Thursday, September 14, 2006

Theories and Methods - Gestalt Therapy

Gestalt therapy is based on the premise of each individual taking responsibility for the way they relate to others as well as living as an integrated self. Gestalt therapy is closely related to the concept of perception. The person is thought to consist of the self and the self-image. The self is the creative side that seeks to live life in an integrated fashion. The self-image is a dark side that imposes standards that inhibit growth. Maladaptive behavior is considered to be a lack of integration due to an abandoned self. Four disturbances mark Gestalt thoughts on maladaptive behavior: introjection is an overly compliant state where the client incorporates whole concepts without fully understanding them; projection is the disowning of certain parts of the self and attributing them to others; retroflection is the internalization of actions, thoughts, emotions, etc. that are meant for another; finally, confluence, is the abandonment of boundaries between the self and the environment.

The goal of Gestalt therapy is the integration of a unified self. Gestalt therapists use several techniques to achieve this goal. There is a focus on the here-an-now, questioning is discouraged, clients are encouraged to use “I” language to accept responsibility for their actions, clients further encouraged to claim responsibility using overt language, the use of role-playing and the empty-chair technique are designed to help clients externalize internal conflicts, finally, dreamwork is used to examine parts of the self that may not be fully accepted. Gestalt therapy is best used with clients who have the intelligence and education to withstand some of the confrontive techniques it uses.

For further review: Gestalt Therapy Integrated: Contours of Theory & Practice

Theories and Methods - Jung

Jung proposed that libidinal energy was more a general force than a sexual force. Furthermore, while paying attention to the ideas of the conscious and unconscious, Jung also proposed a personal and collective unconscious. The personal unconscious contains our experiences that were once conscious but are now unconscious. The collective unconscious is a vault of memories that is handed down from one generation to the next.

Archetypes are part of the collective unconscious and play a role in personality development. The most important archetypes include: the self, the persona, the shadow, the anima and the animus. Jung also posited four basic psychological functions of which one is generally in use by the conscious at all times. These four basic functions are: thinking, feeling, sensing and intuiting. For Jung, maladaptive behavior consists of a message from the unconscious that something has gone awry or that a task needs to be completed. Jungian therapists rely on interpretations in order to help people bridge the gap between the conscious and the unconscious in order to resolve conflict. Dreamwork and counter-transference also play significant roles in Jungian Analysis.

Theories and Methods - Adler

Adler, initially a disciple of Freud, parted ways with him to form an approach to individual psychology that was teleological and formulated that a person was largely motivated by future goals. Adler’s theory posits four major concepts. Inferiority feelings develop during childhood as a result of real or perceived weaknesses. Striving for superiority is a person’s tendency to move toward perfect completion. The way a person chooses to compensate for their inferiority and strive for superiority results in their style of life. Furthermore, Adler posits two different styles of life, healthy and mistaken. A healthy style of life is reflected through an optimistic outlook and contribution to the welfare of others. On the other hand, a mistaken style of life is marked by self-centeredness and striving for personal power.

Adler believes that maladaptive behavior is the result of taking on a mistaken style of life. In order to combat this Adler believed that therapists should establish a collaborative relationship with the client, understand their style of life, and help the client reorient their beliefs and goals. Adler proposes six techniques to further enhance this process, which include: the lifestyle investigation, study of dreams, interpretation of resistance and transference, role-playing of desired behaviors, paradoxical intentions, and encouragement and advice.

Theories and Methods - Neo-Freudians

The neo-Freudians are more apt to emphasize the role of interpersonal and social environmental factors in the development of personality. While the theorists disagree on the appropriate time to apply this emphasis they would admit that social factors are the primary determinants of personality.

Karen Horney viewed maladaptive behavior as the result of anxiety directly resulting from a child’s interpersonal relationships. Sullivan proposed that cognitive factors played a role in development. He proposed that maladaptive behavior stems from parataxic distortions which involve the client’s inability to perceive a person in the present, instead they are conceived of as a significant person from the past.

Sullivan also thought of the therapist as a participant/observer and expert in interpersonal relationships. His thoughts were that the more people were aware of their interpersonal relationships, the more healthy they became.

