Psychoanalysis/Psychodynamic Counseling PDF

Psychoanalysis/ UNIT 1 PSYCHOANALYSIS/ Psychodynamic Counseling PSYCHODYNAMIC COUNSELING Structure 1.0 Introduction 1.1 O...

Psychoanalysis/ UNIT 1 PSYCHOANALYSIS/ Psychodynamic Counseling PSYCHODYNAMIC COUNSELING Structure 1.0 Introduction 1.1 Objectives 1.2 Psychodynamic / Psychoanalysis 1.2.1 Freud and Psychoanalysis 1.2.2 Freud’s Theory of Personality 1.2.3 Origin of Psychodynamics 1.2.4 History of Psychodynamics 1.3 Meaning of Psychodynamics 1.3.1 Definition of Psychodynamics 1.3.2 Freudian Psychodynamics 1.3.3 Jungian Psychodynamics 1.3.4 Meaning of Psychodynamic Counseling 1.3.5 Meaning of Psychodynamic Theory 1.3.6 Psychological Counseling 1.3.7 Definition of Professional Counseling 1.3.8 Counseling and Psychotherapy 1.3.9 Classification of Counseling 1.3.10 Goals of Counseling 1.3.11 Principles of Counseling 1.3.12 Steps in Counseling 1.4 The Situation in Which Counseling is Required 1.5 Let Us Sum Up 1.6 Unit End Questions 1.7 Suggested Readings 1.0 INTRODUCTION Psychodynamic therapy (or Psychoanalytic Psychotherapy as it is sometimes called) is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Like psychoanalysis, Psychoanalytic Psychotherapy uses the basic assumption that everyone has an unconscious mind (this is sometimes called the subconscious), and that feelings held in the unconscious mind are often too painful to be faced. Thus we come up with defenses to protect us knowing about these painful feelings. An example of one of these defenses is called denial, which you may have already come across. Psychodynamic therapy assumes that these defenses have gone wrong and are causing more harm than good that is why you have needed to seek help. It tries to unravel them, as once again, it is assumed that once you are aware of what is really going on in your mind the feelings will not be as painful. 5 Psychological Interventions: Psychodynamic psychotherapy takes as its roots the work of Freud (who most Major Modalities people have heard of) and Melanie Klien (who developed the work with children) and Jung (who was a pupil of Freud’s yet broke away to develop his own theories). Psychodynamics takes the approach that our past affects our present. Those who forget history are doomed to repeat it, and this is the same for an individual. Though we may repress very early experiences (thus we do not remember them), the theory is that the “Id” never forgets the experiences. As a child if we had been rewarded with sweets, even today when matured and grown up we reach out for the tub of ice cream whenever we are depressed and we want cheering up. 1.1 OBJECTIVES On successful completion of this unit, you will be able to: Describe the origin and evolution of Psychoanalysis; Describe the origin and meaning of Psychoanalysis; Define Psychoanalysis/Psychodynamics; Define and understand counseling; Understand Psychological counseling and its requirement; and Explain the use of Psychoanalytic/Psychodynamic counseling. 1.2 PSYCHODYNAMIC / PSYCHOANALYSIS 1.2.1 Freud and Psychoanalysis Sigmund Freud, a Viennese neurologist (1856-1939), is clearly one of the most influential writers of the twentieth century, admired for his wit, intellect, and willingness to revise and improve his theories as his clinical experience grew. Freud began his practice at a time when there were fewer effective from of treatment in most fields of medicine. Effective treatment generally depends on an understanding of the causes of a disorder, and at that time, although accurate diagnoses could sometimes be made, little was known about the causes of disease, whether physical or mental. A disorder that was particularly common during the late 1800s was hysteria, the presence of physical problems in the absence of any physical causes. Like other well trained neurologists of his time, Freud originally used hypnosis to help his hysterical patients lose their symptoms. Then a friend, Joseph Breuer, told Freud that while under hypnosis one of his patients had recalled and understood the emotional experience that had led to the development of her symptoms, and that her symptos had then disappeared. For a time Freud and Breuer used this method of recapturing memories with some success. However, because some patients were not easy to hypnotize and sometimes the positive effects did not last long. Freud began to develop his method of psychoanalysis, in which the patient recaptures forgotten memories without the use of hypnosis. Freud’s psychoanalytical method made him enormously influential among European clinicians. By the time he visited the United States in 1909, his reputation had already spread across the Atlantic. 6 1.2.2 Freud’s Theory of Personality Psychoanalysis/ Psychodynamic Counseling Freud’s theory of personality may seem complicated because they incorporate many interlocking factors, but two basic assumptions viz., psychic determinism and the conscious unconscious dimension underlie the theory The principle of psychic determinism states that all behaviour, whether overt (e.g. a muscle movement) or covert (eg., a thought), is caused or determined by prior mental events. The outside world and the private psychic life of the individual combine to determine all aspects of behaviour. As a clinical practitioner, Freud sought to modify unwanted behaviour by identifying and eliminating its psychic determinants. Freud assumed that mental events such as thoughts and fantasies varied in the ease with which they come to the individual’s awareness. For example, aspects of mental life that are currently in awareness are the conscious. Mental contents that are not currently at the level of awareness but can reach that level fairly easily are the preconscious. Mental contents that can be brought to awareness only with great difficulty are the unconscious. Freud was interested mainly in how these unconscious mental contents could influence overt behaviour. Freud was especially intrigued by thoughts and fantasies that seen to go underground but then reappear at the conscious level. He asserted that the level of intra psychic conflict we a major factor in determining our awareness of particular mental events. According to Freud, the classic example of intra psychic conflict is when a young boy desires to take his father’s place in relation to his mother, but at the same time feel love and affection for his father. Freud believed that the greater the degree of intra psychic conflict, the greater the likelihood that the mental events connected with it would remain unconscious. The more massive the unconscious conflict, the greater the person’s mental events that may remain in the unconscious. The central hypothesis of Freudian psychoanalysis is that human behavior is determined in large part by unconscious motives (Freud, 1961). Our personality and our actions, argued Freud, were in large part determined by thoughts and feelings contained in the unconscious. Repressed content of the unconscious inadvertently slips through into our words or deeds, resulting in what is commonly called as the ‘Freudian slip’. If most activities are governed by the unconscious, the individual may have limited responsibility for his or her actions. Psychoanalytic / psychodynamic practitioners who use this approach tend to view psychological distress as being related to unconscious mental processes (Jacobs, 1998). Freud’s contribution in regard to the mental processes, the unconscious, defense mechanisms etc., have all been developed and expanded by others who were Freud’s students or disciples. Some have followed his basic assumptions, and others have developed more independent approaches. The term “psychodynamic” offers a wider perspective, which encompasses the different analytical approaches. As Jacobs (1998) suggested, psychodynamic implies that the psyche (mind/emotions/ spirit/self) is active, not static. These internal mental processes are dynamic forces that influence our relations with others. The structural concept of Freud’s theory of personality consisted of the id, ego, and superego. The id consists of everything present at birth, including instincts. The ego is the executive of the personality, because it controls the gateways to action, selects the features of the environment to which it will respond, and decides which needs will be satisfied and in which order. The superego is the internalised representative of the traditional values, ideals, and moral standards of society and the super ego strives for perfection. 