Describe_and_Evaluate_Two_Approaches_to_the_Treatment_of_Self-Defeating_Behaviour.

Word count 2261 Self defeating behaviour is an act that causes the individual to fail or suffer but instead of stopping this behaviour, they continue with it. It is defined as “any deliberate or intentional behaviour that has clear, definitely or probably negative effects on the self or on the self’s projects” (Scher & Baumeister 1988). There are many examples of self defeating behaviours like, being needy, guilty, fearful, envious, angry, obsessive, rebellious, addictions, eating disorders, procrastination, controlling, gossiping, self doubt and depression. There are many theories as why humans have a self destruct button and one theory is by Freud, “people have an innate death drive that impels them to pursue their own downfall and death”. Basically self defeating behaviour is a coping mechanism, when we are dealing with a threatening, stressful situation, we grab any solution we can find. The solution might have helped in the short term, which is why we keep repeating it. Nonetheless because it was thought of in a stressful situation it also has a negative impact. When children are supported in a stressful situation they develop healthy coping mechanism, however when they are not supported they then feel, “unprotected and alone”. 1 Many self defeating patterns are thought of in childhood traumas, there is an individual I know who due to her controlling mother, used to use ostrich approach whenever she felt threatened. To this date she avoids confrontations even if confrontation is needed, as that was what she learnt. I have brought to her attention that it was useful then but now I think it is becoming a hindrance. I also mentioned to her that she is no longer a child even though she might feel like one, she has many choices as an adult that were not available to her as a child. There are three models of self destructives: 1) Primary self destruction 2) Trade off 3) Counter productive strategies The primary self destruction is when an individual deliberately hurts themselves like suicide and self harm. The trade off is when for example the individual drinks heavily, they gain by forgetting what was haunting them but suffer due to the hangover. The counter productive strategy is when the individual planned well but the out come is something else. For example when an individual stays up all night to do well at the exam, but can’t think straight because she is too tired. When a person’s self esteem is low, or their ego feels threatened they are likely to behave in a self destructive manner. They are also more likely to suffer from anxiety, depression and emotional unstable due to low self appraisal. “Emotional stress has also had a link to self-defeating behaviour. Anecdotal observations have long suggested that highly distraught people are more likely than others to do self destructive things.”2 Another reason people suffer from self defeating behaviour is that their self regulation has failed. Self regulation assists humans to cope and adapt in a situations. When an individual can self control, self regulate and they then can succeed in most situations. It’s thought that people who have addictions, obsessive compulsive disorder, comfort eating, are not self regulating due to many reasons like lack of attachment from their primary carer and they use unhealthy strategies to cope with that disturbance. “With self-regulation a person can either make sure they succeed or fail in a certain situation. “Self regulation is presumably one of the major capacities that the human self has evolved in order to help bring about positive outcomes. When the self brings about negative outcomes, therefore, one could readily suspect that self-regulation has failed in some crucial way. Ultimately, self-defeating behavior may often result from the failure of the self to regulate its behaviors properly” (Beaumeister, 1997) One type of treatment is Cognitive Behavioural Therapy which is a psychotherapy treatment used to reduce the effect self defeating behaviours have on a client. CBT is used for many disorders like anxiety, addictions, depression, excessive anger, phobia’s, etc. A client’s thinking, feelings and patterns are looked at, do they do all or nothing thinking, over generalisation, focusing on the negative, disqualifying the positive, mind reading, fortune telling, always and never thinking, magnifying and minimization. Cognitive behavioural theory was started by Beck (1976) who believed that negative thinking could be changed by the thinking process. The Cognitive behavioural theory model states that it’s the interpretation of a situation that causes the psychological distress but not the situation per se. Any changes in thoughts, emotions, physical sensations or behaviours are connected. If you change one of them the other parts are affected and will change as well. Cognitive Behavioural Therapy looks at the way people process, interpret, react and handle uncomfortable or distressing experiences. It also deals with what’s happening in the present or the here and now. There are four stages that are important in CBT, physical sensations, thoughts, feelings and behaviour and how they impact on the individual’s relationship with themselves and others. In