INDIVIDUAL THERAPY, THEORETICAL ORIENTATION AND GROUPS

I wrote this post for students and practitioners of psychology/therapy; however, I believe it contains much interesting information for the layperson, especially those interested in psychology and/or philosophy.

INTRODUCTION

The choice of theoretical approach practitioners use in their efforts to conduct the most effective groups raises many questions. How can individual needs be best served? How deep do therapists need to delve into the psyche of clients? What are clients’ level of cognitive functioning? How well can both therapists and clients conceive of and discuss life’s issues and meanings? How important is the need for immediate relief of psychiatric symptoms? What are clients’ and therapists’ strengths and weaknesses? How flexible and integrative are therapists? What length of time are both clients and therapists willing to devote to treatment? What are the resources for treatment? What are the money, social support, education, and development factors? What are clients’ and therapists’ biases?

One of the most important questions, however, is: What are the sources of clients’ problems? Deciding on a group theoretical approach is one of the first steps in the discovery process because focusing on methods of getting at the root causes of clients’ issues can better serve their mental health needs.

THEORETICAL METHODS

To find underlying sources of clients’ dysfunctions clinicians need to look at methods of eliciting information on sources of dysfunction. In focusing on what appears to be the obvious—that clients are people, not pigeons (that is, just laboratory subjects)—it appears imperative clinicians approach clients with those attributes that historically appeal to humans.

Warmth, kindness, caring, and respect all increase the likelihood of engendering positive and productive responses from clients. A humanistic approach needs to be the starting, middle, and ending points in assessment. Combining this general approach with other theoretical approaches can help mental health practitioners elicit more accurate information.

Humanism maintains that clients know the answers to their problems within themselves. However, it is up to therapists to open the door to this cache of knowledge. By encouraging client cooperation and participation, a humanistic approach helps open the door to client-understanding and problem treatment, and helps close it by bringing closure, thereby completing the phases of effective treatment. The humanistic approach is especially valuable because it seems to be effective in building positive relationships with most people, regardless of their differences. Whatever theory is employed in making assessments, it would seem that the method of approaching and implementing those theories depends heavily on incorporating a humanistic approach when conducting groups.

The next layer of discovery appears to lie in examining client behaviors. Behavioral learning theory focuses on what is observable in clients. Behavior is the crust of clients’ psyches. Clinicians can see behavior and measure it—it helps them gain a foothold in understanding clients’ dysfunction. Based on the concept of rewards and punishment, behavioral theory promotes the belief that what can be learned, can be unlearned. But by addressing outward manifestations of dysfunction, can we adequately address the underlying issues? Behavioral theory gives therapists a concrete starting point for effective assessment of individuals’ suitable for groups. However, because outward manifestations are the most superficial aspect of clients’ issues, therapists need to dig deeper to find out what causes these behaviors.

In agreement with social learning theory, mental health practitioners can assess societal and relationally conditioned behaviors that contribute to clients’ dysfunction. By combining both behavioral and social learning theories, practitioners can further enhance their ability to understand clients’ issues and, thereby, their suitability for a particular group. Exploring added dimensions of clients’ worldviews, belief systems, and how they interact resulting in decisions a greater understanding of behavior emerges.

But what is the next step? Do clinicians focus on understanding and changing client behaviors based on their social context or clients’ personal habits or can comprehensive positive change be facilitated by revising clients’ external behaviors alone? Which comes first—the chicken or the egg? In order to understand clients’ outer manifestations, it seems more effective for therapists to focus on clients’ inner world. Part of clients’ inner world consists of the way clients’ think. Therefore, to promote more effective individual suitability for groups, clients’ cognitive functions need to be examined.

Approaching assessment from a cognitive view focuses on thoughts that set up behavior, which in turn helps determine social learning. Cognitive assessment also helps clinicians understand clients’ thoughts that lead to the distressing emotions that usually bring them to therapy in the first place. Therefore, tailoring questions to elicit clients’ thoughts and beliefs leads to more readily available conscious information that facilitates group determination.

According to cognitive theory, therapists can then focus on fostering change in clients’ faulty thinking to facilitate behavioral change. Although many studies seem to indicate that changing thought processes can lead to changes in behaviors, it begs the question: From where do clients’ dysfunctional thinking stem? Are not behaviors external symptoms of deeper issues? Examining sources of cognitive deficits and, therefore, resultant dysfunctional behaviors, takes therapists another step deeper into clients’ psyche.

Once therapists are able to elicit disclosure from clients, they can then apply clients’ thoughts and beliefs to understanding reasons for their behaviors, and help them arrive at a possible diagnosis. Ascertaining a basic understanding of individual client’s issues then promotes better decision-making as to whether or not a particular group will be appropriate for the client.

http://www.mind-mapping.co.uk/make-mind-map.htm

Exploring clients’ philosophies provides a roadmap for challenging faulty thinking. Psychologist and philosopher William James described philosophy as “an unusually stubborn effort to think clearly. (Fulford, et al., 2001, p. 130)” However, clients’ philosophies are often not products of clear thinking. If helping clients think clearly improves clients’ functioning, then the next step in assessment requires understanding their muddy thinking.

An effective understanding of clients’ cognitions requires putting those cognitions into concepts. To help clients answer questions such as, “What does it all mean?”, and “Why did I do that?” practitioners must also be clear about their personal beliefs, philosophies and thinking. Critical thinking is key to paving the way to client-understanding.

An existential approach to individual client assessment can help clinicians sort out how clients’ philosophies affect and motivate them and learn more about their cognitive capabilities. If a penchant for philosophizing and an above average intellect is determined, it may be helpful for that client to participate in a group with an existential framework.

Existentialism is useful for tying environmental, behavioral, cognitive, and affective aspects of clients’ issues together into a cohesive and coherent picture. Without assessing the totality of who clients are, including their philosophies, therapists’ subsequent efforts at effective diagnosis and treatment are significantly hampered.

References by request.