NCE

Classical Conditioning Inspired Models of Therapy

What is Classical Conditioning Anyway?

“The emergence of behaviorism in the early twentieth century brought fresh approaches to the question, how do animals learn? (Rachlin, 1991, p. 62).”  In my old course textbook, Corsini & Wedding (2011). describe theoretical descendants of Pavlov, Wolpe & J.B. Watson’s work as a Neobehavioristic Mediational Stimulus-Response Model (p. 236).”  Overall, these approaches features the application of principles of  classical conditioning derived from the learning theories of these individuals (Corsini & Wedding, 2011). Before providing a “quick and dirty” overview of their work, there an overview of classical conditioning – in its modern format – is worth discussing.

A Core Clinical Hypothesis

I dug up another course textbook that provides an interesting perspective, titled “Clinical Case Formulations,” (Ingram, 2012).  It’s purpose is as follows. “A clinical case formulation is a ‘conceptual scheme that organizes, explains, or makes sense of large amounts of data and influences the treatment decisions’ (Ingram, 2012 p. viii).”  What I love about this book is it provides clinical hypotheses that are useful in providing “a single explanatory idea that helps us structure data about a given client (Ingram, 2012 p. 11).”  In chapter eleven of this textbook is a section titled “Behavior and Learning Models.”  In it is a clinical hypotheses based on theoretical classical conditioning insights.

“Hypothesis BL2: Conditioned Emotional Responses” (Ingram, 2012, p. 239).

The textbook notes that this hypothesis is based on the classical conditioned paradigm and implies that insights from his work are useful when a person is suffering from” high emotional distress and maladaptive avoidant behaviors, (Ingram, 2012 p. 239).”

Here is an explanation of this hypothesis, (Ingram, 2012).  
“When there is an intense emotional response that is not justified by the stimuli in the current environment, along with a lack of cognitive mediation, we can infer that prior learning involved classical conditioning. The treatment will frequently require explore to the conditioned stimuli, counter-conditioning with pleasant emotions and prevention of maladaptive avoidance responses. (Ingram, 2012, p. 239).”
Here is a clinical case example, (Ingram, (2012).
“Zac (42, White Christian), needs to overcome intense public speaking anxiety to attain an important promotion. he can recall the traumatic situation in which the conditioning response occurred. He was giving a speech in his eighth grade class when his mind went blank and he ran out of the room. Even thinking about standing in front of a group produces uncomfortable sensations, (Ingram, 2012, p. 239).”

Potential Problem Areas & Treatment Methods…

Finally, Ingram, (2012), mentions that this core hypothesis is useful with anxiety disorders, like social anxiety, panic, and OCD, as well as with trauma situations.  It is ideally useful in situations in which: (1) the emotional reaction is not contextually appropriate, and; (2) the client experiencing a functional impairment and “negative social consequences” (Ingram, 2012, p. 241). Treatment methods utilized can include exposure therapy (in vivo or via imagery) (Ingram, 2012).  Modern therapies based on Pavlov’s classical conditioning insights also utilized desensitization and flooding techniques, (discussed later).

Classical Conditioning Today…

Proponents of Behavioral therapy assert that it has grown beyond Pavlov’s dog or Watson’s Little Albert experiments.  When Pavlov began his experiments on animal behavior he was inspired by an interest in  ‘psychical activity on physiological facts, [desiring to unite]…the physiological with the psychological, the subjective with the objective (Wolpe & Plaud 1997, p. 966).”  Today rather than simply focusing on pairing a singular stimulus like a bell, with a singular response like drooling.  “Instead, correlations between entire classes of stimulus events can be learned (Corsini & Wedding, 2011, p. 247).”  The goal, however ultimately is the same” extinction or the deconditioning of an emotional / physiological response to a traumatic or anxiety producing situation or event (Corsini & Wedding 2011; Ingram, 2012).

Unique Aspects of this Behavioral Therapy Approach

Classical conditioning tends to focus on involuntary emotional and physiological responses.  In contrast, Skinner’s theory focuses on voluntary behaviors.  The extinction of a behavior for Pavlov is a triggered response that occurs by focusing on the stimulus.   Learning is then a passive process through the adjustment of expectations we develop in a situation based on previous experience.  We associate certain stimuli with an event and a response is elicited as a result.  In contrast, Skinner focuses on the consequences of our behavior, and the client’s role is an active one.   For Pavlov, behavior is more reflexive in nature and consequently they play a passive role in the learning process.

“Founding Fathers”

In this section I’m reviewing individuals reviewed in Rosenthal’s (2005) review CD for the Classical Condtioning of the NCE exam.  Included below is a “quick and dirty” overview of Pavlov, Watson, Wolpe, & Mary Covey Jones work.  

Ivan Pavlov

“While Pavlov was the director of the physiological laboratory at the Institute of Experimental Medicine in Petrograd, he noticed that dogs often would salivate at the sight of the attendant bringing them food or even at the sound of the attendant’s footsteps. Pavlov realized that the attendant was not a natural stimulus for the reflex of salivating; rather, the attendant acquired this power by being associated with food (Shunk 1991, p. 48).”

Pavlovian Conditioning

As the above quote notes, Pavlov noticed dogs salivating at the site of somebody bringing them food, or simply by hearing their footsteps.  He was interested in better understanding the stimuli that preceded these reflexive behaviors and how the to factors became connected.   In the above video is original footage from Pavlov’s classical experiment. “When meat powder was placed in a dog’s mouth, salivation takes place, (Bower & Hilgard, 1981, p. 49).”

UNCONDITIONED STIMULUS (UCS) – The meat powder in the above example is the unconditioned stimulus. It “causes a response without any learning or training, (Ingram, 2012, p. 239.”  
THE UNCONDITIONED RESPONSE (UCR) – The dog’s salivation in the above example, is the unconditioned response.  In Pavlov’s experiment it is an automatic and reflexive response.  

As stated earlier, Pavlov wanted to understand how stimuli become reflexive behaviors and cause them to happen.  In his experiments, he attempted to condition the dogs to salivate when after the presentation of a previously neutral experiment.  For example, Pavlov would ring a bell or turn on a ticking metronome prior to feeding the dogs  Eventually, they came to associate the ringing bell with food, and automatically salivate when hearing this noise….

THE CONDITIONED STIMULUS (CS) –  In this example, the bell or metronome are conditioned stimuli.  “Meaningless in themselves, these stimuli have been paired with an unconditioned stimulus (Ingram, 2012, p. 240.”
THE CONDITIONED RESPONSE (CR) – The conditioned response in Pavolv’s experiments above are conditioned responses when they occur after a previously neutral stimulus.  In the above example, when the dog salvates after the bell rings this is a conditioned response.
THE CONDITIONING PROCESS – “Palov saw conditioning as the establishment of a new reflex by the addition of a new stimulus to the group of stimuli that are capable of triggering a response. (Rachlin, 1991, p. 68).” 

Pavlov’s Hypotheses

From the above research, Pavlov learned that innate reflexive behaviors can be conditioned by establishing a connection in the brain between a conditioned stimulus and an unconditioned stimulus (Rachlin, 1991).  He conceived learning as an automatic process that occurs as a result of repeated CS-UCS pairing (Shunk, 1991). Pavlov has thwo hypotheses to explain how this happens:

STIMULUS SUBSTITUTION – Stimulus substitution occurs when the presence of a bell reminds the food for the dog.  The conditioned stimulus, (i.e. bell), is able to elicited a conditioned response through its association with the unconditioned stimulus.  This is called stimulus substitution.
PREPARATORY HYPOTHESIS – Pavlov also hypothesized that salivation occurs prior to conditioned stimuli because the dog salivation prepares the dog for eating, when food is given to him, (Rachlin, 1991).
EXPECTATIONS – Finally, Pavlov notes that expectations exists as a critical link between a conditioned and unconditioned stimulus.

Reinforcement

What Pavlov felt was crucial about the above hypotheses, is they can allow individuals to either learn new skills or extinguish maladaptive behaviors.  He uses the term reinforcement to refer to “the repeated following of the conditioned stimulus by the unconditioned stimulus and response at appropriate time intervals, (Bower & Hillgard, 1981, p. 50).”

Inhibition….

The gradual loss of a conditioned reflex is called inhibition.  Rosenthal (2005), states it is also sometimes called spontaneous.  Pavlov felt inhibition was not represent the complete removal of an original conditioned response.  Instead, the addition of an equal but opposite negative conditioning caused inhibition.  With this in mind, what follows are a few relevant terms to help understand this process:

INHIBITORY FORCE – Pavlov felt that extinction did not eliminate the original conditioned response, but added an equal opposite conditioning that prevented the emitting of a conditioned response (Rachlin, 1991).
EXTERNAL INHIBITION – “The temporary loss of a CR due to an extraneous distracting stimulus that reduces a conditioned stimulus to a light [response] (Bower & Hillgard, 1981, p. 54).” For example, a painful stimuli might cause a dog to lose it’s appetite.  
INTERNAL INHIBITION – “A learned form of inhibition that is evoked by a stimulus with nonreinforcement under circumstances when the US is otherwise expected (Bower & Hillgard, 1981, p. 54.)”  
EXTINCTION – This happens when the conditioned stimulus is no longer linked to the unconditioned stimulus.  In the above example, if you stop ringing the bell before feedings, the dog will no longer salivate when hearing a bell sound (Rosenthal, 2005).  Bower & Hillgard (1981), note extinction is a type of internal inhibition.

Generalization & Discrimination

Two final concepts are worth noting for this review.  Generalization and discrimination refer to alterations in the conditioned responses to various stimuli over time.  For example, with generalization occurs when a dog salivates with any bell-like sound, like a car horn or phone ringing.  In discrimination, when a dog responds to stimuli with greater levels of specificity.  For example, our cat used to think we were feeding it whenever we used the electric can opener.  Lately, my oldest teenager has been responsible for feeding the cat and changing the litter box.  Therefore, our cat only thinks its being fed when our son is by the can opener.

J.B. Watson

J. B. Watson (1878 – 1958) studied at the University of Chicago when the functionalist school of  “Put his name in history books by coining the term behaviorism in 1912 and is called father of behaviorism” (Rosenthal, 2005).  “The behaviorists…have in common the conviction that a science of psychology must be based upon a study of that which is observable” (Bower & Hillgard, 1981, p. 75).  As a behaviorist, Watson’s goal was to find objective laws of behavior to substitute the subjectivism that was prevalent in the emerging field of psychology.  In his work, Watson conceived feelings, and thoughts as “implicit or covert stimulus-response sequences” (Bower & Hillgard, 1981, p. 76).

The Little Albert Experiment

Inspired by Pavlov’s work, Watson used his experience as a “paradigm for learning and made the conditioned reflex the unit of habit” (Bower & Hillgard, 1981, p. 76).  In his classic “little Albert” experiment,Watson desired to replicate Pavlov’s dog experiment.   He exposed his little subject “Albert” to a loud noise whenever a white rat was present.  “After a few trials pairing rat and loud noise, Albert was afraid of the rat and stimulus generalization, causing him to be afraid of anything small and fury” (Rosenthal, 2005).  Apparently, he was unable to reverse this conditioning, and Albert lived his life in fear of any white furry animals.  While the questionable ethics pertaining to this experiment are obvious, it is frequently discussed in textbooks in relation to classical conditioning.

Insights & Observations

As a result of his “little Albert Experiment” Watson learned that frightening events can become” a conditioned stimulus that elicits a conditioned response that elicits anxiety” (Corsini & Wedding, 2011, p. 247).  Essentially, the reason this research appears repeatedly in Psychology textbooks, it is the first experimental demonstration of emotional conditioning.  In this respect, it provides the groundwork for systematic desensitization (discussed later).

Mary Cover Jones

Mary Cover Jones, (1897-1987), is a psychologist who focused on developmental psychology.  Known commonly as “the mother of behavioral therapy” (Rutherford, 2001), Mary conducted another classical conditioning experiment based on the insights of Pavlov & Watson.  However, her goals were much more noble: to extinguish a phobia in young children like Little Albert.  In her experiment, Mary utilized a young subject by the name of Peter who was about three-years-old.  She began by exposing him to something that scared him: a white rat.  She then followed this “feared object” with the presentation of food, a “craved object”.  After several repeated trials, Mary was able to eliminate Peter’s fear of rats…..

Key Insights…

Mary Cover Jones was able to prove “not only could a phobia be learned, it could be unlearned. In an article I found online, titled “The Elimination of Children’s Fears, ” she lists the results of subsequent research which builds on this insight (Jones, 1924):

“…In our study of methods for removing fear responses, we found unqualified success with only two. By the method of direct conditioning we associated the fear-object with a craving-object, and replaced the fear by a positive response. By the method of social imitation we allowed the subject to share, under controlled conditions, the social activity of a group of children especially chosen with a view to prestige effect. Verbal appeal, elimination through disuse, negative adaptation, “repression,” and “distraction” were methods which proved sometimes effective but were not to be relied upon unless used in combination with other methods, (p. 129).”

Joseph Wolpe

Based on the work of Jones & Watson, Joseph Wolpe (1915 – 1997), attempted to apply classical conditioning techniques to the therapy process. In his work “Psychotherapy by Reciprocal Inhibition”, Wolpe attempted to describe how habits could be unlearned (Corsini & Wedding, 2011).  Later, while working as an army physician in South Africa during, he described what he called “war neurosis” (now PTSD).  Wolpe felt neurosis was a byproduct of persistent anxiety that existed as a result of the autonomic nervous system and was a byproduct of classical conditioning (Corsini & Wedding, 2011).  He would eventually develop systematic desensitization as a therapeutic method to address this issue.  What follows is a description of key insights from Wolpe’s work…

What is Neurosis?

Firstly, Wolpe rejects the classical psychoanalytic view of neurosis as a byproduct of early events in one’s childhood.  Instead he felt it was a byproduct of learning processes and classical conditioning.  Neuroses consisted of persistent anxieties and maladaptive behaviors that can be unlearned.

Reciprocal Inhibition.

In his work, Wolpe, (1995 & 1997), has described the use of counterconditioning techniques to address and eliminate anxiety.  He defines reciprocal inhibition as follows:

“When a response antagonistic to anxiety can be made to occur in the presence of anxiety-evoking stimuli, and in consequence effects a complete or partial suppression of the anxiety response, the bond between…stimuli and…response is weakened (Wolpe, 1995, p. 24).”

Ideal this technique is useful for emotionally conditioned knee-jerk responses and involves some opposite action.   Engaging in an response that is contradictory to the emotions you are feeling, when presented with anxiety-producing stimuli can inhibit a maladaptive behavior.  Wolpe, (1995) notes: “Laughter is inhibited by sadness, anger or anxiety and can in turn inhibit them (p. 26).”

Systematic Desensitization

“Systematic desensitization a conditioning form of therapy for treating phobias that has four distinctive stages after you build a rapport with the client, (Rosenthal, 2005).”  These steps are described as follows:

  1. STAGE ONE – Relaxation Training.  The first step in systematic desensitization involves teaching clients relaxation techniques.  Rosenthal, (2005), notes that the Jacobson Technique is most common.
  2. STAGE TWO – Construct Hierarchy.  – Next, clients rank their list of fears in a hierarchical order so that they can be addressed gradually in therapy.  Rosenthal (2005) suggests utilizing the SUDS (Subjective Units of Distress Scale) to assure accuracy of this hierarchical scale of “feared stimuli”.
  3. STAGE THREE – Imagination.   In the interposition phase, clients utilize their imagination to think about their feared objects on their list, starting with the lowest one.  For me this would involve standing in front of a class and image giving a speech.
  4. STAGE FOUR – in vivo.  Finally, the clients gradually work their way through their feared stimuli.  This might involve co-facilitating of a group therapy class with my supervisor a few times, before running it independently.

Edwin Guthrie

“A combination of stimuli which has accomplished a movement on its recurrence tend to be followed by that movement. Stimuli patterns which are active at the time of a response tend, on being repeated, to elicit a response (Shunk 1991, p. 84).”

While not mentioned in my review CD’s by Rosenthal (2005), there is one more individual that warrants mention.  Edwin R. Guthrie (1886-1959) is a behaviorist who proposed that learning was based on an association & that reward systems were not necessary.  Two separate sources I’ve reviewed provide the above quote, which seems to indicate its important (Bower & Hilgard, 1981; Shunk, 1991).  I’m not a fan of Guthrie’s convoluted writing style.  However, it appears he is making a statement that stimuli and responses that occur together can be expected to do so in the future.  He calls this contiguity learning.  Additionally, he is noting in the above statement that there are two types of behaviors, defined below:

“Movements are discrete behaviors that result from muscle contractions…acts [are] large-scale cassess of movements that produce an outcome (Shunk, 1991, p. 84).”

Principles of Learning

In Guthrie’s writing are observations on Principles of Learning, listed below:

ASSOCIATIVE STRENGTH:  “Guthrie states that learning occurs through the pairing of a stimulus and response” (Shunk, 1991, p. 84).  The success of a learning opportunity is a function of the associative strength between a stimulus and a response.  
ALL-OR-NONE PRINCIPLE:  Guthrie rejected the notion of frequency and repetition as critical for learning (Shunk, 1991).  Instead, he believed that learning had a threshold potential.  In other words a minimal level of associative strength was required for learning.  This – he believe – was more important than repetition.
CONGITUITY: Guthrie believed that reward and punishment was not essential learning.  Instead he discussed the “mechanism of contiguity, or close pairing in time between stimulus and response” (Shunk 1991, p. 45).  
UNLEARNING: Guthrie felt, however, that rewards were helpful in preventing forgetting (or what he calls unlearning).  

How to Break Habits..

