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Use therapeutic relationships to enhance therapeutic process
The therapeutic relationship essay
The therapeutic relationship essay
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Understanding the therapeutic relationship Engagement Dagmar Berman does the work with Lars and collaborates to create a very dynamic helping relationship. Dagmar takes the position of an appreciative ally and stands with Lar being ever curious and attentive to how she could give further support (Madsen, 2007). Dagmar’s stance is evidenced by her support of Lars’ belief that Bianca is real by her animated interactions with Bianca, agreement to treat Bianca for low blood pressure, and attendance at her funeral. Dagmar’s curiosity is evidenced through the discoveries of Lars’ dislike of being touched, anxiety surrounding Karin’s pregnancy, and fear of maternal death. Dagmar’s support for Lars and stance as appreciative ally is evidenced in her …show more content…
statement “He’s [Lars is] making the decisions,” referring to the details of Bianca’s existence and her impending passing. Listening Skills Dagmar continues her support for Lars and position as an appreciative ally by employing the non-directive listening skills of silence and reflection of feeling in her work with Lars. Clarification is a communication approach that allows the client and practitioner to know accurately what is being said by the client. This typically happens as a reiteration of what the client says and a closed ended question. The clinician employs this skill when she clarifies what type of pain Lars admits to feeling when he is touched. Dagmar asks, “Like a cut or a bruise?” The client responded to this question, correcting her estimation and elucidating the type of pain he felt (Sommers-Flanagan & Sommers-Flanagan, 2014). Directive listening skills that Dagmar portrayed included feeling validation and confrontation. Feeling validation is a statement made by the practitioner that affirms the feeling that the client expresses. Dagmar does this particularly well in the second session when loneliness is discussed and Dagmar says “some days I feel so lonely I forget what day it is.” Dagmar is providing validation for Lars’ expression of loneliness by normalizing the feeling so that Lars could express it. Confrontation is the act of bringing attention to the clients distorted perspectives. Confrontation occurs when Lars begins to talk about the recurring pattern of women in his life dying in childbirth, Dagmar responds by responding to Lars’ anxiety with the fact that “we have learned a lot since then[Lars’ and Bianca’s births]” and that “it is highly unlikely” for this to happen in Karin’s pregnancy. Dagmar also employs confrontation in the session where they discussed Lars’s preference to not be touched and the pain connected to being touched. The clinician challenges Lars’ ideas around personal touch by asking if it is hard to get away with not touching anyone and expressing to him that this is an area that she can help him with (Sommers-Flanagan & Sommers-Flanagan, 2014) Attending Behaviors Dagmar expresses visual contact, vocal qualities and body language as attending behaviors in her sessions with Lars (Gillespie, 2007). Visual contact is the amount of time that the client and practitioner look at each other’s eyes during a session. The perplexity of this behavior is that it is one that differs for individuals and various cultures. Dagmar is responsive to Lars in this regard and follows his lead, modeling an appropriate amount of eye contact in both the first and second sessions (Gillespie, 2007). Vocal qualities are the characteristic of one’s voice which include “loudness, pitch, rate, rhythm, inflection, and fluency” (Sommers-Flanagan & Sommers-Flanagan, 2014). Dagmar’s vocal qualities are seen in the session where she and Lars discuss Karin and her excessive hugging. Dagmar mirrors the vocal qualities that Lars expresses, and speaks in a lower tone when he expresses the pain he feels when he is touched to encourage Lars to investigate that emotion (Gillespie, 2007). Body Language refers to the movement and placement of body parts as well as the space between the individuals communicating (Sommers-Flanagan & Sommers-Flanagan, 2014). Ethical Considerations The areas of ethics that Dagmar transgressed were Conflicts of Interest, Informed Consent, Privacy and Confidentiality, Dishonesty Fraud and Deception. In the National Association of Social Workers Code of Ethics informed consent includes keeping the client conversant of the: “purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients’ right to refuse or withdraw consent, and the time frame covered by the consent” (Code of Ethics, 2015). Dagmar failed to inform Lars of the purpose for the services, risks related to the services, and clients’ rights to refuse or withdraw consent. The purpose of the service was not clarified to Lars but was on the contrary, rather misleading. Dagmar expressed that the weekly treatment were necessary to address Bianca’s low blood pressure and not Lars’ delusion. The risk related to the services provided were not expressed to Lars directly regarding the services he received. When Lars asked for an estimate of time that would be spent in treatment, she responds saying that she does not know. Lar’s treatment was also disguised under the pretense of Dagmar’s request for him to “keep me company.” Lars was neither informed about what treatment he was receiving nor about the outcomes nor risks associated with such treatments. Although Dr.
