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Active Suggestive Therapy
View of Human Nature
In the world, everyone is unique. They usually differ on the basis of family in which they grew up and the values, culture, unique experiences and the perceptions they have about their circumstances. I agree with the view of Adler that a person's perception of the past and interpretation of early events influence their behaviours (Corey, 2005). According to Albert Ellis, the belief is that we contribute to our own problems and by this way; we interpret events and situations (Corey, 2005). The basic hypothesis of REBT is that our emotions stem mainly from our beliefs, evaluations, interpretations, and reaction to life's situations (Corey, 2005, p. 272).
Behaviour is learned. Cognitive behaviour therapy states that during childhood we learn our irrational beliefs form others (Corey, 2005). As it is learned, so I believe that we can learn new ways of thinking and behaving. All humans have free will. Adler also supports that the concept of a creative force enables people to make their own decisions and develop their own opinions (Oberst & Stewart, 2003). Albert Ellis says that we can learn to control our emotions by avoiding irrational beliefs (Ellis & MacLaren, 2005). I agree with Adler that the people are social, creative and can make their own decisions (Corey, 2005).
I also believe that people also have certain limitations. I believe that biology and genetics play a role in our behaviour and that we are predisposed to some types of mental illnesses. I believe that some forms of depression like extreme anxiety, bipolar disorder and schizophrenia can be the result of genetics or a chemical imbalance in the brain. Arnold Lazarus, the founder of multimodal therapy states that "when any doubts arise about the probable involvement of biological factors, it is imperative to have them investigated" (Lazarus, 1997, p. 28).
I agree with William Glasser that we have basic needs. He stated that we have the need for survival, love and belonging, power and achievement, freedom or independence, and fun that drive our lives (Corey, 2005). These needs relate to some of the concepts of Adler. The need for love and belonging goes along with Adler's concept of social interest and community feeling. The need for power and achievement is similar to Adler's concept of striving for significance and superiority.
Multimodal therapy creates interests because of the concept of "technical eclecticism”. It states that the therapist uses a collection of techniques from many approaches and from different theories of therapy (Corey, 2005). I like this approach because Arnold Lazarus's concept of the seven major areas of personality is made up of BASIC ID (Corey, 2005). These are behaviour, affect, sensation, imagery, cognition, interpersonal, and drugs/biology (Lazarus, 1997).
It looks at behaviour and addressing self-defeating actions, emotions and reactions; sensory complaints, such as tension and pain; fantasies and images, flashbacks; the person's attitudes, values, beliefs, and opinions; aspects involving relationship with others; and the health of the individual including medical conditions, sleep, exercise, diet, use of drugs, etc. (Lazarus, 1997). The reason why it appeals to me is that it explores many different aspects of our well-being that can affect our mental health.
This type of therapy appeals to me because it uses concrete tests to simplify the process of therapy and get to the problem in an efficient way. The problem identified in the Multimodal Life History Inventory encourages the therapist and client to focus on specific problems; it helps to set goals for treatment (Lazarus, 1997). The multimodal assessment coincides with my view of human nature, as it "implies that we are social beings who move, feel, sense, imagine, and think, and that at base we are biochemical-neurophysiologic entities" (Lazarus, 1997, p. 3).
This theory is brief and effective, which is very important in today's society with insurance issues. Lazarus states that perhaps one would agree that effective therapy depends far less on the hours you put in than on what you put into those hours" (Lazarus, 1997, p. 6). This theory puts the emphasis on breadth more than depth. This theory applies to the unique needs and problems of the client. Lazarus says, "In my estimation, we need bespoke therapy – methods that are carefully tailored and custom-made" (Lazarus, 1997, p. 16). The multimodal method uses several methods to find out what the problems are and the strategies to find out what treatments fit uniquely with each client. It is very flexible and open.
Multimodal therapy has clear goals for therapy and focuses on current issues. It starts out with an initial interview, after this the client takes the Multi-Modal Life History Inventory and uses it to draw up a Modality Profile that lists the complaints and the areas of treatment that should be addressed (Lazarus, 1997). I like the systemic approach because there is a logical pattern to follow in order to find out the problem. Many therapies spend too much time just trying to figure out the problem, which can increase the number of sessions.
Some aspects of other theories that I would like to integrate when using multimodal and Adlerian therapy include some of the concepts from psychoanalytic therapy, such as ego defense mechanisms and Erickson's psychosocial stages of development. I can see the benefit of exploring defense mechanisms and seeing how they play a role in behaviour. Erickson's stages of development are a good framework for understanding development (Corey, 2005).
REBT therapy is behaviour therapy, as is multimodal therapy. The A-B-C theory of personality is a concept that I would integrate with multimodal therapy. It is a common sense approach to show people how they can change their irrational beliefs into rational belief. It assists clients in recognizing their self-defeating thoughts, particularly the absolutist thoughts, such as the "shoulds," "musts," and "oughts" (Corey, 2005).