Guthrie defines habits as “learned dispositions to repeat past responses” (Shunk, 1981, p. 85).  In his theory, he provides three methods for breaking a habit.  The key underlying his methods involves associating new responses to old cues:

THRESHOLD METHOD:   Stimuli that precede a habit are introduced a a weak level below the required associative strength required for learning (Shunk, 1981).  Gradually, increase strength level, but keep the stimuli below required associative strength.  For example, I will increase the amount of time I spend doing homework with my son gradually.  However, I am also mindful of his frustration level.
FATIGUE METHOD:  Stimuli that triggers a bad habit is transformed into one that causes an individual to avoid it  (Shunk, 1981).  For example, when I become stressed I don’t respond by eating, instead I respond by exercising.
INCOMPATIBLE RESPONSE METHOD: “…the cue for the undesired behavior is paired with a response incompatible with the undesired response; that is the two responses cannot be performed simultaneously” (Shunk, 1981, p. 87).

Techniques Based on Classical Conditioning…

I am going to conclude this section with a “quick and dirty” overview of miscellaneous techniques based on classical conditioned discussed in Rosenthal’s (2005) NCE review CD’s.

Sensate Focus

“This popular technique for sexual dysfunction based on Masters & Johnson counterconditioning [is also known as behavioral sexual therapy]…Couples are told to engage in non-erotic touching while very relaxed.  They slowly work up to intercourse like systematic desensitization.” (Rosenthal, 2005).

Assertiveness Training.

Based on Wolpe’s (1995) concept of reciprocal inhibition, assertiveness training involves “overcoming interpersonal timidity.  The person is shown how to express, in all reasonable circumstances, legitimate anger, affection, and other appropriate feelings” (p. 32).  Rosenthal, (2005), notes “it has roots in the work of Andrew Salter who in 1949 wrote a book called “CONDITION REFLEX THERAPY”.  

Aversive Conditioning

Aversive conditioning is based on the classical stimulus-response model.  An unpleasant unconditioned stimulus is paired with a maladaptive behavior so that client develops an avoidance response.   An ideal example includes the pairing the antabuse and alcohol (Rosenthal, 2005).

Flooding & Implosive Therapy

Rosenthal, (2005), describes flooding as a form of exposure therapy ideal for trauma and anxiety related disorders.  It encompasses exposure to an anxiety-producing stimulus, while engaging in response prevention.  In contrast, implosive therapy is an imaginative version of flooding.  Wolpe, (1995), notes that techniques such as flooding are successful due tot their ability to induce extinction processes to occur….

Biofeedback

This high-tech form of behavioral therapy that involves being hooked up to monitors that measure your vital signs.  It is useful with anxiety and stress-related disorders, allowing clients understand the effects of stress, anxiety and relaxation exercises on the body.  Rosenthal (2005), notes that it is based on the work of Neil Miller who noted that we can control the autonomic nervous system.

Paradoxical Intention

As a fan of Viktor Frankl’s work, I will devote another post to his work.  In this post I limit my discussion of Frankl to a concept pertaining to behavioral therapy he calls “paradoxical intention”.  It is useful with anxiety disorders and in family therapy, however “should never be used with suicidal or homicidal patients” (Rosenthal, 2005).   The goal of paradoxical intention is to extinguish maladaptive behaviors.  This is done by having the client engage in a highly exaggerated and inappropriate level of a specific behavior they hope to extinguish.  Underlying this technique is an interesting observation about a vicious cycle underlying anxieties and phobias that this technique addresses through counterconditioning:

“If one wishes to understand how paradoxical intention works, he should take as a starting point the mechanism called anticipatory anxiety: A given symptom evokes, on the part of the patient, a response in terms of the fearful expectation that it might recur; fear, however, always tends to make true precisely that which one is afraid of, and by the same token, anticipatory anxiety is liable to trigger off whata the patient so fearfully expects to happen. Thus a self-sustaining vicious cycle is established: A symptom evokes phobia; the phobia evokes the symptoms…” (Frankl, 1975, 226p).

Beta Hypothesis

Knight Dunlap, another behavioral psychologist and noted a paradoxical aspect of habits similar to Viktor Frankl’s.  Essentially, repetition of a specific habit did not influence is gradual development or emergence.  Instead Dunlap (1928) noted that “importance of anticipatory ideas and desire [are] elementary factors”, (p. 361).  Therefore, Dunlap suggested that clients engage in the dysfunctional habits at times when they would not normally do so.  “Paradoxically enough, this often eliminates or reduces the frequency of the behavior” (Rosenthal, 2005).

Multimodal therapy

Arnold Lazarus (1932-1928) is a clinical psychologist born in South Africa who based a holistic model of mental health (Corsini & Wedding, 2011).  He founded a Multimodal Therapy Approach based on insights from cognitive and social learning therapies (Corsini & Wedding).  Rather than focusing on unconscious vs. unconscious aspects of the psyche, this method involves assessing a client’s needs in several key areas.  This method utilizes the acronym BASIC ID to examine several key aspects of an individual’s well-being: “Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal Relationships, and Drugs” (Rosenthal, 2005).

References

Bower, G.H. & Hilgard, E.R. (1981). Theories of Learning, 5th Ed..  Englewood Cliffs, N.J.: Prentice-Hall.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Guthrie, E.R. (1952). The psychology of learning. New York: Harper Row.
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.
Jones, M. C. (1924). The Elimination of Children’s Fears.  Retrieved from:  http://www1.appstate.edu/~kms/classes/psy5150/Documents/MCJones1924.pdf
Kazdin, A. E. (2012). Behavior modification in applied settings. Waveland Press.
Dunlap, K. (1928). A revision of the fundamental law of habit formation. Science.  Retrieved from: https://www.ganino.com/games/Science/science%20magazine%201920-1939/root/data/Science_1920-1939/pdf/1928_v067_n1736/p1736_0360.pdf
Nye, R.D. (1979). What is B.F. Skinner Really Saying?. Englewood, N.J.: Prentice-Hall.
Pierce, W. D., & Cheney, C. D. (2013). Behavior analysis and learning. Psychology Press.  Retrieved from: https://scholar.google.com/scholar?cluster=8530085740643864664&hl=en&as_sdt=0,28&as_ylo=2012
Rachlin, H. (1991). Introduction to Modern Behaviorism, 3rd. Ed. New York: Freeman & Company.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Rutherford, A. (2001). Introduction to a laboratory study in fear: The Case of Peter. Retrieved from:  http://psychclassics.yorku.ca/Jones/intro.htm
Schunk, D. H. (1991). Learning theories: An educational perspective. Retrieved from: http://s3.amazonaws.com/academia.edu.documents/44670152/_Dale_H._Schunk__Learning_Theories_An_Educational..pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1475602918&Signature=jyd3eErVXh%2F6RaD8I%2B056ea%2FlNw%3D&response-content-disposition=inline%3B%20filename%3DDale_H._Schunk_Learning_Theories_An_Edu.pdf
Frankl, V. E. (1975). Paradoxical intention and dereflection. Psychotherapy: Theory, Research & Practice12(3), 226-237. doi:10.1037/h0086434
Wolpe, J. (1995). Reciprocal inhibition: Major agent of behavior change. In W. T. O’Donohue, L. Krasner, W. T. O’Donohue, L. Krasner (Eds.) , Theories of behavior therapy: Exploring behavior change (pp. 23-57). Washington, DC, US: American Psychological Association. doi:10.1037/10169-002
Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contributions to behavior therapy: The obvious and the not so obvious. American Psychologist, 52(9), 966-972.

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Introduction to Behavioral Therapy


Behavioral Therapy is a relative new counseling theory, with a history that only goes back to the 1950’s (Corsini, 2011).  However, Rosenthal (2005) notes that it in a few early scholars.  For example, it has “roots in John Locke’s philosophy of associationism which notes that mental states operate by association with one another (Rosenthal, 2005).”  It is also influenced heavily by John Locke’s notion of the “tabla raza (Rosenthal, 2005)”, which notes that the mind is blank at brith and the environment molds it. Finally, it has origins in Edward Thorndike’s work on Animal Intelligence which notes the “law of effect” as influencing animal behavior.  Those responses that yield satisfactory outcomes are repeated.

Overall, behavioral therapies are quite popular today with their emphasis on the scientific method and empirically-based technique, (Corsini, 2011). With managed care and the desire to curb costs, brief therapies based on empirical research are strongly emphasized (Corsini, 2011). This bodes well for the future of behavioral therapy. So what is behavioral therapy anyway?

 Overview & Types of…

What is Behavioral Therapy?

“Behavioral therapy is not really a single therapy but a collection of therapies that reduces dysfunctional behaviors and refine productive behaviors (Rosenthal 2005).”  Behavioral therapy focuses on covert and overt behaviors and follow an approach that reflects the scientific approach.  The client is described as a problematic target behavior as a baseline measure, using a clear operational definition (Rosenthal, 2005).  After the intervention is utilized examines the effectiveness of this approach.   This process occurs much like the experimental process.  “Hard core behavioral therapists believe that if you can’t measure it, it doesn’t exist at all (Rosenthal 2005).”

Three Main Approaches

In attempting to make sense of the key forms of behavioral therapy, I utilized Rosenthal (2005), collection of CD’s for the NCE exam, as well as an old textbook by Corsini & Wedding (2011). Rosenthal (2005) divides his discussion of behavioral therapy into main categories: one based on skinner’s work, and another based on pavlov’s work.  However, Corsini & Wedding (2011) note: “Behavior therapy can no longer be defined simply as the clinical application of classical and operant conditioning theory, (p. 235).”  Contemporary behavioral approaches fall into three broad categories.  I will discuss these each in separate posts in greater detail and include links below.

Applied Behavioral Analysis

Applied Behavioral Analysis “is a direct extension of Skinner’s radical behaviorism. It relies on operant conditioning, the fundamental assumption that behaviorism is a function of its consequences. Accordingly, treatment procedures are based on altering relationships between overt behaviors and their consequences. Applied behavioral analysis makes use of reinforcement, punishment, extinction, stimulus control…(Corsini & Wedding, 2011, p. 236).”
The focus is on learning of voluntary behaviors through the manipulation of cconsequences
Antecedents are triggers which precede a behavior (i.e. situations, thoughts & emotions).
Consequences refer to the events that follow the behavior.
Maladaptive behaviors are a function of their consequences altering these alleviates them.  
Learning is the reassortment of an individuals responses to a situation (Shunk, 1991).  
Reinforcers are stimuli which follow a behavior that increase its recurrence.
Conditioning is the strengthening of a behavior through reinforcement.
Extinction is the decline in a specific behavior due to the absence of a reinforcer.
Behavior should be examined as a dependent variable & function of learning processes
Learning is an active and participatory endeavor.
Neobehavioristic Mediational Stimulus-Response Model
This approach features the application of principles of  classical conditioning and derives from the learning theories of Ivan Pavlov…Unlike the operant approach, the S-R model is mediational, with intervening variables and hypothetical constructs prominently featured..techniques of systematic desensitization and flooding, (Corsini & Wedding, 2011, p. 236)” are use in this model.

The focus is on on response conditioning of involuntary emotions and responses.

People have expectations of outcome in a situation based on previous experience.

Conditioned stimuli are known to occur before an event (bell), and elicit a conditioned response (salivation).
Unconditioned stimuli have no correlation to an event, (eating) and do not elicit a response (salivation).
Learning occurs through pairing of a stimulus with a response.
Extinction occurs when the conditioned stimulus no longer occurs before an event.
Consequence (i.e. reward / punishment) is not essential for learning.
Instead the close association in time between stimulus and response is critical.
Behavior is elicited and conceived of from a biological perspective.
Therefore, the client plays a passive and reflexive role in learning.

Social-Cognitive Theory

The social-cognitive approach depends on the theory that behavior is based on three separate but interacting regulatory systems….external stimulus events,,,external reinforcement , and…cognitive mediational processes…(Corsini & Wedding, 2011, p. 236).” Examples of theorists from this perspective include Beck & Bandura.
The relationship between the individual and his environment is seen as reciprocal.
The environment influences our behavior and the environment.
Learning is a byproduct of the interaction between an the individual, their environment and behavioral responses.
In contrast to the previous behavioral models, individuals and initiate change independently.
People desire to self-efficacy and act as agents of change in their own lives., this requires the skills of “forethought, performance, and self-reflection” (Shunk, 2011).
Enactive learning involves learning through doing while vicarious learning occurs through observing others.
An event or stimulus that produces change, but an individual’s interpretation of these specific factors.
Cognitive processes are also part of the behavior learning process and should be addressed for therapeutic success (Corsini & Wedding, 2011).

Assumptions

Based on the insights of Ivan Pavlov, B.F. Skinner, and Watson theory can be thought of as a “learning theory” (Corsini, 2011). While several variants exist, they are based on a few notable assumptions.

Behaviors Are The Result Of Consequences.

What are the consequences of this assumption? The behavioral therapist focuses on understand how a stimulus is perceived, and related motivationally to a response (Corsini, 2011). Interventions utilized for this involve an adjustment of perceived consequences for a behavior with techniques such as operant conditioning and reinforcement (Corsini, 2011)

Current Determinants Are the Priority.

“Behavioral assessment focuses on current determinants of behavior rather than on the analysis of historical antecedents.” (Corsini, 2011, 237).   Of lesser importance are internal personality factors, such as symptomatology, or temperament (Corsini, 2011). Additionally, the historical context of a person’s life isn’t focused upon much within this therapy technique (Corsini, 2011).

Understanding a problem doesn’t yield change it.

Instead change happens through the process of reconditioning behavior (Corsini, 2011). Doing so involves changing preferred ways of coping, homework, and an array of “corrective learning experiences” (Corsini, 2011).

Radical Acceptance & The Third Wave.

While not a key component of all types of behavioral therapy, newer forms of this therapy introduce concepts such as mindfulness and the idea of a “radical acceptance” into the mix (Corsini, 2011). Newer “third wave” versions of behavioral therapy, have introduced these concepts to address the emotive components of behavior (Corsini, 2011).

Uses & Applications

So based on this brief description, in what circumstances and situations might it most ideally be applicable? Behavioral therapy has been fairly useful in an array of psychiatric conditions such as PTSD and OCD as well as an assortment of addictive behaviors (Corsini, 2011). Its greatest use and benefits are for those presenting problems that aren’t affectively address through understanding, practical logic, or emotive release alone (Marom, 2003).

Anxiety, Panic Disorders, & OCD.

Often used in conjunction with psychiatric medication, the utilization of behavioral therapy for anxiety, panic disorders, and OCD has proven particularly beneficial (Clark, 2005; Marom, 2003). The presenting problem in these cases is that of altered brain function. Seemingly inert situations, events and/or objects are associated with a strong anxiety producing response for clients (Clark, 2005; Marom, 2003). In the midst of an extreme panic in the presence of key triggers, behavioral therapy provides clients an opportunity to learn new ways of coping (Clark, 2005; Marom, 2003). These treatment methods are often multimodal, including techniques to help relax and self soothe as well as a systematic exposure program (Clark, 2005; Marom, 2003). These interventions are aimed at reducing maladaptive coping strategies (Clark, 2005). Foremost among these are irrational safety behaviors. (i.e repetitive handwashing, and hoarding), which are utilized in response to anxiety producing triggers (Moran, 2003). When occurring alongside psychiatric follow up, as well as group and individual therapy these methods have been proven effective (Clark, 2005; Marom, 2003).

PTSD & Behavioral Therapy.

Post Traumatic Stress Disorder is a psychiatric disorder that arises in response to an intensely stressful and traumatic event (Corsini, 2011; Jaycox, 2002). In the aftermath of such events, clients are left with an array of troubling symptoms (Corsini, 2011; Jaycox, 2002). Foremost among these is the re-experiencing of feelings associated with the initial trauma in the midst of triggers that produce memories of the event (Jaycox, 2002; Linehan, 1993). Adding to this key symptom is a vacillation between hyper arousal and emotional numbing (Jaycox, 2002; Linehan, 1993). This hyper arousal state is felt in the form of an intense anxiety when confronted with situations that produce memories of the trauma (Jaycox, 2002; Linehan, 1993). In response to this, PTSD sufferers tend to engage in an array of avoidance, and emotional numbing, as a way of coping (Jaycox, 2002; Linehan, 1993).

Of particular benefit in such cases are the “third waves” behavioral therapies such as Dialectical Behavioral Therapy (Jaycox, 2002; Linehan, 1993). DBT includes traditional behavioral techniques with an intermingling of insights from Asian philosophers (Linehan, 1993). For example, its notion of radical acceptance, bears great similarity to Ellis’s concept and is particular helpful in enabling clients to move forward (Linehan, 1993).

The key logic underlying the idea of radical acceptance is that that non-acceptance yields suffering (Linehan, 1993). The goal is to aid clients in coming to terms with traumatic experience by understand this notion (Linehan, 1993). Adding to this insight are components such as mindfulness, self-soothing, and behavioral techniques (Linehan, 1993). Together they can aide clients in moving beyond a desire to resist very real fact that the trauma happened (Linehan, 1993). While therapy can’t ever help erase the event or allow it to be forgotten, the goal is to alter a client’s way of relating to the experience (Linehan, 1993). Ideally, memories of the trauma don’t produce a hyper aroused state they once had (Linehan, 1993). Additionally, in the place of a desire to avoid and engage in emotional numbing is a meaningful processing of the experience (Linehan, 1993).

Addictive Behaviors.

Addictive behaviors, such as hoarding, alcoholism, and compulsive over-eating, and even anorexia nervosa are well suited for behavioral therapies (Corsini, 2011). The key benefit of behavioral therapy, in these instances is in its ability to hit the heart of the issue with these presenting problems (Corsini, 2011).   Clients are provided a structure around which they can come to truly understand emotionally the consequences of their current methods of coping (Corsini, 2011). They can be allowed to understand the faulty thinking underlying their maladaptive behavior (Corsini, 2011).

