The Therapeutic Relationship

The Therapeutic Relationship

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The Therapeutic Relationship

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The Therapeutic Relationship

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Discuss about the therapeutic relationship and psychological trauma or PTSD.

The stress which results from the stressful situations precipitates the spectrum of the psycho-emotional as well as the physiological outcomes (Briere & Scott, 2014). The post-traumatic stress disorder (PSTD) is the psychiatric condition which results from the experience or witnessing of the stressful or maybe the life-threatening events. PSTD has a unique psychobiological aspect which correlates and impair a person everyday life and could be life-threatening situations. The PSTD has an extreme psychobiological correlates that might damage an individual daily life threatening (Cohen, Mannarino & Deblinger, 2016). In light to the present events, a sharp rise continues to be exhibited to the patients that have the PTSD diagnosis which is predicted within the next decade (Briere & Scott, 2014). PTSD is a significant public health issue which compels looking to get the novel paradigms along with the theoretical models to be able to intensify the understanding of the condition and at the same time develops new and improved modes when it comes to the treatment intervention.
The trauma events usually are profoundly stressful. The stress which results from the traumatic events generally precipitates a spectrum of the psycho-emotional along with the physiological outcomes. In its gravest form, this response has been diagnosed as the psychiatric problem that is consequential to the experience of the traumatic events (Douglas, Woolfe, Strawbridge , Kasket & Galbraith, 2016). The facet of the post traumatic stress disorder could result from the experience or simply witnessing the traumatic or life threatening events such as the terrorist attack, violence crime or abuse, combat in the army, natural disasters or maybe the violent individual assaults. The exposure to the environmental toxins might result to the immune systems akins to the PTSD in numerous vulnerable individuals.
The subjects who have PTSD more often could relieve the experience through nightmare as well as the flashbacks (Cohen, Mannarino & Deblinger, 2016). They report difficulty when it comes to sleeping. On the aspect of the behavior they usually becomes significantly detached or even estranged and they are more frequently aggravated by the relevant disorders for instance they might exhibit depression , abuse of substance as well as difficulties associated with the memory and cognition (Cowie & Pecherek, 2017). This disorder could possibly lead to the impairment of ability to function especially in the social or the family life which more regularly could lead to the occupational uncertainty, divorces due to marital issues, discord of the family and even issues in parenting. This condition could be very extreme and can easily lead to the impairment of a person daily life and in some cases it could lead to the suicidal tendencies of the patient. PTSD is generally marked by clear biological changes, additional to the psychological symptoms and it could be complicated in various other issues both of which could be physical and the mental health (Cowie & Pecherek, 2017). In this essay it would explore various issues such as opportunities and the challenges in the therapeutic relationship of client with the childhood psychological trauma when they are engaged to various aspects such as humanistic, CBT and psychodynamic therapy.
Opportunities and challenges in the therapeutic relationship of a client with a childhood PTSD
Humanistic Approach
The method uses a wide range of approaches with regards to conceptualization, therapeutic goals and the intervention strategies in the aspect of PTSD. It emphasis the comprehension of human experience and a focus to the clients as opposed to the symptoms (Craig & Sprang, 2010). This is opportunity since the therapist become familiar with the client experiences and this is done through interacting and getting to know them better (Briere & Scott, 2014). The psychological issues are viewed as a result of the inhibited capability to enable the patient to make authentic, meaningful and self-directed choice on how they live. Thus, the interventions are aimed at increasingly the client self-awareness and the self understanding (Briere & Scott, 2014). The key aspect with regards to the humanistic approach is on acceptance and growth. These are the major themes of existential therapy that are; client responsibility and the freedom. When it comes to the PTSD the humanistic approach might help the clients to free themselves from disabling assumptions and the attitudes which enable them to live fuller lives. The therapists generally emphasize on the growth and the self-actualization rather than curing their disorder or perhaps alleviating it (McLean, Su, Carpenter & Foa, 2017). This perspective targets offers conscious processes rather than the unconscious processes along with the past causes. The advantage associated to this approach is that the therapeutic relationship serves as the vehicles or the context wherein there is fostering of the psychological growth. The therapist tries to create a therapeutic relationship that is warm especially to the clients with a childhood PTSD which is warm and accepting along with trust which the client’s inner drive would be to actualize in the healthy direction (Cowie & Pecherek , 2017 ) . This theory approach is significant to all the stages of client recovery process, since it creates a foundation of respect to the client and the mutual acceptance of the importance of their experiences.
