A Psychodynamic Approach To Brief Therapy

First reaction

After watching the dialogue between the therapist and Nichole I was left with some unanswered questions, as well as some concerns about the approach the worker took when addressing some of the things the client recounted. Once I had time to process what was said and took into account the context of the session, as well as the techniques that were utilized by the worker, I was able to have a better rationale for the worker’s responses to the client. Secondly, I felt as though Nichole had other social factors that should be addressed through therapy; however, I understood the main focus and priority of this brief session was to bring the unconscious sexual abuse history to her conscious, and help her understand that this may be a main factor that has to be dealt with before anything else should be addressed.

Therapeutic approach

The worker’s method when working with Nichole was to use psychodynamic therapy. This form of therapy places importance on several aspects in the therapist-client interaction. For example, it is important that the worker focuses and zeroes in on facial expressions and nonverbal body language, exploring certain emotions the client send off, confronting the client when avoiding a specific topics, and helping the client identify appropriate coping strategies to manage the trauma they have endured. The main and most important part of this kind of therapy is to bring the unconscious to conscious and always reassure the client that healthy defense mechanism are most appropriate. According to Crowe and Dare, Freud’s observations inaugurated techniques to encourage an individual to ‘discharge’ the previously unexpressed feelings and recover, as fully as possible, memories of abusive experiences (1998). The worker in the scenario with Nichole did justice in staying true to the brief aspect of this method, as well as pointing out the underlying truth to her presenting problem.

Clinical skills

I felt that the worker expressed significant clinical abilities, including proper communication, setting boundaries, and critical thinking. Nichole was not a very easy client, and at times her responses were intended to cause a specific reaction from the worker; however, he always made sure to uphold the oath of a therapist and use his clinical skills to continue the therapy session in the best manner he saw fit. Although Nichole presented with multiple psychosocial stressors, the therapist made sure to address the one of most importance and refer her to a different setting he felt would be most beneficial for her. According to Mander, brief therapists have no ambition to cure all and everything; in fact, curing is not a word in their vocabulary (2000). In my opinion, the worker expressed exactly what Gertrude Mander explains throughout the text, A Psychodynamic Approach to Brief Therapy. Nichole has a long way to go in regards to being able to tackle her current problem; however, with the help of this brief therapy session, she is one step closer to her therapeutic goal of resolving her issues with men and intimate relationships.

Values demonstrated by worker

I felt as though the therapist made sure to uphold one of the main values that must be respected during the therapist-client relationship, which is integrity. Although during some moments of the dialogue interaction, the worker could have folded his arms and potentially allowed himself to give in to many tempting factors, he maintained his professionalism. The therapist expressed sufficient competence to help the Nichole, offering his services and ensuring he maintain her own dignity and individuality meanwhile assisting her in exploring different areas of her life; especially when the worker asks the client if she is a “working girl.” Although I was taken aback by his comment, I felt he was also making sure Nichole knew that if that was the case, he was not frowning upon it, he was simply trying to clear things up for his own knowledge. Within the dialogue, social justice is also dabbled with, the worker also asks the client about her sexual orientation, ensuring he is maintaining clarity about social justice issues surrounding sexual orientation. Most importantly, the worker question Nichole enough about her coworkers, friends, and family ensuring to be clear with her that there is a significant amount of value and importance in human relationships in her life.

Nonverbal behaviors by client

From my perspective, I thought the worker should have addressed the client pulling her shirt down in a better manner. I would have asked Nichole something along the lines of, “I understand you stated you are cold, which is why you put your zipper down, but is there any other reasons you felt the need to uncover more? I would feel more comfortable if you were to zip it back up just a bit.” With Nichole behaving in this manner, as well as asking the worker is he was married, it can be assumed that these are normal behaviors and questions the client probably usually asks men in her life. This can be used as an opportunity to further explore this pattern of behavior and confront it, explain to the client that she is currently expressing a technique known as transference. Secondly, when speaking about other women, including coworkers, friends, her sisters, as well as her mother, Nichole instantly shuts down and expresses that with her nonverbal body language. The worker did not attempt to fully address this concerning manner. Family acknowledgement of trauma that has occurred or is occurring is an essential component but can be extremely difficult to achieve, not only because of the criminal charges that might ensure, but also because of the shame and fear of sexuality within these families. The worker attempt to dabble with the word rape, and also asks what her mother’s opinion in the matter was. This is clearly something that has affected certain behaviors in Nichole, especially with trusting women in her life.

Worker’s strengths and weaknesses

Worker did a great job of using universalization and confronting the client’s resistance to speak on the sexual abuse she endured at the age of seven. He was able to be quick on his toes when she asked “do you think I am a hoe or something?” He did great about referring her to a specialist. On the other hand, I felt that the worker should have made sure to place more importance on her unhealthy interpersonal relationships at work, as well as within her family. Initially, the therapist asks Nichole if she is a “working girl.” I felt as though the worker made an assumption based on the client’s disclosure of her behavior with men. Hypothetically, the client could have completely shut down with the therapist after this if she had become offended. For the most part I felt the therapist did a good job; however, there is always room for change and growth within therapy session and learning from others constructive criticism is a great way to get some professional and career growth.

Alternative techniques to use

If given the option of what technique to use when working with a client who has endured previous childhood trauma, including sexual abuse, my first choice would have been psychodynamic as well, like the video gives an example of. I would have liked to do some roleplaying scenarios with Nichole, to potentially offer some advice and coping strategies to have healthier male relationships. It has also been noted within the social work field that cognitive behavioral therapy can also be a very beneficial model and technique to use with an adult wanting to overcome a current problem due to subconscious emotions. Cognitive behavioral therapy states that a person is a product of their environment, and focuses on treatment relating to changing your environment to change a pattern of behavior. This could definitely be an alternative technique to use when speaking on therapeutic approaches. What we are trying to ensure is that the approach continues to be a brief intervention. “The main qualitative differences between brief and long-term psychotherapy are in the limitation of the patient’s regression, in the careful avoidance of dependence, and in the virtual elimination of the ‘working-through’ phase of treatment.” With sexual abuse victims, we want to ensure that they do not become dependent on a therapist relationship to overcome the subconscious feelings. Subsequently, the worker should also steer away from getting the client to take long in the initial phase of the therapy relationship.

11 February 2020
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