Behavioral Therapy For Children.

In the Lifespan Development course for this program, a brief mention was made of behavioral therapy (Broderick, 2010). When providing therapy for children, it is important to consider the very real cognitive limitations they present with developmentally (Broderick, 2010). While assessments need to be made on a case-by-case basis, some generalizations can be made note of (Broderick, 2010). In particular, throughout much of our childhood, we are often unable to process abstract concepts (Broderick, 2010). Additionally, our ability to see beyond our own perspective is limited (Broderick, 2010). In a nutshell, you have a population of individual’s best described as concrete egoists (Broderick, 2010). On the basis of this fact, behavioral therapy is ideal suited to address behavioral disorders in this population (Broderick, 2010).   Providing children with a concrete sets of behavior patterns to better cope, not only heightens their effectiveness, but can boost self-esteem (Broderick, 2010). While schemas regarding the self concept are fairly indelible at this age, with consistency and time, they can be effective (Broderick, 2010).

Behavioral Family Therapy

This portion of the post includes excerpts from a paper for a marriage and family counseling course….

In an effort to dispel a historically negative caricature of behavioral therapy in family therapy, Gurman (2013) provides a historical review of behavioral therapy’s course of development. According to Gurman (2013), despite the historical distrust of this method, approximately 80% of all couple and family therapists now utilize it (p115).   Next is a review of Gurman’s (2013) description of behavioral therapy’s development and application in the field of family therapy.

Individual Behavioral Therapy.

Behavioral therapy’s origins begin with Pavlov’s classical condition and Skinners operant conditioning models. During individual behavioral therapy’s first wave of development in the 50’s and 60’s, efforts were being undertaken to address the deficits of psychoanalysis (Gurman, 2013). The stimulus-response learning perspectives of early behavioral therapy were nonetheless criticized as emphasizing first-order changes and a mechanistic in orientation (Gurman, 2013). Bandura’s social learning theory introduced behavioral therapy’s second wave of development (Gurman, 2013). In an effort to address a wider range of difficulties, cognitive variables were incorporated with behavioral therapy methods.   Finally during behavioral therapy’s third wave of development cognitive behavioral approaches were applied to an ever increasingly range of issues. The influences of eastern thought and Buddhist practices were then integrated into many third wave therapies, including Acceptance and Commitment Therapy, and DBT (Gurnman, 2013). In reaction to the early first-wave behavioral therapies, these third wave CBT therapies emphasized a holistic perspective that considers the importance of context.

Behavioral Couple’s Therapy (BCT).

Interestingly, the development of Behavioral Couples Therapy (BCT) followed a similar path as its individualized variant. During its first wave of development Gurnman, (2013) describes Operant-Interpersonal Treatment for Marital Discord (OMIT, and Traditional Behavioral Couple Therapy (TBCT). OMIT, closely resembling early forms of individual behavioral therapy and focuses on each partner’s responsibility. OMIT focuses on changing behavior with techniques that include techniques and marital token economies, and Quid Pro Quo Contracts (Gurnman, 2013). TBCT, also a first wave couples behavioral therapy, includes a rewards vs. cost perspective.   Skill development became the focus for TBCT, based on the notion that “nastiness begets nastiness” (Gurnman, 2013, 119).   Since Gotmann’s research has confirmed the uselessness of these early interventions, BCT has developed well beyond its historical origins.

Cognitive-Behavioral Couple’s Therapy (CBCT) constitutes the second wave of BCT’s evolution and development (Gurnman, 2013).   With this perspective the emphasis on skills training was now considered too limiting. Internal psychological process including automatic thoughts and schemas gained attention in BCT’s ongoing development. Internal belief structures, and each partner’s attachment history, gained new attention through CBCT.

Integrative Behavioral Couple’s Therapy (IBCT)– The Third Wave

Gurnman, (2013) concludes his paper with a description of BCT’s third wave approach: Integrative Behavioral Couple’s Therapy. IBCT is a unique form of behavioral therapy that appreciates individual differences and facilitates empathy (Gurnman, 2013). Central to this approach is non-judgmental perspective in which a holistic analysis is given priority. The context of a given situation, is important in understanding why behaviors and interactions persist. In IBCT, context refers to “the term used for changeable steams of events that can exert an organizing influence on behavior” (Gurnman, 2013). Understanding the function and purpose of behavioral patterns means examining context. This requires a close examining of a early child experiences, attachment histories and recurrent core themes or patterns in a relationship.

Unlike the earlier forms of Behavioral Couple’s Therapy (BCT) in its third wave of development, insights have been incorporated to address effectively Gotmann’s perpetual problems (Gurnman, 2013).   Functional analysis is useful in explaining how the effects of context and the causal historical underpinnings of ongoing interpersonal relationship patterns. Techniques and skills taught therapy, can provide a secure and safe place to discuss issue openly during a session. For example, carefully wording one’s words, by using “I” to discuss one’s feelings and “it” to describe problems in a neutral third-part context are convenient examples (Gurnman, 2013).   Other unique interventions include tolerance-building, which involves a process of learning to find new experiential meaning in the midst of ongoing unsolvable conflicts. This technique is quite intriguing since it reflects an insight of the Gottman’s regarding masters and disasters and how they take in life experiences.

References

Biography.com (n.d.) John Locke – Philosopher.  Retrieved from: http://www.biography.com/people/john-locke-9384544
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Clark, D. (2005). Focus on “cognition” in cognitive behavioral therapy for OCD: Is it really necessary? Cognitive Behavior Therapy. 34(3), 134-139.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Dixon, D. R., Vogel, T., & Tarbox, J. (2012). A Brief History of Functional Analysis and Applied Behavior Analysis.  Retrieved from:  https://scholar.google.com/scholar?cluster=6590433815737513224&hl=en&as_sdt=0,28&as_ylo=2012
Gurman, A. S. (2013). Behavioral couple therapy: Building a secure base for therapeutic integration. Family Process, 52(1), 115-138. doi:10.1111/famp.12014
Holland, J. (Director & Schein, L. (Producer. (1995). The Angry Couple [Video File]. Psychotherapy.net. Retrieved November 11, 2015, from The Psychotherapy.net Collection.
Jaycox, L., Zoeliner, L. & Foa, E. (2002). Cognitive behavior therapy for PTSD in rape survivors. Journal of Clinical Psychology. 58(8). 891-906.
Lebow, J. (2006, Sep). FROM RESEARCH TO PRACTICE, scoreboard for couples therapies. Psychotherapy Networker, 30 Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/233324408  ?accountid=28125
Linehan, M.M. (1993). Cognitive behavioral therapy for borderline personality disorder. New York: Guilford Press.
Marom, S. & Hermesh, H. (2003). Cognitive behavior therapy (CBT) in anxiety disorders. The Israel Journal of Psychiatry and Related Sciences. 40(2) 135-144.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Schunk, D. H. (1991). Learning theories: An educational perspective. Retrieved from: http://s3.amazonaws.com/academia.edu.documents/44670152/_Dale_H._Schunk__Learning_Theories_An_Educational..pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1475602918&Signature=jyd3eErVXh%2F6RaD8I%2B056ea%2FlNw%3D&response-content-disposition=inline%3B%20filename%3DDale_H._Schunk_Learning_Theories_An_Edu.pdf

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Karen Horney (Psychoanalysis)

Biographical Overview

“Karen Horney was born Karen Danielsen in a suburb of Hamburg on September 15, 1885.  Her father was a sea captain of Norwegian origin;  her mother was of Dutch-German Extraction (Schultz & Schultz, 2016, p. 2).”  She had an older brother named Bernstein who died at the age of 40, of a lung infection.  Her father was a harsh discplinarian and apparently they were never very close (Boeree, 2006).  However, she had a close attachment to her mother, Sonni, who was 19 years younger than her father, (and his second wife).  They divorced when she was a young adult.

She decided to become a doctor as a young child and was one of the first women in Germany to become a doctor. (Schultz & Schulta, 2016).  While in college, she met her future husband Oskar Horney and married him in 1909.  The had three daughters together.

Karen Horney struggled with mental health problems throughout her life.  After a series of life events including the death of her brother and mom, she was first exposed to psychotherapy.  She eventually decided to enter the field of psychoanalysis and was a co-founder of the Berlin Psychoanalytic Institute.  In 1932 she moved to the United States, and passed away in 1952.

Horney’s New Psychoanalysis

“Karen Danielsen Horney was another defector from the orthodox Freudian point of view. Although never a disciple or colleague of Freud’s, Horney was trained in the official psychoanalytic doctrine. But she did not remain long in the Freudian camp (Schultz & Schultz, 2016, p. 159).”

Portrayal of Women

Horney criticized early psychoanalysis as focusing “more on men’s development that women’s (Schultz & Schultz, 2016, p. 159).”  Insisting that “anatomy is not destiny” (Fadiman & Frager, 1976, p. 8).”  Additionally, Horney had problem with Freud’s description of women, due to its masculine orientation and in implicit preconception of female inferiority.  In her view, the woman’s psyche was a byproduct of cultural influences and social standards at the time.

The Role of Culture

Like many of Freud’s predecessors, Horney felt his perspective overemphasized the influences of biology on mental health.  This has caused an overestimation of the “universality of the feelings, attitudes and kinds of relationships that were common (Fadiman & Frager, 1976, p. 10), in Freud’s work.  “Horney found that her American patients were so unlike her previous German patients, both in their neuroses and in their normal personalities that she believed only the different social forces to which they had been exposed could account for the variation (Schultz & Schultz, 2016, p. 159).”  On the basis of this, Horney concluded social and cultural factors have a great influence on our overall well-being and prisons, development.

The Cause of Neurosis

Horney felt that neurosis was caused by “disturbances in human relationships (Fadiman & Frager, 1976, p. 11).” In contrast, Freud felt neurosis was caused by something within the subconscious. In response to these varied definitions of neurosis, Horney and Freud utilized divergent approaches.  Freud focused on uncovering infantile origins as a cause for one’s problems.  In contrast, Horney felt it was important to examine defense mechanisms in our relationships.

Focus on the Present

“Perhaps the most significant aspect of Horney’s new version of psychoanalysis was her shift in emphasis…from the past to the present (Fadiman & Frager, 1976, p. 11).” Essentially, Horney rejected Freud’s assertion that the impact of our earliest experiences remain unchanged in adulthood.  Horney felt personal growth is ongoing, and doesn’t end with childhood.  Each successive life experience builds upon previous ones.  In her work, “New Ways of Psychoanalysis”, she differentiated her perspective from Freud’s by labeling his as mechanical-evolutionists  while calling hers evolutionistic, (Fadiman & Frager, 1976).    At the heart of Freud’s neurosis are unconscious fixations.  At the heart of Horney’s neurosis are early experiences that cause us to repeat adaptive responses to certain situational needs.  These defense mechanisms are self-perpetuating until one acknowledges them.

A New Perspective on Neurosis

What is Neurosis?

Horney saw “neurosis as an attempt to make life bearable, as a way of ‘interpersonal control and coping’ (Boeree, 2006, p. 4).” In other words neurosis is a response to basic anxiety [discussed later] caused by “disturbances in human relationships (Fadiman & Frager, 1976, p. 11).”  They are early defense mechanisms in response to interpersonal difficulties that continually evolve as we grow.

Origins of a Neurosis

“Horney agreed with Freud, in principle, about the importance of the early years of childhood in shaping the adult personality. However, they differed on the specifics of how personality is formed. Horney believed that social forces in childhood, not biological forces, influence personality development. There are neither universal developmental stages nor inevitable childhood conflicts. Instead, the social relationship between the child and his or her parents is a key factor in one’s early development (Schultz & Schultz, 2016, p. 162).”

Safety Needs

According to Horney, our earliest childhood experiences are defined by a need for safety and security (Schultz & Schultz, 2016).  Fulfilling these needs requires caregivers to respond in a manner that allows children to be free of for their emotional and physical well-being.   Additionally, Horney felt displays of affection and warmth are especially critical for a sense of security.  In contrast, “If children are kept…excessively dependent…feelings of helplessness will be encouraged (Schultz & Schultz, 2016, p. 163).”  Conversely, They can become fearful of caregiver through excessive intimidation or abuse.  The point is, how caregivers respond to safety needs greatly impacts a child’s early development.

Basic Anxiety

“Pathogenic conditions in the family…make children feel unsafe, unloved, and unvalued” (Fadiman & Frager, 1976, p. 10),  Parental indifference plants the seeds for a neurosis in adulthood and calls this a “basic evil” (Boeree, 2006, p. 5).  Conversely, providing warmth and affection are key in preventing neurosis (Schultz & Schultz, 2016).

As a result of early pathological interpersonal experiences, children can be overcome with a sense of fear, anxiety, helplessness, hostility, and guilt.  Over time they develop repetitive coping styles that condition “how we respond to the world (Fadiman & Frager, 1976, p. 12).   Horney claims these emotions and adaptive coping responses are evidence of basic anxiety, which she defines as an “insidiously increasing, all-pervading feeling of being lonely and helpless in a hostile world” (Horney, 1937, p. 89).

In a nutshell, when parents are ineffective in responding to a child’s safety needs, they develop hostile negative emotions towards their parents.  This is basic anxiety.

Early Coping Responses

When a child’s security needs are not met, they develop a suppressed hostility towards their parents alongside a fear of abandonment and helplessness (Boeree, 2006).  Horney, (1937), describes the feeling of basic anxiety as follows:  “small, insignificant, helpless, deserted, endangered, in a world that is out to abuse, cheat, attack, humiliate, betray” (p. 92).  In response to basic anxiety, children can be found to utilize four common coping responses (Schultz & Schultz, 2016).

COPING RESPONSE #1: “Securing affection and love (Schultz & Schultz, 2016, p. 164).”  The logic here is that if I’m loved by someone, that means they won’t hurt me.  Affection is a form of reassurance.  Conversely, a rejection is feared.  “If you love me, you will not hurt me ((Schultz & Schultz, 2016, p.  164).”
COPING RESPONSE #2: “Being submissive (Schultz & Schultz, 2016, p. 164).”  The logic here for a child is that if I do whatever I’m asked then everyone will be pleased with me.   The goal is not angering or offending someone.  Personal needs are suppressed for the sake of others.  “If I give in I will not be hurt (Schultz & Schultz, 2016, p. 164)”
COPING RESPONSE #3: “Attaining power (Schultz & Schultz, 2016, p. 164)”   This coping skill involves overcompensating for feelings of helplessness.  Achievement and success in areas one has control over provide feelings of superiority.  “If [I] have power no one will harm [me] (Schultz & Schultz, 2016, p. 164)”
COPING RESPONSE #4: “Withdrawing (Schultz & Schultz, 2016, p. 164).” Here children withdrawal psychologically and learn to rely on themselves as much as possible. An aloofness can be observed around others as the child no longer seeks other to satisfy any emotional needs.

Goal of Coping Responses

The singular goal of all these coping responses is simply to avoid basic anxiety.  “They motivate the person to seek security and reassurance rather than happiness or pleasure. They are a defense against pain, not a pursuit of well-being (Schultz & Schultz, 2016, p. 164).”

Consequences of Coping Responses

Horney felt that these coping strategies are “doomed to fail because they generate ‘vicious cycles’ in which the means employed to allay anxiety tend to increase it (Schultz & Schultz, 2016).”  Let’s look at the first coping response mentioned above on a desire to secure affection and love:

This desire for love is motivated by a desire to avoid pain of rejection due to a lack of fulfillment of one’s security needs.
As a result it is magnified by unresolved an unresolved basic anxiety and becomes insatiable, needy, demanding, and unrealistic.
Behaviors such as “demandingness and jealousy that follow make it less likely than ever The at the person will receive affection (Boeree, 2006, p. 11).”
In time, “people who have not been loved develop a feeling of being unlovable…[they] discount any evidence to the contrary (Boeree, 2006, p. 11).”
“Being deprived of affection has made them dependent on others, but they are afraid of that dependency because it makes them too vulnerable (Boeree, 2006, p. 11).”

Neurotic Needs – Interpersonal Defenses

“Horney believed that any of these self-protective mechanisms could become so permanent, a part of the personality that it assumes the characteristics of a drive or need in determining the individual’s behavior. (Schultz & Schultz, 2016, p. 165).”

What are Neurotic Needs?

From her early clinical work, Horney observed ten common distorted interpersonal needs in clients (Boeree, 2006).   These “neurotic needs” (Boeree, 2006, p. 4), as she calls them, emerge as a characteristic drive definitive of one’s personality in adulthood (Schultz & Schultz, 2016).  Finally, she notes that intense anxiety appears to fuel the distorted nature of these neurotic needs and its “unrealistic and unreasonable nature (Schultz & Schultz, 2016, p. 4).”  These ten neurotic needs are listed below (Boeree, 2006; Schultz & Schultz, 2016):

NEUROTIC NEED #1:  A desire for affection and approval emerges as an “indiscriminate need to please others and be liked by them (Boeree, 2006, p. 4)”.
NEUROTIC NEED #2:  “Desire for a dominate partner (Schultz & Schultz, 2016, p. 165)” or “someone who will take over one’s life, [based on] the idea that love will solve all of one’s problems” (Boeree, 2006, p. 4).
NEUROTIC NEED #3:  “The neurotic need for power or control over others for a facade of omnipotence (Boeree, 2006, p. 4).”  
NEUROTIC NEED #4:  A need for exploitation, or “get the better of (Boeree, 2006, p 4)” others.  Underling this neurotic need is the belief in manipulation as commonplace in relationships.
NEUROTIC NEED #5:  A need for prestige and social recognition can present as a result of a neurotic desire for appreciation.  “These people are overwhelmingly concerned with appearances and popularity (Boeree, 2006, p, 4).
NEUROTIC NEED #6:  A need for admiration from others appears in many respects similar to the previous one.  However, it presents more as a desperate desire to be valued and recognized by others (Boeree, 2006).
NEUROTIC NEED #7:  A need for personal achievement can cause individuals to excel in all things they do.  “They have to be number one (Boeree, 2006, p. 5).”
NEUROTIC NEED #8: A neurotic desire for self-sufficiency can present as an aversion to commitment in relationships and refusal to seek help from others (Boeree, 2006).
NEUROTIC NEED #9:  A need for perfection can appear similar to the #7, however here individuals have a fear of being flawed and making mistakes (Boeree, 2006).
NEUROTIC NEED #10:  A neurotic need to limit one’s demands and expectations from life can exist in response to a highly stressful life as a desire to “disappear into routine (Boeree, 2006, p 5)”.