7 Psychological Interventions: Under the pressure of excessive anxiety, the ego is forced to take extreme measures Major Modalities to relieve the pressure. These measures are called defense mechanisms, because they defend the ego against anxiety. The principal defenses are repression, projection, reaction formation, intellectualisation, denial, rationalisation, displacement, and regression. These defense mechanisms have crept into contemporary therapy as denial and regression. Hence, someone is in denial because they are unable to accept a tragic event as having occurred and keep on stating that it had not occurred. Or to take another example, a child regresses to a previous developmental stage as a way of dealing with a tragic death. In general, Psychodynamics, also known as dynamic psychology, is the study of interrelationship of various parts of the mind, personality, or psyche as they relate to mental, emotional, or motivational forces especially at the unconscious level. The mental forces involved in Psychodynamics are often divided into two parts a) Interaction of emotional forces: the interaction of the emotional and motivational forces that affect behaviour and mental states, especially on a subconscious level; b) Inner forces affecting behaviour: the study of the emotional and motivational forces that affect behaviour and states of mind; Freud proposed that psychological energy was constant (hence, emotional changes consisted only in displacements) and that it ended to rest (point attractor) through discharge (catharsis). In mate selection psychology, psychodynamics is defined as the study of the forces, motives and energy generated by the deepest of human needs. 1.2.3 Origin of Psychodynamics The original concept of “psychodynamics” was developed by Sigmund Freud. Freud suggested that psychological processes are flows of psychological energy in a complex brain, establishing “psychodynamics” on the basis of psychological energy, which he referred to as the libido. In general, psychodynamics studies the transformations and exchanges of “psychic energy” within the personality. A focus in psychodynamics is the connection between the energetics of emotional states in the id, ego and superego as they relate to early childhood developments and processes. At the heart of psychological processes, according to Freud, is the ego, which is envisioned as battling with three forces, viz., the id, the superego and the outside world. Hence, the basic psychodynamic model focuses on the dynamic interactions between the id, ego and superego. Psychodynamics, subsequently, attempts to explain or interpret behaviour or mental states in terms of innate emotional forces or processes. 1.2.4 History of Psychodynamics Psychodynamics was initially developed by Sigmund Freud, Carl Jung, Alfred Adler and Melanie Klein. By the mid 1940s and into the 1950s, the general application of the “psychodynamics theory” had been well established. In his 1988 book “Introduction to psychodynamics – a New Synthesis”, psychiatrist Mardi J. Horowitz states that his own interest and fascination with psychodynamics 8 began during the 1950s, when he heard Ralph Greenson, a popular local psychoanalyst who spoke to the public on topics such as “People who hate”, and also his speeches Psychoanalysis/ Psychodynamic on the radio at UCLA. In his radio discussion, according to Horowitz, he ‘vividly Counseling described neurotic behaviour and unconscious mental processes and linked psychodynamics theory directly to everyday life. In the 1950s, American psychiatrist Eric Berne built on Freud’s psychodynamic model, particularly that of the “ego states”, to develop a psychology of human interactions called transactional analysis which, according to physician James R. Allen, is a “Cognitive behavioural approach to treatment and that it is a very effective way of dealing with internal models of self and others as well as other psychodynamic issues.” The theory was popularized in the 1964 book “Games people Play”. 1.3 MEANING OF PSYCHODYNAMICS 1) Psychodynamics is the systematic study and theory of the psychological forces that underlie human behaviour, emphasising the interplay between unconscious and conscious motivation. 2) The psychology of mental or emotional forces or processes developing especially in early childhood and their effects on behavior and mental states. 3) Explanation or interpretation, as of behaviour or mental states, in terms of mental or emotional forces or processes. 4) Motivational forces acting especially at the unconscious level. 1.3.1 Definition of Psychodynamics According to the American psychologist Calvin S. Hall, from his 1954 “Primer in Freudian psychology”, the definition of psychodynamics is as given below: “A dynamic psychology is one that studies the transformations and exchanges of energy within the personality.” This was Freud’s greatest achievement and as one of the greatest achievements in modern science, it is certainly crucial in the history of psychology. In 1930s, Freud’s daughter Anna Freud began to apply Freud’s psychodynamic theories of the “ego” to the study of parent child attachment and especially deprivation and in doing so developed ego psychology. 1.3.2 Freudian Psychodynamics According to Freud, the ego is seen as battling with three forces, the id, the super ego and the outside world. In his writings about the “engines of human behaviour”, Freud used the German word “Id” a word that can be translated into English as either instinct or drive. 1.3.3 Jungian Psychodynamics A Swiss psychiatrist Carl Jung’s in his first book, published in the year 1907, entitled, “Psychology of dementia praecox”, upheld the Freudian psychodynamic view point, although with some reservation. Carl Jung’s contribution in psychodynamics psychology includes the following: 1) The psyche tends toward wholeness. 2) The self is composed of the ego, the personal unconscious, the collective unconscious,and the archetypes. 9 Psychological Interventions: 3) Archetypes are composed of dynamic tensions and arise spontaneously in the Major Modalities individual and collective psyche. Archetypes are autonomous energies common to the human species. They give the psyche its dynamic properties and help organise it. 4) The transcendent function: the emergence of the third resolves the split between dynamic polar tensions within the archetypal structure. 5) The recognition of the spiritual dimension of the human psyche. 6) Recognition of the multiplicity of psyche and psychic life. Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Like psychoanalysis, psychodynamic psychotherapy uses the basic assumption that everyone has an unconscious mind, and that feeling held in the unconscious mind are often too painful to be faced. Thus we come up with defenses to protect us from becoming aware of these painful feelings. Psychodynamic therapy assumes that these defenses have gone wrong and are causing more harm than good that is why you have needed to seek help. It tries to unravel them, as once again. It is assumed that once you are aware of what is really going on in your mind feeding will not be as painful. 1.3.4 Meaning of Psychodynamic Counseling Psychodynamic counseling is based on acceptance, empathy and understanding, with an emphasis on developing a good working alliance that fosters trust. The counselor takes account of the real world of the client, including the impact of trauma, cultural difference, sexual orientation, disability and social context. Psychodynamic counseling places more emphasis on the influence of past experience on the development of current behaviour, mediated in part through unconscious processes. It is influenced by object relations theory, that is, by the idea that previous relationships leave lasting traces which affect self esteem and may result in maladaptive patterns of behaviour. Psychodynamic counseling skills and theory can be valuable in many working and social environments. The insight and understanding about human functions gained from psychoanalytic theory can enhance the life of the counselor as well as the client and can be put to a variety of good uses. 1.3.5 Meaning of Psychodynamic Theory Psychodynamic psychotherapy is derived from psychoanalysis and is based on a number of key analytical concepts. These include Freud’s ideas about psychosexual development, defense mechanisms. Free association as the method of recall, and the therapeutic techniques of interpretation, including that of transference, defenses and dreams. Such therapy usually involves once-weekly 50-minute sessions, the length of treatment varying between 3 months and 2 years. The long-term aim of such therapy is twofold: symptom relief and personality change. Psychodynamic psychotherapy is classically indicated in the treatment of unresolved conflicts in early life, as might be found in non psychotic and personality disorders, but to date there is a lack of convincing evidence concerning its superiority over other forms of treatment. 10 Psychodynamic theory is based on the premise that human behaviour and relationships Psychoanalysis/ Psychodynamic are shaped by conscious and unconscious influences. Counseling Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient’s conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. Psychodynamic counseling places more emphasis on the influence of past experience on the development of current behaviour, mediated in part through unconscious processes. It is influenced by object relations theory, that is, by the idea that previous relationships leave lasting traces which affect self-esteem and may result in maladaptive patterns of behaviour. 