training, my practice will remain aligned with the Ten Essential Shared Capabilities (Department of Health, 2004). In particular, SFBT focuses on ‘working in partnership’, ‘identifying people’s needs and strengths’, providing service user care’ and promoting safety and positive risk taking’ (Department of Health, 2004, p.4).

In a literature review, Ferraz & Wellman (2008) emphasise that it is possible to incorporate these essential capabilities into SFBT techniques in current practice. They suggest that SFBT is particularly appropriate when staff have relatively brief contact with clients. SFBT is congruent with these essential capabilities, enabling nurses to develop improved therapeutic relationships with clients, improved communication skills, and a goal orientated approach to recovery (De Shazer & Dolan, 2007).

Whilst there is limited research surrounding SFBT in comparison to other psychotherapies, the evidence base has developed in recent years (Gingerich & Eisengart, 2000). However, much of the initial research was conducted by the pioneers of SFBT, e. g. De Shazer & Molnar (1984) and Kiser (1988), and is therefore likely to be in favour of SFBT. In terms of success rate, Kiser (1988) and Kiser & Nunnally (1990) conducted six month follow up studies which showed an 80% success rate of clients who had received SFBT.

However, these studies can be criticised as only 14.7% clients reported considerable improvements beyond meeting their treatment goals. Much research into the effectiveness of SFBT concludes a success rate which is calculated by a combination of clients who achieved their goals and clients who made significant improvements. Further to this, Macdonald (1994; 1997) argued success rates of 64% at a three year follow up. Moreover, DeJong & Berg (1998) report that SFBT achieves 70% or more success rates for multitude of social and mental health issues, including depression, suicidal ideation, relationship difficulties, domestic violence, and self-esteem.

As such, the underlying principals of SFBT can be applied to the Seven Stage Crisis Intervention Model (R-SSCIM; Roberts, 1991). For example, stage 3 of Roberts’ model (1991) help clients to identify their strengths, resources and past coping skills. This can be achieved through the use of exception and coping questions (O’Connell, 2005). De Shazer & Dolan (2007) expand on this by advising that identifying strengths and resources can help build rapport and trust with the client as the focus is shifted away from short-comings and towards complimenting the client.

During Stages 4 & 5, feelings and emotions are explored, and alternatives are generated and explored (Roberts, 1991). SFBT utilises these stages by acknowledge client’s current experiences and aiding them to create an action plan. The client I chose to utilise SFBT techniques with had an extensive mental health history. He has been known to community services for the past 5 years, and has a diagnosis of major depression. He had been referred to CRHT following deterioration in mood and was expressing suicidal ideation. The client had consented to me using SFBT techniques during a home treatment visit.

I utilised several assessment tools of SFBT including pre-session changes, goal setting, exception seeking and coping questions, miracle question, scaling question, and task setting. I have chosen to reflect on the use of scaling questions and exception seeking questions. O’Connell (2005, p. 35) stipulates that scaling is a technique whereby the therapist asks the client to rate on a scale of zero to ten, where zero is the worst they have felt recently and ten is the best they have felt recently, for a particular issue.

O’Connell (2005, p. 35) goes on to state that scaling can be used to set treatment goals, measure progress, establish priorities, rate the clients motivation, and discover the client’s confidence in resolving their issues. I have chosen to reflect on scaling techniques as I felt confident and noticed my personal strengths but also identified some areas for development. I first introduced scaling with my client when asking about pre-session changes.

I explained the scale to him and asked where he would place himself today and if this was any different from when he had contacted CRHT. I reassured the client by complimenting him for contacting CRHT regarding his mental health. The second time I used scaling questions was following the miracle question. This was to assess whether the client had shown any sessional changes from the score he reported earlier. Finally, I used scaling when amplifying homework tasks. This was to assess whether the client was motivated and confident in achieving these tasks, and whether these tasks would improve the client’s depressive symptoms.