Berman respected Lars’ self-determination, she did not express to him that he possessed the ability to refuse services or withdraw consent for the services he received. The lack of informed consent was a factor in the dishonesty and deception about who the recipient of treatment was and what type of treatment was being provided. Dagmar identified herself to Lars as a medical doctor and not once onscreen mentioned her presence in his life as a therapist. This is deceptive and fraudulent as she omits the portion of her identity that is most applicable to the relationship that the two have. Dr. Berman breached privacy and confidentiality by using Gus and Karen as informants without Lars’ knowledge or approval. Dagmar asks Gus and Karen questions that are pertinent to a full assessment including information regarding the presenting problem and family context. Dagmar also keeps Gus and Karen current on Lars’ treatment answering specific questions about Lars’ delusion and some of the changes that happen within it over time which is a breach of confidentiality. Dagmar also breaches confidentiality and privacy by answering Karen’s question as to why things were happening as they were with the situation being Lars’ decision because “he is the one who is in control.” Possible Practice Approaches Cognitive Behavioral Therapy is an approach that focuses on the connection between behavior, thoughts and feelings. The approach seeks to ameliorate difficulties by changing unhelpful thinking patterns. This approach would be helpful to work with Lars as he has a struggle with the belief that Bianca is a human being and that he and her are in intimate relationship. Structural
theory
March 30, 1981 was a peaceful day. President Ronald Reagan was walking outside enjoying the fresh air when suddenly shots were fired. Six shots were fired in total, but only one shot hit Reagan due to a bullet that ricocheted. Luckily, Reagan was hit in the abdomen; therefore, he survived. The “mastermind” behind the attempted assassination was a man named John Hinckley. Hinckley believed by going through with this assassination it would be a romantic scenario for himself to confess his undying love for the actress Jodie Foster. Before long it was time for the Hinckley trial and after hearing his side of the story, the jury came to the conclusion that he was crazy. Hinckley was later found not guilty by reason of insanity and admitted to
Grant successfully managed to treat Mr. G she comes to the realization that a doctor should not judge a patient no matter how they may act, as each patient may have a reason for acting the way they do. Dr. Grant has managed to learn how to combine her own personal experience with her doctoral skills she had learned in medical schools. Dr Grant believes. “ …[A]fter twenty-eight years of schooling, my education continues, both inside and outside the classroom” ( 183). Mr. G was the key figure in changing Dr. Grants judgement. If Mr. G had not shed light onto why he was in the hospital and how he felt stripped of his freedom to Dr. Grant she probably would have just branded him as crazy, she probably would have done the same to similar patients. As Dr. Grant states, “ … I was proud of myself for having accomplished my task… I was proud of myself because I had decided not to prejudge Mr. G” (182). Mr. G exposing his true emotions to Dr. Grant was the reason that she learned that she should not judge unique patients but instead, she should try to communicate with them and better understand so she can better help
Cullen and Klein understand that deception is wrong and disrespectful to the patient but criticize that some cases are more complicated and not so black and white. They argue that physicians should be able to withhold information that can significantly benefit the patient. The key part is that the benefit is greater than what the deception causes.
The cognitive approach involves the development of a person’s thought process. This involves things like memory, thinking, perception, and problem solving (Myers, 2014). The cognitive therapy approach teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions (Myers, 2014). In other words, the harmful or negative thought patterns are identified and examined, and better, less threatening alternative thinking patterns are created to replace the negative thought patterns. This is, especially useful, as the compulsive actions are a response to the negative thought patterns that cause
Over the course of their therapeutic relationship, Dr. Davenport violates client confidentiality as it is described by the American Counseling
As a social worker, I can see that Marcel may be using drugs and alcohol to cover up some of the emotions that he has, and I believe that he is hiding some depression issues with abusing alcohol and drugs. I would like to use cognitive behavioral therapy in our intervention as well to address some of the underlying issues that Marcel has with depression. CBT works well with individuals who have some type of mental issue. In Marcels case, he happens to have some depression issues, so I believe that CBT will work well to solve some of those issues or to see where these issues are coming from. Cognitive behavioral therapy is a therapy that can be used to achieve a short-term or a long-term goal. It is a problem-solving therapy that focuses on how to solve the current problem that the client may have. It doesn’t put much emphasis on the past and past situations, it focuses more on the here and not. According to the article “Staff Expectations and Views of Cognitive Behavior Therapy (CBT) for Adults with Intellectual Disabilities” has some information that state the same thing. “There is an assumption in CBT that an individual will develop new understanding regarding their cognitive processes and acquire cognitive and behavioral skills during the therapy session which they can then apply independently and successfully in their ‘real world’. This allows the newly
The main action of the cognitive behavioural therapist is to recognise the client’s problems in a cognitive way (Curwen, Ruddell, and Palmer, 2000).