1.3.6 Psychological Counseling Counseling is as old as society itself. In every day life, we find, counseling goes on at many levels in a family set up, parents counsel their children, in society doctors counsel patients, lawyers their clients, and teachers their students. There is no limit to the problems on which counseling can be offered nor to the persons who can render this help. Counseling is the core of the guidance program and is considered to be its most intimate and vital part. 1.3.7 Definition of Professional Counseling What counseling is, especially the Professional counseling, in its present form, which is a recent development. Educational institutions, industries and business establishments are becoming increasingly interpersonal in their relationships. It is believed, where no counsel is, the people fall. But in the multitude of counselors, there is safety. No wonder, counseling is being recognised as an important technique of guidance. Counseling has been understood and defined in a number of ways: The Webster’s dictionary defines counseling as “consultation, mutual interchange of opinions, deliverating together.” Wren says, “Counseling is a dynamic and purposeful relationship between two people who approach a mutually defined problem with mutual consideration of each other to the end that the younger or less mature, or more troubled of the two is aided to a self-determined resolution of his problem.” Pepinsky and Pepinsky feel that, “Counseling relationship refers to the interaction which i) occurs between two individuals called “the counsellor” and the “client”, ii) takes place within a professional setting, and iii) is initiated and maintained as a means of facilitating changes in the behaviour of the client. The counseling relationship develops from the interaction between two individuals, one a professionally trained worker and the other a person who seeks his services.” Hahn and MacLean define counseling as “a process which takes place in a one to one relationship between an individual beset by problems with which he cannot cope alone and a professional worker whose training and experience have qualified him to help others reach solutions to various types of personal difficulties.” 11 Psychological Interventions: An analysis of the above view points will reveal the major elements of counseling: Major Modalities Counseling involves two individuals, that is, one seeking help and the other, a professional, trained person, who can help the first. There should be a relationship of mutual respect between the two individuals. The counselor should be friendly and co-operative and the counselee should have trust and confidence in the counselor. The aim of counseling is to a help a students form a decision, make a choice or find a direction at some important fork in the road such as that of planning a life career, a programme in college or university, or a campaign to obtain employment. It helps the counselee acquire independence and develop a sense of responsibility. It helps him explore and utilise his potentialities and actualise himself. It is more than advice giving. The progress comes through the thinking that a person with a problem does for himself rather than through solutions suggested by the counselors. It involves something more than the solution to an immediate problem. Its function is to produce changes in the individual that will enable him to extricate himself from his immediate difficulties. It concerns itself with attitudes as well as action. Emotional rather than purely intellectual attitudes are the raw material of the counseling have their place in the counseling process. But it is the emotionalized feelings which are most important. 1.3.8 Counseling and Psychotherapy Differences between Psychotherapy and Counseling Psychotherapy has roots in Freudian psychodynamics, so that a medical aspect to the training was involved in the past, which lends it an air of respectability. The training period for psychotherapy is long, and involved working with real clients under supervision. The courses in counseling have training shorter and less intensive. Also psychotherapy requires a long period of self analysis. Psychotherapy focuses on in-depth consideration of past issues. As compared to psychotherapy, counseling courses are short, cheaper and more accessible courses and they are very inclusive. Working mothers, part time workers, the unemployed etc can normally find some way to take some form of counseling course. Psychotherapy involves working in greater depth than counseling, that clients see their therapist more frequently and for a long period of time. By contrast counseling takes place over a shorter period of time. Counseling is seen to be about short-term help, and psychotherapy about longer term. The focus in psychotherapy is on the past causes of the issues whereas the focus of counseling is in regard to the present issues. Psychotherapy is concerned with some type of deeper personality change; but counseling is concerned with helping individuals develop their full coping potential in regards to some particular issue. 12 The setting of the treatment in counseling session often takes place in a number of Psychoanalysis/ Psychodynamic non-medical settings such as an office or small therapy centre, or even in the therapists Counseling flat. Where as Psychotherapy is often thought of as taking place in a more medical setting, perhaps a clinic or hospital. Psychotherapy is better for those who find it difficult to open up, Counseling, according to Morgan-Ayers, is a process in which the therapist is there as a ‘tour guide’ for the client, refocusing them in a process that they are otherwise quite good at exploring themselves. Similarities between Psychotherapy and Counseling The aims of both are similar. Both can be seen as an attempt to allow the person to build up resources to live in more healthy, meaningful and satisfying ways, and to develop self awareness. Also a high degree of respect for the autonomy of the client is a basic principle in both counseling and Psychotherapy. Both counseling and psychotherapy involve clear contracts between the therapist and the client as to what the aims are and the roles involved. Both counseling and psychotherapy require the therapist to have highly developed skills. Counseling and psychotherapy are different. Although the psychotherapist uses counseling as one of the techniques of treatment, psychotherapy is usually concerned with individuals whose behavior is neurotic. While it deals with repressed individuals, counseling is concerned with normal anxieties. Psychotherapy operates in a medical setting, whereas counseling operates in an educational environment. The psychotherapist uses play therapy, psychodrama, and socio-drama as techniques. In counseling, such techniques are used as can be employed in educational institutions and individual establishments. Psychotherapy is deeper in scope, whereas counseling has wider implications. A counselor cannot be a psychotherapist, but a psychotherapist being better and specially qualified can be a counselor. 1.3.9 Classification of Counseling Generally, categorisation of counseling is based on the nature and character of situation, age group, community, society, etc. There are so many classification of counseling like students counseling, educational counseling, interpersonal and intra personal counseling, adolescent counseling, social counseling, marriage counseling, pre-marital counseling, counseling related to any kind of behaviour, habits and attitudes, career counseling, counseling related to social problems, industrial counseling, management counseling, counseling of life threatening factors…etc. So the subject of counseling is like big ocean. No definite definition and a single tested approach can be applied for all cases. It is heterogeneous in nature. Every case is different, but approach can be common in most of the cases. Reasons are not same for the same cases. Why? Man is a social animal with variable natures, attitudes, aptitudes, aspirations reactions, different responsive nature. It is different from person to person. So no single approach and solutions can be offered. Every case has to be studied separately and to be dealt carefully with deeper and committed insight. 13 Psychological Interventions: Counseling can thus be classified according to the nature of the problem, the Major Modalities complexity of treatment, and the competence of the counselor. Some writers classify counseling in terms of several factors. Lloyd Jones and Smith, for example, describe various levels of counseling with respect to the depth of the problem, length of contact, degree of need, and the skill of the counselor. At the surface level is the counseling offered when the student wishes only some item of information. The counseling given may be casual; it is brief, and it may be superficial in that it is not extensive or intensive. The need for help is important even though slight, and the relationship maintained through the brief contact should not be less than that maintained during the long counseling session. Counseling at the next level requires a more prolonged contact because the counselee needs more of complicated information. He may, for example, wish assistance in planning a programme of study for a two or a four year period. As the problems become complicated and as an intensive study of the case is required, and more specialised help is needed, counseling at deeper levels becomes necessary. When the student is seriously disturbed, therapeutic counseling may be needed. Williamson feels that counseling is needed not only for helping individuals to gain insight into their emotional conflicts but also for helping them with problems stemming from lack of information, such as information about vocational aptitudes and interests or about work opportunities, so that they may conduct their future adjustments in such a way that a ‘minimum of maladaptive repressions’ occur. 