The history of psychology reveals many schools of thoughts and many different approaches to therapy. Each type of therapy is unique in its own way, but all therapy has the same goal: to relieve the patient of their troubles. This can be approached by modifying troubling behavior, gaining insight into a person’s unconscious feelings, or by helping the patient to become more aware of their thoughts and feelings. This paper will explore some of the psychological concepts which can be applied when treating a patient and the therapies of three major psychological orientations.
CASE BACKGROUND
The following case study will be on a 27 year old man by the name of Max who seems to be suffering from some sort of delusional thinking. Max’s troubles begin to arise shortly after high school. He was working as an employee at a grocery store when he began having irrational thoughts about being under surveillance. The suspicious thoughts about being watched were also accompanied by voices that only Max could hear. He claims that the voices tell him that he is evil and he has a hard time shutting them out. Max’s paranoia surrounding being watched was taken to another level when he began to feel as if the FBI were following him. As a result, Max has grown rather agitated and confused. At the tail end of his six month stint at the grocery store Max quit his job after having a confrontation with his employer. His complaint was that he couldn’t work under the pressure of being continuously watched on monitors. He is unable to function as an adult in society and has found himself hospitalized for his condition.
In order for Max to shed the confusion, agitation, and anxiety brought on by his irrational thoughts he will need to undergo some type of treatment. The treatment should focus on explaining and dispelling the irrational thoughts and ideas that Max is plagued with. By addressing the underlying reasons for the onset of his condition, Max will have a better understanding of exactly what is happening to him. This will open up some new doors for Max and he will be better equipped to deal with these thoughts of paranoia. While it may not be possible to completely rid his mind of these notions all together, a better understanding of the source and nature of them may aid Max in learning new coping skills. These skills, when applied correctly will surely provide Max with some relief. The ultimate goal of treatment for Max will be to help him arrive to a point where he can re-enter the work force and function in society without becoming agitated or paranoid.
APPLYING CONCEPTS
Before ultimately deciding on which route to pursue in regards to Max’s treatment, it would be a good idea to take a look at how some of the concepts from early to modern day psychology could be applied to this case. By looking at the whole picture, the therapist is better equipped to choose which path to take in treating Max. It could be a case in which multiple forms of methods of therapy could be applied, so it is important to cover all the bases before beginning treatment.
Taking cues from structuralism, Max’s issues can be broken down into simpler mental processes. Structuralism focuses on breaking down these mental processes into their simplest of forms (Schultz amp; Schultz, 2008). Titchener’s structuralism places a lot of focus on the act of introspection. It may be possible for Max to use this method to take a deep look at his experiences and the sum of those experiences. By looking at his own thoughts Max will be then able to apply the elements of consciousness to his condition. After careful introspection, the next logical action would be to take these newly found conscious thoughts and determine how they are associated with one another and with Max’s mindset as a whole (Schultz amp; Schultz, 2008). By connecting each mental process or irrational thought it is possible to not only see the link between each one, but to pinpoint the origin of them.
The functionalist approach can also be applied to the troubles that Max has been suffering from. Similar to structuralism in the sense that the focus is on the mental processes, functionalism is a more organized and systematic way of accomplishing the same thing. Instead of just focusing on the elements of or each of Max’s irrational thoughts, the functionalist approach would be to examine the purpose of the paranoid thoughts. Max could be instructed to examine himself closely to see if he can understand exactly why he has these types of delusions. It is possible that he has some underlying concern or issue that he is not aware of. The irrational thoughts may be Max’s way of dealing with this issue or concern.
Some ideas derived from phenomenology may also be used to treat and assess Max. Phenomenology is an approach that in a sense sheds the ideas of the deep consciousness and past experiences. Instead it focuses on the here and the now (Schultz amp; Schultz, 2008). By taking a phenomenological approach to Max’s troubles, the therapy would center around his immediate experiences as they occur. Max could be instructed to stop each time his irrational thoughts arise and take note of the what is going on at the exact moment. In a sense he would be doing some introspection, but in this case it would be more of a surface type introspection. The goal would be to gain a better understanding of these troubling voices and experiences which would aid Max and the therapist in being able to communicate on the subject better.
