Therapists Differ and so do Their Approaches

In the most basic sense, therapy is a form of treatment for disorders.  However, not every person that seeks therapy meets the full criteria for a clinical diagnosis, thus therapists are often engaging a client regarding presenting problems.  These issues may or may not lead to diagnosis, but more often than not, are affecting the individual’s overall functionality.  So, while you as a client may feel that you need therapy, understand that you may not be receiving treatment for a disorder. In many cases, at the request of the client, therapists seek to assist the client with restoring or increasing the client’s level of functionality (often recognized by the client as balance, happiness, meaning or fulfillment).  This process typically includes a clinical assessment of the client’s level of functionality, and a determination on whether or not the client’s thoughts or actions meet the criteria for diagnosis.

In order to provide therapeutic assistance, therapists use their experience and expertise, which may be derived from a variety of tools, techniques, theories and models.  Because of the vastness of the research, experiments and studies that have occurred over time, there are an abundance of valid (proven) approaches to therapy that may be chosen by a given practitioner.  While there is no identified “best” approach to therapy, the client’s situation and the therapist’s competence play a large role in determining which model the therapeutic engagement will follow.  If you are interested in seeking therapy, it may prove helpful to understand what specialties potential therapists claim, as well as what approach(es) to therapy they practice.  Below is a comparative look at a few popular therapeutic models.

Reality Group Therapy versus Structural Family Therapy

While applying the Reality Group Therapy method, the therapist focuses on the individual’s control of their behaviors.  The clinician aides the client in performing a self-evaluation in which they identify the quality of their behaviors, then determines what the contributors of their failures are.  The therapist’s role is to guide the client through the process of developing a plan of action to eliminate these behaviors, and then hold them accountable throughout the execution of the devised plan by confronting them and identifying any possible deterrents or reasons for any incapability of completing the plan.  The therapist and client work closely together to formulate the plan of action for the client to modify the behaviors causing their negative emotions in order to reach the desired outcome.  Whereas, in Structural Family Therapy, the therapist emphasizes the dysfunctions of the family as opposed to strictly the individual’s control of the issues.  Abiding by the Structural approach limits the therapist’s overall involvement as he is not used to establish intensive reparative for the family members, but to simply outline the framework, develop the foundation for reframing, and then encourage the family to continue a positive progression of growth.  The Structural therapist’s role is to be an active agent in the process of restructuring the family, emphasize clear boundaries, facilitate the unearthing of hidden family conflicts and then outline the manner in which the family can modify them.

Person-Centered Therapy versus Strategic Family Therapy

The Person-Centered therapist is one who is congruent, removing all sense of authority and de-masking of professionalism.  To be an effective Person-Centered therapist, it entails revealing personal information if it is an accelerant to the progression of therapy.  Typically therapists have the general understanding of the limitations when involving self-disclosure; however, in Person-Centered therapy the clinician is transparent.  Person-Centered therapy is client-guided as they explore their life experiences, and with the aid of the therapist, analyze their history and the result is the client resolving their own issues.  In this approach, it is vital for the therapist to exude unconditional positive regard, providing no criticism, guidance for behavior, or discouraging them from any behaviors.  In opposition, Strategic Family Theory requires the therapist to employ guidelines and directives, no matter how ambiguous.  The Strategic therapist pays extreme attention to detail and accepts only the positive, whereas the Person-Centered therapist must accept all aspects of the client—positive as well as negative.  Therapists abiding by the Strategic approach also develop a distinct outline for treatment involving defining the problem, investigating all solutions, defining clear change to achieve, and formulating strategy for change.

Rational Emotive Group Therapy versus Psychodynamic/Bowenian Family Therapy

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences.  In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally and inevitably reducing the conflict.  In a group setting, the therapist takes a lead role in attempting to change the minds of the clients.  The therapist can accomplish this without fostering a “warm” relationship with the clients.  In a group setting, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience.  Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational, and both preserving and destructive.  Therapists must promote clients to confront their behaviors as well as accept their faults.   Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructure their way of thinking.  In this light, the therapist must continue to encourage self-discipline as well as self-direction.  The primary similarity between Rational Emotive Behavior therapists and Psychodynamic therapists is that the principle focus of both is essentially for the client to reach full self-reliance, and operate at a high level of differentiation by exploring and developing their own autonomy.  The Psychodynamic therapist accomplishes this not through confrontation, but through examining the client’s family of origin, constructing and dissecting a multigenerational diagram, and guiding the client to remove emotionality from their family system and begin approaching it from an objective approach in order to identify its highest level of functionality.