1.3.10 Goals of Counseling Counseling goals may be simply classified in terms of counselor goals and the client goals or the immediate intermediate or long range goals of therapy. Regardless of how one chooses to classify the goals, counseling, like all other meaningful activities, must be goal driven, have a purpose, or seek an objective. Broadly speaking counseling goals may be separated into following categories: Developmental goals wherein client is assisted in meeting his/her anticipated human growth and development. Preventive goals Enhancement goals Remedial goals Exploratory goals Reinforcement goals Cognitive goals Psychological goals Physiological goals 1.3.11 Principles of Counseling Relationship between the counselor and counseling is based on prevalent amount of trust, confidence and openness. Here the counselor will be helping the client to find his existent potentialities. Respect: This is a very important principle of counseling. The counsellor must respect the client and whatever he or she is expressing with concern, respect and 14 understanding. Transparency and understanding in communication: The Counsellor must be Psychoanalysis/ Psychodynamic transparent and must not say something while thinking the opposite. Every attempt Counseling should be made by the counsellor to understand whatever is being expressed by the client with genuine interest and concern. Knowing the counsellor understanding him from his situation: This is yet another important principle. In this the counsellor is expected to know the client completely in terms of the facts gathered during interview and also view him and his problems from the situation that the client faces. Availability: After giving an appointment at a particular time, the counsellor should never miss the appointment. In case there is an emergency and the appointment cannot be kept up, the counsellor must inform the client ahead in advance and apologise for the cancellation. Privacy: Whatever is being told by the client has to be considered as completely private and at no time these information should be conveyed to anyone without the clear permission from the client. Positive approach and recognising client’s potentiality: The counsellor must have a positive approach towards the client and his or her problems and should recognise the potentialities that the client has. Focusing on follow up specifications. Trustworthy and no misrepresentation/ black mail. Constant /regular consultation is essential. 1.3.12 Steps in Counseling The action of transition of theories into action is referred to as counseling process. A process usually specified by a sequence of interaction of steps. Hackney and Cormier (1996) identified the stages as follows: Relation establishment. Problem identification and exploration. Planning for problem solving. Solution application and termination. Self Assessment Questions 1) Psychodynamic counseling places more emphasis on ___________ on the development of current behaviour. 2) Counselor’s goal is to establish a ________ and _______ relationship. 3) Problem identification is main purpose of counseling (True/False). 4) Psychodynamics is a part of psychoanalysis (True/False). 1.4 THE SITUATION IN WHICH COUNSELING IS REQUIRED The following are some of the situations in which counseling is needed: 1) When the student needs not only reliable information but an interested interpretation of such information as meets his own personal difficulties. 15 Psychological Interventions: 2) When the student needs a wise, sympathetic listener with broader experience Major Modalities than his own, to whom he can recount his difficulties and from whom he may gain suggestions regarding his own proposed plan of action. 3) When the counselor has access to facilities for helping in the solution of a students’ problem. 4) When the student is unaware that he has a certain problem but, for his best development, must be aroused to a consciousness of that problem. 5) When the student is aware of a problem and of the strain and difficulty it is causing, but is unable to define and understand it, and is unable to cope with it independently. The Psychoanalytical context, then, reducing tension becomes a major goal of counseling. Because personality conflict is present all people, nearly everyone can benefit from professional counseling. In as much the Psychoanalytical approach requires insights that in turn rely on openness and self disclosure. Psychoanalytic theory usually views the client as a person in need of assistance in restructuring his / her personality. The counselor in the role of expert will facilitate or direct this restructuring. The client will be encouraged to talk freely, to disclose unpleasant, difficult, or embarrassing thoughts. The counselor will provide interpretation as appropriate, attempting to increase client insights. This in turn may lead the client to work through the unconscious and eventually achieve the ability to cope realistically with the demands of the client’s world and society as a whole. In this process, among the techniques the psychoanalytic counselor may employ projective tests, play therapy, dream analysis and free association, all of which require special training for the counselor, usually available only at the doctoral level. 1.5 LET US SUM UP We have discussed the theoretical basis and origin of Psychoanalysis and Psychodynamics and it’s uses in counseling role and goals of counseling. The clear meaning and definition of Psychoanalytic/Psychodynamic counseling. The students may find the theoretical background helpful to get the clear understanding of counseling in Psychoanalytic context. 1.6 UNIT END QUESTIONS 1) When or under what circumstances would you encourage a friend to seek counseling? 2) What are the basic elements of Psychoanalysis? 3) What is the origin of Psychodynamics? 4) What are the goals of a counselor? 5) What is Psychoanalytic counseling? 16  Psychoanalysis/ 1.7 SUGGESTED READINGS Psychodynamic Counseling Corey, G. (1986): “Theory and Practice of Counseling and Psychology”, California Books / Cole Publishing Seligman, L. (2001): “Systems, Strategies and Skills of Counseling and Psychotherapy”, N. J. Merrill, Prentice Hall Kaslow, H. W. (Ed.) (2002): “Comprehensive Handbook of Psychotherapy (Vol. I, II, III, IV), John Wiley & Sons Woolfe & Dryden, W. (1996): “Handbook of Counseling Psychology”, New Delhi, Sage 17 Psychological Interventions: Major Modalities UNIT 2 INSIGHT AND SHORT TERM COUNSELING Structure 2.0 Introduction 2.1 Objectives 2.2 Insight as a Counseling Method 2.2.1 Definition of Insight 2.2.2 Definition of Insight Counseling 2.2.3 Counseling and Insight 2.2.4 Psychoanalysis 2.2.5 Humanistic and Existential Approach 2.2.6 Psychodynamic Therapy 2.3 Adlerian Psychology 2.4 Existential Therapy 2.5 Person Centered Therapy 2.6 Gestalt Therapy 2.7 Short Term Counseling 2.7.1 A Focus on a Specific Solution that the Counselee Wants to Get 2.7.2 A Willingness to Change 2.7.3 A Limited Time Frame 2.7.4 A Commitment to Spiritual Development 2.7.5 Short Term Counseling 2.7.6 Meaning and Definition of Brief Therapy 2.7.7 Developments that Influenced Brief Therapies 2.7.8 Common Aspects to Many Brief Therapies 2.8 Let Us Sum Up 2.9 Unit End Questions 2.10 Suggested Readings 2.0 INTRODUCTION It has already been discussed what are the objectives of counseling in general along with one method of counseling has also been discussed earlier. It should be kept in mind always that there are several methods / modalities in counseling clients. But all may not be applicable for at all the clients at all the times. Hence we discuss other modalities as well, which have usage for specific populations. Short term counseling and insight counseling are our topic of discussion here. Counseling is an attempt to uncover the deep causes of the individual’s problem and to help eliminate defense mechanisms Counseling is the treatment of a personality disorder by attempting to uncover the deep causes of the individual’s problem and to help eliminate defense mechanisms 18  Insight and Short 2.1 OBJECTIVES Term Counseling On successful completion of this unit, you will be able to: Define insight as a counseling method; Define insight counseling; Describe various insight therapies; Explain short term counseling; Elucidate the characteristics of short term counseling; Define brief therapy; and Differentiate between short term counseling and other modalities. 2.2 INSIGHT AS A COUNSELING METHOD Having the capacity to step outside of one’s immediate experience and to think about oneself from the perspective of an observer is a very useful ingredient for most Psychoanalytic and Psychodynamic interventions. That is what insight is all about. Insight is a major goal of both Psychoanalysis and Psychodynamic Psychotherapy counseling because of the belief that as people acquire a more realistic view of their motivations and the needs of other people, the likelihood of behavioral change increases. 