Insight-Oriented and Action-Oriented Approaches to Therapy

Abstract

The purpose of this paper is to discuss, analyze, and compare insight-oriented approaches and action-oriented approaches. It will first examine the psychoanalytical approach. Next, it will investigate John Bowlby’s Attachment Theory. Following, it will examine and evaluate the action-oriented approach; Cognitive Behavioral Therapy. Finally, a conclusion will compare insight-oriented and action-oriented approaches.

Keywords: Psychoanalytical, Cognitive Behavioral Therapy, Attachment Theory

Insight-Oriented and Action-Oriented Approaches to Therapy

Counselors are asked to identify what theory of practice they have chosen. However, that decision may not be as easy as it sounds. Also, counselors can be guided by theoretical frameworks as they apply to specific theories and practice” (Cottone, 2013). However, that decision may not be as easy as it sounds. With opposing and contradictory approaches, choosing an insight-oriented approach or action-oriented approach can seem overwhelming. With that said, a theory is like a roadmap that guides a counselor with a set of directions. Furthermore, the key to a personal theory evolves from concepts and techniques used in contemporary therapeutic models (Cory, Cory, & Cory, 2014). So, counselors must make the decision to follow an action-oriented approach, insight-oriented approach, or an individually designed approach that integrates a combination of the two (Kottler & Shepard, 2015). Furthermore, counselors should understand their own values, morals, and standards; as this will guide them towards existing theories they can identify with (Kottler & Shepard, 2015).  With that in mind, people are the creation of their choices and are influenced by their own personal thoughts and feelings.  An experienced, knowledgeable, and competent counselor must evaluate and analyze the various approaches and methods. Moreover, the counselor must decide if the chosen path of practice should place more or less emphasis on the therapeutic relationship.

Insight-Oriented Approach

(Psychoanalytic Approach/Attachment Therapy)

 Psychoanalytic therapyis based upon the idea that much of our behavior, thoughts, and attitudes are regulated by the unconscious portion of the mind and are not within ordinary conscious control (Psychoanalytic Psychotherapy). Furthermore, psychoanalytical therapy can be used by children, adults, families, and couples. It treats a variety of issues such as; emotional pain, inability to express emotion, inability to maintain friendships and relations, lack of goals, and so on. The goal of psychoanalytic therapy is to help clients better understand the unconscious forces that play a role in their current behaviors, thoughts, and emotions (Cherry, 2019).

There are different levels associated with the clients motivating factors such as; the id, ego, and superego. As stated in Kottler and Shepard (2015) “there are several regions of the mind: the conscious mind, which contains those thoughts and feelings that are always accessible; the preconscious mind, which holds elements of awareness on the edge of awareness that, with manual effort, can be made immediately accessible; and the unconscious mind which harbors the secrets of the soul” (p.127). The human mind has many aspects that can be investigated and analyzed. With that in mind, each layer of awareness that is peeled away gives therapist access into the human psyche by allowing the unconscious thoughts of the client to surface (Kottler & Shepard, 2015).

Clients should be encouraged to say what comes to mind; even if it seems silly, irrelevant, or embarrassing. One such way of accomplishing this is through the technique of free association. Free association involves exploring a person’s unconscious mind through spontaneous word association (Study, 2018). Then the responsibility of interpreting the responses is left to the therapist. By using free association to make patterns, a theme may become apparent. For example, let’s say a client recently divorced. A therapist may say commitment and the client may say failure. With that, a theme starts to form. Also, it allows a therapist to indulge into the client’s past occurrences; possibly revealing an attachment issue in childhood. Free association is used to uncover unconscious desires or intense emotions that have been blocked (Study, 2018). Talk therapy is designed to help uncover unconscious occurrences. Moreover, talk therapy, “allows clients to recount painful memories as well as reveal their innermost unconscious desires”(Kottler & Shepard, 2015, p. 126). By gaining access to a client’s mind, a therapist can begin the long process of decoding the information. Then, the originating cause can be identified.