Some of the key component of this approach includes the Abraham Maslow, who had popularized on the concept of the self-actualization and Carl Rogers who had formulated the person-centered therapy which is more focused on the wholeness of the individual experience at any particular moment (Craig & Sprang, 2010). These components prove some useful especially at the treatment of clients who had suffered PTSD at their childhood. The emphasizes is the choice to seek help which is regarded as a sign of courage that could occur immediately, and placing the responsibility and the wisdom with the client that they could follow.
Challenges of humanistic therapy approach
As much as there are opportunities associated in the therapeutic relationship of client with the childhood psychological trauma who have engaged in the humanistic approach there are challenges associated to it. These are as follows;
Identifying the real issues which are impacting the client: The humanistic approach to therapeutic relationship include the concept that the decision of the therapist should be made after consultation with the client (Cohen, Mannarino & Deblinger, 2016). The challenge may arise in this concept. One challenge is that it may not be easy to always identify the real issues which are affecting the client and at the same time the client could give conflicting needs and priorities to the issues which are affecting them.  Balancing on the conflicting issues of the client could be a challenging task in the humanistic approach.
Cognitive behavioral therapy approach
CBT is therapeutic intervention which involves strategies for example the use of the discussion or perhaps the imagery in order to revisit a traumatic event, stress management and relation techniques, as well as rethinking counterproductive trauma-related thoughts and association (Jarecki & Greenwald, 2016). The significance of this technique combines very effective kind of psychotherapy which is cognitive therapy and the behavior therapy (Craig & Sprang, 2010). The aspect of the behavior therapy is based on the learning theories, which would help the clients especially who have had PTSD in their childhood to weaken the connections between the troublesome thoughts and situations as well as their habitual reactions to them (Schnyder, Ehlers, Elbert, Foa, Gersons, Resick & Cloitre, 2015). This is an opportunity on this therapy approach since the client would be able to weaken on some of those traumatic connections they had over the years.
Another advantage of this therapy is on the cognitive therapy part, which teaches the clients how certain thinking patterns could be the major cause of their difficulties by providing them with the distorted pictures and making them to feel depressed, anxious or even angry (Jarecki & Greenwald, 2016). When these two approaches have been combined into the CBT, behavior therapy as well as the cognitive therapy could offer powerful symptom alleviation and this could help the clients with childhood with PSTD to resume to their normal functioning.
The cognitive method has been stumbled to be beneficial as an appropriate framework with regards to the trauma therapy given that the traumatic encounters usually impedes on the emotional process through contradictory with the pre-existing cognitive schemas (Gutermann, Schreiber, Matulis, Stangier, Rosner & Steil, 2015). The cognitive dissonance that happens whenever thoughts, memories and images of trauma could not be reconciled with the current means structures, which may result in distress. The cognitive system is generally driven by the completion tendency to match up the new information with the most inner models which are based on the older information and the revision of both until they can agree (Knight, 2015). This method is thus effective when it comes to such particular aspects to the clients who have had experienced traumatic experiences especially in their childhood.
The clients could reappraise the events and also rehearse on their cognitive schemas they had organized previously (Jarecki & Greenwald, 2016). The typical reactions as well as the cognitive processes seen among the trauma survivors could be described utilizing the framework of the cognitive theory (De Silva, 2014). This therapy entails working with the client who has cognitions to change emotions, thoughts as well as the behaviors.
