This assignment will first begin by describing and discussing two theories used in counselling. The approaches of Sigmund Freud and the psychodynamic theory and Carl Rogers and the client centred therapy approach will be discussed. From that there will be advantages and disadvantages to both models offered to gain an insight into the type of relationships that can be built within a care setting. Finally, the application of these theories within my workplace which is a residential addiction rehabilitation centre will be examined.
Identify, define and discuss two approaches.
Client centred therapy:
The first theory to be identified is client centred therapy, or is now known as the person centred approach. When defining this approach it is simply put that this approach deals with the idea that a person is good and has the capacity to actualise themselves through a non-directive concept of counselling. The approach follows the idea of the client coming to their own conclusions and answers to the problems they have encountered. According to Mulhauser, (2010) "The person-centered approach views the client as their own best authority on their own experience, and it views the client as being fully capable of fulfilling their own potential for growth". This approach emphasises the importance of listening to the service user, showing empathy and gaining an understanding with the service user through openness and honesty, otherwise known as congruence. In this approach he also championed 'unconditional positive regard'.
The relationship between service user and provider is sometimes distant and carried out in a manner where the service user does not get much of a say, however, Rogers approach lets the service user come to their own conclusions and decisions in a softly approach, over time. It is fair to say that, when a service user feels listened to, he/she gains the confidence and trust to be able to share more and more with the counsellor. Leading on from this, when the carer is showing empathy, the service user begins to feel that he/she is not alone with their problems and that the carer understands the nature of the problem and the possible solutions. All the way through this relationship is unconditional positive regard, meaning that the service user feels un-judged and accepted for who they are and for whatever problems they have in their lives.
This process does take some time as with all relationships, however, whilst working in addiction where Rogerian counselling is widely practised it is easy to see how this strong relationship is built. Nonetheless one must also be very careful not to create a dependency on the counsellor and to empower the service user to negotiate life through coping skills. Also, it may be fair to say that this psychological approach is one that takes into account the psychological needs of a person rather than probing and prodding around in one's head looking for sensory imbalances.
Dr Sigmund Freud is best known today as the godfather of psychoanalysis which is the basis for psychotherapy and is famous for his theory of the conscious and unconscious minds. According to Freud, 'the conscious and unconscious parts of the mind can come into conflict with one another, producing a phenomena called repression (a state where you are unaware of having certain troubling motives, wishes or desires but they influence you negatively just the same). In general, psychodynamic theories suggest that a person must successfully resolve early developmental conflicts (e.g., gaining trust, affection, successful interpersonal relationships, mastering body functions, etc...) in order to overcome repression and achieve psychological health. Psychodynamic Theory is based on the idea that human behaviour and relationships are shaped by conscious and unconscious influences. Psychodynamic therapies focus on resolving the patient's conflicted feelings.
Psychodynamic counselling focuses mainly on past experience rather than on current behaviours and is influenced by object relations theory, meaning that previous relationships can leave traces which affect self-esteem and therefore could result in maladaptive behaviour i.e. depression. In this form of therapy, psycho dynamic therapists may use the depressive's words and behaviours to make their interpretation of where the problem lies and how it can be resolved. Also, they may employ the use of dream analysis and sometimes even hypnosis, however, they do not console themselves to these methods, and they do use other methods such as cognitive behavioural techniques for particular problems. McLeod (2009, p 79) states that "the aim of psychodynamic counselling is to help clients to achieve insight and understanding around the reasons for their problems, and translate this insight into a mature capacity to cope with any future difficulties"
Advantages and disadvantages of both methods:
Freud's psychodynamic therapy for psychological problems was one of the most used treatments across the world and is still a very widely used and pretty effective treatment in the world of psychological problems. One advantage of this approach is that it takes place over long periods of time and sometimes can last years, therefore providing a platform for long term stability and results. The disadvantage to this timeframe is the cost, it can cost from â‚¬60-80 a session and â‚¬45 for medical card holders in Ireland (Waterford counselling and psychotherapy.ie) also, many therapists will operate it on a sliding scale according to your ability to pay. It is a costly method of therapy and therefore is accessible mainly to those who can afford it. Another advantage of psychotherapy is in the idea that it is meant to get the root of the problems in that it goes way back into childhood or into a specific traumatic event, therefore giving the service user time to get to the root of the problem and to work their way to an understanding of the issue. The disadvantage to this is that many people who experienced traumatic events do not want to relive the ordeal or in the event of a child who has been abused they may not want to disclose the perpetrator nor revisit the painful memories.