“There is no single cognitive-behavioral method or theory” a quote by McGuire, quoted by Pearson and Lipton et al. in their study of Behavioral/Cognitive-Behavioral Programs on Recidivism (Pearson & Lipton et al., 2002). According to the National Association of Cognitive-Behavioral Therapists (NACBT), Cognitive-Behavioral Therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel/act better even if the situation does not change includes but is not limited to: social skill training (NACBT).
Cognitive behavioural therapy (CBT) is a counselling model based greatly on talking therapy. It focuses on peoples underlying thoughts and past experiences, and how they influence current habits and behaviours. CBT tries to correct these and learn alternative ways of processing information to alter the undesired behaviour and/or habits. This is done through a combination of cognitive therapy (looking at the ways and things you think) and behavioural therapy (looking at the things you do).
The main definition that this author describes cognitive behavioral therapy as is an active, directive, time-limited, structured approach to treat a variety of psychiatric disorders (Beck, 1979). Understanding that this treatment can assist many different disorders allows a worker to not only use it for the client that is being bullied and has been effected by anxiety but also resulting into depression. Beck mentions a few cognitive techniques used to test misconceptions that a client may be thinking. Cognitive techniques such as monitoring automatic negative thoughts, recognizing the connections between thoughts, the affects, and behaviors, and learning to examine and explore these thoughts at different dimensions (Beck, 1979). The goal of cognitive behavioral therapy is to simply relieve emotional distress and other symptoms of mental illness (Beck, 1979). When working with a Mormon the worker will have to identify the differences between thoughts and feelings so the client can identify their own by personal reflection instead of what the worker may think is
“Cognitive-behavior therapy refers to those approaches inspired by the work of Albert Ellis (1962) and Aaron Beck (1976) that emphasize the need for attitude change to promote and maintain behavior modification” (Nichols, 2013, p.185). A fictitious case study will next be presented in order to describe ways in which cognitive behavioral therapy can be used to treat the family members given their presenting problems.
In it's simplest form, Cognitive Behavioral Therapy, (or CBT as it will be referred to from here on out), refers to the approach of changing dysfunctional behaviors and thoughts to realistic and healthy ones. CBT encompasses several types of therapy focusing on the impact of an individual's thinking as it relates to expressed behaviors. Such models include rational emotive therapy (RET), rational emotive behavioral therapy (REBT), behavior therapy (BT), Rational Behavior Therapy (RBT), Schema Focused Therapy, Cognitive therapy (CT). Most recently a few other variations have been linked to CBT such as acceptance and commitment therapy (ACT), dialectic behavioral therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT) (Harrington and Pickles, 2009). The main aspect that all of these branches of therapy share, is that our thoughts relate to our external behaviors. External events and individuals do not cause the negative thoughts or feelings, but, instead the perception of events and situations is the root cause (National Association of Cognitive Behavioral Therapists, 2010).
Cognitive behavioral therapy earliest inventors were behaviorist, such as Skinner, Watson, and Pavlov. They’re the ones who led to the advancement for behavioral treatment of mental disorders. Behavioral modification is a technique that uses positive and negative reinforcements to change a particular behavior and reaction to a stimulus. Behavioral therapist only focused on an individual’s behavior not their thoughts. During this era, psychologists applied B.F. Skinner’s radical behaviorism to clinical work. Much of these studies focused on chronic psychiatric disorders, such as autism and psychotic behavior. His methods also focus...
Cognitive is defined as a mental process; it refers to everything going on in your mind including your thought processes and the way you are thinking and feeling. Behaviour refers to everything that you may do; this includes any action that you may present or act out, this can also be an indirect action that is caused by other underlying behaviours. Therapy is a systematic approach to try and resolve a problem, illness, actions, irregular thought patterns or anything that may be a disturbance that distracts you from your everyday functioning. Cognitive Behavioural Therapy (CBT) is a dynamic mode of holistic intervention that seeks to change thought processes that are linked with emotions through a goal-orientated process (Freeman and Ronen, 2007). Individuals have a three-step thought process; inferences, evaluations and core beliefs. Cognitive Behavioural Therapy looks into the dysfunctional thinking a client may have, which influences their thoughts, mood and behaviour. This theory is kept very loose and non-structured; depending on the client different theories will have to be applied depending on their needs and emotions.
They take things that are not physically observable, and make different inferences towards them. Language, memory, and thinking are some examples of the processes that are explored. In this, the individual searches for useful information from a certain stimuli. So, as shown, both the cognitive and the behavioral therapies both use stimuli. The beginning of the therapy would start by targeting thoughts, behaviors or the individual’s goals. The next step would be to make a list of “thinking errors” and find why they are “errors”. A few thinking errors are “Black or White” thinking, “Should” statements, and “filtering”. The therapist can help to find and point out the different thinking errors but the individual needs to work at the problem outside of the sessions for it to have a positive