Throughout the home visit, I felt extremely nervous, tense and pressurised because I was also being assessed by my mentor as part of the Direct Observation of a Nursing Activity. I was also aware that the client was at crisis point and was somewhat volatile in mental state. This made me feel inexperienced and very aware that I had limited training in SFBT. Initially, I felt apprehensive at making a mistake or asking the wrong question, and this was clear to the client when I had perplexed the explanation of the scale.

Upon reflection, my emotions affected my performance throughout the intervention; for example, as I became more relaxed I gave a more apparent explanation of the scale for confidence in completing homework tasks. My strengths were that I was able to obtain a baseline of the client’s rating of their mood, affirm sessional changes to mood, and attain a rating of the client’s motivation and confidence in achieving set tasks. I felt the client responded well to the scaling questions as it did not involve him explaining in depth his feelings, but rather focused on how to resolve his current crisis state (De Shazer & Dolan, 2007).

However, I feel my weaknesses lie in the timing of the scaling questions. For example, I introduced the scale near to the start of the home visit and then a further two times during the visit. As a result I felt I had to explain the scale each time I used it. I feel this made the intervention slightly disordered and therefore illogical to the client.

The use of scaling questions following the miracle question was partially inappropriate as the client stated that he had just answered questions regarding his preferred future (i. e. where the client would like to be on the scale) when amplifying the miracle question. In hindsight, I feel that these questions were somewhat unnecessary. In contrast to this, De Shazer & Dolan (2007) stipulate in their G. E. M. S approach that scaling questions should follow the miracle question due to its effectiveness in obtaining measures of where clients would rate themselves today, and their preferred future. Furthermore, O’Connell (2005, p. 52) describes the importance of scaling questions with regard to communication with a client.

He advises that it gives the opportunity for the client to express how they are feeling and eliminates the therapist making assumptions. He argues that scaling provides a comprehensive interpretation of the client’s feelings on a particular issue, with limited scope for individual interpretation. However, there is much research (Chant, Jenkinson, Randle & Russell, 2002; Sumner, 2001) to suggest that communication and interpretation of a client’s feelings is eclectically gained through the practitioner’s emotions, personal development, perception of others, and the circumstances of the interaction.

I feel this is particularly relevant to my performance since my communication was adversely affected initially due to my anxieties and the circumstances of being assessed. This therapeutic intervention provided me with first hand experience of these barriers to communication (Sumner, 2001) and as such I am aware of how my communication is affected by anxiety which in turn impacted on the scaling technique I was using. This issue could be resolved through the use of further reflections and SFBT with other clients.

I feel that utilising SFBT techniques in my future practice will improve my confidence and my ability to concisely deliver explanations of scaling questions as I will no longer feel like a novice. I have also chosen to reflect on the use of exception questions with the client as I feel that I need to expand my current knowledge base of how to carry out these questions effectively in order to develop my skills in SFBT. Macdonald (2007, p. 15) advises that exception seeking questions are particularly useful when clients are feeling hopeless.

I feel this was very relevant to my client as he was somewhat resistant to change initially. However, through the use of these questions my client identified small exceptions where he was able to control improve his low mood, which in turn improved his motivation and confidence in setting small tasks. In this instance, I used exception questions with the intention of demonstrating to the client that his low mood was not occurring all of the time. However, my client was vague and negative in his response. I intended to demonstrate previous enjoyment to the client by focusing on spending time with his family.

I felt very inexperienced and incompetent when using this technique as I struggled initially to achieve my intentions. As a result, I felt very aware that I was being assessed by my mentor, which added to my anxieties. I felt frustrated that my client was unable to identify any positive aspects in his life, but began to relax when he described the pleasure he gains from spending time with his children. I felt positive and confident when my client became facially bright and was laughing when telling personal anecdotes.

De Shazer & Dolan (2007) highlight the difference between previous solutions and exceptions, with exceptions being times when the problem could have occurred but did not. In hindsight, I feel I was searching for previous solutions rather than exceptions. Furthermore, they go to theorise that the role of the therapist to recognise opportunity for exceptions during the session rather than actively seek out opportunities to utilise this technique. Therefore, as a skilled therapist I should be seeking opportunities to amplify exceptions rather than explicitly questioning the client in this way.