Categorization of Neurotic Needs.

“In her later writings, [Horney] reformulated these needs…she concluded that the needs could be presented in three groups, each indicating a person’s attitudes towards self and others (Schultz & Schultz, 2016, p. 166).”  Essentially, she categorized these neurotic needs into three overarching attitude that can be observed in one’s  interpersonal relationships.  She called them “neurotic trends” and defined this term as a set of behaviors and attitudes that define one’s overall personality.  These neurotic trends are described below:

“THE COMPLIANT PERSONALITY (Schultz & Schultz, 2016, p. 166).”:  Boeree, (2006), notes that this personality type encompasses neurotic needs #1, #2 & #10 listed above.  The compliant personality reflects a “self-effacing solution…[or] moving-toward strategy (Boeree, 2006, p. 5) in one’s interpersonal relationships.”  For example, these individuals display “an intense and continuous need for affection….they usually have a need for one dominant person…who will take charge of their lives and provide protection and guidance (Schultz & Schultz, 2016, p. 166-167).”
“THE AGGRESSIVE PERSONALITY (Schultz & Schultz, 2016, p. 167).”:Boeree, (2006), notes that this personality type encompasses neurotic needs #3 – #7 listed above.  The aggressive personality reflects an “expansive solution…[or] moving-against strategy (Boeree, 2006, p. 5) in one’s interpersonal relationships.”  For example, the aggressive personality perceives the world as a hostile place where “only the fittest and most cunning survive (Schultz & Schultz, 2016, p. 167).”  Consequently, they have a tough demeanor and alleviate basic anxiety by through domination over others.  
“THE DETACHED PERSONALITY (Schultz & Schultz, 2016, p. 168).”: Boeree, (2006), notes that this personality type encompasses neurotic needs #8 – #10 listed above.  The detached personality reflects a “resigning solution…[or] moving-away-from strategy (Boeree, 2006, p. 5) in one’s interpersonal relationships.”   Detached personalities are driven to main an emotional distance from others and are become self-sufficient and independent (Schultz & Schultz, 2016).  

The Self – Intrapersonal Defenses

“In reviewing the evolution of her theory at the end of Neurosis and Human Growth (1950) Horney observed that at first she saw neurosis as essentially a disturbance in human relationships. This disturbance creates basic anxiety against which we defend ourselves by employing the interpersonal strategies of defense….She came to realize, however, that…Neurosis is a disturbance not only in our relationships with others but also in our relationship with ourselves (Fadiman & Frager, 1976, p.17-18).”

As the above quote states, Horney notes in her later work, that her description of neurosis is incomplete. Essentially, her later work describes the lasting effects of the neurotic trends listed above.  These neurotic trends affect the development of “the self”.   When viewing neurosis from this perspective, we see a series of fragmented self-images.   These self-images exist in response to the self as”looking-glass images that reflect an internalization of messages from others throughout life.

The Real Self

“According to Horney, people have a real self that requires favorable conditions to be actualized  (Fadiman & Frager, 1976, p. 12).”  Our true “self” is a potential innate to our being, that would represent an accurate portrayal of ourselves minus the influence of a lifetime of interpersonal defense strategies (Boeree, 2006).  Horney, believed that a primary goal of therapy is to restore clients to their true selves  (Fadiman & Frager, 1976).

The ideal self represents our innate potential.
While not a set of acquired or learned abilities, it requires optimal conditions to develop.  
Realizing our true self requires an atmosphere of warmth from one’s caregivers who are responsive to our safety needs.   

The Idealized Self

As a result of an individual’s early experiences with basic anxiety, messages from others become ingrained about what is needed to receive the affection and acceptance one naturally craves.  The lasting impact of these internalized messages are feelings of “weakness, worthlessness, and inadequacy  (Fadiman & Frager, 1976, p. 15).”  These feelings of inadequacy exist as a result of one’s response to a consistent failure of caregivers to respond to our safety needs in the manners described earlier.  To compensate for these feelings we develop an “idealized image of ourselves that we endow with unlimited powers and exalted faculties  (Fadiman & Frager, 1976, p. 15).”  Here are a few examples:

“The complaint person believes ‘I should be sweet, self-sacrificing, saintly’ (Boeree, 2006, p. 6).”  Lovable qualities include humility, goodness, selflessness, and saintliness  (Fadiman & Frager, 1976).
“The aggressive person says ‘I should be powerful, recognized, a winner’ (Boeree, 2006, p. 6).”  For example narcissistics might see themselves as having unlimited capabilities while arrogant and vindictive people might view themselves as tougher, smarter, and able to outsmart others  (Fadiman & Frager, 1976).
“The withdrawn person believes ‘I should be independent, aloof, perfect’ (Boeree, 2006, p. 6).”  Self-sufficiency, freedom from desire, and independence are revered qualities  (Fadiman & Frager, 1976).

The Despised Self

The ideal-self can be understood as a personal goal of who we wish to be.  It is an image we hope to uphold throughout our lives.  Essentially, these ideal-self images represent “should’s” of who we need to be in order to manage unresolved anxiety.  When we succeed in living up to our idealized self-image we feel worthwhile.  However, any personal shortcomings can produce feelings of inadequacy.  Horney utilizes the term “despised self” to represent those denied aspects of ourselves that fail to coincide with who we wish to ideally become.  “People shuttle….between ‘a feeling of arrogant omnipotence and of being scum of the earth’ (Fadiman & Frager, 1976, p. 16).”

The Pride System & Internal Conflicts

So what are the consequences of this divided self, as Horney describes above?

Firstly, as noted above, an idealized self produces a “the tyranny of the should (Fadiman & Frager, 1976, p. 16),”  These idealized images rule every aspect of our lives, and are fueled by an anxiety-riddled emotions that exist as a result of a lifetime of coping with unmet needs.   The problem is, the idealized-self, reflects unresolved traumas stemming from problematic interpersonal experiences and our chosen coping responses to them.  As a result, they are “doomed to fail because they are not based on a realistic appraisal of personal strengths and weaknesses…it is…an illusion, an unattainable ideal of absolute perfection (Schultz & Schultz, 2016, p. 169).”   Horney claims, that the idealized self-image is unhealthy since it is not based on reality and is absolute.  It can cause individuals to either project these standards onto others or “embark on a search for glory (Fadiman & Frager, 1976, p. 16),” as an actualization of the idealized self.

Neurotic pride is a byproduct of the shoulds reflected in our idealized self.

Neurotic pride involves a substitution of pride in who we really are, for pride in who we ideally feel we should be (Fadiman & Frager, 1976).    Threats to neurotic pride are met with “anxiety and hostility…result[ing] in self-contempt and despair (Fadiman & Frager, 1976, p. 16).”  We believe unquestioningly in our idealized self to such a degree that it is a critical determinant of our emotional well being.  When we live up to our shoulds we have neurotic pride, when we fail we have despair.

Neurotic pride causes us to make unrealistic demands on the world.

The shoulds that underlie our idealized self comprise a “bargain with fate (Fadiman & Frager, 1976, p. 16).”  It is our go-to solution to our external reality as a preferred coping mechanism in all interpersonal relationships.  We expect it to work, and demand the world bend to our own version of reality as dictated by the shoulds that comprise our idealized self.  Horney calls this a neurotic claim, in which we expect others to treat us in accordance with the standards defined by our idealized self-image (Fadiman & Frager, 1976).   For example, the compliant personality expects others to accept and love them when they are acting humble and selfless, while the aggressive personality expects a trump-like recognition for his winning attitude.

So what are the consequences of this?

The idealized self systems, and should messages we tell ourselves are intrapsychic strategies of defense, that mirror the interpersonal strategies discussed earlier.  Horney states that self-hatred is a byproduct of this intrapsychic defense mechanism.  Interestingly, while it is intended as solution to our problems, all it does is perpetuate them.  This is because the idealized self is not realistic and we inevitably fail in living up to these should’s.  Overall, Fadiman & Frager, (1976) note that Horney’s conception of the self has a dynamic quality in which the pride system cause a “seesawing between the idealized and despised selves (p. 17).”

Feminist Psychology

“Psychoanalysis is the creation of a male genius and almost all those who have developed his ideas have been men. It is only right and reasonable that they should evolve more easily a masculine psychology and understand more of the development of men than of women” (Horney, 1967, p. 54)”

Horney is a founder of feminine psychology, who “expressed her disagreement with Feud’s views on women (Schultz & Schultz, 2016, p. 170).”   In particular, she rejected Freud’s biological reductionism and asserted that anatomy is not destiny, noting the influence of sociocultural factors on a women’s development.  As noted in the above quote, Horney felt Freud’s psychoanalysis was a byproduct of a male viewpoint reflecting a masculine psychology.  She attempted to expose the lack of scientific evidence underlying the view of women that existed in Freudian psychoanalysis at the time.  She was also critical of Freud’s penis envy notion and provided a description of a male-oriented concept which she called “womb envy” (Fadiman & Frager, 1976, p. 8).  However, in 1935, she abandoned the topic of feminine psychology since “the role of culture in shaping the female psyche makes it impossible to determine what is distinctively feminine (Fadiman & Frager, 1976, p. 10).”

Practical Application

“The object of therapy for Horney is to help people relinquish their defenses – which alientate them from their true likes and dislikes, hopes, fears, and desires, so they can get in touch with what she calls the real self (Boeree, 2006, p. 2).”

Like Freud, Horney utilized free association and dream analysis, however she believed that “Freud played too passive a role and was too distant and intellectual (Schultz & Schultz, 2016, p. 174.”  Additionally, rather than focusing on uncovering repressed aspects of one’s early childhood, Horney believed that clients emotions, attitudes, and behaviors reflected internal conflicts, defense mechanisms, coping tools, and unresolved neuroses from interpersonal issues.  Schultz & Schultz (2016) also mention briefly a few assessments which have been developed based on Horney’s work which I find quite intriguing.  For example, the “HCTI” Horney-Coolidge Type Indicator.  It is a 57-item self-reported assessment that measures for the presence of Horney’s three neurotic trends.

References

Boeree, G. (2006). Karen Horney.  Retrieved from:  http://www.social-psychology.de/do/pt_horney.pdf
Fadiman, J., & Frager, R. (1976). Personality and personal growth. New York: Harper & Row. Retrieved from:  http://plaza.ufl.edu/bjparis/ikhs/horney/fadiman/fadiman.pdf
Horney, K. (1937). The neurotic personality of our time. New York: Norton.
Horney K (1967). Feminine psychology. New York, NY: W. W. Norton.
Schultz, D. P., & Schultz, S. E. (2016). Theories of personality. Cengage Learning. Retrieved from: http://cengagesites.com/academic/assets/sites/schultz_ch04.pdf

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Alfred Adler (Adlerian Psychotherapy)

Biographical Overview

Alfred Adler was born in 1870 in Vienna Austria.  He is the third of seven children and decided to become a doctor after a series of medical problems throughout his childhood.  He graduated from the University of Vienna in 1895 with a degree in opthamology.  In 1902, he was invited to work with Sigmund Freud, and together they founded the Vienna Psychoanalytic Society.  In 1911 he parted ways with Freud due to a personal disagreement with aspects of his theoretical perspective.

Overview of Theory

Differences between Freud & Adler

“Adler throughout his lifetime credited Freud with primacy in the development of a dynamic psychology.  He consistently gave credit to Freud for explicating the purposefulness of symptoms and for discovering that dreams were meaningful (Corsini & Wedding, 2011, p. 67).”  However several differences can be seen between Freud and Adler.  Firstly, Freud conceived of the psyche in terms of fragmented components Adler perceived the human mind holistically.  Additionally, Freud “emphasized the role of psychosexual development…Adler focused on the effects of children’s perceptions of their-family constellation and on their struggle to find a place of significance within it (Corsini & Wedding, 2011, p. 67).”   Finally, while Freud is provides an objective and causal view of individuals as victims of their biology Adler provides a subjective and social psychology orientation to human nature (Corsini & Wedding, 2010).  Rather than conceiving individuals as victims of biology, Adler believes we are able to choose and shape our internal and social world as a matter of conscious choice (Corsini & Wedding, 2010).

What is Individual Psychology?

“Alfred Adler fashioned an image of human nature that did not depict people as victimized by instincts and conflict and doomed by biological forces and childhood experiences. He called his approach individual psychology because it focused on the uniqueness of each person and denied the universality of biological motives and goals ascribed to us by Sigmund Freud. (Alfred Adler Individual Psychology, n.d., p. 130).”

He choose to utilize the term individual to describe his theory, since in German this term literally means “undivided” (Boree, 2006).  As a neurologist, Freud’s theory focused on our biology as an innate explanatory factor for “why we are as we are”.  In contrast Adler believed we were social beings and develop as we are as a result of our interaction with the world around us (Alfred Adler Individual Psychology, n.d.).   Additionally, rather than conceiving humans as sexual beings, Adler focuses on social factors stating that we strive to become members of a group.  What follows is a list of basic assumptions of Adlerian psychotherapy according to my course textbook (Corsini & Wedding, 2010).

  1. “All Behavior occurs in a social context..people cannot be studied in isolation (Corsini & Wedding, 2010, p. 68).”
  2. “Individual psychology is an interpersonal psychology (Corsini & Wedding, 2010, p. 68).”  How we work to transcend social interactions is critical to personal development and growth.
  3. Adler’s perspective focuses on a holistic perspective that favors social psychology in favor of a biological reductionism.  “This renders the polarities of conscious and unconscious, mind and body, approach and avoidance…meaningless (Corsini & Wedding, 2010, p. 68).”
  4. In Adlerian psychotherapy, the conscious and unconscious serve the individual’s personal goals.  In this respect the unconscious is not a separate cognitive structure within the mind but an adjective which describes that which is not understood (Wedding & Corsini, 2010).
  5. Conflict is interpersonal as a result existing as a byproduct of ambivalent action.  “Although people experience themselves in the throws of conflict… they create these antagonistic feelings, ideas, and values because they are unwilling to…solving their problems (Corsini & Wedding, 2010, p. 68).”  
  6. Subjectivity not objectivity is critical when understanding the person.  “Understanding the individual requires understanding… the convictions individuals develop early in life to help them organize experience, to understand it, to predict it and to control it. (Corsini & Wedding, 2010, p. 68)” 
  7. Our behaviors change in accordance with the immediate demands of our life situation as well as our long-range goals (Corsini & Wedding, 2010).
  8. People are not pushed forward in life by an external cause (i.e. hereditary and the environment). Instead, “people move toward self-selected goals….and will preserve their self-esteem (Corsini & Wedding, 2010, p. 69).”  
  9. “The central striving of human beings has been variously described as completion, perfection, superiority, self-realization, self-actualization, and mastery (Corsini & Wedding, 2010,  p. 69).”
  10. We are move through life confronted with alternatives and have the ability to choose based on our own values, beliefs and personal sense of meaning.
  11. Adlerians aren’t very concerned with diagnosis since & all behavior is seen as a “purposeful, psychogenic symptom (Corsini & Wedding, 2010, p. 69).”
  12. Life presents key challenges, or life tasks, socially, vocationally, sexually, and spiritually (Corsini & Wedding, 2010, p. 70).
  13. Courage in addressing these life tasks is essential, defined as: “the willingness to engage in risk-taking behavior” (Corsini & Wedding, 2010, p. 70) while weighting options.
  14. “Life has no intrinsic meaning.  We give meaning to life (Corsini & Wedding, 2010, p. 70).”  This meaning determines our behavior, since we assume this meaning is a fact and not perception.  Life then is expected to coincide with this.

Key Concepts

What Motivates Us?

“Adler felt that the ‘will to power’  or ‘the striving for superiority’ are the major sources for motivation in humans (Rosenthal, 2005).” Freud conceived human behavior as a byproduct of innate biological instincts and mechanical in nature.   In contrast, “Adler sees motivation as a matter of moving towards the future, rather than being driven, mechanistically, by the past. We are drawn towards our goals, our purposes, our ideals. This is called teleology (Boeree, 2006, p. 6).” This notion is based on Nietzsche’s concept of will-to-power which influenced Adler’s work.  Several other concepts pertaining to Adler’s definition of motivation are worth mentioning:

Inferiority Complex

Adler felt that “dealing with inferiority and striving for perfection are innate qualities (Rosenthal, 2005),” were innate components of human motivation.  Additionally, a feeling of inferiority exists as a motivating force for one’s behavior.   It can result in compensating for our inadequacies or striving to grow beyond them.  An inferiority complex is defined as “a condition that develops when a person is unable to compensate for normal inferiority feelings (Alfred Adler Individual Psychology, n.d.).”

Superiority Complex

When individual’s overcompensate for shortcomings this is a superiority complex.  “This involves an exagger- ated opinion of one’s abilities and accomplishments. Such a person may feel inwardly self-satisfied and superior and show no need to demonstrate his or her superiority with accomplishments. Or the person may feel such a need and work to become extremely successful (Alfred Adler Individual Psychology, n.d.).”