Early childhood is a time of growth and development.  Furthermore, it shapes a child’s future. With that said, children need a secure base to explore all the world has to offer. Moreover, the relationship between a parent and child serves as a blueprint for the child’s future interpersonal relationships. As children develop so does their attachments; especially with their parent(s). John Bowlby’s evolutionary theory of attachment suggests “that children come into the world biologically pre-programmed to form attachments with others” (Mcleod, 2017). Therefore, it can be assumed that children have an innate need to attach.However, if attachment issues are broken and left unresolved, they may inhibit and restrict relationships later in life. Bosman (2016) states that “as a consequence, insecure attachment is considered an important transdiagnostic risk factor in the development of psychopathology and could, therefore, be an important factor to take into account during the treatment of any child and adolescent emotional or behavioral disorder” (312). With that in mind, the parent-child relationship will either foster trust or doubt.

Trusting children have a support system, whereas, doubtful children will feel rejected or disappointed by their primary caregivers (Bosmans, 2016, p. 312).  The failure to create a bond between caregiver and child could lead to serious negative consequences, possibly including affectionless psychopathy (Bosmans, 2016, p. 312). A therapist who utilizes the psychoanalytical approach encourages clients to look deep inside to where it all began.

The psychoanalytic approach can benefit a child who lacks a healthy attachment style. According to the attachment theory, “children are born with a biologically determined behavioral system aimed at eliciting caregiver care and support during distress” (Bosmans, 2016, p. 311). If a child repeatedly receives responsive care, then they develop secure attachments. However, if the parent fails to nurture then the child can suffer the consequences. Psychoanalytic therapy can show a child what a healthy relationship looks like. Moreover, “children can explore ways to form constructive bonds with caregivers and develop ways to cope with the symptoms that resulted from their early attachment issues” (Mcleod, 2017). Psychoanalytical therapy can also create a therapeutic relationship since the client and therapist will spend a great deal of time together. The therapeutic relationship is considered as one of the most fundamental aspects of psychological therapy (Parpottas, 2012, p. 96). It is where adults and children learn to develop healthy relationships. Furthermore, during therapy adults can mourn the lost childhood bonds, while learning how to develop healthy attachments.

The psychoanalytical approach and the attachment theory are useful in uncovering suppressed memories that may be buried deep in the unconscious mind. Furthermore, this insight approach can be useful in rebuilding relationships.

Action-Oriented Approach

(Cognitive Behavioral Therapy)

In childhood, a set of assumptions (schemas) is learned that influence the interpretations of daily life situations and occurrences (Kottler and Shepard, 2015). Moreover, self-critical beliefs can generate distorted, unrealistic, automatic thoughts (Kottler and Shepard, 2015). These thoughts can negatively affect a person’s disposition creating maladaptive behaviors. Cognitive Behavioral Therapy (CBT), helps clients create new behavioral patterns by focusing on changing the behaviors of maladaptive cognitions, to accepting emotional distress (Bosman, 2016, p.310).

Cognitive Behavioral Therapy (CBT), an action-oriented approach, provides effective evidence-based treatment for children and adults with emotional and behavioral problems (Bosmans, 2016, p.310). It is a method that involves a restructuring of a persons’ harmful thought process into something more constructive and optimistic. Moreover, CBT is flexible. That is, CBT can be applied to practical issues or severe problems. Furthermore, CBT addresses a variety of unpleasant situations such as stress, anger, troublesome emotions, and procrastination (Aprile, 2014). With the right tools, CBT can provide guidance to engage a powerful course of change.

Clients who utilize CBT may be given a series of homework assignments. Homework is used to challenge the client’s beliefs. Likewise, homework can also be beneficial. For example, a person who is afraid of public speaking and crowds may be encouraged by their counselor to attend a community social and speak to at least one person. By doing this, the client can reach Olympian size proportions of achievement; especially if they are successful. CBT allows clients to address behaviors in small steps in order to experience positivity. (Aprile, 2014) Likewise, with success comes feelings of pride and accomplishment. This confidence can project a client further into more uncomfortable situations.  By constantly challenging old feelings and thoughts, clients can begin to gradually see the big picture of themselves’.

In addition to pulling clients out of their comfort zone, clients can be challenged to write down personal thoughts. CBT places emphasis on changing specific behaviors and developing problem-solving skills, rather than just expressing past feelings with a psychoanalytic therapist (Corey, et al, 2014). So, writing down thoughts and feelings and making them concrete, gives a client the acknowledgment that the issues are real. When looking at issues head on people can make appropriate sense of them.