2.2.1 Definition of Insight Insight is self knowledge, understanding the significance and purpose of one’s motives or behaviour including the ability to recognise the inappropriateness and irrationality. 2.2.2 Definition of Insight Counseling “Insight is an integral process in both individual and group process where the client makes connection between new information generated in therapy and present circumstances.” 2.2.3 Counseling and Insight Insight recognises that the first step to solving any problem begins with asking the right questions. Psychologists help their clients to become aware of factors affecting their well being and plan out a treatment programme which is the most appropriate for the client’s problem. Insight promotes the mental health of the clients by generating an awareness into their own conflicts and problems and how the same was caused and what could be done to overcome the same. Insight can help clients to realise their full potentials. Insight actually refers to the treatments involving complex conversations between therapists and clients. The treatment helps clients understand the nature of their problems and the meaning of their behaviour, thoughts and feelings. In other words it helps the person become aware of why he behaves as he does. Thus insight therapy is an umbrella term used to describe a group of different therapy techniques that have some similar characteristics in theory and thought. Insight therapy assumes that a person’s behaviour, thoughts, and emotions become disordered 19 Psychological Interventions: because the individual does not understand what motivates him, especially when a Major Modalities conflict develops between the person’s needs and his drives. The theory of insight therapy, therefore, is that a greater awareness of motivation will result in an increase in control and an improvement in thought, emotion, and behaviour. The goal of this therapy is to help an individual discover the reasons and motivation for his behaviour, feelings, and thinking. The different types of insight therapies are described below. 2.2.4 Psychoanalysis Freud believed that personal development is based on inborn, and particularly sexual, drives that exist in everyone. He also believed that the mind, or the psyche, is divided into three parts, namely the Id, Ego and the Superego. These three parts function together as a whole and these three parts represent specific energies in a person. Psychoanalytic theory and psychoanalysis are based on Freud’s second theory of neurotic anxiety, which is the reaction of the ego when a previously repressed id impulse pushes it to express itself. The unconscious part of the ego, for example, encounters a situation that reminds it of a repressed childhood conflict, often related to a sexual or aggressive impulse, and is overcome by an overwhelming feeling of tension. Psychoanalytic therapy tries to remove the earlier repression and helps the patient resolve the childhood conflict through the use of adult reality. The childhood repression had prevented the ego from growing; as the conflict is faced and resolved, the ego can reenter a healthy growth pattern. There are certain important psychoanalytic techniques such as free association, dream analysis, transference etc. In free association the client is free to express what ever he or she wants without inhibition. In the process the client brings into the conscious many of the repressed materials which normally he cannot mention without feeling guilty or ashamed. Once these repressed materials come into the conscious, the therapist or the counsellor is able to provide insight to the client regarding these materials and how these in turn are causing the various symptoms and problems. This insight helps the client to face the problem squarely and understand his or her own behaviours in terms of the root causes. Once the cause is known, the client is able to get over the problem. Thus insight development in psychoanalysis through free association is undertaken. Another technique of psychoanalysis is what we call as the dream analysis. When a person sleeps the repressed materials are allowed to enter the consciousness. However as these repressed thoughts are threatening they cannot be experienced in their actual form. The thoughts are disguised in dreams, which then become symbolic and significant to the client’s psychoanalytic work. As the dreams are told and narrated to the counsellor / therapist, the same is analysed and interpreted by the therapist. As the dreams are interpreted the therapist helps the client to develop insight into the causes of his problems as interpreted from the dreams. This insight helps the client to understand why he behaved as he did and thus change the behaviour. Another technique of psychoanalysis is the transference. Through transference the psychoanalyst gains insight into the childhood origin of repressed conflicts. One focus of psychoanalysis is the analysis of defenses. This can provide the analyst a clear picture of some of the patient’s conflict. The counsellor studies the client’s defense mechanisms which are the ego’s unconscious way of warding off a confrontation with anxiety. The counsellor tries to interpret the client’s behaviour, pointing out its defensive nature in order to stimulate the client to realise that she is avoiding the topic. This insight helps the client to understand the underlying conflicts 20 and helps overcome the problems and symptoms. 2.2.5 Humanistic and Existential Approach Insight and Short Term Counseling These also fall under the category of insight therapies. These therapies are insight focussed and they are based on the assumption that disordered behaviour can be overcome by increasing the awareness of the client of their motivation and needs. Humanistic and existential therapists / counsellors place more emphasis on a person’s freedom of choice, and believe that free will is a person’s most valuable trait and is considered a gift to be used wisely. Analytical psychology organises personality types into groups; the familiar terms “extraverted,” or acting out, and “introverted,” or turning oneself inward, are Jungian terms used to describe personality traits. Developing a purpose, decision making, and setting goals are other components of Jung’s theory. Whereas Freud believed that a person’s current and future behaviour is based on experiences of the past, Jungian theorists often focus on dreams, fantasies, and other things that come from or involve the unconscious. Jungian therapy, then, focuses on an analysis of the patient’s unconscious processes so the patient can ultimately integrate them into conscious thought and deal with them. Much of the Jungian technique is based on bringing the unconscious into the conscious. In explaining personality, Jung said there are three levels of consciousness: the conscious, the personal unconscious, and the collective unconscious. 2.2.6 Psychodynamic Therapy In 1946, psychodynamic therapy was developed in part through the work of Franz Gabriel Alexander, M.D., and Thomas Morton French, M.D., who were supporters of a briefer analytic therapy than Freud’s psychoanalytic theory, using a present and more future-oriented approach. Influenced by such Freudian concepts as the defense mechanism and unconscious motivation, psychodynamic therapy is more active than Freudian therapy and focuses more on present problems and relationships than on childhood conflicts. Psychodynamic therapy slowly examines the true sources of client’s tension and unhappiness by facing repressed feelings and eventually lifting that repression. The personal unconscious is the landing area of the brain for the thoughts, feelings, experiences, and perceptions that are not picked up by the ego. Repressed personal conflicts or unresolved issues are also stored here. Jung wove this concept into his psychoanalytic theory: often thoughts, memories and other material in the personal unconscious are associated with each other and form an involuntary theme. Jung assigned the term “complex” to describe this theme. These complexes can have an extreme emotional effect on a person. Jung believed that to fully understand people, one has to appreciate a person’s dreams and not just his or her past experiences. Through analytical psychology, the therapist and patient work together to uncover both parts of the person and address conflicts existing in that person. 21 Psychological Interventions: Major Modalities Self Assessment Questions 1) Define insight............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2) Define insight counseling............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 3) What is the relationship between insight and counseling?............................................................................................................................................................................................................................................................................................................................................................................................................................................................ 