Fictional Finalism

Boeree (2006) also notes that Adler was influenced by the work of Hans Vaihinger, who wrote  a book titled  “The Philosophy of ‘as if'”.  He continues by noting that “we use these fictions in day to day living as well. We behave as if we knew the world would be here tomorrow (Boree, 2006, p. 6).”   Essentially, in order to move towards our goals, we conceive them as actualities in a future perfect sense.  He called this term fictional finalism (Alfred Adler Individual Psychology, n.d.).

Social Interest

In the course of our early childhood development Adler believed that getting along with others and belonging were key tasks.  “He proposed the concept of social interest, which he defined as the individual’s innate potential to cooperate with other people to achieve personal and societal goals (Alfred Adler Individual Psychology, n.d.).”   While biology does provide some motivational influence in our lives, it isn’t considered primary, as in Freud’s theory.  Instead, Adler notes that in order to this social interest is a byproduct of our desire to achieve our developmental life goals.  We need to cooperate with others in order to achieve them.

Birth Order

Adler was the first to note the influence of birth order on one’s development.  He first notes that three early childhood experiences have a profound influence on one’s personality development: (1) health (i.e organ inferiority); (2) neglect, and; (3) pampering (Boeree, 2006).  With this in mind, Adler notes that the birth order of an individual determines which of these experiences predominate their childhood.

  1. First-Born Children receive quite a bit of pampering & attention until this status is “dethrowned” when a younger sibling is born.  Consequently, they can respond by behaving badly, and become rebellious. “Adler found that first-borns are often oriented toward the past, locked in nostalgia and pessimistic about the future…[and] also take an unusual interest in maintaining order and authority. (Alfred Adler Individual Psychology, n.d.).”
  2. Second-Born Children don’t receive a sense of dethrownment.  Instead they can tend to experience a sense of competition with the oldest for a parents attention.  Their parents adopt a more relaxed style and are more likely to develop into competitive and ambitious adults (Alfred Adler Individual Psychology, n.d.).
  3. “The youngest child is likely to be the most pampered in a family with more than one child. After all, he or she is the only one who is never dethroned! And so youngest children are the second most likely source of problem children, just behind first children. On the other hand, the youngest may also feel incredible inferiority, with everyone older and ‘therefore’ superior. (Boeree, 2006, p. 10)”
  4. “Only children never lose the position of primacy and power they hold in the family; they remain the focus and center of attention. Spending more time in the company of adults than a child with siblings, only children often mature early and manifest adult behaviors and attitudes (Alfred Adler Individual Psychology, n.d.).”

Psychological Types

According to Adler, we are social beings.  Therefore, he conceived personality as something that was shaped by “social environments and the interactions (Alfred Adler Individual Psychology, n.d, p. 131).”  Therefore a discussion of psychological personality types for Adler would involve a discussion of how they adapt to their social world as well as their lifestyle.  In contrast Freud’s biological determinism, Adler held the belief that we create our personality.  “…neither heredity nor environment provides a complete explanation for personality development.  Instead the way we interpret these influences forms the basis for the creative construction of our attitude toward life (Alfred Adler Individual Psychology”, n.d., p. 137).” Two aspects of of this attitude toward life are worth noting: (1) our lifestyle (discussed in a later section); (2) and our social style.

As social creatures, “Alfred Adler postulates a ‘single drive’ or motivating force behind all our behavior and experience…the striving for perfection (Boeree, 2006, p. 5).”  Later he termed this striving for superiority. Additionally, we all inevitably end up falling short in one respect or another.  For example. Adler describes poor health as organ inferiority and psychological inferiorities as a personal character trait we interpret negatively.  When individuals encounter an inner conflict between a desire to strive for superiority an an awareness of inferiority, they struggle with neurosis.  This neurosis involves an insufficient level of social interest as the individual becomes ego-driven by a desire to hide their inferiority and compensate for it.  He describes four psychological types, each a unique social style based on a desire to compensate:

Ruling Type

Have a social style originating in childhood that produces a tendency toward aggression and social dominance.  They have low levels of social awareness and behave “without regard for others (Alfred Adler Independent Psychology, n.d., p. 147).” “The most energetic ones are bullies and sadists; somewhat less energetic ones hurt others by hurting themselves and include alcoholics. Drug addicts, and suicides (Boeree, 2006, p. 9).”

Getting/Leaning Type

This type of social style presents a sensitive and dependent temperament.  Boeree, (2006) states that they: “have developed a shell around themselves which protects them, but they must rely on others to carry them through life’s difficulties (p. 9).”  Additionally, Adler states that this type can suffer from phobia, obsession, compulsion, and anxiety (Boeree, 2006).

Avoiding Type

These low-energy types “makes no attempt to face life’s problems (Alfred Adler Independent Psychology, n.d., p. 137).” Boeree, (2006), notes they assume an avoidant approach towards people be life in general. Extreme avoidance, Adler’s view produces psychosis.

Socially Useful Type

Is an energetic and socially interested healthy personality.  “The socially useful type cooperates with others and acts in accordance their needs…cope with problems within a well-developed framework of social-interest (Alfred Adler Independent Psychology, n.d., p. 138).”

Style of Life

“…instead of talking about a person’s personality, with the traditional sense of internal traits, structures, dynamics, conflicts, and so on, he preferred to talk about style of life (Boeree, 2006, p. 6).”  Instead, Adler felt a person’s lifestyle reflected their personality by reflecting how one adapts to the social world.  Additionally, our lifestyle reflects efforts to achieve personal goals, (or  striving for perfection).   In doing so we act “as if” what we wish to be/become is present today.  “Each other f our lifestyles, there sits one of these fictions, an important one about who we are and where we are going (Boeree, 2006, p. 6).”

Overview of Counseling Process

How does change happen?

Alder felt human beings were social creatures and we all strive to achieve an idealized version of ourselves.   In doing so, we tend to perceive our reality in a future perfect tense.   What I believe I am is a self-fulfilling prophecy that is reflected throughout our lives.  In order for change to happen, “the patient must come to understand his or her lifestyle and its root in self-centered fictions (Boeree, 2006, p. 12).”  Since this insight cannot be forced, part of a therapists job is to help the client along the stages of change.  Clientd must want to understand and grow.   They are ultimately responsible for themselves.

Adler’s therapeutic style.

“Adler’s approach was more relaxed and informal than Freud’s (Alfred Adler Independent Psychology, n.d., p. 143).”   Conversations necessitated a building of rapport through the use for humor and some casual conversation.  Adler preferred to speak with clients face to face and avoided “appearing too authoritarian (Boetee, 2006, p. 12).

Assessment in Adlerian Psychotherapy

In order to help you discover the ‘fictions’ your lifestyle is based upon, Adler would look at a great variety of things (Alfred Adler Independent Psychology, n.d., p. 11).”  Overall, his methods of assessment are less scientific, involving empathy and intuition.   Key factors that can help uncover our personal fictions are discussed below.

Verbal & Nonverbal Communication

Adler assessed the personalities of his patients by observing everything about them: the way they walked and sat, their manner of shaking hands, even their choice of which chair to sit in. He suggested that the way we use our bodies indicates something of our style of life (Alfred Adler Independent Psychology, n.d., p. 143).”  The point is, how is the client communicating their belief system about who they are.  How does this fictionalizef self-fulfilling prophecy play out in their lives?

Early Childhood Memory

people remember from early childhood (a) only images that confirm and support their current views of themselves in the world . . . and (b) only those memories that support their direction of striving for significance and security. [His] focus on selective memory and lifestyle emphasize what is remembered. In contrast, Freud’s approach to interpret- ing early memories emphasizes what is forgotten through the mechanism of repression. (Kopp & Eckstein, 2004, p. 165)

Adler felt our lifestyle choices and social style develops as a result of our earliest childhood experiences.  In his research, Adler found a correlation between lifestyle choices and early childhood memories. Therefore, he cautioned it was important to use their s as a contextualizing factor when assessing the impact of early events (Alfred Adler Individuals Psychology, n.d.).

Dream Analysis

Like Freud, Adler felt “dreams were important (Boeree , 2096, p 11).”  However, while Freud interpreted dreams as pertaining to the unconscious, Adler felt they represented lifestyle choices.  Additionally, Adler interpreted dreams pragmatically: “dreams involve our feelings about a current problem and what we intend to do about it (Alfred Adler Individual Psychology, n.d., p. 144).”  However, he cautioned against interpreting dreams without knowledge of the client’s lifestyle.

Measures of Social Interest

“Psychologists have developed tests to measure Adler’s concept of social interest (Alfred Adler Individual Psychology, n.d., p.145).” These tests include include the Social Interest Scale (SIS) and the basic Adlerian Scales for Interpersonal  Succesd (BASIC-A) (Alfred Adler Individual Psychology, n.d.). While Adler had no interest in measuring personalities using an assessment, research has proven they are useful.

References

Alfred Adler Individual Psychology, (n.d.) Retrieved from: cengagesites.com/academic/assets/sites/schultz_ch03.
Boeree, C. G. (2006). Alfred Adler:  Personality Theories.   Retrieved from: http://www.social-psychology.de/do/pt_adler.pdf
Corsini , R.J. & Wedding, D. (2010). Current psychotherapies. John Wiley & Sons, Inc.
Kopp, R., & Eckstein, D. (2004). Using Early Memory Metaphors and Client-Generated Metaphors in Adlerian Therapy. Journal of Individual Psychology, 60(2), pp. 163-275.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.

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Carl Jung (Analytic Psychology)

Biographical Overview

Carl Jung was born in 1875 and died in 1961.  According to Rosenthal, (2005), he was once considered Freud’s “crown prince” as an early collaborator and apprentice (of sorts).  As an only child he was introverted, lonely and observant of the adults in his life.  His father was a religious clergy man.  His mother suffered from a mental illness spending some time at a psychiatric hospital.  He was trained as a Doctor at the University of Zurich.  “He broke away from Freud because he felt Freud over-emphasized man’s sexual nature (Rosenthal, 2005).  He also disagreed with Freud’s negative interpretation of human nature (Rosenthal, 2005).   Carl Jung coined the term “analytic psychology” after splitting with Freud in order to differentiate his approach from Freud’s psychoanalysis (Rosenthal, 2005).  It can be classified as a form of psychodynamic therapy.

A Definition of Jungian Analytic Psychology

“Analytic psychotherapy offers a map of the human psyche that encompasses conscious and unconscious elements including both a transpersonal (archetypal) and personal layer in the unconscious. The goals of psychotherapy are reintegration, self-knowledge, and individuation (Corsini & Wedding, 2010, p. 113).”

“The cornerstone of Jung’s [analytic psychology] is his concept of the psyche, the inner realm of the personality that balances the outer reality of material objects (Wedding & Corsini, 2010, p. 113).”  An individual’s inner world, exists as a sum of their conscious and unconscious processes.  Most importantly, since all the physical world is only perceivable through “a person’s psychic images…what people perceive is in large part determined by who they are (Corsini, 2010, p. 113).”

Comparing Jung & Freud

So how is Jung’s Analytic Psychology different from Freud?  Firstly, he conceived the libido as more of a general life force (Rosenthal, 2005).  Secondly, as noted earlier his view of human nature is much more positive.  “Rather than seeing the unconscious as something that needs to be cleaned out…Jung felt that individuals grow towards wholeness when both conscious and unconscious parts of the mind work in harmony (Corsini & Wedding, 2010, p. 115).”  Regarding the unconsciousness, Freud believed that people are perpetually driven by inner conflicts…and that compromise is a necessary solution. (Kassim, 2001, p581).  In contrast, Jung felt that the brains conscious and unconscious parts work in harmony and individuals are motivated to grow towards wholeness, (or individuation) (Corsini & Wedding, 2010). Finally, while Freud’s conception of the mind contained the id, ego, and superego, Jung’s unconscious included personal and collective components.

Basic Tenants of Analytic Psychology

View of Human Nature

Jung felt that the purpose of personal development is to grow towards wholeness of all one’s psychic components.  He called this process individuation.  While Freud conceived our developmental process as ending with childhood, Jung described felt it was a lifelong path of personal growth.  “The psyche’s goal throughout life is to create meaning out of our existence through the interpretation of information from our external reality.  “Human nature is rather essentially positive or good but there is always a dark side that needs to become conscious and that necessitates a ‘promethian struggle’, as Jung said to enlighten or make conscious the unconscious operations of one’s psyche (Colombus, n.d., p. 3).”

Definition of Healthy Personality

Jung felt the process of individuation is essential for the development of a healthy personality (Colombus, n.d.).  Individuation is “the process by which an individual becomes an indivisible and integrated whole person responsibly embodying his or her individual strengths and limitations (Corsini & Wedding, 2010, p. 609).”  This process usually occurs at middle age and involves embracing and understanding our true nature.    The process of individuation involves the assimilation of our shadow – aspects of our temperament and personality we deny.

The Unconscious & Its Symbols

“A basic tenet of Jung’s Analytical Theory is that all products of the unconscious are symbolic and can be taken as guiding messages (Daniels, V., 2011, p. 3).”   Jung believed that since the parts of the psyche work together towards wholeness and harmony, byproducts of unconsciousness are messages guiding us along this path.  Jung believed the repressed parts of our psyche, were those things that were most painful.

“By Jung’s definition it also includes everything that: (1) I know but am not now thinking about; (2) I was once conscious of but have forgotten; (3) Is perceived by the sensed but not noticed by my conscious mind; (4) Involuntarily and without noticing it, I feel, think, remember, want and do; (5) Is taking shape in me and will come to consciousness at some point. (Daniels, V., 2010, p. 3)”

Theory of Dysfunction

For Jung, dysfunction was a byproduct of unsuccessful individuation.  “When individuation cannot take place harmoniously and smoothy…there are energy disrepancies…in the dynamics of the persona, the ego, the self, the shadow, and the anima or animus (Colombus, n.d., p. 10).”  Daniels, (2010) notes that Jung’s conception of dysfunction had interpersonal elements.  Since individuals attempt to construct a meaning of their lives in what Jung called a “personal story”, dysfunction can result when it is denied or rejected (by oneself or others) (Daniels, 2010).  For example, Jung believed a neurosis is the byproduct of two conflicting tendencies, one which is expressed and one which is repressed (Daniels, 2010).  Neuroses exist as a result of a one-sided attitude towards life.  In contrast, complexes consists of elements of the mind (thoughts, feelings, etc) that are repressed from the consciousness.  Essentially, complexes contain traumatic and disturbing material.

Key Concepts

Concepts Pertaining to the Self…

Psyche

The Psyche is the inner world of the personality and is a summative of conscious and unconscious processes.  It influences our perception of reality and and “who we are” (Corsini & Wedding, 2010). I contains our consciousness alongside personal and collective aspects of the unconsciousness.

Consciousness

The consciousness comprises the thoughts, memories, and emotions we are aware Our consciousness streams from the senses and our perception and it is our knowing and realization of our positive traits and problems alike (Colombos, n.d., p. 2).”

Personal Unconsciousness

While the collective side of one’s consciousness comprises the senses, intellect, emotion, and desire, the “personal unconsciousness contains elements of our personal experience we have either forgotten or denied (Corsini & Wedding, 2010, p. 120).”  According to Jung, this aspect of the human psyche is accessible only through dreamwork and analysis.

Collective Unconsciousness

“According  to Jungian theory, our conscious understanding of who we are comes from two sources: the first derives from encounters with social reality, such as the things people tell us about ourselves, the second comes from what we deduce from our observation of others (Corsini & Wedding, 2010, p. 120).” The collective unconsciousness is a social and biological construct that comprises shared experiences, instincts and experiences common to mankind (Daniels, 2011).

Archetypes

The collective unconsciousness consists of instincts and archetypes (Colombos, n.d., p. 3).  Instincts are unconscious and involuntary drives towards certain action they are guided by archetypes (Daniels, 2011).  Archetypes are components of the collective consciousness that appear to describe how information is organized there.  “an archetype is analogous to the circuitry pattern in the brain that orders and structures reality; as a system of readiness, it parallels human instincts (Corsini & Wedding, 2010, p. 114).”  It propels human interaction in a manner that patterns after universal aspects of the collective consciousness. “These primordial images reflect basic patterns or universal themes common to us all which are present in the unconscious. (Daniels, 2011, p. 3).”

The self

“Jung defined the self as archetypal energy that orders and integrates the personality, an encompassing wholeness out of which personality evolves. (Corsini & Wedding, 2010, p. 121)”  It unifies the conscious and unconsciousness aspects of our mind and is an end goal guiding the personal development process (Corsini & Wedding, 2010; Daniels, 2011).

The Ego

The most important aspect of the self is the ego, it emerges early in life and provides children a sense of identity.  “This ego becomes the ‘I’ – an entity comprising everything a person believes himself or herself to be, including thoughts, feelings, wants and bodily sensations. (Corsini & Wedding, 2011 p. 121).”  It acts as a “go between” mediating information between the unconsciousness and the outer world.

The Persona

The persona represents the social mask we present to the world or how we desire the world to see us.  It acts as a shield of our ego, or sense of identity, from aspects of ourselves we desire to hide from the world. The persona allows us to conduct ourselves according to societal demands.  It represents the conscious aspects of our ego and our attempts to adapt with the outer world (Daniels, 2011).

The Shadow

While the persona represents the face we presents to the world, the shadow represents the denied aspects of ourselves.  “The shadow contains everything that could or should be part of the ego but that [it] denies (Corsini & Wedding, 2011, p. 121).”  It involves those aspects of who we are that are not acceptable according to the demands of those around us in our daily lives.

The Jungian Androgynous Mind…

Jung felt that the mind contains both female and male archetypes.  Essentially we are all basically androgynous psychologically (Corsini & Wedding, 2011).  The self contains both female and male archetypes.  “Anima and Animus are Personifications of the feminine nature of a man’s unconscious and the masculine nature of a woman’s (Daniel, 2011, p. 6).”  The anima is the feminine side of the personality in men and the animus is the masculine aspect of the personality in women (Rosenthal, 2005). Societal norms are what cause us to repress these aspects of ourselves (Rosenthal, 2005).