Due to my limited training in SFBT I felt like a novice and did not utilise the true nature of exception seeking questions. Following this reflection I am now more aware of the difference between previous solutions and exceptions that De Shazer & Dolan (2007) hypothesised, and how they can both influence the therapeutic intervention. As I gain experience and further develop my knowledge base of SFBT, I feel that I will be able to use exception questions when required rather than expectantly.

In my future practice as a registered mental health nurse, I plan to utilise SFBT techniques with service users, particularly those experiencing relapse, as the use of these tools can provide immediate improvements and allows for a future focused approach rather than problem orientated. I must remain mindful of the barriers that exist in communication (Kiser, Piercy & Lipchink, 1993) and apply this when delivering SFBT techniques. However, De Shazer & Dolan (2007) theorise that scaling is a very effective tool for the client to verbalise their emotions.

Therefore, this could be used in my future practice, particularly when building a therapeutic relationship with clients. In terms of current practice, I have effectively demonstrated the scaling technique within cognitive behavioural therapy; however, I am aware that these two therapies use the scale in different ways. To conclude, this assignment has allowed me to develop my knowledge of the key principals of SFBT, the practical applications, and the limitations of my inexperience when utilising SFBT assessment tools.

I believe SFBT shares many fundamental assumptions with person centred therapy. The underpinning principals are apt for contemporary nursing, particularly as it fits wells with the Ten Essential Shared Capabilities (DoH, 2004). There are some limitations to this approach, such as lack of extensive research (Gingerich & Eisengart, 2000). However, I feel that this approach is appropriate to use with clients who are experiencing mental health difficulties.

Ahmad’s case story presents interesting facts about how he thinks and feels about his situation. He seems to think about his life as something destined to be what it is. Ahmad said that his friends did not make him bad; he was already bad to begin with. This demonstrates a way of thinking with a strong locus of control. He knew why he turned out to be a problem child and he did not blame his friends for his mistakes, crimes and decisions. But he did emphasize that his mother had told him what he was going to be in the future.

As a child, Ahmad may have come to believe in this prophecy which is why he thinks like that. This tells us that Ahmad is capable of thinking logically; he actually did not blame his mother for turning out to be the person he is, but to him his mother was right in saying he was going to be a bad person in the future. Ahmad seems to have the ability to take responsibility for his actions and maybe in this case he can also plan for his future. These are the reasons why Ahmad can benefit with solution focused brief therapy.

Solution focused brief therapy would help Ahmad think about his present situation which he already have done in his case interview. The focus of the therapy is on helping the client recognize his ability to negotiate, plan and act on his desired outcomes of the therapy even in one session. It is important to note that solution focused brief therapy believes that the client is motivated to achieve his goals in therapy, and Ahmad has all the indications that he is motivated.

Moreover, solution focused brief therapy is suitable in cases where the client firmly believes that what he/she is cannot be changed but rather to be able to find the means to move on with their life. For Ahmad, the focus is not on knowing why he became like this but rather to plan for his goals after this therapy. Solution focused brief therapy had been found to work well with all kinds of clients even with children, thus increasing the suitability of the approach to this case. 2. Discuss some of key counseling issues that Ahmad is facing

The key counseling issues that Ahmad is presenting include a poor self-concept, a deterministic sense of where his life is heading and an inadequate relationship with significant others. Ahmad says that he is destined to be a thief just as his father was destined to be a drug addict. This tells us that Ahmad had begun on the path of self-fulfilling prophecy because it was what he always heard from his mother. Moreover, he did not resist this prophecy because it validated his relationship as his father’s son which he might have not known while he was a child.

At the same time, Ahmad seemed to be mostly affected by his mother’s behavior towards him. He even blamed his mother for starting him on smoking when he was in kindergarten. From this statement, it could be surmised that Ahmad’s mother was not very present in his early life, the mother was permissive, did not show any affection or care even when he did not go home for days and beat him when she knew he did something wrong. The attempts of the mother to discipline Ahmad only contributed to the child’s belief that he was not wanted or that he was a bad person.