4) Describe psychoanalysis as insight therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 5) Elucidate humanistic approach as insight therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 6) Explain psychodynamic approach as insight counseling............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2.3 ADLERIAN PSYCHOLOGY Adler’s view of personality stressed the importance of the person as a whole but also of the individual’s interaction with surrounding society. He also saw the person as a goal directed, creative individual responsible for his own future. 22 He emphasised in his own theories of working toward superiority, but not in an Insight and Short Term Counseling antisocial sense. Instead, he viewed people as tied to their surroundings; Adler claimed that a person’s fulfillment was based on doing things for the “social good.” Like Jung, Adler also argued the importance of working toward personal goals in therapy. The main factor in Adler’s work was a focus on individual psychology, or individual phenomenology—working to help patients get over the “illogical expectations” made on themselves and their lives Crucial to the Adlerian therapy technique is the establishment of a good therapeutic relationship between therapist and patient, particularly one based on respect and mutual trust. One of the most important goals of Adlerian therapy is the patient’s increase in social interests, as well as an increase in self-awareness and self-confidence. Adlerian therapy is a practical, humanistic therapy method that helps individuals to identify and change the dysfunction in their lives. 2.4 EXISTENTIAL THERAPY Another insight therapy, existential therapy is based on the philosophical theory of existentialism, which emphasises the importance of existence, including one’s responsibility for one’s own psychological existence. One important component of this theory is dealing with life themes instead of techniques; more than other therapies, existential therapy looks at a patient’s self awareness and his ability to look beyond the immediate problems and events in his or her life and focus instead on problems of human existence. The first existential therapists were trained in Freud’s theories of psychoanalysis, but they disagreed with Freud’s stress on the importance of biological drives and unconscious processes in the psyche. Instead, these therapists saw their patients as they were in reality, not as subjects based on theory. With existential therapy, the focus is not on technique but on existential themes and how they apply to the patient. Through a positive, constructive therapeutic relationship between therapist and patient, existential therapy uncovers common themes occurring in the patient’s life. Patients discover that they are not living their lives to the full potential and learn what they must do to realise their full capacity. The existential therapist must be fully aware of patients and their needs in order to help them attain that position of living to the full of their existence. As patients become more aware of themselves and the results of their actions, they take more responsibility for life and become more “active.” In this sense this is a therapy that instills insight about the individual’s behaviour to himself or herself. 2.5 PERSON CENTERED THERAPY Once called nondirective therapy, the client centered therapy, person centered therapy was developed by American psychologist Carl Rogers. Drawing from years of in depth clinical research, Rogers’s therapy is based on four stages, viz., (i) the developmental stage, (ii) the nondirective stage, (iii) the client centered stage, and (iv) the person centered stage. Person centered therapy looks at assumptions made about human nature and how people can try to understand these assumptions. Like other humanistic therapists, 23 Psychological Interventions: Rogers believed that people should be responsible for themselves, even when they Major Modalities are troubled. Person centered therapy takes a positive view of patients, believing that they tend to move toward being fully functioning instead of wallowing in their problems. Person centered therapy is based more on a way of being rather than a therapy technique. It focusses on understanding and caring instead of diagnosis and advice, Rogers believed that change in the patient could take place if only a few criteria were met, which according to in were: 1) The patient must be anxious or incongruent (lacking harmony) and be in contact with the therapist. 2) The therapist must be genuine; that is, a therapist’s words and feelings must agree. 3) The therapist must accept the client and care unconditionally for the client. 4) In addition, the therapist must understand the patient’s thoughts and experiences and relay this understanding to the patient. If the patient is able to perceive these conditions offered by the therapist, then the therapeutic change in the patient will take place and personal growth and higher consciousness can be reached. In this manner the patient develops an insight into his own conditions, the problems that are affecting him and how to handle with his own efforts etc. 2.6 GESTALT THERAPY Gestalt psychology emerged from the work of Frederich S. Perls, who felt that a focus on perception, and on the development of the whole individual, were important. This was attained by increasing the patient’s awareness of unacknowledged feelings and becoming aware of parts of the patient’s personality that had been previously denied. Gestalt therapy has both humanistic and existential aspects. Gestalt theory states that people are basically good and that this goodness should be allowed to show itself. Also, psychological problems originate in frustrations and denials of this innate goodness. Gestalt therapists focus on the creative aspects of people, instead of their problematic parts. There is a focus on the patient in the therapy room, in the present, instead of a launching into the past; what is most important for the patient is what is happening in that room at that time. If the past enters a session and creates problems for the patient, it is brought into the present and discussed. The question of “why” is discouraged in Gestalt therapy, because trying to find causes in the past is considered an attempt to escape the responsibility for decisions made in the present. The therapist plays a role, too: Patients are sometimes forced or even bullied into an awareness of every minute detail of the present situation. Gestaltists believed that awareness acted as a curative, so it is an integral part of this therapy process. The goal of Gestalt therapy is to help patients understand and accept their needs and fears as well as increase awareness of how they keep themselves from reaching their goals and taking care of their needs. Also, the Gestalt therapist strives to help the patient encounter the world in a nonjudgmental way. Concentration on the “here and now” and on the patient as responsible for his or her 24 actions and behaviour is an end result.  Insight and Short Self Assessment Questions Term Counseling 1) Describe Adlerian psychology and indicate how it is insight therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2) Elucidate existential therapy approach as part of insight therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 3) How does person centered approach an insight therapy?............................................................................................................................................................................................................................................................................................................................................................................................................................................................ 4) Explain Gestalt approach as an insight therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2.7 SHORT TERM COUNSELING There has been a lot of discussion and research into the question of what kind of couple receives the most benefit from the least amount of marriage counseling. In other words, what type of couples can get help the fastest, in the least amount of sessions. Like any type of generalisation, there are absolute exceptions. However the following will generally receive and also benefit from short term counseling, especially marriage counseling. Couples who are still in active love. Couples who are open to therapy and change. However short term marriage counseling will not be of use to the following persons Couples who wait too long before seeking help. Couples where one is already set on getting a divorce and are closed to suggestions that may save the marriage. Instead of looking at these items in terms of who benefits the least from short term counseling, one could look at them instead, in terms of what will benefit each the most. That is, there are different set of problems and require different solutions. 