Now it has been established that there are many ideas and concepts which can be applied to the treatment of Max, it is time to take three major psychological movements into consideration and evaluate how each can be used to help him. The three methods of therapy which will be examined and applied to Max’s case study will be behaviorism, gestalt, and psychoanalysis. After carefully going over each method of treatment, it will then be decided which will work best to treat Max.
BEHAVIORIST APPROACH
Using a behaviorist approach to therapy Max will be taught how to self-modify his own behavior. The goal of this behaviorist therapy will be to change Max’s behavior in reaction to his paranoid thoughts. Instead of becoming agitated and confused Max will learn to find new ways to cope. These new coping methods will replace Max’s outbursts and agitation. By eliminating the unwanted behavior Max should be able to successfully deal with the voices and paranoia in a more positive and healthy manner. It is also important to note that with this behavioral therapy Max will not just be undergoing behavior modification, but also learning the skills to partake in self-modification of his behavior.
The very first step will be to identify the problem behavior (“The Behaviorist Approach,” n.d.). This will be accomplished by sitting down with Max and talking about his issues. The process of discussing the problematic behaviors is also going to be beneficial to Max in the sense that it may open his eyes up to some things he didn’t realize were problems for him. In this case the problematic behavior is the manner in which Max has been dealing with his troubling thoughts. His agitation has led him to act irritable and have angry outbursts. It is important that Max understands just how these behaviors are problematic. It should be pointed out that this type of behavior is holding Max back from living a productive life. By doing things like yelling at his boss or accusing customers of spying on him, he is not a likely candidate for employment.
After going over the many problematic behaviors, Max will then be asked to decide which one causes him the most trouble. The one problematic behavior that will be worked on first should be a very specific problem. Instead of just coming to the conclusion that the irrational thoughts make him angry, Max will be encouraged to phrase it in a more specific and concrete manner. So, the problem would be stated as, “the thoughts of being under surveillance make me mad and I yell at people”. By avoiding a generalization of the problem, Max will have more of a goal to tackle when modifying the behavior (“The Behaviorist Approach,” n.d.).
Now that Max has been taught how to identify his specific problem he will be working on, it is time to state the goal. A good suggestion would be something along the lines of, “I will not let my thoughts of being watched lead me to becoming angry” (“The Behaviorist Approach,” n.d.). The next step to take would be to identify some actions to take to help Max attain his goal of not becoming angry and agitated by the thoughts and voices he experiences. These actions or steps Max will take towards reaching his goal must be realistic. An example would be to pause and take a few deep breaths when troubling thoughts arise. By doing this Max will be taking time to reflect on what he his thinking and refrain from having outbursts. The ultimate goal of this type of treatment is to aid Max in replacing his outbursts with more positive behaviors. With practice and commitment, it is very possible that Max’s behavior can be modified and he can return to work.
GESTALT APPROACH
Switching gears a bit and straying from the behaviorist approach, Max is now going to see if he can benefit from a gestalt approach to therapy. Instead of focusing on his behavior, Max is going to be encouraged to take a look at his problem from a “here and now” type of treatment. The main focus of Gestalt therapy is self-awareness by stressing more of the process of healing, or what is happening at the moment rather than the content, or what is being discussed. As a result, emphasis is put on what is being thought or felt at the moment rather than what was or what could be (Yontef, 1993).
Gestalt therapy with Max would begin with him explaining how he is feeling at the exact moment. Max will be asked if anything is presently bothering him. If something is then the therapist and Max would spend some time talking about that. It would be beneficial to ask Max questions pertaining to his present feelings to encourage him to open up. If Max were to start thinking of the past or about things that could happen due to his irrational thoughts, he would be encouraged to instead focus on the present. By placing more emphasis on what is going on inside at the exact moment Max will become more self aware of his feelings (Yontef, 1993).
The empty chair technique is also a method used in Gestalt therapy. For this technique, Max will be sat facing an empty chair. A good idea would be to have Max pretend the chair is occupied by someone who he has issues with. Since Max’s irrational thoughts center around being watched, it may be necessary to “fill” the chair with someone who Max believes is responsible for watching him. Max would be instructed to confront the person and to let all of this thoughts just come out. If it would be beneficial for Max to yell at the empty chair, then he will be instructed to do so. The goal of this empty chair technique is for Max to be able to get some things off his chest that involve the person he chose to fill the chair.
