A a client and how to interpret progress

A Theorists Perspective

As
a practitioner evaluates treatment options for clients, consideration of the
theory is of upmost importance for maintaining consistency and fluidity of the
treatment.  Differing theories would
indicate different methods of communicating with a client and how to interpret
progress for the client.  Of the various
theories, Adler, Jung, Sullivan, and Object Relations Theory all have different
approaches to the various concerns of the client and thus would lead to
different treatment modalities.  How the
theory applies to the client’s concerns and the various impacts this may have
on the treatment plan will be further discussed.

            Prior
to a client beginning therapy, the practitioner must also consider the cultural
implications that might impact treatment. 
This understanding aids in choosing the theory to base the treatment
modality.  When we see the client as a 19
year-old Chinese male, we must consider the possibility of cultural influences.

 If Joe has grown up in a traditional
Chinese home, it is possible, given his age, that he has been lead to believe
that, “adolescence has limited meaning in most Asian cultures because
individuation carries little value and seeking a definition of self outside the
family is not encouraged” (Kramer, Kwong, Lee, Chung, 2002, pg 229).  So the practitioner must ask cultural specific
questions to gain an understanding of Joe’s perspective and what his potential
treatment outcome goals he might need.

            One
theory to consider would be that of Adler.  Adler postulated in his psychoanalytic
approach that anxiety and depression might be the result of feeling inferior in
some way.  When considering this theory,
life is goal oriented though occupation/work, society/friendship, and
love/sexuality.  Looking at harmonizing
the goals would increase the mental health of the person. Being the first-born
child in this family has a meaningful impact when using this theory.  As the first-born more attention would be
given and with the introduction of additional siblings Joes strive to re-gain
the attention is lost as he is now attending to his mother and his father is
not around.  The genesis of the statement
that he doesn’t seem good enough could be because he feels inferior since his
father will not maintain a constant presence in his life.  If Joe’s family subscribed to the cultural
traditions he may be looking to find meaning in his life when his discovering
his sense of self outside the family is discouraged.  This can create some very confusing emotions
within Joe and may the root of his anxiety and depression. This would also help
explain the anger towards his father.  As
a practitioner adopting this theory some prevention strategies may be
considered to help maintain the level of anxiety and then ultimately decrease
the anxiety and depression by promoting social interests and developing a sense
of belonging. This must be done while respecting Joe’s cultural expectations.

Adler suggested assumptions that could be made regarding personality. Among
these assumptions are the ideas of people striving for purpose in life, a sense
of belonging, the mind and body working together. Though these serve as
guidelines for treatment goals, this theory is difficult to research.  “Assumptions in and of themselves cannot be
tested, because they provide the underlying basis on which postulates are
derived and then tested. When the data are unclear, theory and the basic
assumptions underlying that theory are the only guidelines for therapeutic
decision making” (Maniacci,
Carlson, & Sackett-Maniacci, 2017, p. 98).  Making ethical and legal decisions for
clients, practitioners must strive to use research-based practices. This is a
difficult task with Adler’s theory so the practitioner must strive to stay
within the loose structure of the theory when treating clients.

Carl
Jung is another theorist that a practitioner could consider. Jung postulated
that cultural had significant implications upon personality. When looking at
mental health concerns in a traditional Chinese family the practitioner must
consider,

In
the traditional belief system, mental illnesses are caused by a lack of harmony
of emotions or, sometimes, by evil spirits. Mental wellness occurs when
psychological and physiologic functions are integrated. Some elderly Asian
Americans share the Buddhist belief that problems in this life are most likely
related to transgressions committed in a past life. In addition, our previous
life and our future life are as much a part of the life cycle as our present
life (Kramer, Kwong, Lee, Chung, 2002, pg 228).

This consideration is further shaped
by Jung’s ideas of archetypes. Discovering how a male assuming the archetypal
responsibilities of the female may prevent harmony within Joe. Joe may be
motivated by past experiences and expectations of the future. It is possible
that in the five years that Joe was apart of a ‘typical’ family structure he
was secure in his position within the family. Joe then experienced seven years
without his father and could have assumed the traditional male role in the
family only to have this change again upon his father’s return. The return of
his father changed Joe’s role again with now being the big brother and then
later, the caregiver of both his mother and his siblings.  If Joe truly is motivated by past experiences
and this guides his expectations of the future, it is possible that the flux of
his growth has left him confused. Additionally, “another important aspect of
Jung’s theory is his emphasis on how people struggle with opposing forces
within them. For example, there is the struggle between the face or mask we
present to others, represented in the archetype of the persona, and the private
or personal self” (Cervone & Pervin, 2017, pg 122).  When potentially conflicted between the
person he wants to be and the position he is in with his family he could
develop these feelings of anxiety and depression.  Additionally, developmentally speaking, Joe
would be ending his childhood, and beginning the desire to start his own
family; this may conflict with his current situation.  A Jung based practitioner would desire to help
Joe to seek out a sense of self, within the confines of cultural expectations,
and help him develop a sense of future expectations.  Ethical and legal considerations would also be
a part of treatment planning.  Jung’s
theory is difficult to research, as it cannot withstand falsification, so
limited research-based practices are available. The practitioner would have to
be cautious about assuming cultural expectations and tradition as much of Jung’s
theory is centered on the collective unconscious and the importance of cultural
influence.

            A
different theory to consider is that of Harry Stack Sullivan.  Much of Sullivan’s theory was the importance
of influences during pre-adolescence that significantly impacted the
development of personality. Specifically, “the juvenile era and preadolescence.