With person-centered, I would like to draw on the empathetic relationship aspect of this type of therapy. The use of the concept of unconditional positive self-regard is essential. Adler describes social interest in terms of empathic understanding. Adler sums it by saying, "To see with the eyes of another, to hear with the ears of another, to feel with the heart of another" (Ansbacher & Ansbacher, 1956, p. 135). Reality therapy is a lot like multimodal and Adlerian therapies in that it is directive, active and educational. The five basic needs of survival, i.e. love and belonging, power and achievement, freedom or independence, and fun is something that I would integrate into my own therapy (Corey, 2005).
Some aspects of solution-focused therapy and narrative therapy appeal to me. Solution-focused therapy takes on a positive and optimistic view of the future and looks for what is working. I would use the three questions of solution-focused therapy; the exception question, the miracle question, and the scaling question (Corey, 2005). Narrative therapy is similar to Adler's concept of early recollections. This is a very interesting form of therapy and I would like to learn a lot more about it. I would like to take some of the aspects also of Asian therapy, such as aromatherapy and creating an atmosphere of relaxation.
It is extremely important to consider differences in culture when engaging in therapy with a client. Adler focuses on the person in their environment, allowing exploration of cultural issues. Behaviour therapy's focus is on behaviour rather than feelings, which can be compatible with many cultures (Corey, 2005).
The concepts of Adlerian therapy state about social interest, birth orders and sibling relationships, fictions, and early recollections. Adlerian counselors educate clients in new ways of looking at their lives. The process of therapy used by me would be to foster social interest, which would help the clients to overcome the feelings of discouragement and inferiority, modify their lifestyle, assisting client's in feeling a sense of equality and help people to be contributing members of society (Corey, 2005).
The four phases of the therapeutic process are a part of Adlerian therapy that I would integrate with other methods. These are establishing a proper therapeutic relationship, doing a Lifestyle Assessment, encouragement and insight into purpose, and reorientation and education (Corey, 2005). The Adlerian concept of the five basic mistakes people make developed by Mosak is of interest to me.
These are overgeneralization, false and impossible goals, misperceptions of life and life's demands, denial or minimization of one's worth, and faulty values (Corey, 2005). This is very similar to the core irrational belief concept used in REBT. The core irrational beliefs are "awfulizing" and I-can't-stand its over generalizing, jumping to conclusions, focusing on the negative, disqualifying the positive, minimizing good things, personalizing, phoneyism, and perfectionism (Lazarus, 1997).
The importance of the therapeutic relationship varies among different types of therapy. Some therapies focus on the personal relationship as crucial to therapy while other therapies do not give so much emphasis on the relationship. The importance of the therapist/client relationship in relation to my philosophy is that it is important, but is not the central focus. I agree with Adler's view on joint responsibility between the client and the therapist (Corey, 2005). My focus as a therapist is to engage the client in a learning process and to act as a teacher and consultant. I agree that there needs to be empathy and positive self-regard for the clients who want to change. The relationship needs to be a good working relationship. Encouragement from the therapist is essential.
Two major theories that I am going to discuss in regards of the therapist/client relationship are cognitive behaviour therapy and person-centered therapy. With person-centered therapy, the main focus is on the relationship. It is the primary focus of therapy. "Rogers emphasizes the attitudes and personal characteristics of the therapist and the quality of the client-therapist relationship as the prime determinants of the outcomes of therapy" (Corey, 2005, p.85).
With cognitive behaviour therapy, the therapist functions as a teacher and is highly directive. The relationship is important, but not as important as in the person-centered therapy. The success of cognitive behaviour therapy depends on certain characteristics of the therapist, such as warmth, accurate empathy, nonjudgmental acceptance, trust and rapport with the client (Corey, 2005).
Both theories rely on the concept of unconditional positive self-regard and empathetic listening. "The caring is unconditional; it is not contaminated by evaluation or judgment of the client's feelings, thoughts, and behaviour as good or bad" (Corey, 2005, p. 172). Cognitive therapy describes it as unconditional acceptance. Ellis states that, "In addition to modeling unconditional acceptance for your client, it is vital that you actively teach the theory and practice of unconditional self-acceptance (USA) and unconditional other acceptance (UOA)" (Ellis & MacLaren, 2005, p. 85).
Specific techniques that I would use come from multimodal therapy, REBT, and Adlerian therapy. With multimodal therapy technique, I would use the Multimodal Life History Inventory. The Multimodal Life History Inventory is a 15-page questionnaire used for problem identification and patient history pertaining to the seven major areas of personality, or the BASIC ID, which I described earlier in the paper (Corey, 2005).