Since Max’s issues obviously leave him feeling a bit alienated it also may be a good idea to try some group therapy. Max could attend a group with a few other people. They all would meet and discuss their problems. It would be nice if the group had some people in it who also suffered from troubling or irrational thoughts. By discussing their problems together Max and the others in the group would be able to see that they are not alone. They can learn from one another by talking about their coping methods. The ideal group would be led by a therapist who encourages the group to focus on what they are feeling at the time (Yontef, 1993).
PSYCHOANALYSIS
The final approach to therapy with Max will be psychoanalysis. People are naturally unaware of factors that determine their thoughts and behaviors. Psychoanalysis attempts to make the client or patient aware of these unconscious factors that create turmoil in their lives (“About Psychoanalysis,” n.d.) These unconscious factors sometime arise in the form of symptoms that are recognizable, but also arise in the form of troubling personality traits. In the case of Max there must be some underlying factors that contribute to his irrational thoughts of being under surveillance.
Psychoanalysis can thought of to be a sort of partnership between the patient and the therapist. The patients job it to talk about their experiences and thoughts. The therapists job is to listen and to understand. Max’s first session of psychoanalytical treatment would involve him taking a comfortable seat and being encouraged to talk freely about whatever is on his mind. This could be anything from home life, to what he wants to do later in the day. As Max becomes more comfortable with the therapist, he will begin to open up more and speak about not just mundane day to day things, but about issues he has in relationships and things that weigh heavy on his mind.
Psychoanalytical therapy is usually conducted frequently. Max should undergo therapy 3-4 days a week. As Max begins to open up more, the therapist will start to better understand him and notice patterns or feelings that seem to be missing from important situations. Since Max’s problems seem to center around his delusions and the feelings those create for him, he will be encouraged to talk about this often. The main job of the therapist will be to listen, but it is also beneficial to lead Max in certain directions with the therapy. By asking him questions like “how did that make you feel,” the therapist will be helping Max to get in touch with feelings that he otherwise would have never dealt with. It is important that the therapist always remain neutral in regards to Max’s feelings or conflicts. The method of free association may also help Max to gain a better understanding of the nature and impact of his issues (“About Psychoanalysis,” n.d.).
THE BEST APPROACH FOR MAX
Now that these three approaches to therapy have been discussed and it is clear as how to apply each on to Max’s case it is time to choose which would be most effective. While they all three seem like they could be beneficial to Max in some form or another, there must be one that will do him the most good. Given the nature of Max’s problem and the history he has of acting out when troubled by this thoughts, the behaviorist approach appears to be the one that Max would get the most from. His thoughts of being watched lead him to act out in ways that are not socially acceptable. The results of his behavior has left him unemployed and still residing in his parent’s home. The key word here is behavior. Max’s behavior needs to be addressed and changed. Therefore by taking a behaviorist approach to treating Max he can undergo behavior modification sessions. Not only will Max benefit from these sessions, but he will also learn how to self-modify his behavior. This is a skill that he can then apply to other problems that pop up for him in the future.
MY INPUT
As a psychology student and mother I can easily say that I identify with the behaviorist approach. I have seen firsthand how modification of behavior can help to solve problems. I often reward my children for doing a good job on things like cleaning up following directions. There was a time when my soon to be four year old son would destroy his bedroom in a matter of minutes. The messy bedroom resulted in my son becoming irritable and bored. This was something that we needed to work on. So I made a simple chart and he was to do a little clean up every day. Each day that he cleaned up he received a sticker, and once a row of stickers was complete he would get to choose a paper out of my “fun bag”. Each paper had some sort of fun activity written on it like go to the park. This proved rather effective in helping him not only overcome his messy behaviors, but also made him happy in the long run. His clean room proved to also improve is mood and cut back on the boredom.
While I do admit that I favor behaviorism, I can’t fully discredit the other approaches that I have covered in this paper. I can see how each type of therapy could be beneficial in different cases. This fact leads me to believe that a patient should be encouraged to experiment with different types of therapy before choosing which one to undergo. Everyone is different and it may be that different approaches work better for different people.