Jung’s Psychological Types

Jung states that individuals vary in the ways they habitually respond to the world (Corsini & Wedding, 2011, p. 122).  In his work on Psychological Types, Carl Jung classified personality types based on several dichotomous personality traits: (1) intuition vs. sensation; (2) thinking vs. feeling; and (4) extroversion and introversion.  For example, while intuition and sensation describe our preferred manner of taking in information from the world around us.  In contrast thinking and feeling describe how how we prefer make sense of this information and make decisions. Finally, introversion & extroversion describe what captures our attention and where we go to “recharge”.  This work is based on the Myer’s Brigg’s personality test, which I disuss in my own blog here.

Our personalities are formed based on how we prefer to interact with the world around us.  In this sense, Jung’s work on psychological types reflects our cognitive preferences.  It doesn’t assess or measure our abilities and weaknesses.  As we rely on our preferred cognitive functions, they tend to predominate while others become underdeveloped.

Overview of Counseling Process

“Jung built his system of psychotherapy on four tenents: (1) the psyche is a self-regulating system, (2) the unconscious has a creative and compensatory component, (3) the doctor relationship plays a major role in facilitating self-awareness and healing, and (4) personality growht takes place at many stages over the life span (Corsini & wedding, 2010, p. 126).”

The Goal of Therapy….

Individuation and self-actualization are goals of therapy in analytical psychology.  This requires an integration of oneself and working towards wholeness.  “Jung’s beliefs that the principal aim of psychotherapy is ultimately neither curing nor alleviating patients’ unhappiness but increasing patients’ self-respect and self-knowledge.  A sense of peace and greater capacity for both suffering and joy can accompany this expanded sense of self (Corsini & Wedding, 2011, p. 127).”

The Process of Therapy

The therapeutic process occurs in two aspects analysis & synthesis.  “The analytic stages begins with confession (Daniels, 2011, p. 13)” and ends with education and transformation.  “Jung delineated four stages in this process: confession, elucidation, education and transformation (Corsini & Wedding, 2011, p. 127).”  Confession involves a cathartic recounting of one’s own life history (Corsini & Wedding, 2011).  During this stage the conscious and unconsciousness aspects of the client revealed.   During the elucidation phase, ” therapist draws attention to the transference relationship (Corsini & Wedding, 2011, p. 128).”  Education involves promoting a learning process and “is concerned with persona and ego tasks (Corsini & Wedding, 2011, p. 128).”  Transformation involves as a gradual integration of unconscious and conscious aspects of the self.  As the person becomes whole they are able “to become a uniquely individual self (Corsini & Wedding, 2011, p. 128).”

When Treatment Ends

According to Daniels, (2011), treatment may come to an end when: “Unwanted symptoms have vanished…there is satisfactory development. from a childish state…new and better adaptation to life have been achieved…[they have] moved beyond feeling stuck (p. 11).”

References

Colombos, A. (n.d.) Analytical Psychology: The Theory of Carl G. Jung  Retrieved from:  http://hellenicpsyche.blogspot.com/2012/12/analytical-psychology-theory-of-carl-g.html
Daniels, V. (2011).  The Analytical Psychology of Carl Gustav Jung.  Retrieved from:  http://www.matrixmeditations.info/bonusJung.pdf
Corsini , R.J. & Wedding, D. (2010). Current psychotherapies. John Wiley & Sons, Inc.
Kassin, Paul. (2001). Psychology. (3rd Ed.). Upper Saddle Creek River, NJ: Prentice Hall.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.

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What is Psychodynamic Therapy???

Psychodynamic Therapy Defined….

 “Psychodynamic theory (sometimes called psychoanalytic theory) explains personality in terms of unconscious psychological processes (for example, wishes and fears of which we’re not fully aware), and contends that childhood experiences are crucial in shaping adult personality.” (Borstein, 2013).  According to my course textbook, psychodynamics involves the interplay of forces within the mind, (Corsini & Wedding, 2010).  Psychiatric symptoms are interpreted as byproducts of inner conflict between conscious and unconscious parts of the psyche.  Corsini & Wedding (2010) state:  “psychotherapies that follow in a psychoanalytic tradition are referred to as psychodynamic treatments.  They retain the central dynamic principles of psychoanalysis but do not make use of the metapsychology, or formal structures of the mind” (p. 17).

Key Assumptions of Psychodynamic Theory

“Primacy of Unconscious” (Borstein, 2013).

According to psychodynamic therapy, “the majority of psychological processes take place outside conscious awareness.” (Borstein, 2013).   Consequently, this perspective interprets behaviors, thoughts, and feelings as having both manifest and latent meanings (Barth, 2014).   With this in mind, a primary goal of this therapy method is to explore those aspects of ourselves that are unconscious and bring them into awareness (Shedler, 2010).  Interestingly, research on the brain has confirmed the notion that many of the mind’s inner workings remain outside our awareness (Borstein, 2013).

The Role of Childhood Experience

“A third characteristic shared by psychoanalytically oriented clinicians is a belief that childhood experiences influence personality development, current relationships, and emotional vulnerabilities” (Corsini & Wedding, 2010, p. 21).  Borstein, (2013) adds that while other approaches also acknowledge the influence of childhood experiences, psychoanalytic approaches state they are determinants of our personality.   Corsini & Wedding, (2010) add that personality is a byproduct of the interaction between biological factors and personal experience.  These lasting personality characteristics are often experienced as defense mechanisms, and basic attitudes towards life (Corsini & Wedding, 2010).

The Principle of Causality.

“The third core assumption of psychodynamic theory is that nothing in mental life happens by chance—that there is no such thing as a random thought, feeling, motive, or behavior. This has come to be known as the principle of psychic causality” (Borstein, 2013).  This assumption stems from the previous assumption regarding the primacy of unconsciousness.  Behaviors, attitudes, and thoughts are not random and meaningless.  They have a meaning that reflects something unrecognized within our minds.

Transference & Countertransference

Corsini & Wedding, (2010), state that “in psychoanalysis, the analysis of transference is fundamental to treatment” (p. 18).  Transference is a term that refers to a Freud’s assertion that clients can be observed to transfer feelings onto their therapist that originate in early relationships.  Countertransference, then refers to the transference of a therapist’s emotions from early relationships onto the client.  By attending to the issue of transference and countertransference in therapy, it is possible to examine the impact of the unconscious and early childhood experiences on a client’s present-day functioning (Corsini & Wedding, 2010).

Tenents and Features…

Tenents of Psychodynamically-Oriented Practitioners

Barth, (2014), describes psychodynamic therapy as a talk therapy that involves recognizing, expressing, and understanding both latent and manifest meanings in our thoughts, feelings and behaviors.  This requires therapists to listen for defense mechanisms and feelings of resistance.  Examining how this exists as a form of self-protection is useful.  Patterns of interaction & behavior can help understand how relationships & aspects of the inner self reflect repetitive patterns (Barth, 2014). These repetitive patterns tend to reflect early unresolved experiences originating in childhood. Finally, the therapeutic relationship, and any transference issues are made a “subject of inquiry” as symptomatic of unresolved issues in the unconscious.

“Psychodynamically oriented practitioners…agree on certain basic tenents: (1) provide a setting in which the client feels safe; (2) help clients recognize ways to avoid distressing emotions; (3) be aware of the importance of relationships; (4) be aware of a client’s sense of self; (5) pay attention to the therapeutic relationship; (6) look for patterns of behavior that have been repeated over time; (7) think about and explore conscious meaning (Barth, 2014, p. 23).”

Features of Psychodynamic Theory – (Shedler, 2010).

The above list of tenants provide a good overview of the psychodynamic approach.  In his article “The Efficacy of Psychodynamic Psychotherapy,” Shedler, 2010 describes what makes this approach unique in comparison to other therapy methods.   Psychodynamic therapy is focused on more than simply on present-day symptom reduction.  It is aimed at provide a historical context for an individual’s dysfunction in order to build up their coping skills and self-awareness.  These goals are accomplished in the context of a therapeutic relationship that can empower a client to engage in self-exploration (Shedler, 2010).  What follows is a listing of seven unique features of psychodynamic therapy:

“Seven features reliably distinguished psychodynamic therapy from other therapies…(1) Focus on affect and expression of emotion…(2) Exploring attempts to avoid distressing thoughts and feelings…(3) Identifying recurring themes and patterns…(4) Discussion of past experience (developmental focus)…(5) Focus on interpersonal relations…(6) Focus on the therapy relationship…(7) Exploration of wishes and fantasies (Shedler, 2010, p. 11-12).”

Psychodynamic Theory “In Action”

What Change Looks Like

“Change is seen as a gradual process of (1) opening up to self-discovery, (2) discovering of relating and perceiving that stand in the way of current functioning, (3) finding ways to disentangle the influences of the past from the present and, (4) finding new ways to cope (Corsini & Wedding, 2010, p. 38).”   Messer, (2013) notes thatht he following are key mechanisms of change: (1) an understanding of the role of affect; (2) insight into transference issues; and (3) a therapeutic alliance.  For example, examining one’s way of relating and perceiving can happen by gaining insight into transference issues.  Opening up to the process of self-discovery can happen through a process of free association.

Purpose of Interventions

What exactly is the useful purpose of examining the unconscious?  Is it always necessarily useful to discuss one’s childhood in order to ascertain the pragmatic solutions to present-day problems?  According to my textbook, what follows are the theoretical reasons underlying the psychodynamic approach:

Purpose One: “to uncover inner problems that had been disguised as symptoms (Corsini & Wedding, 2010, p. 39).

According to this approach, it is useless to develop a solution without an understanding of the problem’s source.  As stated earlier understanding the unconscious is a primary element of this method.  Therefore, the first step towards healing and growth occurs as an individual understands the meanings expressed in various symptoms.  While they may appear unrelated and random, this asserts they are likely related to early unresolved experiences in one’s childhood.

Purpose Two: “To become integrated (Corsini & Wedding, 2010, p. 39)”

According to this approach internal conflict is a reflection of the fact that latent and manifest components of the self are at odds with one another.  The solution, therefore, is a full integration of those aspects of oneself that are at odds.  An awareness of those unconscious aspects of the self is just a first step.

Purpose Three: “To uncover the sources of past pain that may be embedded in the present (Corsini & Wedding, 2010, p. 39)”

This approach is useful in addressing unresolved pains of our childhood and examining how they influence our daily lives in the present.  This historical approach is helpful in contextualizing the “how come” and why certain experiences keep repeating in our lives.

Purpose Four: “Discover what stands in the way of appropriate actions for the self (Corsini & Wedding, 2010, p. 39).”

Finally, this approach is useful in addressing an inexplicable stuckness, or why even the “best plans sometimes go nowhere because of other forces within the patient” (Corsini & Wedding, 2010, p. 39).   It appears to me that this approach insists upon an understanding the problems at their core.  The problems are, in this respect, not what they might appear on the surface.  Instead they often reflect unresolved aspects of our history and unconscious.

When is this Approach Useful?

This approach is not useful when a “client needs immediate intervention, has no access to feelings, is not able to think abstractly, or confused/psychotic” (Barth, 2014, p. 24).  It is useful when a client is” (1) interested in gaining insight into their feelings, thoughts, and behaviors; (2) can tolerate the feelings and thoughts that emerge; (3) displaying resistance and disengagement; (4) displays transference issues. Barth, 2014).

References

Barth, F. D. (2014). Contemporary Psychodynamic Models. In Integrative Clinical Social Work Practice (pp. 17-28). Springer New York.
Bornstein, R. (2013). The Psychodynamic Perspective. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. DOI:nobaproject.com.
Corsini , R.J. & Wedding, D. (2010). Current psychotherapies. John Wiley & Sons, Inc.

Messer, S. B. (2013). Three mechanisms of change in psychodynamic therapy: insight, affect, and alliance. Psychotherapy, 50(3), 408.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. The American psychologist, 65(2), 9-25.

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Freud’s Ego Defense Mechanisms (Psychoanalysis)

In his article titled “On The Psychology of Self-Deception”,  Shapiro, (1996) asks: “Self-deception can easily seem paradoxical. How can the knowing deceiver also be the unknowing deceived? How can one intentionally, knowingly, not know?”   While many of Freud’s concepts have long been dismissed, several aspects of his work have made a lasting impact on the field of psychology.  One of these concepts pertains to the notion of repression within the mind’s subconscious.  So why is it we lie to ourselves and hold outside our awareness a critical component of reality from our understanding??  Baumeister, et al, (1998) state the following:

“Nearly all adults hold preferred views of themselves. In most cases, these are favorable views of self—indeed, somewhat more favorable than the objective facts would entirely warrant, as nearly all writers on the self have observed. A recurrent problem of human functioning, therefore, is how to sustain these favorable views of self. Patterns of self-deception can help create these inflated self-perceptions (p. 110).”

According to Freud, upholding a preferred view of ourselves and the world we live requires some mental gymnastics of sorts.  “Defense Mechanisms are, in essence, attentional tricks we play on ourselves to avoid pain….the ostrich policy” (Goleman, 1996, p. 118).  Rosenthal, (2005) describes defense mechanisms as the mind’s ability to conceal from our awareness anything that causes us pain or anxiety. What follows is a list of common defense mechanisms.

Repression

Repression is a simple defense mechanism that involves “keeping a thought, impulse or memory from awareness” (Goleman, 1996, p. 119).  Shameful and dreadful memories or impulses that run counter to our values or idealized self-perception are “forgotten” and blocked from memory.  Freud notes that ordinary individual efforts are generally unsuccessful in recalling this information. Psychoanalysis is required (Rosenthal, 2005).  It occurs unconsciously.

Sublimation

Sublimation occurs when we channel an unacceptable and unconscious urge into something socially acceptable.  For example, a person with violence and aggressive urges can take up a job as a professional boxer (Rosenthal, 2005).   Goleman, (1996) notes that this defense mechanisms “satisfies the unacceptable impulse indirectly by taking on an approved object…[it] is the great civilizer, the force which keeps mankind manageable” (p. 121).

Reaction Formation

“Denial is a refusal to accept things as they are…[a] common first reaction to devastating loss” (Goleman, 1996, p. 120).  On other occasions, denial can pertain to an unwanted or shame-inducing impulse and/or desire.  With reaction formation we start by denying this fact or impulse and then transforming it denied into its polar opposite.   Reaction formation replaces  anxiety by producing impulses and unconsciously rejects them by producing an instinct to do the exact opposite in our mind (Rosenthal, 2005).  In doing so, it seems that we are able to prove ourselves we aren’t we what we loathe.  I’m definitely guilty of doing this as an INFP with OCDish tendencies who loathes her own absentmindedness.

Suppression

Suppression is a deliberate choice to not think about something (Rosenthal, 2005).  In other words, this defense mechanism involves a willful denial of reality.  In contrast, repression is an unconscious process that occurs out of our arenas.  It generates traumatic anxiety and pertains to those things that are way too painful to directly address.  A convenient example of this can be found here and here on my blog.

Regression

“Occurs when a person revers to a behavior that he/she has outgrown” (Rosenthal, 2005).  In this instance, individuals hope to refer to a time when they feel happy and secure.  The most convenient example I know if, includes my teenage boy’s behaviors shorty after his last heart surgery.  Normally your typically independent teenage male, in a hurry to grow up, the pain after his surgery was overwhelming.  Suddenly he had reverted to that kid who always needed me around.  Click on this link to read more about my experiences as a parent raising an ill child.  

Rationalization

Rationalization involves attempting to defend behavior and/or life outcome by utilizing a socially acceptable explanation (Rosenthal, 2005). “Rationalization allows the denial of one’s true motives by covering over unpleasant impulses with a cloak of reasonableness” (p. 121).  In other words, these are slick lies we tell others and ourselves in order to avoid revealing our true motives.  The best example I have of this comes from my youngest son, during dinner.  He looks at me with his best innocent smile and states: “I want to save some of this for you”, and then grabs dessert.

Projection

Projection involves attributing a character trait to other people that you despise in yourself (Rosenthal, 2005).  Goleman (1996) describes this as a distancing of one’s own emotions.  This occurs in a two-step process.  First, we deny a certain aspect of ourselves that we dislike.  Then, once blocked out of consciousness, we “displace those feelings outward onto someone else…Once cast out onto someone else, the projected part of the self is encountered as though it were a complete stranger” (Goleman, 1996, p. 121).  For a convenient example of projection, click here.

Displacement

Displacement is a defense mechanism that refers to how we handle pent up negative feelings.  It involves expressing hidden and unconscious feelings or instincts onto a convenient target.  The first step in this process involves a denial of some hidden emotion or instinct.  The second step involves a purging of negative emotions associated with this denied aspect of ourselves.  For example, lets say you’re mad at your husband and frustrated at work.  So you go home and scream at your wife and kick the dog.  This is displacement.