Challenges of engaging with the client using Cognitive behavioral therapy
There are some challenges in the therapeutic relationship with the client with childhood PTSD disorder especially when utilizing the CBT approach to engage with them some of these are as follows;
One of the challenges is that the client could have the difficulty to identify emotions and the thoughts. This is usually a common aspect to the customers to experience emotion just before any specific conscious recognition to their earlier thoughts (Rapcencu, Gorter, Kennis, van & Geuze, 2017). This might be challenging for the therapists to determine the actual thoughts that are activating the emotional reaction to the clients. To help them to identify on these thoughts, therapists need to use specific techniques for questioning in order to be able to isolate the thoughts (Harned, Wilks, Schmidt & Coyle, 2018). Additionally, there is need for role playing a given situation and stopping the scenes at the crucial times when it comes to the sequence that could help the client to recall on their thinking. Another challenge is when the clients agree with the principles but they seem to alter on their thinking: In most of the cases the clients report that they can comprehends the concepts of cognitive therapy at the intellectual level, however generally they apparently apply that understanding in a manner which could promote real changes (Briere & Scott, 2014). Reinforcing of the alterations sometimes might take some time and even preempting problems particularly in shifting from the head level to the gut feelings. These might be useful methods to prepare the client to stick with the techniques. It would be a matter of the repetition and practice for the clients while they are working through the change from the head through to the heart. An additional challenge is the fact the client bears the limited motivation to change. For the clients who are not attending counseling on their own, it is important for the therapist to establish motivating aspects to the clients especially those who have PTSD in their childhood in the initial stages of the therapy (Jongh, Resick, Zoellner, Minnen, Lee Monson & Rauch, 2016).  Sometimes, the client could be attending counseling in order to keep harmony in significant relationship or perhaps elicit help to get someone off their back.
Psychodynamic therapy
The therapy highlights that emotional conflicts are majorly due to the traumatic situations which are the focus to the treatment , particularly because they refers to the early experience of the client for example the childhood ( Cook, Spinazzola, Ford, Lanktree , Blaustein , Cloitre & Mallah , 2017). The rationale of the psychodynamic psychotherapy is the client is retelling the traumatic event to an empathetic, calm, compassionate and even nonjudgmental therapist which would definitely result to the greater self-esteem and effective thinking strategies and improve on their capability to manage intense emotions a lot more successfully.  These approaches provide an opportunity to the client to tell their traumatic experience to the therapist particularly on the traumatic experience they encountered previously in their childhood. Additionally, the approach is advantageous since the therapist helps the client to identify on their client life situations which could have triggered their traumatic memories as well as exacerbate the PTSD symptoms (Van, 2017). The major emphasizes is on the concept of denial, abreaction as well as catharsis.
The key theoretical aspect to this approach is that of counter-transference describes the totality of the unconscious reactions of the therapist to client in addition to the client’s transference in the therapy.  The feeling usually shift from the client to the therapist and their powerful feeling that could discriminate well between their feeling towards the client which are directly related to the projection of the client. This response function in this theory in that it is the primary instrument to analyse the conflict of the client and the therapist own conflict (Machtinger, Cuca, Khanna, Rose & Kimberg, 2015). The responses of this concept could differ from the physiological ones for example the heartbeat, agitation to the emotional elements for example the sadness and even strong feelings towards the client. Nevertheless, you can find difficulties with regards to the counter-transference difficulties that could arise in the trauma therapy. The client who shows the PTSD reactions for instance, re-experiencing aspect of the childhood trauma as well as emotional numbing, they have experienced the conspiracy of the silence which surround the traumatic events. They are more silence whenever the trauma has occurred, as the environment in most of the cases tend to deny the occurrence as well as the intensity of the event.
There are numerous counter-transference themes which could take place in the therapy of the clients who have been traumatized. There is need for the therapist to provide means to the client to be able to express themselves in relation to the traumatic experiences, in order to support the positive coping strategies (Cowie & Pecherek, 2017). More often the traumatic experiences of the client could bring horror, grief or even mourning. The therapists could feel a sense of bond to client when they recognize a familiar aspect of the trauma story they could relate to them. Range could be the most difficult counter -transference reaction which one could deal with, since it could distract the therapist from the process of treatment and to hinder them rational.