Because these comparisons are very general it may prove helpful to conduct further research regarding any approaches that are of interest.  Additionally, understand that there are a multitude of other approaches to therapy as well and the best interpretation for you to have regarding any approach is the interpretation used by your therapist.  Understand that even though some therapist’s practices are based on the same principals, each therapist will inevitably approach therapy in their own manner.  This is to say that just because a certain therapy model was unsuccessful in the past with a specific therapist, you should not necessarily avoid seeking help from others utilizing a similar approach.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

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Glasser’s Reality Therapy, Choice and Control

Reality therapy is based on the notion that individuals hold responsibility for their actions and thoughts.  This approach aids individual’s ability to make choices in difficult situations.  The late, William Glasser is credited with developing reality therapy.  He developed this approach to therapy because of his dissatisfaction with the traditional psychoanalytic training he received.  Influential in the development of the approach was Glasser’s advisor G.L. Harrington, who supported Glasser for over seven years.

In 1956 Glasser worked as a psychiatrist at an institution for girls.  During his time at this state institution Glasser was able to focus on friendliness and responsibility.  He conducted group and individual therapy as well as staff training while on staff at the institution.  As his reputation grew he became a consultant to the California school system.  He focused his attention towards the prevention of “failure identity”.

Glasser introduced choice theory to the management and administration of schools.  He developed methods for teachers to utilize choice theory with many issues, particularly in dealing with delinquents.  Along his journey, Glasser was introduced to the ideas of William T. Powers which related to what is now referred to as perceptual control theory.  Glasser took from Powers the ideas pertaining to individuals making choices in an attempt to control their own lives…“control theory”.

Eventually, Glasser began to change his focus from control theory to choice theory in order to sway individuals from believing that his reality personality theory was the same as Powers’s broad theory of control.  Before his death, Glasser created works that described his disapproval for medications, because he felt that medicine was responsible for preventing individuals from making positive choices and maintaining responsibility.

There are multiple aspects of choice theory that have proven to be staple components of reality therapy.  Glasser suggested that individuals merely have a picture of reality and are unable to fully know reality itself.  With this note, Glasser went on to say that each individual’s perception is different, and that on occasion individuals become interested in others’ perceptions in order to satisfy their own needs.

Glasser believed that our perceptions determine our behaviors, and that our perceptions are often derived from our desire to satisfy our needs.  If these perceptions (or pictures) prove to provide satisfaction we store them as the “quality world”.  Glasser believed that eight percent of our perceptions are visual and thus he referred to them as pictures.  These pictures are often irrational and promote destructive behavior.  According to Glasser there are five basic needs that include the following: survival, belonging, power, freedom and fun.  These needs are met through our perceptions.

Glasser had a unique approach to describing psychological problems, and he referred to the problems as verbs such as depressing or anxietizing.  His purpose was to emphasize action and choice.  He suggested that people do not become these things but choose to be them.  Glasser defined behavior as “all we know how to do, think and feel”.  He divided behavior into two parts, what we are familiar with and what is constantly being reorganized.  Glasser believed that we face a multitude of situations in life and use different behaviors to deal with those situations.  Behavior itself is made up of four components: doing, thinking, feeling and physiology.  These four components are key to understanding Glasser’s view of behavior.

The key to changing our behavior is in changing our doing and thinking, which in turn will change our emotional and physiological reactions.

It is my belief that we are all free individuals when it comes to making choices.  Some may suggest that law, morals and ethics constrict our ability to choose.  I do believe that these things narrow our pool of choices; however, the majority of the time it is to prevent harm or unfairness to other individuals.  I feel that there are factors in a person’s life, especially at a young age that they have no control over.  These factors often impact the individual’s perceptions and thus guide their behavior.

Yet and still these unfortunate individuals have opportunities to make choices that can free them of a negative life style.  Choice implies responsibility, and I agree that individuals should at all times be responsible for their actions.  It may be difficult to convince some individuals that they are choosing to be a certain way.

Many times individuals look for excuses and something or someone to blame for their actions.  I suggest that therapists and coaches can provide a great service to individuals who are stuck in these beliefs.  Assisting individuals with changing these negative behaviors will allow them to break free.

But remember, individuals subject to this path don’t necessarily benefit from blame but alternatively must be encouraged towards positive change and credited with the progress.

Author’s Note: Rest in peace Dr. William Glasser (August 23, 2013), this composition was constructed from the authors own scholastic submissions from April 2008 and brought forth in this capacity as a tribute to Dr. Glasser’s contributions to theory, therapy and psychiatry.

For more on Choice and Dr. Glasser, please visit William Glasser Institute.

 

Atlas Concepts, LLC_Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach and a student of Marriage and Family Therapy.