Theories and Methods - Object Relations

Object relations theory shares a similar interest in the early development of personality with Freudian theory. However, object relations is more concerned with the self and object relationship (hence the name) than with unconscious drives.

Margaret Mahler’s theory of development is well-known in object relations. Through this theory she posits four stages of development. First there is normal autism which is an undifferentiated state where the infant is oblivious to the external environment. Second is the symbiotic phase the infant recognizes but does not differentiate between the self and the mother. The third phase is differentiation where the child (7 months) separates the self from the other and begins to recognize the differences inherent in each. Finally, the child (2 years old by now) reaches the stage of integration or rapprochement during which the self and the external object are perceived as independent and can have a relationship with one another.

In order to be healthy the child must move through these four stages and develop a coherent idea of self as apart from the other. If the development of early object relations is stunted then the individual will be unable to render the self and the other appropriately and become fixated on an earlier stage of development. The goals of object relations therapy are to provide support, acceptance and opportunity for the client to view themselves and relate to others in a meaningful way.

For further review: Object Social Work Practice

Theories and Methods - Ego Analysts

The ego analysts also place an emphasis on the development of the ego for personality characteristics; however, they also see development as taking place across the lifespan rather than just in childhood. Ego analysts view maladaptive behavior as the loss of control by or the assimilation of the ego, which allows the id and superego to run rampant. Ego analysts are more apt to focus on the present and on reparenting the individual, though their techniques of analysis do not differ much from Freudian analysis. Finally, ego analysts focus on the development of functional methods of living in a social reality rather than unconscious drives.

Theories and Methods - Defense Mechanisms

This list is not comprehensive but instead offers an overview of the most common defense mechanisms.

Repression – is the most basic of all defense mechanisms, repression occurs when the drives of the id are forced into the unconscious and denied by the individual

Regression – occurs when a person retreats to a safer earlier stage of development

Projection – happens when a person attributes their own unacceptable needs and drives onto another person.

Reaction Formation – occurs when a person avoids a particular instinct by expressing its opposite.

Displacement – is the transfer of an instinctual drive from one target to a less threatening target.

Sublimation – is the acting out of a socially acceptable behavior as a direct reaction to the drive to do something unacceptable

Denial – is the admission of socially unacceptable impulses joined with the inability to attribute them to oneself

Introjection – is the ascribing of another’s thoughts and behaviors to the self in order to better control one’s own thoughts and behaviors.

Rationalization – is the interpretation of behaviors in a manner that makes them appear more rational or logical

Fixation – is the arresting of libidinal energy in an unresolved conflict

Undoing – is the repetition of a behavior in order to undo the effects of a past action.

Theories and Methods - Brief Psychotherapies

Brief psychotherapy has its roots in psychoanalytic therapy but shares some characteristics with crisis interventions. However, brief psychotherapies are more apt to use catharsis, transference and interpretation as part of the therapeutic milieu.

Rather than seeing the client’s anxiety as situational, these therapies see them as pathological. The therapist takes on a participant observer role rather than being an active participant and focuses on the past rather than the current crisis.

For further review: Brief Dynamic Therapy

Theories and Methods - Crisis Intervention

A crisis manifests as an emotional and/or biophysical upset, or as a cognitive disturbance. Crisis treatment is time-limited and uses a here-and-now orientation and the interventions are concrete. Currently, there are thought to be three types of crisis: Situational, Motivational, and Cultural or societal crisis.

Crises tend to move through five stages: the hazardous event, a vulnerable state, precipitating factor, active crisis, and reintegration. Reintegration and a return to a previous level of functioning are the goals of the therapist using crisis intervention techniques.

Finally, there are several things that can be said about the types of interventions and treatment that are indicative of crisis therapy. In this form of therapy interventions are immediate, concentrate on limited goals, and focus on problem solving. Furthermore, the treatment is active and directive, encourages self-reliance, supports the client, is designed to give hope, and enhances self-esteem.

For further review: Essentials of Crisis Counseling and Intervention (Essentials of Mental Health Practice)