During the juvenile stage-roughly the grammar school years- a child’s
experiences with friends and teachers begin to rival the influence of his or
her parents (Cervone & Pervin, 2017, pg 126-127). During this time Joe was
experiencing some home difficulties that may have impacted his interpersonal
relationships and development of his self-esteem.  This self-esteem would serve him later in his
ability to navigate interpersonal relationships without anxiety or lingering
feelings of depression. In Joe’s later years, the “relationship of a close
friendship, of love, forms the basis for the development of a love relationship
with a person of the opposite sex during adolescence (Cervone & Pervin,
2017, pg 127). As a practitioner of Sullivan’s theory, one must consider if
these developmental needs were met during this time, as he was the primary
caretaker of his mother and two siblings for the past five years. This could
have impacted his ability to develop and maintain these relationships, thus
impacting his personality development. 
Additionally, the mother plays a significant role in personality
development.  The practitioner can learn
a great deal by asking Joe about his relationship with his mother prior to her
car accident to ascertain his capacity for developing meaningful interpersonal
relationships.  Also, if Joe did have a
secure relationship with his mother, the practitioner could then hypothesis,
based on Sullivan’s theory, that Joe is experiencing anxiety because he is
perusing the childhood wish for security. 
Unknown is also Joe’s ability to escape his anxiety as the primary
caretaker and his mother and siblings. 
Sullivan would have supported developing an interpersonal relationship
with Joe to increase his skill and comfort with interpersonal
relationships.  While utilizing this
theory to develop methodology, the practitioner should look at ethical
implications. Joe’s culture could have implications in regards to his
development of interpersonal relationships. Where Sullivan theorized the
influence of the mother/child relationship, this may not hold the same impact
with the gender roles of Joe’s culture. Additionally, as Sullivan was ‘practice
focused’ as opposed to ‘academic focused’ there is limited research regarding
his theory.  Additionally, Sullivan’s
theory is difficult to withstand falsification and the lack of testing validity
decreases his theory’s use as a practical guide for treatment modalities.

Sullivan’s theory of personality development does raise some excellent
questions about Joe’s ability to develop interpersonal relationships and how
this impacts his anxiety and depression and anger towards his father.

            Another
theory to consider is Object Relations Theory.  “According to
object relations theory, beginning during infancy, people develop
“internal representations” of themselves and of other people.

Representations of the self ultimately give rise to what is popularly known as
the “self-concept”” (Hoermann, Zupanik & Dombek, n.d., para.

2).  If Joe was struggling with his
self-concept as could be seen by his indication that he is not good
enough.  The development of
personality, in relation to Object Relations theory, the sense of self is developed
in relation to others. The practitioner should consider that Joe’s relationship
with his father might have influenced his personality development. If Joe
expresses a drive to get out of his current situation this could bring him
closer to being like his father and this dissention could be the cause of the
anxiety and depression.  Additionally, this
theory postulates that the mother-infant relationship has major implications on
personality formation and the mother is the first object that is internalized.  The practitioner using this theory would need
to ask Joe about his relationship with his mother prior to the accident. This
would also include questions about how he perceived his identity when he was a
part of an in tact family until the age of five and then how his dynamic with
his mother changed.  Unfortunately, Joe’s
mother is unavailable to discuss bonding during infancy so this would be
difficult for the Object Relations practitioner to assess. Much of this theory
was contrived with a developed family unit with a present mother and father.

Joe appears to have had this family structure for the first five years and then
sporadically in the years that follow.  In
relation to brain functioning, this theory has led to some recent research
using scientific advances.  Cervone &
Pervin (2017) report, “the brain systems that play the key roles in attachment
are likely to be the same ones that are key to human emotions” (pg. 133).  The practitioner guided by this theory would
try to ascertain how Joe’s attachment with his mother. This process would then
allow for the opportunity to discover how these early interpersonal
relationships have affected his sense of self. 
The practitioner would attempt transference to help Joe interpret his
interpersonal relationships and how this has guided his way of relating to the
world around him (Cervone & Pervin, 2017). 
Additionally, cultural norms and expectations were not considered during
the development of this theory so the practitioner would have to consider this;
as well as gender roles and expectations. If the practitioner is female, she
may have difficulty with Joe accepting the interpretations of the practitioner
as traditional gender roles in Chinese culture might impact this process.  When looking at additional ethical
implications of this theory, the ability to use scientific research to test
both brain functioning and behavior increases the practitioners chance to use
research-based methodologies with Joe.

            There
are various theories that a practitioner should consider prior to entering a
counseling relationship with a client.  A
careful examination of the culture, family structure and expectations from the
counseling process among other things can help guide the practitioner into
making best practice decisions for their clients.  When the theory helps deterine the methodology
of the counseling practice, the practitioner can provide a structure to the
process and can understand both the legal and ethical implications.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

References

 

Cervone, D.,
& Pervin, L. A. (2017). Personality:
theory and research. Hoboken, NJ: Wiley

 

Hoermann,
S., Zupanick, C. E., & Dombek, M. (n.d.). Object Relations Theory of
Personality Disorders. Retrieved January 11, 2018 from
https://www.gulfbend.org/poc/view_doc.php?type=doc&id=41560&cn=8

 

Kramer, E. J., Kwong, K., Lee, E., & Chung,
H. (2002). Cultural factors influencing the mental health of Asian
Americans. Western Journal of Medicine, 176(4),
227–231.

 

Maniacci,
M. P., Carlson, J., & Sackett-Maniacci, L. (2017). Neo-Alderian Approaches
to Psychotherapy. Journal of Individual
Psychology, 72(2), summer, 95-109. Retrieved January 10, 2018.