Another advantage of psychotherapy is that in Ireland it is a stringent training process to qualify as a psychotherapist, it requires years of training, years of supervision and is thought in only the most prestigious universities. On the other hand these factors can be seen as a disadvantage also. Because of the years of training and supervision it can be very stressful and strenuous on the person studying. As well as this, the cost of such lengthy study at these prestigious colleges can run into numerous thousands and to add to these disadvantages, the prestige of these colleges can cast a sense of snobbery over many and discourage many students from applying for such training.
Person centred theory:
Rogers's person centred approach also has many advantages and disadvantages. One of the advantages of the approach is in its accessibility. The counselling approach which is widely called 'Rogerian' counselling is a very commonly used approach especially in addiction rehabilitation. It can also be used in marriage counselling, the rehabilitation of offenders and those who have negative outlooks on life. It is also much cheaper than psychotherapy and can cost as little as â‚¬5 per session (Galway diocesan youth services). Another advantage to person centred therapy is that it focuses mainly on the present and the possible outcomes for the future. It tends not revisit the past too often, therefore easing the anxieties that many people may face when attending counselling. An example of this is evident in addiction as the clients are trying to progress with a brighter outlook for the future instead of staying stuck in the shame and guilt of the past. Nonetheless, this can be a disadvantage as many of the stressors and causes of addiction originate in the past and more often than not, originate in the experiences of childhood, conditioning and sense of the world around the client.
Another advantage of person centred therapy is that it takes into account the social and cultural factors as well as other possible influences involved in the therapy of a client. According to Languani (1997, cited in Palmer and Languani p 141) "A theory needs to take into account its historical antecedents, its prevalent social, religious, economic (and other) conditions, including the objective and subjective states of knowledge which exist in a given society at a specific point in time". This suggests that person centred therapy has the ability to encompass all aspects of the client. The disadvantage to this is that there could be too many influences considered and the counsellor could possibly skirt over the important analysis that psychotherapy such as word association. Also, Languini's above statement lends weight to a suggestion that these factors could serve to weaken the principle of empathy if counsellor and client are from two different cultures, countries, backgrounds or have very different belief systems.
Counselling in the workplace:
Counselling is available in my workplace and it provides major benefits to all involved. The types of counselling used in my workplace is mainly group therapy, however, once a week accredited addiction counsellors visit the centre to work with the clients. The scope of the group therapy is wide. In the first two weeks the clients are introduced to the group therapy and after the second week they will then be introduced to the one to one form of counselling. In describing the scope of the counselling in the centre it is important point out that a number of the staff come from addiction themselves and this provides a basis for empathy and understanding with the client. Although this is not a counselling theory it does help the client to open up to the therapy and feel safe in the knowledge that somebody knows exactly what they are talking about. The scope of the one to one therapy is mainly to cover what is not covered in groups, for example, a disclosure of abuse or the threat to harm themselves or someone else is something that is definitely taken care of by the visiting counsellor.
The visiting counsellors also deal with more of the psychodynamic factors by searching for the causes, stressors and conditioning elements that have affected the client in the past and brought them to this point. The psychodynamic approach has been hugely successful in encouraging the clients to reveal their anxieties within the group and has also been hugely successful in encouraging the clients to seek further help when they leave the centre. The accessibility to counselling is constant as there is usually at least one member of staff with a counselling qualification present. As well as this, the clients who finish the twelve week programme are referred onto counsellors and psychotherapists according to need. What is meant by need is, over the twelve weeks the clients will give lots of information about their past and their problems and their possible solutions. Judgements are then made at the end of the twelve weeks when the counsellors, the facilitators and the clients' feelings, opinions and needs are considered. At that point a collaborative decision is made on where to refer the client.