References

Baumeister, R. F., Dale, K., & Sommer, K. L. (1998). Freudian defense mechanisms and empirical findings in modern social psychology: Reaction formation, projection, displacement, undoing, isolation, sublimation, and denial. Journal of Personality66(6), 1081-1124.
Goleman, D. (1996). Vital lies, simple truths: The psychology of self deception. Simon and Schuster.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Shapiro, D. (1996). On the Psychology of Self-Deception.  Social Research, 63(3). Retrieved from:  http://www.communicationcache.com/uploads/1/0/8/8/10887248/on_the_psychology_of_self-deception.pdf

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Sigmund Freud (Psychoanalysis)

This post is an attempt (on my part) to make the most of a very “UN-FUN” goal – to study for the NCE exam. Since I loathe the idea of rote memorization, I’ve decided to use this blog, to make the study process less boring. I begin this studying by listening to a series of CD’s by Howard Rosenthal (2005). He starts of reviewing Sigmund Freud’s works…

Biographical Overview

Freud lived from 1856 – 1939 and is considered the father of psychoanalysis.  “Originally, Freud has intended to pursue a career as a biological research scientist” (Corsini & Wedding, 2010, p. 22).  Therefore, Freud was trained formally as a doctor and did neuropsychological research in Vienna, Austria (Corsini & Wedding, 2010; Rosenthal, 2005).  Prior to Freud, “psychology was dominated by phrenology and mesmerism” (Rosenthal, 2005).  Phrenology pertains to an assessment of mental faculties by examining bumps on the skull.  Mesmerism is based on the idea that “special magnetic fluids could be liberated via a technique of animal magnetism” (Rosenthal, 2005).  As you can see, these Freudian precursors are far from scientific.  While many of his concepts have since been proven to hold water, his impact cannot be ignored.  He brought into the field of psychology a scientific spirit while asserting that the stuff occurring behind the ears was worth of analysis and understanding.

It is also worth noting the historical context within which Freud’s entry to the psychology field occurred.  “During his formative years great strides were being made in neurophysiology…psychology separated from philosophy as an independence science” (Corsini & Wedding, 2010, p. 22).   During this point in psychology’s history, Freud became interested in studying emotional disorders after participating in neuropsychological research as a doctor in Vienna (Rosenthal, 2005).   Through his career, Freud had revised his theories continually & his many writings reflect this evolution…

Freud’s Psychoanalysis

Psychodynamic Theories

Freud’s psychoanalysis falls under the umbrella of “psychodynamic theories” which refers to the work of Freud as well as his followers: (Jung, Adler, etc).  Psychodynamics is the…interplay of forces in the mind…symptoms in psychodynamic theory are seen as an expression of inner conflict” (Corsini & Wedding, 2010, p. 17).    Additionally, since all behaviors, emotions, and thoughts pertain to unconscious and our mind is structured accommodate both conscious and unconscious elements.

Psychoanalysis Defined.

According to Rosenthal (2005) Freud called his psychoanalytic theory “dynamic” in nature.  This term was inspired by developments in physics at the time.  “In physics dynamic is the study of motion and forces impacting movement.  In therapy dynamic refers to the energy or mental forces of the mind, (Rosenthal, 2005).”  

Freud’s Psychoanalysis is based on the idea that individual’s aren’t aware of many factors affecting their feelings thoughts and behaviors.  The goal of Psychoanalysis is to “seek to understand human behavior through an investigation of inner experience” (Corsini & Wedding, 2010, p. 16).  This allows the client to release any repressed information within the unconscious.

According to Rosenthal, (2005), Freud’s approach is a long and expensive process that requires sessions 3-5 times weekly for several years.   In Freud’s psychoanalysis, a couch is utilized and the client is facing away from the therapist.   In contrast, psychodynamic therapy is performed face-to-face and requires fewer sessions.  Rosenthal, (2005) states that it works best on clients who are highly motivated and not facing crisis situations.

Early Career – “Studies in Hysteria”

Early in his career, Freud worked with hypnotist Josef Breuer (Corsini & Wedding, 2010; Rosenthal, 2005).  Breuer was an Austrian doctor that utilized hypnosis in order to understand oppressed traumatic and emotionally impactful events within the client’s minds.  Corsini & Wedding (2010) state the following about how Breuer’s work left an impression on Freud:

“While awake, the patient was completely aware of the ‘traumatic’ event or its connection with her disability, but after relating it under diagnosis, the patient was cured of her disability.  The report made a deep impression on Freud” (p. 23).

After learning about this, Freud was inspired to learn more about hypnosis, however discovered later he was “not very good at it” (Rosenthal, 2005).  He eventually hooked up with Breuer at some point again to further verify his research findings.  The result of this collaboration was a work titled “Studies in Hysteria”.    It is interesting to note that “hysteria” is an ancient Green root word that means “womb or uterus”.  At the time that this work was published, “hysteria” was a general term referring to “mental illness”.  In other words, one might infer from this f’d up term that mental illness was – at this time in history – likened to “acting like a woman”.  ((However, I’m getting off track aren’t I 🙂 )) …

untitledAt any rate, Freud came to several conclusions as a result of this collaborative work, while working with the famous “Anna O / Bertha Pappenheim” (See pic).  These conclusions were to be key elements of his psychoanalytic theory:

FIRSTLY, knowledge of a traumatic event isn’t enough (Rosenthal, 2005).

“The discharge of the appropriate amount of emotion was also necessary” (Corsini & Wedding, 2010, p. 23).  This insight led Freud to eventually utilize catharsis (talking cure) and free association (saying whatever comes to mind) in is psychoanalytic therapy (Rosenthal, 2005).

SECONDLY, Freud noticed that “traumatic events were forgotten or excluded from consciousness” (Corsini & Wedding, 2010, p. 23).

This insight led Freud to conclude that client’s desired to defend (consciously or unconsciously) their psyche from traumatic memories.  The result was a series of ego defense mechanisms and a repressed memory that would complicate their lives until the traumatic memories could be resolved.  Essentially, he felt the mind desired to maximize pleasure (pleasure principle), minimize pain, and is structured accordingly.

THIRDLY, Freud noted these cases of hysteria were related early traumatic childhood sexual experiences.

These early “clinical experiences laid a foundation for the theory he later developed. He was convinced that the traumas and conflicts of early childhood can have lasting effects, that we are ruled by unconscious forces.” (Kassim, 2001, p580).  As a result, in Freud’s psychoanalysis he desired to examine key events in a person’s childhood and the lasting effect it had on the remainder of their lives (Broderick & Blewitt, 2010).   Additionally, he felt a cases of “hysteria” were generally related to early childhood sexual experiences and included these concepts in his developmental theory.  Rosenthal (2005 ) notes that while these concepts have been debunked, it is worth reviewing as a foundational element in psychology’s history.

2nd Phase of Career – Interpretation of Dreams.

In 1900 Sigmund Freud published a book titled “Interpretation of Dreams”, considered the “bible of psychoanalysis” (Rosenthal, 2005).  by those who study his work.  Freud was interested in learning how dreams and how might be utilized to interpret symptoms within the unconscious.  According to Howard Rosenthal, (2005), “Freud called the dream the royal road to the unconscious mind.”   Freud felt that dreams reflected the mind’s structure and were products of “conflicting forces in the mind – between unconscious wishes and the repressive activity.” (Corsini & Wedding, 2010 p. 24).  Dreams can be thought of distorted versions of the repressed desires and memories, residing in our unconscious.  Dream interpretation became a key element of Freud’s psychoanalysis and involved deciphering between manifest and latent content.  While manifest content refers to the dream’s actual subject matter, the latent content referred to its hidden meaning (Rosenthal, 2005).  In this work he includes the concept of “self-analysis”, and provides the following commentary:

“Freud remained ambivalent of the possibility of usefulness of self-analysis.   My self-analysis is the most essential thing I have at present [however] remains interrupted.   I can analyze myself only with the help of knowledge obtained objectively…True self analysis is impossible.” (Erwin, 2002, p. 570).

The Topographical Hypothesis

dscf9020Rosenthal (2005) notes that while Freud’s structural theory (id, ego, & superego), has received widespread attention, his topographical notion has also made a huge impact on the behavioral sciences.  Essentially he states that we are like iceberg’s since much of makes us “who we are”,  resides below the surface.  This is known as “Depth Psychology” (Rosenthal, 2005).  According to the Freud, the mind contains both conscious, preconscious and unconscious elements (Broderick, 2010; Kassim, 2010).   The conscious mind is that portion of our mind we are aware of in the moment (Broderick, 2010; Kassim, 2010). It is the portion of the iceberg popping out of the water for all to see.  The preconscious is information that can be recalled with some effort. Our unconscious mind, on the other hand, exists outside our own awareness and is comprised of drive and instinct (Broderick, 2010; Kassim, 2010).  It is the largest part of the iceberg and exists below the matter, outside our awareness (Rosenthal, 2005).

Structural Theory

Freud believed that people are perpetually driven by inner conflicts…and that compromise is a necessary solution. (Kassim, 2001, p581).  As a result, Freud conceived the human mind as a “psychic apparatus containing of three parts, the Id, ego and superego…psychological constructs and not physical entities” (Rosenthal, 2005).  The balance of these three entities is essential to minimize intrapsychic energy conflict (Rosenthal, 2005).

img_2900The id the most basic part of the psych and the first to develop (Broderick, 2010; Kassim, 2001). It is driven by the pleasure principle.  Its primary goal is need fulfillment.   It predominates in the first few years of life, and focuses around an infant’s immediate needs (Broderick, 2010; Kassim, 2001).  It is best described as a reflection of our basic instinctually driven needs.  On its on, the id is chaotic, unconscious, and is driven by the satisfaction of needs.  It has no sense of time or morals.  We experience it as neurotic symptoms, in dreams, and during cathartic free association utilized during Freud’s psychoanalysis.
img_2902The second component of the mind to develop is the EGO.  It comprises as an emerging understanding of the consequences of behavior.  As the ego develops, children display a greater sense of rationale is exercised in interaction with others (Broderick, 2010; Kassim, 2001). While the id represents our instinctual drive, the ego runs on the basis of a “reality principle” and operates as the executive administrator of the mind (Rosenthal, 2005).  Our ego-based defense mechanisms reside here as a result of the mind’s efforts to separate repressed memories from the superego’s conscious self.  In this respect, it is the face we present to the world, and represents our moment-to-moment conscious awareness. It is logical and reasonable.  It uses judgment to reign in the id’s desires.  it is a mediator between the person and their reality (Rosenthal, 2005).
img_2903Finally is a psychic construct that reflects our moral conscience.  In this respect, it represents an internalization of cultural and social values we learn from others growing up.  It contains our ego-ideal, or our idealized self and represents a set of moral standard s.  According to Freud’s theory “it is a byproduct of the child’s successfully passing through the Oedipus complex (Rosenthal, 2005).”  Providing an individual of a strong moral code of right and wrong, it represents the internalization and internalization of our parental figures (Rosenthal, 2005).

Eros & Thanatos

According to Freud, two major instincts motivate all human behavior, the first are collectively referred to as life instincts, which include the need for food, water, air and sex….a second darker side of human nature….is a death instinct, a need to reduce all tensions. (Kassim, 2001, p581).  The life energy created by these instincts is defined as the libido (Rosenthal, 2005).   Freud called the life instinct “eros” and it signified for him our instinct for self-preservation.  Thanatos, in contrast, is our self-destructive death wish, however he stated that this instinct was unconscious (Kassim, 2001).

Transference

“Freud was the first to recognize the therapeutic value of transference phenomena, in which the patient comes to experience others, the analyst in particular, in ways that are colored by…early experiences with [others]” (Corsini & Wedding, 2010 p. 20).   Rosenthal, (2005) defines transference as reacting to the therapist as if they were a significant other from the past.  Transference feelings can be positive, negative or ambivalent in nature (Rosenthal, 2005).  Finally, countertransference is a therapist’s transference issues upon the client as if they were somebody from the past (Corsini & Wedding, 2010; Rosenthal, 2005).  Therapists are all susceptible to countertransference with their clients, and need to be aware of them and address these issues honestly.  There’s definitely more than a grain of truth to the fact that “every therapist needs their own therapist”.

Concluding comments..

This overview is by no means comprehensive.  In future posts, I intend to review his ego defenses and four stages of psychosexual development….

References

Erwin, E. (2002). The Freud encyclopedia: Theory, therapy, and culture. Taylor & Francis.
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Corsini , R.J. & Wedding, D. (2010). Current psychotherapies. John Wiley & Sons, Inc.
Kassin, Paul. (2001). Psychology. (3rd Ed.). Upper Saddle Creek River, NJ: Prentice Hall.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.

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NCE STUDY – Native Americans

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

A Historical Cultural Assessment

In order to understand the Native American’s perceptions of the dominating Euro-American culture a historical context is important.  Historically, the relationship between Euro-Americans and Native Americans has been fraught with a mixture of cooperation and conflict (Hays & Iwasama, 2006).   The assimilation of Native American’s into the dominant Euro-American culture has been brought with trauma and varied forms of assimilation.  For this reason, an assessment of the cultural background and assimilation experiences of Native American’s who we provide counseling to.  As a biracial individual, I can personally attest to the fact that a person’s phenotypic appearance doesn’t reflect their cultural background.  It is therefore inaccurate to look at person and make judgments of their culture based on whether they appear Indian.  For example, while I look white, key aspects of my own childhood have provided me with a cultural belief system that reflects my mother’s culture.  I may not look very Filipino in appearance but have some belief systems that are reflect of this culture.

Educational Disparities

A great disparity has existed historically between how Native Americans have conceived education, and how it is viewed from a Westernized perspective.  Historically, governmental policies have managed to instill a high level of distrust in governmental services.   From an educational standpoint, our governmental education policies have included attempts to eradicate Native American culture and assimilate individuals into a Westernized educational system.  In fact, separating children from their home environment, takes children out of the natural setting in which they learned.   According to our textbook, Indian children tend to prefer visual learning to the verbal and auditory methods utilized in Westernized school systems.

Mental Health & Multicultural Competency

According to the 1999 Surgeon General’s report, the Native American community has  suicide rate 1.5x the national rate.   High rates of PTSD, and alcohol abuse exist in this population.   However despite this fact, the Native American community tends to under-utilize available counseling services and experience high drop-out rates.  Cultural competency within the counseling field is essential to overcome a 500-year history of oppression and domination from the American government.  Cultural sensitivity starts with an awareness of cultural differences and their underlying historical context.  For example, our course textbook states that 85% of psychologist are from an European American heritage in which the following cultural beliefs are dominant:

Assertiveness in social interactions take precedence over subtlety as a preferred response (Hays & Iwasama, 2006).  
Change takes precedence over acceptance and patience as a life-solution.  (Hays & Iwasama, 2006).  
Personal independence takes precedence over dependence and duty to family. (Hays & Iwasama, 2006).  
Self-disclosure and directness is preferred to cautious protection of a family’s reputation. (Hays & Iwasama, 2006).

Belief Systems & Counseling Practice

In this final section, I feel it may be useful to list some belief systems common in Native American culture that diverge from the typical Euro-American perspective that dominates the mental health field.  I list them below in no particular order:

Counseling Goals.

Within the mental health field a medical perspective dominates that choose to view problems as a matter of individual dysfunction.  The CBT-oriented perspective focuses on dysfunctional thoughts, feelings and behaviors, as an effective solution.  In contrast, Hays & Iwasama (2006) suggest that harmony of body mind and spirit is critical for wellness in Native American culture.

Acceptance & Mindfulness.

A Euro-American perspective is solution-focused.  In counseling this might translate to pragmatic CBT approaches, stages of change and motivational interviewing.   In contrast Native American culture might also include components of acceptance and mindfulness.  Traditional healers and the utilization of substances in context of spiritual practices are common.  Rosenthal, (2005) latest that “drinking large quantities of beer is a way of enjoying oneself and is more socially acceptable”.

Nonassertive & Agreeable Passivity.

Rosenthal (2005) states that a “counselor should feel free to ask questions in order to ascertain where the client is coming from and what they think.”  In Native American culture a nonassertive passivity is more preferred in the context of social interactions.  Direct the conversation with questions is essential to understand the client’s perspective.

Possessions & Self Worth.

American Indian’s historically have a relationship with things that diverges greatly from the Euro-American’s materialistic perspective.  For example, how does one “own the air”?  It is just out there as something to enjoy.  It doesn’t reflect who we are or our worth.  This perspective is divergent from the dominant perspective in American in which social class is dependent on an array of ecumenic factors that tend to determine our sense of worth, (i.e. “keeping up with the Jonses”).

Time Orientation

In American culture, we are long-range planners.  We think about our pasts and how we got to here.  We then examine our goals for our future, and sacrifice for today, what we hope to achieve for tomorrow.  This hamster-wheel existence diverges from Native American culture in which one lives in the present more.  Rosenthal, (2005) suggests they “are not generally accustomed to delayed gratification and long-range planning”.

References

Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.

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NCE STUDY – Understanding LGBT Clients…

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

PART ONE: A Literature Review Paper…

According to research, higher rates of mental health diagnosis, substance abuse and suicidal ideation exist within the LGB by community (Biescheke, et al, 2007, Hays & Iwasama 2006; Herek & Greene, 1998).   With mental health diagnoses concentrated in the areas of anxiety, depression, and suicidal ideation, it is important to note these issues are commonly correlated with “minority stress” in research, (Biescheke, et al, 2007, Hays & Iwasama 2006; Herek & Greene, 1998). Defined as a form of social stress related to stigmatized minority status, it will be essential to start off with a discussion of this concept. (Meyer, 2003, p675).

In this paper, I begin by discussing the concept of “minority stress”. I then discuss key issues common within the LGB community: identity development, coming out, and internalized homophobia. I conclude by providing a summary of how these key issues affect LGB youth and how to develop a treatment plan with these factors in mind.

Minority Stress.

In attempting to understand the concept of minority stress, it is vital to understand how discrimination exists as its cause. With social discrimination bringing about a stigmatized status amongst LGB minorities, the result is the minority stress they are forced to contend with (Herek & Greene, 1998; Meyer, 2003)

Discrimination as Cause.

Firstly in contextualizing the nature of minority stress, it is important to understand the nature of the discrimination they encounter. In a book titled “Stigma and Sexual Orientation” there is a brief review of research that examines the underlying motivations of assaultive acts against LGB victims. The conclusions made from this research are that assaults on LGB individuals can be seen as resulting from motives best defined as “a learned form of social control of deviance”, (Herek & Grene, 1998, p7). In this respect the motives aren’t entirely personal in nature, but simply an extreme form of gender norm reinforcement, (Herek & Greene, 1998).