His poor self-concept was probably developed from what he heard from his mother who to him is the most significant person. These key cousnelling issues are important because it would hinder Ahmad’s chances of realizing his goals in therapy. His self-determinism and poor self-concept may stop him from thinking about his future since he is already a bad person there is nothing that could be done about it. His inadequate relationship with his mother has actually caused his poor self-concept which can be worked on during therapy.

3. Discuss the therapeutic goals and how you would manage the case of Ahmad using your chosen therapeutic approach Solution focused brief therapy relies on three fundamental questions that needs to be asked by the therapist to the client which if done properly can lead to realizations that would help the client reach his goals. The therapist has to trust the client that he would answer the questions and the therapist has to ask the questions in such a way that the client would be able to adequately answer it.

The basic questions include what are client’s hopes for the outcome of the therapy, what would be the client’s life be if these hopes are realized and what have the client been doing now and in the past that would help the client realize his goals. In Ahmad’s case the therapist first asks the question what are his goals in this therapy. Whatever Ahmad’s response be, it would be accepted as valid and real to him and can be established as the desired goals of the therapy. Ahmad’s goals should be placed foremost in the therapeutic relationship.

The therapist can further ask Ahmad what he would feel if he realized this goal, would it make him feel better or not. In this way the client could further examine his goals if it is really what he wanted. The therapist also does not impose his/her own values or beliefs into the client’s goals. After establishing the desired goals of the client, the therapist then can begin asking the second question centering on the preferred situation or kind of life that Ahmad wants to have when his goals are realized.

In this stage of the therapy, the client is asked to elaborate on what his goals would bring him in the future. If his goal is to stop being apprehended then a likely approach would be to ask Ahmad what would his lie become if he does not have to face the police and the court as much, in this way Ahmad would realize a future without the threat of being caught by the police a likely possibility and which he can attain. By discussing the client’s feelings, thoughts and reactions to the desired goal for the future, it becomes more present to Ahmad and become more attainable.

In this part of the therapy, the therapist can ask Ahmad the “magic question”. The magic question had been developed to help the client think more about his/her desired goals. The magic question is phrased as “if you wake up in the morning and all of the things you would want to happen have happened already how you would feel? ” The goal is to be able to help the client realize that there is something after the problem, that there is no need to figure out the solution because occasionally the solution will present itself and the client just have to recognize it.

In Ahmad’s case, the magic question would be “if you wake up in the morning and a miracle had occurred to wipe all your problems, what would be the things you would notice that tells you that a miracle did occur? ” After this elaboration, the therapist then asks Ahmad to describe what he had been doing now or in past that he thinks would likely lead him to his goals. The idea here is to draw out the skills and resources that the client already has in attaining his goals, it focuses more on the strengths of the client rather than his past or his problem behaviors.

The client must be able to make the connection between what he already has done that have worked to help him reach his goal and the therapist can do this by asking the right questions and leading the client to discover for himself what those resources are. Solution focused brief therapy is called brief because sessions would only range from one to six times where significant realization and improvement can already occur. Ahmad is an intelligent person and he may be able to benefit from 2 or 3 sessions just to get his work through his issues with his relationship with his mother.

4. Discuss the limitation challenges and ethical issues you might face in managing this case The limitations of solution focused brief therapy are dependent on the kind of problems and clients that come to the therapy. For example, if the client has substance abuse problems and would actually want to stop being caught by the police as her likely goal, this becomes an ethical dilemma for the counselor since solution focused brief therapy would accept all the goals of the client be it bad or good.

However, a skilled therapist can always lead the client to positive future behaviors rather than dwell on the negative goals of the client. If the goal is to learn how to get away from the authorities, then the therapist has to ask the client what she thinks would lead her to this goal, and naturally the client would say to stop doing bad things. On the other hand, solution focused brief therapy generally work well with logical clients, if the client had a mental illness or a disability and is not capable of making decisions by themselves, then the approach would not work.