In addition to writing personal thoughts, writing about a traumatizing event from childhood can prove therapeutically beneficial.  For example, having a client write about a traumatizing occurrence; then rewriting the ending, making it a happier time and place; will show the client a different of the problem. By seeing the issues in black and white, changing the ending, the client can be in control, therefore, changing their behaviors on a positive level (Grant & Gray, 2007). Having to think about the automatic thoughts which set off old feelings, and then having to describe them on paper is often a revelation to many clients (Grant & Gray, 2007). Writing is an important tool used in CBT.

Conclusion

The differing theories are useful for understanding people and behaviors, and promoting change, however, each theorist seems to contradict one another (Kottler & Shepard, 2015). Furthermore, “the movement towards evidence-based approaches, has insight-oriented counselors concerned because action-oriented approaches have received strong empirical support” (Kottler & Shepard, 2015, p.195). Insight-oriented approaches promote understanding and focus on issues from the past, current family interactions, dysfunctional thinking, behavioral inconsistency’s, or functional aspects of continuing to act self-destructively (Kottler & Shepard, 2015, p. 201). Likewise, psychoanalytic approaches center beliefs on how early occurrences in life, may have affected and influenced a client’s behaviors (Cory, et al., 2014). Whereas, action-oriented approaches focused on solutions in the here-and-now. With that said, CBT and Psychanalytical therapy are two vastly different approaches.

For the client looking to address issues rapidly, the psychoanalytical approach may not be enough. That is because psychoanalytical therapists spend the first few months just listening to the clients (Kottler & Shepard). Likewise, the counselor will “carefully think about everything the client says while searching for hidden meanings in the clients’ unconscious fantasies and desires” (Kottler & Shepard, 2015, p. 127).  Talk therapy, found in psychoanalytical approaches, can be long, and constantly shifting with topics. By contrast, “CBT is usually a short-term,  solutions-oriented form of therapy intended to help patients manage or change specific behavioral and/or thought patterns” (Heaney, 2018). Scientific support for talk therapy’s efficacy is mixed. Furthermore, many people find “talk therapy” helpful, particularly when struggling to locate and/or work through longer-term issues and feelings (Heaney, 2018). On the other hand, CBT differs from talk therapy, as it is used to help clients figure out the areas that need assistance in the here-and-now. 

The psychoanalytical approach, however, takes considerable time as it is largely based on insight. “Insight-oriented approaches focus on helping clients to understand their own inner workings and motivation’s” (Insight-Oriented Psychotherapy for mental health treatment, 2016). Unlike psychoanalytical therapy,however,CBT is goal-oriented and short-termed. This is beneficial to those without or with limited health insurance. However, if longer, more insightful therapy is required then the psychoanalytical approach can make insurance companies wealthy. Since CBT focuses on the here-and-now, this approach can be cost-effective. Whereas, the psychanalytical approach, which last month’s, can be extremely expensive.

“It can be argued that CBTis a therapeutic modality which has given more attention to techniques and ‘doing’ therapy, rather than the therapeutic relationship itself” (Parpottas, 2012, p. 91). Additionally, Psychoanalytical approaches search the unconscious mind of the client, because the dynamics of behavior are rooted in the past (Corey, et al., 2014). On the other hand, CBT places emphasis on changing specific behaviors. Furthermore, CBT works at developing problem-solving skills, rather than investigating past occurrences for a cause (Corey, et al, 2014). CBT is also a more present-oriented kind of treatment, meaning that we deal with the problems that a person is having in the here and now,” (Heaney, 2018).

Building a skill set must include the ability to build a working therapeutic relationship with the client. In action-oriented approaches, such as CBT, the therapeutic relationship is not the focus. However, in the psychoanalytical approach “the counselor must be able to develop a road map, helping provide the patient the freedom to play or talk in a way that will lead to a deeper awareness of the self, which may be experienced as good and bad, and create the space to express emotions without fear” (Delgado, 2008). Each approach is beneficial; however, it depends on the client and needs.

In conclusion, the theoretic choice a person makes will be unique to them. CBT, an action-oriented approach, helps to change patterns of thinking and behavior that prevents people from overcoming barriers and negative behaviors (Aprile, 2014). Moreover, it places less emphasis on the relationship and more on goals and results. Whereas, psychoanalytic therapy, uses techniques like the talking cure and free association to reach deep inside a client’s unconscious mind; creating a therapeutic relationship. Whether a counselor chooses an insight or action-oriented approach, the counselor must consider the various methods and line them up with their values and beliefs.

References

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