25 Psychological Interventions: Couples who have been waiting for a long time before entering into marriage Major Modalities counseling are couples who have had years to build bad habits and negative responses and behaviours. Habits that took years to form take time to change and it would be not correct to assume otherwise. Couples who are still in love but need help resolving some marital issues are having a specific problem that can be addressed in specific ways with specific solutions, making this type of relationship perfect for short term counseling. The Basis of the Short term Model of counseling. The short term counseling model is based on the following principles: 2.7.1 A Focus on a Specific Solution that the Counselee Wants to Get Most people want to focus on the problem, which means looking at the negative side of the issue. While problems cannot be ignored, success is better if the major effort is aimed at the solution to the situation. The counselee is the one who selects the focus, or the preferable future. Counseling is about the counselee, not the counselor. This takes the pressure off the counsellor to be the expert, or the one who must figure out what is best for someone else. The counsellor’s task is to work with the counselee in moving to a creative solution. 2.7.2 A Willingness to Change The basis for helping people is anchored in the understanding that people do have the ability to change. Change is inevitable in people’s lives. When we recognise that change is always occurring and that people are continuously changing, we are much more likely to look for change in the clients lives. We also realise that people’s problems are always changing. It is easy to slip into the misconception that change always means a radical, 180- degree reversal. At the same time it must be remembered that one does not make change in giant steps. In counseling, change is made in small, seemingly insignificant movements. Change is an action step. If a person takes even a tiny action of change, it means more change is possible. 2.7.3 A Limited Time Frame With the many time demands on a counsellor, counseling must be kept in balance with other duties. Some people like to talk about their problems but do not really want to change. One of the hardest aspects of counseling for most counselors is setting the necessary limits on the relationship. Limits are worked out by the counsellor and it should be adhered to by both counselee and the counsellor. In the long term counseling it is never helpful if limits are consistently ignored. Limit setting is, therefore, a part of all responsible counseling. What is a reasonable limitation? While there are always exceptions, generally four to six sessions should be a reasonable time frame in dealing with a single, focused solution. If more time is needed, a counsellor may consider referring the counselee to someone who may be more qualified. 26 2.7.4 A Commitment to Spiritual Development Insight and Short Term Counseling A person’s spiritual life is not an appendage tacked on, like buying an option on a new car. Our spiritual life is related to all aspects of our human existence. “The master goal of counseling is the facilitation of psychological growth. This involves helping people to understand their problems and their lives in the light of their relationship to the others in their lives and to the counsellor and then to live more fully in this relationship. The counsellor’s ability to help others arises out of their personal commitment to grow in their relationship in their own life too. As we considered in the previous sections, the major goal of a counselor in a counseling process is to establish comfortable and positive relationship, facilitate communications, identify and verify the client concerns and plan with the client, to obtain assessment data needed to proceed with counseling process. As far as the client is concerned, his or her major goal is to share and amplify reasons for seeking counseling and cooperate in the assessment of both the problem and self. For both the purposes a related concept that is important to assess early in treatment is patient’s ability to have some “insight”. Insight is skills in a constructive way to obtain a new understanding of the problems and difficulties that had not been consciously realised before by the client. Sometimes counselors may provide a relatively benign interpretive comment early in treatment to assess the client or patient’s readiness, willingness and capacity for insight (Wanier 1998). Although such interventions must be very carefully timed and crafted, they may allow counselors to get a feeling of how likely patients (clients) will engage in obtaining new levels of understanding. In fact it is often the case that simply summarizing for clients what they have said in ways to draw an association between two important ideas will provide an opportunity to assess how insightful they are. Metallisation and Insight As described by Fonagy and colleagues (Fonagy & Target, 1996, 1997; Fonaggy, Gergely, Jurist & Target, 2002), mentalisation or reflective capacity, is the ability of patients to conceive of and to understand their mental states and that of others as an understandable causative mechanism of behavior and experience. Mentalisation means to perceive and communicate mental states, such as beliefs, desires, plans, and goals. Mental states are unobservable constructs that must be inferred by observers rather than perceived directly. Most of us know what an ego is (and we probably have run into one that is “inflated”) but no one has ever perceived an ego directly. Even your own ego has to be inferred. Mentalisation is largely communication outside of language. Mentalisation draws heavily from context or the implications of an environment. A gun in a display case will have a different implicit sense to it than a gun being held by a police officer or soldier. We need to be able to mentalise in order to get the implicit meaning of things. Mentalisation is necessary to “get” the meaning behind metaphor. Metaphor accurately depicts the nature of a situation (the objective reality) and is designed to convey a mental state. Infants are born with an imitative brain. In other words, infants are born with an innate desire to imitate a social partner. Imitation is the seed that will eventually (if all goes well) bear mentalising fruit (to use a metaphor). 27 Psychological Interventions: Empathy is a form of mentalisation. It is difficult to be empathetic (sympathetic maybe) Major Modalities without the ability to mentalise. Researchers, such as Russell Barkley (1997) are looking at a possible connection between certain forms of ADHD and an impaired capacity to mentalise. The same brain regions are activated during imitation and mentalisation Mentalisation is a way to find social partners in the world. Mentalisation is necessary for the development of a fully developed sense of self and acquired in the context of early attachments, specifically primary object relationships. It is typically the case that the more severe a persons’ psychopathology, the more poorly developed is his/her reflective capacity (mentalisation). When patients show very little awareness or recognition of their mental states or inner life, this should be a sign to therapists that more expressive interventions may not be appropriate or well received at this time and that supportive interventions are indicated. The range of interventions would involve reflection and attention by the therapist to signs of patients’ mental state and their psychological symptoms. By way of contrast, patients with greater levels of mentalisation are more likely to come in with some ideas about what is going on in their minds or in the behaviours of others that could be contributing to their difficulties. It is not the case that patients have to have highly well-developed mentalisation capacities for psychoanalytic and psychodynamic interventions to be successful, particularly with interventions targeted toward current life situations. However, an indicator of patients’ abilities to improve with psychoanalytic or psychodynamic treatment is related to mentalisation. Therefore to make good decisions about how to proceed with treatment, it is necessary to assess patients psychological well being and ways of functioning. This can be done by evaluating the capacity for insight or reflective functioning. Psychodynamic psychotherapy is also known as an “insight” approach, because it is the practice of exploring deeply the inner workings of the mind (how the psyche actually works). Old, unresolved conflicts and beliefs drain energy from people. By using an insight approach, the counsellor intends to understand the places in the psyche where one has got stuck so that the stuckness—the inability to move forward in life—can relax with the awareness of new options. When a person really sees that now, in the current life, he or she has actually fresh possibilities for action, the old painful dilemmas naturally melt away. To make permanent change in the reoccurrence of depression and anxiety, it is important to combine insight therapy with the skill building of CBT and mindfulness training. This will lead to relatively more permanent change. Also known as psychodynamic psychotherapy, insight therapy is a technique which assumes that a person’s behavior, thoughts, and emotions become disordered as a result of the individual’s lack of understanding as to what motivates him or her, such as unresolved old