Counseling approach to change behavior more helpful than looking for the root cause
Looking at our traditional psychological therapeutic practices that long back to psychodynamic psychotherapies by Freud, there has always been a major emphasis on generating insight into the patient. The insight follows into the realm of searching into the past of the patient and understanding what led to their reactions, emotions, feelings in the present situation. This required an in-depth analysis of the patient’s childhood memories, his dreams, hidden wishes, desires, conflicts, fears that are embedded in his unconscious mind, all of which are responsible for his current suffering. It was believed that this generation of insight into patients led to changes in his behavior and functioning, which caused the healing of his illness.
However, if we look at another perspective, it also leaves patients with a lot of information about themselves to think upon. The more they discover the hidden reasons or motives behind their behavior, the more they start to blame themselves or others, the more intensified their feelings of depression, anger, anxiety, embarrassment, weaknesses, abandonment grow and it makes a whole more complicated for them to move towards positive changes and behavior as they are all stuck in their past.
Let’s take an example-“A patient who was a successful businessman found himself depressed and unable to enjoy his success. During therapy, it was found that he was interested in becoming a musician and could not take a stand for himself in front of his dominant father. This drowned him into more depressive feelings accompanied by feelings of embarrassment and self-blame of being unable to defend his interests.”
Consider another example of a similar context in which –“A patient who found difficulties in forming a sexual relationship with her partner, discovered during her therapy that she was sexually abused as a child and thus, was facing problems in her relationship with men. This discovery not only filled her with embarrassment but also intensified sexual rejection towards her partner.”
Both these examples indicate that only insight generation inpatient does not cause healing because insight explores “Why the problem occurred” rather than “What we should do regarding that”. It is now seen that intellectual insight in itself is not sufficient to bring about positive changes, as it requires emotional insight for these changes to take place. This requires a “change of meaning consciously” i.e. understanding themselves along with emotional experiencing. Thus, the patient does not generalize his past reactions to the present and adapts to adaptive behaviors leaving the maladaptive ones aside.
The entire process involved in insight generation in psychodynamic therapy is quite expensive and time-consuming. Whereas, it is recommended that the therapy should be in such a manner where it works on finding a solution to the problem rather than exaggerating the causes and manifestation of the problem. Thus, it’s the responsibility of the counselor to take the patient towards creative solutions to the problem that operates on their present functioning.
It is observed by various therapists that developing insight wasn’t necessary for improving the situation of patients and solely helping them change their behavior relieved their symptoms without any necessity of insight generation in them. Anna Zajenkowska et al. (2019) in their study found that CBT did relieve depression after three months of therapy but psychodynamic therapy did not show much effect.
These approaches that promote changes in behavior may include behavioral therapies that rely on assumption that all behavior is learned and thus, all maladaptive behavior can be unlearned using similar learning approaches. They also make use of learning principles like classical conditioning, operant conditioning, contingency management, etc. The techniques used are systematic desensitization, exposure therapy, relaxation therapy, behavioral rehearsal, and so on. The patient is made aware that they can change and this change needs not to require taking big footsteps rather taking small steps towards that major change is the key.
The most popular approach to psychotherapy prevailing these days is Cognitive Behavior Therapy(CBT) which focuses on changing our negative thoughts and which in turn impact our feelings, emotion, and behavior. Other therapies that are recently introduced include Dialectical Behavior Therapy(DBT), Metacognitive Therapy(MCT), Strength-Based Therapy, and many others. Each of these therapies focuses on current problems of the patient in the present and doesn’t involve searching causes in the patient’s unconscious or childhood past. They work on the cognition, beliefs, emotions, and behavioral aspects of a patient’s functioning and operate on these to decrease the impairment and dysfunction.
Let’s take an example to understand the difference better-“A patient who had a phobia of snakes visited the therapist, to which the therapist conducted psychoanalysis and found that one of her friends in her childhood died of snake bite. Now, this discovery solely didn’t contribute to the healing of the clients nor any change in her behavior. While on the other hand, the therapist when applied Cognitive Behavior Therapies on her allowed her to talk of her fear and change her irrational thoughts about it. Along with, exposing the patient to a hierarchy of fear accompanied by periods of relaxation. This approach not only helped the patient to change her negative thoughts and beliefs but also helped her in overcoming the fear by exposure.”
Thus, when it comes to treating phobias, anxiety, or panic attack situations, the use of a tiresome and time consuming psychoanalytic approach would not do much good as in such situations patients require a rather quick solution to their suffering and not a deep digging into their past. Hence, it can be concluded that solely generating insight into a patient regarding himself doesn’t cause healing on its own, and there require therapies that cause positive behavior changes to improve the functioning of the patient.