Ahmad is clearly logical but a limitation would be that he is already convinced that he is bad and he does not see any problem with it. Solution focused brief therapy is only possible when the client has a clear idea of his problems, and Ahmad clearly does not think that being bad is an issue, he was maybe born to be bad. Solution focused brief therapy also does not allow therapists to change the values, ideas and emotions of the client and working with Ahmad’s concept of his being bad would definitely be a challenge. 5. Discuss the therapeutic technique that you would use this case and discuss the limitation of the technique

Solution focused brief therapy had been borne out of the belief that instead of trying to understand the problem and finding solutions to it, it is more beneficial to focus on the future and the solution to the problem. More importantly, the client often has the resources to solve the problem which can be drawn out by the therapist using magic questions. This approach also says that the past is done with and the client or the therapist cannot do anything to undo it, so it is more worthwhile to focus on the future and the solution to the problem.

The approach is called brief since therapy is initiated only when the client needs to work on a problem and when the client already knows what to do with the problem, then the therapy is terminated, in this case one or two sessions would be sufficient. The limitations of the technique heavily depend on the inability of the client to work past the problem identification stage to the goal identification stage. If the client has difficulty in this area, the therapist can throw questions that lead the client to coping behaviors which also facilitate a clear identification of goals.

Although solution focused brief therapy is simple in theory, it is actually very difficult to apply in real cases since it lacks structure and the therapist must have the presence of mind to stop from delving into the past since it is not relevant to the approach. Person Centered Therapy 1. After reading the story of Ahmad use one approach in counseling that you think might be helpful in managing this case. Explain briefly why you have chosen this approach. Ahmad’s case story is the best candidate for the application of the person centered therapy since Ahmad had issues with his self-concept and this is the forte of person centered therapy.

Ahmad’s poor self-concept that is being a bad person because he was born that way was an acceptance of his mother’s conditional regard for him. He would rather be a bad person because his mother says so and which tells him he is like his father and therefore gain acceptance than to resist the idea of being a bad person and be ignored by his mother. From Ahmad’s narrative, it was obvious that his mother only paid attention to him when he was found to misbehave or when he did something really bad.

Not going home for several days was not bad since his mother according to him trusted him; it was only when his mother knew of his stealing and vandalism that he was punished. To Ahmad, even a negative attention is more important than no attention at all from his mother. The person centered therapy specifically believes that psychological problems or disturbances stem from the inadequacy of unconditional positive regard that the client experiences in his childhood thereby stifling his growth and personal development.

The person centered approach also believes that each one of us has the ability to grow and to achieve our potentials given the right amount and quality of positive regard. 2. Discuss some of key counseling issues that Ahmad is facing Ahmad has already formed his identity and self concept based on other people’s opinion of him, and that is a bad person. He even goes as far as saying that some people are borne to be good or bad and he is one of those who were already bad when they first came to the world. All the experiences he had in his life seemed to affirm this idea which has led to his own acceptance of that self-concept.

Ahmad’s life had probably turned from bad to worse as he got older because he lacked the caring and nurturing relationships that would initiate change in his life. All his life, he had been doing bad things such as smoking in kindergarten, dropping out of school, stealing, leading a pack of boys to commit stress crimes, and yet he does not seem to be bitter about it. Ahmad had come to believe that it is his birthright to be bad, which to the person centered therapist, is a very alarming and poor self-concept.

Another counseling issue that Ahmad needs to work with the therapist is how his relationship with his mother had contributed to his self-concept and that not because his mother sees him as a bad person does not mean that all the people in the world see him as such. 3. Discuss the therapeutic goals and how you would manage the case of Ahmad using your chosen therapeutic approach The person centered approach rests on the principle that when the client experiences the core conditions that are necessary for the therapeutic relationship, he/she will begin to experience change.

