Despite a therapists’ ability to categorize issues, disorders and presenting problems, it is largely agreeable that all clients are unique. There are a plethora of reasons why a therapist may seek to gain familiarity with a specific therapeutic approach. Sometimes that reason is based simply on the therapists’ effort to best serve a local service population.
Herein are a few examples of how various therapeutic models may be used in particular instances. If you find yourself working with clients whose presenting problems are similar to the issues described in the examples, it may be beneficial to take some time to learn a little more about the model presented in that example.
Several approaches to therapy are very broad-based and may be used in a variety of contexts. It is possible for a therapist to become comfortable in such an approach, most likely because it works. Yet it is critical to understand that it is your responsibility as a helping professional to continually educate and professionally develop yourself.
The most basic benefit of researching other approaches is to build your knowledge-base.
However, through new understandings you are actually afforded opportunities to increase your level of experience. This process enables you to become a better therapist…efficiency via competence. While you don’t necessarily need to change your “style”, a new tool or technique may come in handy. Perhaps, take a look at some of the “classics” for inspiration…
A husband and wife are unable to agree on how to discipline their two small children. The wife grew up in a family where there was violence and child abuse. The husband’s father had a very demanding job and his mother was socially engaged.
Due to the distinct family of origin issues described, Bowen Family Therapy may be a viable approach to assist this family.
Using Bowen therapy, both parents should be assessed to discern if they have a healthy level of differentiation. Because they are having difficulty disciplining their children (a process in which the children are likely involved), they may run the risk of perpetuating the lineage of negative multigenerational transmissions. The conflict between the parents in regard to disciplining the children can result in triangulation as well as cutoffs.
In addition, because there are two children involved, therapy may include dealing with sibling position; in the event that this concept is budding while the children are “small” it would be prudent to address the issue in a timely manner.
Having the parents construct a genogram of their respective family of origin may prove helpful in a reasonably short amount of time. Through assisting these clients in dealing with unresolved issues, I believe that they would also find the disciplining of their children more agreeable and, in effect, they would be empowered to control their family’s multigenerational patterns.
An 8-year old girl has been wetting her bed for the last four weeks. Her parents began to argue frequently several months ago concerning the family budget. They are both frustrated by the bed wetting and desire an immediate solution.
Behavioral Family Therapy has its origin in parent’s modification of children’s actions. Not only does it appear at a glance that the parent’s discourse is responsible for the child’s bed wetting, but it seems that they have a problem with it as well. The parents need to know that they harness the ability to foster an environment for change, and, through training and empowering the parents, the therapist can allow the parents to take credit for working together to resolve the bed wetting issue.
By simply defining the problem behavior and then explaining the behavioral patterns to the parents, both the therapist and parents can monitor that behavior and as well monitor the child’s bed wetting habit as a means of marking progress.
It is foremost irrational that the parents believe that their child’s behavior can stop immediately; however, when concentrating on the dyadic parent relationship they will find that the family in its entirety will benefit.
A 12-year-old boy began displaying temper tantrums around the time his divorced mother announced she was going to remarry. She and her new husband are having a difficult time dealing with the situation.
One may lean upon the experiences of Minuchin (Structural Therapy) to assist the family in this scenario. By observing the patterns in this family, the therapist would hope to gain knowledge of the family’s structure. As well, it may be important to determine what may be different about the family structure once the mother remarried.
It is apparent that the divorce and second marriage were stressful times for the child. The child’s outcry could be in part due to the demolition of a coalition with his father. Though the family underwent a marital (or legal) restructuring, it may be necessary to restructure the “living” system in an effort to make the family stronger.
It may be plausible to address any incumbent boundaries caused by the marital shift. Due to the new “executive” system that is in place, it is necessary to evaluate the cohesion of that system and examine any residual effects. Additionally, this parental union may have to be alerted of the signs of triangulation as well as the methods for its avoidance.
The structural approach involves the technique of reframing, which can also be useful in assisting the child with coping with his “fits”. In short, there is a basic need for this family to redefine its boundaries to deal with the relevant stage of development. If appropriately applied, the Structural Approach may prove to be of assistance to this family.
A 34-year old female physician began getting anxious in elevators about 7 months ago. She became progressively more anxious in a variety of situations. Now she cannot cross bridges or go out to crowded places.
Cognitive-Behavioral Therapy, having roots in the social learning theory, would be a solid approach to this scenario. Cognitive restructuring may be a beneficial technique to accomplish modifying the client’s behaviors.
It is plausible that the client is dealing with issues regarding her beliefs and reasoning in a fashion that has affected her behavior. Through desensitization the client may be able to overcome the unnecessary anxiety that is associated with the situations described in the vignette.
By enhancing the client’s problem-solving and behavior-change skills she may be empowered to overcome her anxiety through a self-renown confidence. Additionally, a specific technique such as shaping could be employed, as it appears that the client has reached an extreme level of anxiety. It may require the client to take gradual steps towards such goals as crossing bridges and going into crowded places before she can achieve these feats.
A 43-year old male, recently unhappy with his career, sees himself as a failure and has begun to isolate himself because of a lack of confidence.
In dealing with this man’s career issue, one may employ the Strategic approach. In the vignette there is a clear problem that needs to be resolved or removed. It is beneficial to begin by defining the problem and then moving towards evaluating what the client has done to fix the issue.
By defining the necessary change and implementing a strategy for achieving that change, the client could be propelled to a more virtuous cycle. Additionally, the client could benefit from the reframing techniques practiced in Strategic Therapy.
By emphasizing positives and assisting the client through encouragement and direction, he may also begin to see his career in a different light. It seems the issue is rooted in his malcontent with his employment. In this instance I believe the lack of confidence may be a residual effect of his job situation. However, through combating his isolation through actions, he may be able to perpetuate his own confidence and gain a new awareness of his ability to acquire a job that may be more conducive to his happiness.
Another way the Strategic Approach may prove helpful is by utilizing the ordeals technique; in this instance the client may discard his isolated ways as he realizes that this behavior is not constructive.
A 24-year old male who is high functioning with no obvious diagnosis is confused about his goals in life.
Due to the over-functioning nature of the male depicted in the vignette, I believe that Experiential Therapy may be of most benefit, especially considering that there is no “obvious diagnosis”.
The Experiential approach is helpful because it relies on the personality of the therapist more so than that of the client. In this case, there is not much known about the client thus, the Experiential approach allows for the therapist to guide the therapeutic environment in an effort to learn more about the client. One manner in which the therapist can begin to assess the client is by evaluating the client’s level of individuality. An Experiential therapist can achieve this by fostering a warm climate in which the client feels respected and accepted.
As well, it is important for the client and therapist to work towards determining the nature of the client’s confusion (i.e. what about his life goals is confusing). The therapist has the ability to help the client see his confusion as meaningful. The client should be led to understand that it is productive to have goals and that his confusion pertaining them may only be a result of his personal growth.
By utilizing alternatives to reality, the therapist can allow the client to assess whether or not his goals are feasible, thus eliminating goals that are too vague or nested in improper judgments. The more excitement the therapist shows for the client’s progress, the greater stimulation the client is likely to experience, in turn providing the client opportunity for personal existential encounters.
While I may not be able to teach you more than you already know about these approaches, my effort is simply to remind you of the validity and importance thereof. If graduate school is the last time you encountered one of these models, consider this written for you.
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 holds a Master’s Degree in Human Services.