conflicts or beliefs. The idea behind this therapy is that the therapist will help the client become more aware of themselves and therefore the client can go on to live a more full life. Example: A clinician trained in insight therapy helps his client to realise and break free of undesirable old patterns by examining how the man has reacted to certain situations in the past 28 2.7.5 Short Term Counseling Insight and Short Term Counseling Short Term Counseling: A Six Session Model. Short term counseling in an occupational health setting is an effective means of reaching a population that may otherwise not have considered counseling. However, because of the time limits, the practitioner must be able to make a quick assessment of the kind of help needed. The seven principles of short term treatment are: 1) Mutual goal directedness; 2) Quick problem identification; 3) Reminder of finiteness of sessions; 4) Making an appropriate referral; 5) Confidentiality; 6) Open communication; and 7) Follow up. In a six session model, sessions 1 and 2 are for assessment. Sessions 3 and 4 are for development of insights and strategies Sessions 5 and 6 are for termination. Occupational health nurses with mental health training are ideal practitioners of short term counseling, because they can recognise many physical symptoms as having a psychological basis. Researchers report that a brief behavioral treatment appears to alleviate insomnia in older adults for at least six months. The intervention consisted of two in-person sessions and two phone calls. Even though pharmacologic and behavioural treatments are approximately equally effective, older adults are prescribed hypnotic agents at disproportionate rates and are also more likely than younger patients to experience adverse drug effects. Daniel J. Buysse, M.D., of the University of Pittsburgh School of Medicine, and colleagues conducted a randomized clinical trial of a brief behavioural treatment involving 79 older adults (average age 71.7) with insomnia. Thirty-nine received the treatment, consisting of individualised behavioural instruction delivered by a nurse clinician over four sessions, two in person and two by phone. The other 40 were assigned to an information control group and received only general printed educational material about insomnia and sleep habits. All participants provided demographic information, completed self report and interviewer administered questionnaires about sleep habits, kept two-week sleep diaries and underwent sleep assessment by actigraphy (using a wrist or ankle monitor) and polysomnography (a more in-depth monitoring procedure) before treatment and four weeks after beginning therapy. Participants who showed a response to the brief treatment were contacted again after six months and asked to complete questionnaires and sleep diaries. After four weeks, a larger percentage of those receiving the brief behavioural treatment showed a favorable response to the treatment (67 percent vs. 25 percent) or were classified as no longer having insomnia (55 percent vs. 13 percent). 29 Psychological Interventions: Recent years have witnessed increased interest in and practice of short term Major Modalities counseling (Brief therapy) in practice, brief therapy is probably as old as therapy itself; however, it has only recently been recognized and written about as a viable approach for the delivery of counseling assistance. Many a studies indicate that short-term therapy is at least as effective as long term, if not more so, produces lasting or durable results; and more frequently responsible to the client’s anticipation of treatment line. 2.7.6 Meaning and Definition of Brief Therapy Brief therapy, short-term therapy, time limited therapy: making time a defining element in the psychotherapy relationship The meaning of “brief” is relative to what is considered “long” or “typical.” A typical course of classical psychoanalysis often involved three to five years of treatment with 2 to 3 sessions a week (4 and 5 sessions a week might occur by were unusual in standard practice; as was once a week treatment). More than a precise number of sessions or duration of treatment, the critical feature of the “briefer” therapies is that time becomes an explicit defining feature in the therapeutic contract. Implicit in this type of therapy is the clear view of the starting and ending point, and the pathway that will lead from one to the other. Open ended therapy contacts are defined by broad, mutually agreed upon goals but do not specify the rate of change that is the outcome. 2.7.7 Developments that Influenced Brief Therapies Several developments contributed to the interest in briefer therapies over the past several decades: Much of the identifiable change in psychotherapy occurred within the first 10 sessions. Increasing interest in how to make psychotherapy available to larger segments of society / meet the need / demand for psychological services. Economic incentives favoring briefer therapies. Increased interest in so-called “symptomatic treatments” such as behaviour therapy, marital counseling, problem solving strategies which focused on specific treatments goals rather than change of basic personality patterns / traits. Continuing developments have bolstered interest in briefer therapies: Managed care strongly encouraged briefer treatments. Highly structured, especially “manualized” treatments have become a principal focus of psychotherapy outcome research—the brief therapies were easily adaptable to this model of research. Empirical evidence supporting the effectiveness of brief therapies accumulated. Virtually all therapeutic models and schools have been able to offer brief therapy alternatives such as psychoanalytic/psychodynamic/object relations therapy, solution focused/narrative therapy, cognitive-behavioral therapy etc. The major of presenting problems can be approached from a brief therapy model: most presenting concerns of individuals work with adolescents 30  couple counseling Insight and Short Term Counseling crisis intervention group therapy parent training family therapy Self Assessment Questions 1) Describe short term counseling............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2) What are the conditions for success of short term counseling?............................................................................................................................................................................................................................................................................................................................................................................................................................................................ 3) What is meant by commitment to spiritual development?............................................................................................................................................................................................................................................................................................................................................................................................................................................................ 4) Describe the meaning and definition of brief therapy............................................................................................................................................................................................................................................................................................................................................................................................................................................................. 2.7.8 Common Aspects to Many Brief Therapies Problem/solution vs. pathology/understanding focus Active/involved vs. passive/reserved therapist Active/experimental vs. passive/receptive client Sharply focused and delimited therapeutic goals Therapeutic emphasis on the power of thought/image and language for change Utilisation of life beyond the therapy session in the process of change ‘Descriptions of “Short term” seem to vary somewhat, but it seems to be in the range of one to five sessions with the average length of one hour.” 31 Psychological Interventions: The process itself is characterised by - Major Modalities Specific Population for Whom Short Term Counseling (STC) is Used Counselors in nearly all settings deal with a variety of individual problems and concerns STC may be used for these special client populations i) People who Abuse Drugs ii) People who use tobacco iii) People who abuse Alcohol iv) People with disabilities v) Women vi) Victims of Abuse vii) Older Adults Use of Short Term Counseling for Child Victim of Sexual Abuse (A Case) Finding key safe persons for the child and building rapport and trust are key elements at the outside of treatment. The child’s safe person can serve as a bridging tool in the following ways: Preparing the child for counseling Exhibit stability Support the child throughout counseling Come to the actual counseling sessions with the child Help the child express feelings and contents (if needed) Protect the child from the abuser family home life Clients Concerns in STC for whom STC is used