Theoretical Approaches to Counseling and Therapy

In social work and counseling, different needs of clients brings forth many unique ways to assist clients with various circumstances. A few approaches that may be implemented are ego psychology, behaviorism, cognitive-behaviorism, and crisis intervention. Differences can be found within these four treatment types. The goal is always to help clients attain freedom from the issues holding them back.

Ego psychology involves clinicians reaching into a client's early life experiences to determine how those experiences pertain to their functioning and personality (Rothman & Sager, 1998). If a client's early encounters caused him or her to develop maladaptive defense mechanisms, the client is likely to interact with his or her environment in negative ways (Rothman & Sager, 1998). Maladaptive behavior is harmful to professional identity, can lead to neglect of personal health, and can lead to inadequate behaviors that inhibit the ability to change (Adkins, 2006). The following is an example of one who has developed maladaptive behavior:
Tim suffers from anxiety. He does not eat well, he complains of tension headaches and body aches, and says he cannot sleep. He cannot concentrate well at work. When in public, he thinks everyone is looking at him, and he sweats profusely. Because of his anxiety, he only goes out to work and returns directly home. Avoidance is one of Tim's maladaptive behaviors. By avoiding going out, he is receiving relief from his anxiety.

In intervention, clinicians will assist clients in developing mature defense mechanisms. Clients may practice new defense mechanisms by citing situations they have been enmeshed in, by reflecting on how they have acted in those situations, and then by discovering more productive ways they could interact in similar situations.
A key aspect of intervention is helping people to first acknowledge their defense mechanisms are maladaptive. With support from clinicians, clients can learn how to interact in healthier ways. When clients do not receive adequate nurturing during their formative years, they may benefit from validation clinicians offer (Rothman & Sager, 1998). The goal of intervention is to help clients develop behaviors that will lead to positive interactions and advancement.

Behaviorism is another theoretical approach. Behavioral therapy focuses on behavior that has been learned from experience, but the destructive behavior can be reconditioned without evaluating the past to find the reason behind a client's behaviors (Havoca, 2006). The purpose of the behavioral approach is to decrease undesirable behaviors and to increase behaviors that are desired. Behaviorism deals with problems that are observable and problems in which improvements can be measurable. Whatever the main problem is, the basis for intervention is guided (Rothman & Sager, 1998).

Behavioral therapy, or behavioral modification, is based on observable antecedents, which are events that happen before behaviors are apparent, is based on observable behavior, and is based on consequences (National Youth Network, 2010). In this framework of therapy, the practitioner rearranges the antecedent events by means of stimulus control. Consequences also can be arranged by way of structuring favorable and unfavorable outcomes of behavior (Rothman & Sager, 1998).

Reinforcement theory plays a part in behavioral therapy because it is used to strengthen positive behavior. Positive and negative reinforcement are two types of reinforcement. Positive reinforcement offers pleasant rewards to reinforce good behavior. Negative reinforcement helps strengthen a behavior because a negative result will cease when the client has reacted in the appropriate manner (National Youth Network, 2010). Behavioral therapy is effective with different types of clients such as those with depression, those who want to quit smoking, or people who have phobias or problems with anxiety.

Cognitive-behavioral therapy is a type of psychotherapy that aims to solve problems concerning dysfunctional behaviors, emotions, or cognitions by coming up with a systematic procedure. In most cases, a goal-oriented approach is used so that clients can reprogram the part of the brain that causes them to behave in negative manners. Some clinicians use cognitive restructuring, and other clinicians use exposure therapy. These two methods are intervention techniques that guide clients to an understanding of their situations. The techniques teach them to reformulate to positive frames of mind and think of constructive self statements.

An example of a client who suffers from a cognitive-behavior issue would be one that suffers from depression, has low self esteem, or thinks his or her appearance is not desirable to others. The goal is to help the client achieve the confidence he or she needs to apply what he or she has learned, not only concerning the issue the client was treated for, but for application of new knowledge to other situations that they might encounter in their lives.

A crisis is any situation in which people lose their ability to cope and work through existing problems. Crisis intervention changes how individuals react to a crisis. The goal is to provide tools for the needs of those in crisis so they can return to normality in their daily lives. The reaction people present in crisis situations is diffused using assurance that others undergoing similar circumstances are reacting normally and the reactions are usually temporary. During this elevation of anxiety and stress, individuals are more likely to accept help and guidance to cope with the crisis.

Crisis events leave individuals in a weakened state, allowing different influences. Time is essential in these circumstances. Although employed techniques and approaches can be applied for long-term, short-term is critical in diffusing any destructive behaviors that may be present. Short-term assistance is most beneficial in crisis intervention and includes linking functions allowing for referral to support groups and reinforcement of coping skills.

The theoretical approaches that are applied in crisis intervention vary. The widely used technique for coping strategies is relaxation techniques, including exercise. Journaling has been used for crisis individuals. Journaling encourages individuals to write down their thoughts and reactions to a situation, including feelings and emotions that may arise during reflection. Other approaches appropriate in these situations include cognitive, narrative, cognitive-behavioral therapy, family systems, and experiential/existential therapy. No single theory or practice can be applied to all crisis situations.

Clients are all individuals and have differences among them. Being knowledgeable of different ways to counsel clients gives clinicians and their clients increased success rates. In ego psychology, clients go into their past to overcome current setbacks. In behaviorism and cognitive-behaviorism, the goal is to change and control behavioral issues. Clients are assisted with learning how to stop dysfunctional behaviors. Finally, crisis intervention is aimed at helping those in crisis situations. Case managers, social workers, or counselors need to assess clients and decide the courses of action to follow in each case. Regardless of the situation, clients can be helped by way of ego psychology, behaviorism, cognitive-behaviorism, and crisis intervention, which are all beneficial theoretical approaches.

References

Adkins, R. (2006). Elemental truths, Retrieved from http://elementaltruths.blogspot.com/2006/10/your-own-maladaptive-behavior.html

Havoca (2006). Types of therapy. Retrieved from http://www.havoca.org/Therapy/Therapy%20types.htm

National Youth Network. Behavior Modification-Child behavior problems-out of control teens. Retrieved from http://www.nationalyouth.com/behaviormodification.html

Rothman, J., & Sager, J.S. (1998). Case management: integrating individual and community
practice, 2e. Retrieved from https://ecampus.phoenix.edu/content/eBookLibrary2/content/eReader.aspx