I would also use "bridging," which is used when clients do not want to talk about their feelings. "The bridging technique consists of entering the client's preferred mode (cognitions) and then, asking about a different (presumably more neutral) modality (e.g., imagery, or sensations)" (Lazarus, 1997, p. 48). The Marital Satisfaction Questionnaire would be a technique I would use when working with couples, which covers major areas of concern that most couples have. These concerns include communication, sex, money, togetherness, friendship, parenting, etc. (Lazarus, 1997).
Some specific techniques that I would use from REBT are disputing of irrational beliefs which would include the REBT Self-Help Form, humor, rational-emotive imagery, role playing, homework and educational materials. (Corey, 2005). Adlerian techniques I would use are the Lifestyle Assessment, early recollections and "The Question" (Corey, 2005).
I like the concept of "The Question." It is a subjective question of, "How would you like your life to be different, and what would you do differently, if you did not have this symptom or problem" (Corey, 2005). This is very similar to the "miracle question" in solution-focused therapy. Early recollection techniques ask the client to talk about their earliest memories. Early recollections use an assessment tool to see how clients feel about themselves and others, in order to discover the client's strengths and assets (Corey, 2005).
In contrast, cognitive behavioural techniques focus on tailoring the therapy to suit the individual and focus on changing the thinking patterns and behaviour of the client. There are several techniques available to use with this theory. With existential therapy and person-centered therapy, very few techniques are used. A history of the client, questioning and probing, and testing are not used in person-centered therapy or existential therapy, whereas in cognitive therapy it is the basis for the therapy. Existential therapy does not appeal to me because it is not technique oriented and there is a lack of direction from the counselor.
As far as similarities between the person-centered technique and cognitive behaviour therapy are concerned, I really do not see any. They are completely different types of therapies.
As far as my strengths as a therapist are concerned, I am very insightful and in tune with how people are feeling. I am not afraid to be myself as a therapist. Realizing my imperfections, I do not feel that I need to be perfect in my style of counseling. Trustworthiness is essential to me regarding my role as a therapist. Listening is one of my strong points. Realizing my limitations and accepting the fact that I will not be able to help every client or get along with every client, it is important that I refer them to seek help from another counselor. Boundaries are crucial in the therapy setting. Taking on the responsibility of the client's obligation is something that I would be very aware of and try to avoid.
Something that I would like to add to my role as a therapist and something that I feel very strongly about is the role of spirituality. Incorporating client's religious and spiritual beliefs in the counseling process is important, and I feel it needs to be addressed.
Regarding my limitations as a therapist, I tend to give people advice and I need to be careful with this. It will be difficult for me to deal with certain types of clients. I would not be able to work with sex offenders, pedophiles, abusive men or severely mentally ill patients. Helping people who do not want to be helped is also a difficult issue for me. I would need to learn some techniques on how to deal with this problem. At times, I like to tell my own story and share my own experiences in an attempt to show others how my experiences have affected me. Getting off track in thinking that this would be helpful to the client is something I need to be aware of. I still question my ability as a counselor and feel I have not had enough classes to make this judgment yet.
In concluding the paper, I realize the importance of trying to find my own unique style. Finding what fits with my personality and what I feel comfortable with is a thing that will make me a competent therapist. Cognitive behavioural therapy (multimodal and REBT) and Adlerian therapy are concepts I want to work with, and I would like to do more reading and research into these theories in order to learn more about the processes and techniques used. Learning about the variety of theories, the techniques used, the goals of therapy and view of human nature has really opened my eyes to the vast amount of information about the theories of psychology.
The reason I called my theory active suggestive therapy is that I want to take an active role as a therapist and make therapy a learning process. I would like to make suggestions to clients on how they can deal with their problems and offer concrete ways of learning that they can apply outside of therapy. Some would say that suggestions would be giving advice, but I feel that it would be beneficial to some clients. The suggestions are presented in a way as to make the client feel responsible and active in coming up with a plan on how to use the suggestions given.
This class has given me a well-rounded view of the theory and practice of counseling and psychotherapy.
Ansbacher, H. L. & Ansbacher, R. R. (1956). The Individual Psychology of Alfred Adler. New York: Harper Perennial.
Corey, G. (2005). Student Manual: Theory and Practice of Counseling & Psychotherapy (7th Edition, p. 85). California: Brooks/Cole
Corey, G. (2005). Theory and Practice of Counseling & Psychotherapy (7th ed.). California: Brooks/Cole.
Ellis, A. & MacLaren, C. (2005). Rational Emotive Behaviour Therapy: A Therapist's Guide (2nd Edition). California: Impact Publishers.
Lazarus, A. A. (1997). Brief but Comprehensive Psychotherapy: The Multimodal Way. New York: Springer Publishing Company.
Oberst, U. E. & Stewart, A. E. (2003). Adlerian Psychology: An Advanced Approach Individual Psychology. New York: Routeledge.