One of the challenges is that the survivors of the traumatic event could pose relational challenge to the therapist. The clients are more often mistrustful at the same time they want a trustworthy relationship thus there could occur a push-pull dynamic.  The therapist therefore, could find themselves fascinated by and invested to the history abuse of the client.
There are numerous models which are utilized in the treatment of the PTSD disorder. These include the CBT, humanistic, and psychodynamic therapy. Thus so far, the CBT approach has shown the most success. The other treatments have obtained widely divergent evaluations particularly from the scientific along with the professional community. The psychodynamic therapy may be necessary adjunctive treatment to the clients that have had intense traumatic symptoms particularly in their childhood. In this research, it has explored various issues such as opportunities and the challenges in the therapeutic relationship of client with the childhood psychological trauma when they are engaged to various therapies such as humanistic, CBT and psychodynamic therapy.
Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2016). Treating trauma and traumatic grief in  children and adolescents. Guilford Publications
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., … & Mallah, K.  (2017). Complex trauma in children and adolescents. Psychiatric annals, 35(5), 390-398
Cowie, H., & Pecherek, A. (2017). Counselling: approaches and issues in education. Routledge.
Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress, & Coping, 23(3), 319-          339.
De Silva, P. (2014). An Introduction to Buddhist Psychology and Counselling: Pathways of Mindfulness-Based Therapies. Springer.
Douglas, B., Woolfe, R., Strawbridge, S., Kasket, E., & Galbraith, V. (Eds.). (2016). The   handbook of counselling psychology. SAGE.
Gutermann, J., Schreiber, F., Matulis, S., Stangier, U., Rosner, R., & Steil, R. (2015).  Therapeutic adherence and competence scales for Developmentally Adapted Cognitive Processing Therapy for adolescents with PTSD. European journal of    psychotraumatology, 6(1), 26632.
Harned, M. S., Wilks, C. R., Schmidt, S. C., & Coyle, T. N. (2018). Improving functional             outcomes in women with borderline personality disorder and PTSD by changing PTSD             severity and post-traumatic cognitions. Behaviour research and therapy.
Jarecki, K., & Greenwald, R. (2016). Progressive counting with therapy clients with          post?traumatic stress disorder: Three cases. Counselling and Psychotherapy Research,  Jongh, A., Resick, P. A., Zoellner, L. A., Minnen, A., Lee, C. W., Monson, C. M., … & Rauch, S.            A. (2016). Critical analysis of the current treatment guidelines for complex PTSD in    adults. Depression and Anxiety, 33(5), 359-369.
Knight, C. (2015). Trauma-informed social work practice: Practice considerations and       challenges. Clinical Social Work Journal, 43(1), 25-37.
Machtinger, E. L., Cuca, Y. P., Khanna, N., Rose, C. D., & Kimberg, L. S. (2015). From treatment to healing: the promise of trauma-informed primary care. Women’s Health Issues, 25(3), 193-197.
McLean, C. P., Su, Y. J., Carpenter, J. K., & Foa, E. B. (2017). Changes in PTSD and depression  during prolonged exposure and client-centered therapy for PTSD in adolescents. Journal of Clinical Child & Adolescent Psychology, 46(4), 500-510.
Rapcencu, A. E., Gorter, R., Kennis, M., van Rooij, S. J., & Geuze, E. (2017). Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder          after treatment. Psychoneuroendocrinology, 82, 1-8.
Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Physical activity in the treatment of post-traumatic stress disorder: a systematic review   and meta-analysis. Psychiatry research, 230(2), 130-136.
Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P., Resick, P. A., … & Cloitre, M.(2015). Psychotherapies for PTSD: what do they have in common?. European Journal of   Psychotraumatology, 6(1), 28186.
Van der Kolk, B. A. (2017). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), 401-408.

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