“To reconcile the apparent contradiction between the socially normative attitudes held by assailants and the visciousness and brutality of their behavior….during the course of my research I came to conceptualize the violence not in terms of individual hatred but as an extreme expression of American cultural stereotypes and expectations regarding male and female behavior…From this perspective, assaults on homosexuals and other individuals who deviate from sex role norms are viewed as a learned form of social control of deviance rather than a defensive response to personal threat.” (Herek & Greene, 1998, p7)

Stigma as Cause of Minority Stress.

With this perspective in mind it is important to note that the definition of stigma is simply a “characteristic of persons that is contrary to a norm of social unity”, (Herek & Greene, 1998, p108). Key aspects of the underlying causes of stigma exist external to the individual. Additionally, when you note that such a stigma is associated with an elemental component of one’s overall identity, the result is minority stress. Understanding the nature of this minority stress as comprising an array of interrelated individual and social factors is essential, and will be discussed next.

The Nature of Minority Stress.

It is clear, when taking time to understand the nature of minority stress, it exists as an interrelated set of social, group, and individual components, (Meyer, 2003). For example, society is comprised of social structures that appear to stand against an LGB minority lifestyle. Additionally, the social environments in which an LGB individual lives often create a meaning system that completely negates their experience (Meyer, 2003).   Against these social factors, are other variables such as family dynamics, social environment, and individual factors that also play a part. For example, individual factors such as methods of handling stress and forms of cognitive appraisal influence the nature these social factors have on a person:

“The more an individual identifies with, is committed to, or has highly developed self-schemas in a particular life domain, the greater will be the emotional impact of stressors that occur in that domain.” (Meyer, 2003, p678)

Distal / Proximal View of Minority Stress

In attempting to bring some clarity to the interrelated factors that comprise minority stress, a research article I found (Meyer, 2003), describes an interesting perspective of stress worth mentioning. Firstly, this research proposed that stress is comprised of three components as discussed in the following quote:

“I have previously suggested three processes of minority stress relevant to LGB individuals. From the distal to the proximal they are (a) external, objective stressful events and conditions (chronic and acute), (b) expectations of such events and the vigilance this expectation requires, and (c) the internalization of negative societal attitudes. (Meyer, 2003 p676)”

While well beyond the scope of this paper, the article then goes on to provide some discussion of how such factors are interrelated.   The crux of this theory’s proposed stance is that such abstract social concepts become relevant psychological through the manner in which we decide to cognitively appraise them (Meyer, 2003, p676).

Common LGB Issues

In attempting to further put into perspective key issues common within the LGB community, a few key observations can be made that help put them into context.   In this section I discuss three key issues in the LGB community: (1) identity formation, (2) coming out, and (3) cognitive appraisal.

Identity Formation.

“In social identity theory and identity theory, the self is reflexive in that it can take itself as itself as an object and can categorize, classify, or name itself in particular ways in relation to other social categories or classifications.” (Stets & Burke, 2000, p224).

As the above quote indicates a person’s identity is essentially an internalized subjective construct of “you”. (Stets & Burke, 2000). In this respect, it can be thought of as a byproduct of our interpretations. For individuals with a sexual minority status, developing a positive identity is problematic as a result. (Bieske, et al, 2007, p19).

Before going further it must be noted briefly, that much in-group diversity exists within the LGB community. For example, contextual factors such as cultural background, sexual preference, and gender orientation influence individual LGB identities. Adding to these factors is the historical context within which a person lives.   Finally, adding to the confusion is the fact that the three components of sexual orientation (same sex identity, same sex behavior, same sex attractions) don’t exist in equal degrees with all LGB identifying persons, (Hays & Iwasama, 2006). Finally, while stage theories help to conceptualize the identity formation process, it must be noted, that identity development isn’t necessarily experienced like that first-hand. Instead often described as a fluid and abstract notion, it is more accurately understood as a lifelong process.

Coming Out.

It is important to note, that unlike many minority groups, LGB individuals have the option of concealing this stigmatized status (Hays & Iwasama, 2006). Early on in the process of LGB identity development, this concealment is often an essential coping mechanism. Having said this it should also be noted that coming out “is associated with lower psychological stress” (Hays & Iwasama, 2006, p224).

Internalized Homophobia.

Another key factor to note, that makes the LGB community unique amongst all minority groups, is their status is often not shared within the family (Hays & Iwasama, 2006). As a result, LGB individuals are often raised within a cisgendered, heteronormative environment to varying degrees (LGBTQA, 2014). The consequence of this is a learned belief system defined as “internalized homophobia” (Hays & Iwasama, 2006). Overcoming this is key in the coming out and identity formation process for LGB individuals.

Counseling LGB Youth.

In taking time to consider what the concept of minority stress means in the daily lives of LGB youth during key developmental years, concepts such as Marsha Linehan’s “invalidation” and Brene Brown’s “shame” come to my mind.

LGB youth, in the early developmental stages of form an adult identity, often deal with the issues above as an internal struggle without little outside guidance.   In doing research for this paper, I found two great resources that were helpful in allowing me to develop a rudimentary understanding of how to begin to formulate a treatment plan for this community of individuals. In providing counseling for any LGB youth, the eclectic counseling perspective mentioned in our Hays textbook, (2006), would be my starting point. Key insights, such as what I discuss from these resources, will be helpful in the ongoing case conceptualization and treatment formulation process.

Early LGB Identity Development.

The first key insights I found beneficial were within the video link provided in the assignment description for this week. Titled, “Working with Gay/Lesbian Youth Clients”, this video provides samples of counseling scenarios with LGB youth clients. What I found most interesting were the varied stages of development displayed within each counseling session.   With each stage of development there exists a unique set of characteristics, and counseling considerations with each stage. I discuss each of these stages briefly below.

Identity Confusion Phase.

During this early phase of LGB identity development, the client is experiencing a growing internal awareness that is not well defined.   As noted earlier, the majority of LGB individuals often hold this minority status alone in the family. Without any family or friends to provide guidance, the growing internal awareness can be experienced at first as just “being different somehow” (Sage Productions, 2014). Often understood within a heteronormative family environment, the growing awareness of homosexuality exists against within an array of denial strategies.   Often not ready to admit such feelings outwardly, or put labels to things, ongoing self-rejection is an early core issue. Key goals during this stage include: (1) empathetic listening, (2) building trust, (3) validating confusion, (4) assessing suicide risk potential, and finally (6) probe for greater specifics regarding situations and associated feelings, (Sage Productions, 2014).

Early Identity Acceptance.

During the early identity acceptance stage there exists a clear awareness of the nature of one’s attraction. With a greater degree of awareness, there still exists much internal confusion and heightened degrees of anxiety in moving forward.   Key goals during this stage include: assessing the use of support systems and providing tools with which to address anxiety in a healthy manner (Sage Productions, 2014).

It is useful to note, in concluding my remarks on this stage with a brief quote from another resource that sheds light on the importance of a support system for LGB youths:

“Through reappraisal, the in-group validates deviant experiences and feelings of minority persons….It is important to distinguish between group-level and personal resources because when group-level resources are absent, even otherwise-resourceful individuals have deficient coping. Group-level resources may therefore define the boundaries of individual coping efforts.” (Meyer, 2003, p677)

Late Identity Acceptance.

With greater internal clarity and awareness of oneself, the process of coming out to oneself and others becomes the overarching goal during this stage. Continuing to assess the degree of clarity, helping clients to forge a new positive identity will be important focuses during this stage of the counseling process.

In concluding this brief discussion on LGB Identity formation, it must be noted that much in-group variation exists. An in depth discussion of this matter is well beyond the scope of this assignment. Therefore, this discussion is just a brief cursory overview that is helpful for me as a useful as a form of rudimentary case conceptualization.

Addressing Key Stressors For LGB Youth.

“Four stressors are of particular importance to lesbian, bisexual and gay youth, (a) overt acts of abuse, harassment, and violence, (2) development of one’s identity as a sexual minority person and related internalized homophobia, (3) disclosure of sexual orientation to others and related lack of adult social support, and (4) development of platonic and romantic relationships with other lesbian, gay male, and bisexual peers.” (Safran, et al, 2001, p217)

Understanding key issues associated with a stigmatized sexual minority status as an LGB youth is one critical matter that cannot go without mention. When you consider the overt expressions of hatred, heteronormative environments along with a scarcity of social support, the heightened risks to an individual’s well being become clear. An article titled “Cognitive Behavioral Therapy with Lesbian, Gay and Bisexual Youth”, lists stress reduction, anxiety, and depression as three key issues for individuals in this community, (Safran, et al, 2001).  I discuss each of these in turn briefly below:

Depression & CBT.

As per the cognitive behavioral perspective, stigmatizing experiences alongside negative environment factors and a “dysfunctional attribution style” are what lead to feelings of hopelessness in LGB a youth (Safren, et al, 2001). Utilizing CBT techniques such as cognitive restructuring are useful in addressing negative preconceptions of any same-sex attraction, (Safren, et al, 2001, p221).   Alleviating thinking errors such as “catastrophizing” (Safrem, et sl, 2001), and self-blame, can help with depressive systems. The importance of this consideration becomes clear in light of the higher rates of substance abuse and suicide associated with the greater prevalence of depression,

Anxiety & CBT.

It’s not surprising that LGB youth experience higher rates of social anxiety when you consider the lack of social support they often receive. In fact, preconceived “what if’s”, (often in the form of worst case scenario conceptions), frequently underlie this anxiety, and can produce an avoidance-based coping style. Ultimately, this fear of self-disclosure and social situations can only limit normal adolescent development.   Assisting LGB youth through cognitive restructuring and varied forms of social support can give these individuals a new frame of reference with which to move forward (Safran, 2001).

Stress Reduction & CBT.

“It is not the stressors themselves that cause depression but that one’s cognitive interpretation plays a mediating role. From a cognitive-behavioral perspective, external acts of homophobia, if occurring chronically, uncontrollably, or unpredictably, can lead to internalized homophobia, as well as helpless or hopeless attributions.” (Safram, 2001, p222).

Addressing one’s ability to cope with daily stressors is yet a final key priority that cannot go without mention. In fact, I find this notion of internalized homophobia as a root cause especially troubling. It will be useful to conclude this paper by discussing internalized homophobia (and the stress that comes with it), from within the framework of the earlier discussion.

Firstly, it is important to note that LGB discrimination is best understood as “a learned form of social control of deviance”, (Herek & Greene, 1998, p7). Stigma resulting from this is simply due to holding a characteristic which “is contrary to a norm of social unity”, (Herek & Greene, 1998, p108). Based on these definitions, internalized homophobia can be thought of as a stigmatized self-concept based on discriminatory experiences. This internalized homophobia, influencing ones identity and belief systems, produces minority stress as a result, (Herek & Greene, 1998; Meyer, 2003).

Having said all this, I conclude with the thought that it seems once belief systems of ourselves become internalized they exist as self fulfilling prophecies. We become what we believe we are and get what we are told is possible. CBT a can become a much-need coping tool in this by helping LGB youth understand they always have the ability to choose otherwise.

PART TWO: Exploratory Exercise Paper….

((ABSTRACT – In this paper I provide a summary of my experiences in joining in with an LGBTQI University Organization Meeting.  I start with a review of relevant literature and end with a discussion of insights gained.  From this experience I have concluded that continued service within this community is essential in order to serve it effectively as an LGBTQI ally.))

Initial Thoughts

Approximately, 33% of females and 37% of males have had a climax with somebody of the same sex after 18 (Rosenthal, 2005).  Additionally about 10% of the U.S. Population identifies as gay & lesbian (Rosenthal, 2005).  A quick literature review shows a higher rate of mental health diagnosis, substance use, and suicide within the LGBT community as a whole (Biescheke, et al, 2007; Herek & Green, 1998).    Additionally, mental health diagnoses heightened in the areas of depression and substance use (Biescheke, et al, 2007; Herek & Green, 1998).  Additionally, a book titled “Stigma & Sexual Orientation (Herek & Green, 1998), makes it clear that discrimination (and the stigma that exists as result) are predominant causes of these high rates of mental health and substance abuse problems.

To understand this discrimination as cause, it is important to step back and understand the concept of identity a bit.  As the above quote alludes to, identity is an internalized construct of the self, based on an interaction with others and the environment.  When you consider how discriminatory acts against one’s very identity, I can only imagine how stigmatizing and shame-inducing and invalidating this might be. Defined as “a characteristic of person’s that is contrary to a norm of social unity” (Herek & Green, 1998, p. 108), stigma can produce a highly problematic identity formation process.  When taken alongside ostracizing reactions of family and friends LGBT individual’s internalized homophobia, transphobia and minority stress are often the norm (Herek & Green, 1998).

Summary of my Experience…

(((Here I provide just brief excerpts from my paper, in order to show, that there is much left to learn.  As I have discovered, intention means little if there is no action to back it up.  Understanding the privilege that comes with being a cisgendered heterosexual is critical.  Ignorance is never an excuse for any shortcomings in my desire to act as an LGBTQI ally as a future counselor)))

The Importance of Community….

“An element included in virtually all sexual-orientation models is finding and developing some sort of connection to the LGBT community. Community is important in helping break the sense of isolation and despair that can occur from being different, which is an early piece of identity development, (Biescheke, et al, 2007, p. 213).”

The first thing that struck me was how welcoming and friendly everyone was.  While I am a cisgendered heterosexual, I felt an immediate belonging and camaraderie within the group.  As a bullied child with few friends, I also struggled in my teens and 20’s.  It is for this reason, that I immediately appreciated the efforts of this organization to provide members a chance to interact with others who implicitly understood them.  The interaction was light-hearted and fun.  We decorated cookies while watching a movie and engaged in casual conversation.

In-Group Trust.

Implicit social norms existed that presumed an understanding of relevant social norms.  These implied social norms appeared to allow a heightened level of trust to exist amongst participants regarding things such as proper rules of preferred pronoun usage for example.   As somebody mentioned to me at one point: “It is simply nice to just hang out and have fun”.  This comment really struck me as I came to appreciate in that moment the privilege of cisgendered heterosexual.   I was able to just be me unselfconsciously.  For example, the idea of being “clocked” as a trans person, puts you constantly on edge.  I came to realize how luck I was to not know what this is like.  The idea of in-group trust stands out as a essential from this perspective.  Community organizations such as this provide participants a chance to be themselves “unselfconsciously” as I live my life 100% of the time.

I left the experience wondering if my own ignorance regarding the LGBTQI community reflected what I’ve witnessed within the extended family as a biracial child.  While I cringed at the thought of this, I reminded myself that all I can do by denying this fact is perpetuate it.  Self-awareness, on the other hand, is ultimately empowering if it leads to change and growth.

“privilege also tends to isolate people, cutting them off from information and experiences related to specific minority groups that could be helpful and enrich their lives…privileged areas are often in those areas in which people hold the least awareness.” (Hays, 2008, p. 42).
 

Identity as a Foundation of Self

During this meeting I became aware elemental sexual preference and gender identity are as fundamental aspects of daily living.  While conceived of in black and white terms for the cisgendered heterosexuals,  these concepts in reality are much more fluid. This fact helped me understand better why LGBT community in Omaha was so protective.   I left this experience with a profound realization of how being LGBTQI can potentially affect  all aspects of your life.

In-Group Diversity

The LGBTQI community is very diverse and is an umbrella term that comprises many sub-groups.  For example, sexual orientations vary greatly from lesbian, gay, bisexual, and even asexual.  Additionally within the trans community you have concepts such as FTM, MTF, bigender, gender, trans, and genderqueer.

**Here’s a link to a list of terms that I could useful.
**Here are some tips to being a better LGBTQI ally.

In conclusion, it appears there is much left for me to learn.  Developing multicultural competency will be a life-long commitment & personal journey as I increase my understanding of those communities I hope to serve within.  

References

Bieschke, K.J., Perez, R.M., & DeBord, K.A. (2007). Handbook of Counseling and Psychotherapy with Lesbian, Gay, Bisexual and Transgender Clients. Washington D.C.: American Psychological Association.
Bilodeau, B.L. & Renn, K.A. (2005).  Analysis of LGBT Identity Development Models and Implications for Practice. Gender Identity and Sexual Orientation: Research, Policy and Personality. 111, pp. 25-39.  
Hays, P. (2008). Addressing cultural complexities in practice. (2nd ed.) Washington, D.C.: American Psychological Association.
Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American PsychologicalAssociation.
Herek, G.M. & Green, B. (Eds.) (1998). Stigma and Sexual Orientation. (Vol. 4). Thousand Oaks, CA: Sage Publications.
Johnson, R. (2013) Forensic and Culturally Responsive Approach for the DSM-5: Just the Facts. Journal of Theory Construction & testing. 17(1), 18-22.
LGBTQI (2014). About LGBTQI+ In Lincoln, Nebraska. Lincoln, NE: University of Nebraska Lincoln.
Mays, V.M., Cochran, S.D. (2001). Mental health correlates of perceived discrimination among lesbian, gay and bisexual adults in the United States. American Journal of Public Health. 91(11). 1869-1976.
Meyer, I.H. (2003). Prejudice, social stress and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin. 129(5). 684-697.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Safren, S.A., Hollander, G., Hart, T.A., & Heimberg, R.G. (2001). Cognitive-behavioral therapy with lesbian, gay and bisexual youth. Cognitive and Behavioral Practice. 8. 215-223.
Sage Productions. (2014) Working with Gay/Lesbian and Youth Clients. Retrieved from:https://ssoblackboard.bellevue.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_328162_1%26url%3D
Stets, J. E., & Burke, P. J. (2000). Identity theory and social identity theory. Social Psychology Quarterly, 63(3), 224-237. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/212780126?accountid=28125

 

 

 

 

 

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