Counseling and Psychotherapy
In therapeutic settings, clients may benefit from a specific approach over others. For example, in trauma intervention among veterans, the counselor will start with whatever piece they have at hand. In tandem with Young’s (2021) quilt metaphor, “constructing a treatment plan…Either you pick up the pieces nearest to you and sew them together…or… start with a pattern and find the pieces that fit into your design.” Starting with a pre-designed method allows for more productive therapy, leading to positive outcomes, especially for the client. Young (2017) suggested that both the client and the helper should set agreed-upon goals that will guide technique or method selection aimed at achieving those objectives. The REPLAN system provides substantive information about underlying dynamics that impact the clients and the therapy process.
Furthermore, therapeutic factors underlie the REPLAN system such that the helper adopts these aspects to fulfill client goals. The six facets include relationship, enhancing self-esteem and efficacy, emotional arousal, new learning experiences, new behaviors, and activating client expectations, motivation, and hope. Among the techniques relevant to the REPLAN treatment planning process include reflecting and invitational skills, self-esteem inventory and thought stopping for enhancing self-esteem and efficacy, and role-playing that is particularly instrumental in practicing new behaviors (Cuttler et al., 2019; Rostiana et al., 2018). Although clients might have a similar diagnosis, they may need different treatment plans. For example, a helper will likely use varying approaches when dealing with veterans experiencing post-traumatic stress disorder (PTSD). With the REPLAN system, a helper can generate strategies that meet unique client needs.
The theoretical orientation that appeals to me the most right now is cognitive behavioral therapy (CBT). A wealth of literature demonstrates CBT as an effective psychological treatment approach to a range of problems, including PTSD, anxiety, depression, alcohol and substance abuse, and other severe mental problems. Cognitive therapy and rational emotive behavior therapy (REBT) are some of the therapeutic approaches involving CBT (Ellis, 2021; Leahy, 2017). Clients dealing with psychological issues can learn better-coping mechanisms, thereby improving their well-being and overall health. CBT essentially involves efforts to change clients’ behavioral and thinking patterns, and some of the strategies include the use of problem-solving skills, developing a greater sense of self-awareness and confidence, and role-playing, which coincides with the REPLAN system.
Through CBT, a helper can identify and challenge clients’ thoughts realistically and objectively. For a therapist, it is critical to learn the specific situation, feelings, or traits that contribute to a client’s maladaptive behavior. However, achieving this can be difficult, especially when handling individuals struggling with PTSD. According to Beck (2020), CBT provides insights crucial to the treatment process, both for the client and the helper. Following the REPLAN system, goal planning is a vital step in recovery. During CBT, a therapist can guide the client on building and strengthening their goal-setting skills, with a focus on the treatment process (Beck, 2020). With CBT, I can help clients understand their current health status, and formulate and evaluate the strengths and weaknesses of potential solutions to their psychological problems. Therefore, the primary function of CBT in case conceptualization is guiding therapy to build resilience while relieving distress among clients.
A good client-therapist relationship is essential for a successful treatment process. However, several factors might lead to therapy termination. For one, I can end the session if I have an existing relationship with a client’s family or share mutual friends. Sharing a therapeutic bond with a patient can result in bias, potentially harming the person seeking help. Another reason is my breadth of experience and professional capacity. If the challenges facing the client fall outside my scope of practice, I am ethically obliged to refer the person to another therapist with the competence and knowledge to meet the patient’s needs. Cases like Collins v. Meeker (1967) set a legal precedent on psychotherapy termination (Barnett & Coffman, n.d.). The ruling made clear that therapy can end if the provider’s professional judgment indicates that the patient is no longer or unlikely to benefit from the treatment plan, or can be harmed by it. Other reasons would be if the client frequently cancels sessions, shows no commitment, and fails to take ownership of their actions.
In most cases, the client chooses to end a treatment plan, but therapists can similarly decide on the same or refer the patient elsewhere. However, there are crucial steps to consider regardless of the reason behind the termination. The first step is addressing potential problems that might arise from the beginning, including informed consent and agreement (O’Neill, 2017). Helping the clients understand how treatment might end is vital in making decisions about treatment participation. Next, a therapist should set an agreement on the goals for successful therapy completion (Beck, 2020). Subsequently, a helper should prepare for any session interruptions to guide ongoing discussions with patients about therapy progress.
Reflection
During my first practical application session, I was a bit robotic. Dealing with new issues and trying to generate the best solution was quite stressful, which contributed to my high anxiety level. Additionally, the fear of experiencing emotional arousal during the session was overwhelming. Gradually I became more authentic and comfortable with each practice process. A successful counselor must hone a solid set of skills, which I can develop through experience, supervision, and training. The skills will help me build a robust therapeutic alliance with clients and achieve positive outcomes as part of the treatment process.
References
Barnett, J. & Coffman, C. (n.d.). Termination and abandonment: A proactive approach to ethical practice. Society for the Advancements for Psychotherapy. Web.
Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond. Guilford Publications.
Cuttler, E., Hill, C. E., King, S., & Kivlighan Jr, D. M. (2019). Productive silence is golden: Predicting changes in client collaboration from process during silence and client attachment style in psychodynamic psychotherapy. Psychotherapy, 56(4), 568. Web.
Ellis, D. J. (2021). Rational emotive behavior therapy. American Psychological Association.
Leahy, R. L. (2017). Cognitive therapy techniques: A practitioner’s guide. Guilford Publications.
O’Neill, O. (2017). Some limits of informed consent. In The Elderly (pp. 103-106). Routledge.
Rostiana, D., Wibowo, M. E., & Purwanto, E. (2018). The implementation of self-instruction and thought-stopping group counseling techniques to improve victim bullying self-esteem. Jurnal Bimbingan Konseling, 7(1), 36-40. Web.