The therapy first begins with the therapist establishing a relationship with Ahmad wherein the therapist must let Ahmad feel that he is accepted for who is and what he has done in the past, that Ahmad is a person of worth and that the therapist is there to listen and to understand his experiences. The person centered approach also believes that the client knows his/her problems better than any other person and the focus is not to find solutions or to explore the client’s problems but to provide the necessary core conditions to inspire change in the client.

Thus Ahmad would be asked to return for a regular session, wherein the therapist would make the client feel that he is happy to be with Ahmad, that he listens and empathize with Ahmad, when Ahmad says he does not like being in therapy, the therapist would not be quick to refute any of it but rather accepts that feeling as valid and help Ahmad explore more that feeling without the need for meeting any desired behavior or rules of the therapist.

If Ahmad refuses to talk during therapy, then the therapist must not force him to talk but rather make him feel that even if he does not talk, the therapist still values his effort in coming to the session. The third core condition is congruence which means that the therapist is genuine and honest about his feelings and ideas, this demonstrates to Ahmad that the therapist is transparent and that he does not have to be someone else than himself during their counseling sessions. During each session, the therapist must strive to make Ahmad feel that he is accepted, loved, listened to and welcomed.

In this way, Ahmad would soon trust and realize that the therapist is a real person who is willing to give him attention and care without being anything else other than himself, during sessions the therapist can ask Ahmad questions about his life, his experiences, his goals for the future and his feelings and thoughts which would later on make Ahmad share his dreams and aspirations and maybe on his own begin to act on his plans or change his behaviors because each person is capable of change, of doing good and of becoming better persons.

Hopefully, the quality of the therapist’s relationship with Ahmad makes him realize that he is not a bad person, that he just believed he was because it was what he always heard. 4. Discuss the limitation challenges and ethical issues you might face in managing this case The limitations in using the person centered approach in Ahmad’s case is that he may not have the luxury of time to always come for sessions, he may be in a facility for youth offenders or he may even be imprisoned due to his crimes which would make it impossible for him to work with a therapist.

Although group homes have in-house counselors and Ahmad might be able to work with them. Another challenge is the fact that an accepting and emphatic counselor might instead validate or reinforce Ahmad’s belief that there is nothing wrong with his behavior because he is destined to be bad. In fact, Ahmad may seem to have rationalized his self-concept into saying that bad people naturally do bad things, so if he is a bad person, then it is natural for him to do bad things.

Moreover, there is no way to verify Ahmad’s stories because in this approach the therapist believes and relies on the client’s accounts as being true. 5. Discuss the therapeutic technique that you would use this case and discuss the limitation of the technique The person centered approach believes in the fundamental goodness of all human being, thus no matter how bad a person is, there will always be room for goodness to grow in his person. As such, the therapeutic relationship is established to provide the client with the core conditions necessary fro growth.

Psychological disturbances occur because people do not always receive unconditional positive regard, empathy and genuineness; moreover, the individual comes to accept the positive regard of other people despite its being conditional because it is better to have any kind of attention than no attention at all. This approach also believes that by providing the right nurturing environment the client would become more aware of his thoughts and feelings would be able to understand more of himself and his behaviors.

This approach however is not for everyone, very young children who lack self-awareness, and those who do not want to explore their thoughts and feelings or expose their inner self to other people would not find this approach very useful. The goal of person centered therapy is found its fundamental belief and faith in the person, thus the therapy is also focused on the person’s experiences, beliefs, wishes, feelings and issues which have either prevented him/her from growing into the person that he/she should be.

There are a number of criticisms leveled against person centered approach because it lacks direction and it structure. It depends heavily on the problems that the client brings to the therapy. Another criticism is that if person centered therapy claims that a healthy relationship is more important than the expertise of the therapist then what then the difference of this approach from other approaches is.

However, research although controversial at this point had found that the effectiveness of the therapeutic relationship is strongly associated with the quality of the relationship of the client and the therapist. References de Shazer, S. , Berg, I. , Lipchik, et al. (1986). Brief therapy: Focused solution development. Family Process, 25, 207-221. Mearns, D. & Thorne, B. (1999). Person-Centered Counseling in Action, 2nd ed.. London: Sage.