The potential benefits for clients when using the therapy in the centre are many. To begin with, the clients gain an insight of their own feelings and emotions and begin to learn that feelings and emotions are some of the reasons why they used drugs in the first place; they also learn that these feelings and emotions if identified and expressed correctly can the key to future progress with their drug addiction. McLeod (2005 pp 12-13) explains this insight as "the acquisition of the origins and development of emotional difficulties, leading to an increased capacity to take rational control over feelings and actions". This insight is brought about in the groups and with specific one to one counselling.
The benefit of empowerment is evident in the centre too as there is a structure every day which entails getting up and spending their first half hour on personal hygiene. This includes the cleaning of their bedroom. For many addicts hygiene and cleanliness is far from top of the agenda and for many of those who come into recovery it is a necessary skill that has been lost over time. Further to this, the structure of the whole day includes cooking, cleaning and general house and ground duties when they are required. This process empowers the clients to carry out such duties and become aware of the many responsibilities that are involved in maintaining a home.
Another potential benefit to the clients is the benefit of restitution or making amends for their previous behaviour. Many families can be torn apart by the devastation of the addict's actions and one of the suggestions made to the clients is to make amends with family members. This is facilitated by the centres family support programme. The family support programme helps to bring client and family back together in non-confrontational sessions while advising the family what to expect from the client if they return home. Also, the family are given insights into addiction away from the client to prepare them to help and deal with an addicted family member. To help with making amends the clients are visited twice a week by the Narcotics Anonymous twelve step programme, as part of their twelve steps there is an emphasis on making a list and directly making amends to people they may have caused harm to, although this is not a recognised counselling theory, it encompasses many of the principles involved in Rogerian counselling through empathy, congruence and unconditional positive regard.
Social skills benefits are at the forefront of the centres capabilities. Because the groups live together, share rooms together, cook together and have house meetings together they learn how to be assertive, respectful and considerate. Of course, the first week or two can be chaotic, however it is with the application of doing things together that they begin to learn the skills needed to contribute and participate in society. Aiding this process is the involvement of the staff. All general meal times such as breakfast, dinner and tea are participated in by staff; the staff sit with the clients for these meals and take part in any conversation that is being held. The purpose of this exercise is to hit home the importance of social skills not just at home but also at events.
It can be concluded that the techniques formed by Freud and Rogers can have success in any place there is a need for counselling and it is evident as seen above that they have their limitations as much as they have their uses. In conclusion it is also obvious that while the two theories are very different in application, they are very similar in what they are trying to achieve. The two approaches can complement each other as well as conflict with each other, however the end result is, that when either approach is applied properly the outcome for the client can be hugely positive.
There should be a full time qualified counsellor on site at all times. This would reduce the number of residents leaving after a day or two.
There could be a self help group constructed for the family members to use each other as supports therefore giving opportunities to the families and the client to discuss issues when the twelve week program has concluded. This would be beneficial because the programme ends after twelve weeks so this would mean that they are replacing one support with another.
There should be an allowance made for children who have been affected by the clients behaviour over time, this could come in the form of counselling. This would help to analyse the childs behaviour as a result of addiction and would help to identify if the child needs further psychological help in the future.
There should be one to one counselling afforded to teenagers and older children should the parents or legal guardians request it. This would help to minimise the risk of the child developing addiction themselves and would help teenagers to begin to accept the past behaviours and to understand that their parents are trying to change.
Authorities such as the HSE should allow recognition for centres of charitable status, therefore increasing the chances of referring the clients chances of being referred onto more qualified and specialist help, this in turn would provide a longer term treatment programme for the client.
The centre if afforded some of the above recommendations should be extended to six months treatment because this would increase the chances of the clients staying clean when they leave and it would also allow for their accommodation referrals to be processed by the accommodation providers and the waiting to reduce, therefore allowing them to keep a roof over their head for a little longer.