order for cognitive behavioural therapy to work effectively the client has to understand and identify the four stages. Assumptions are harder to identify until they are described verbally, when the client speaks about themselves .e.g. “if I speak up, then all the others will hate me”. The core beliefs that the individual has is deep rooted and are more self persecuting e.g. everyone thinks I’m worthless .The idea in CBT is that the four stages, physical sensations, thoughts, feelings and behaviour are connected. If one of the stages was manipulated or changed positively then it would change the negative behaviour in the individual to a positive. CBT tries to make the client look at situations differently and also question their reasoning surrounding a distressing event. Example client says “I am stupid.” Therapist ask client who’s the most stupid person you know and on a scale of 1 to 100 where would you put them' A few examples would be given until the therapist asks the client where they would put themselves on the scale. The client will no longer think they deserve to be number 100 and gives them the chance to put things into perspective. Then the Negative Automatic Thoughts (Nats) are looked into which are mostly caused by childhood events or stressful incidents. They are unconscious thoughts that flow freely whilst reinforcing and magnifying any negative feeling the individual has about themselves. Depending on the issue a range of CBT is used like, “exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behaviour therapy, and acceptance and commitment therapy”. (3) CBT has six phases: 1. Assessment or psychological assessment; 2. Reconceptualization; 3. Skills acquisition; 4. Skills consolidation and application training; 5. Generalization and maintenance; 6. Post-treatment assessment follow-up. (4) The therapist will use many techniques in CBT, like the validity testing which means the client objectively defends their thoughts and if they can’t, then a flaw is exposed. The client is then asked to go through a cognitive rehearsal, where they try to solve a previous situation in a positive manner and therefore when the situation arises again, they are better prepared. Guided discovery is when the client describes through incidents when their thinking became distorted. They are asked to keep a journal of their thoughts, emotions and actions. The therapist and patient then go over the journal, identifying the negative patterns and thoughts. The counsellor can also use positive or with holding reinforcement to strengthen and motivate the client’s behaviour. Another technique used is aversive conditioning when a behaviour has become habitual or temporarily rewarding, like with addictions. Nausea inducing drugs with an alcoholic drink can be given to alcoholics, in order for them to associate the alcohol with the nausea. A method used in phobias is systematic desensitization, where the individual is trained to relax in an anxiety inducing situation. Generally cognitive behavioural therapy is used along side medications and other psychotherapies. “However, several studies have indicated that CBT: • may reduce the rate of rehospitalisation and improve social and occupational functioning for bipolar disorder patients, when combined with pharmacotherapy (treatment with medication) • is an effective treatment for patients with bulimia nervosa • can help generalized anxiety patients manage their worry, when combined with relaxation exercises • is helpful in treating hypochondriacs • may be effective for treating depression, especially when combined with pharmacotherapy, and may also prevent depression in at-risk children • is one of the first-line treatments for obsessive-compulsive disorder • that focuses on education and provides some exposure and coping skills is effective for treating panic disorder without agoraphobia • is effective for helping to treat insomnia, and its effects may be sustained longer than the effects of medications alone.” (5) Another treatment for self defeating behaviour is the person centred therapy that Carl Rodger’s introduced. His approach is based on the concept, a person can grow and achieve his potential given an environment that provides him with genuineness, acceptance and empathy. To facilitate this, the therapist must fulfil 6 Core Conditions (Rogers, 1957). They are: 1. Psychological contact must exist whereby both client and therapist are present and aware of each other’s perception and the client is aware that something isn’t working in his life. 2. Congruence, the therapist must be genuine and true to himself, so that this will allow transparency to his client and thus build trust. 3. The client is in-congruent and vulnerable which causes in him anxiety, and it is the desire to resolve these conflicts that drive the relationship. 4. Unconditional positive regard is to see and accept the other as they are, to accept their humanity, without any prejudice and judgement. 5. The client should be able to perceive at least some of the unconditional positive regard to allow him to feel accepted. 6. Empathic understanding, allows the therapist to be able to feel and see what the client is experiencing as if in his place. The counsellor places himself or herself in the clients shoes and is non judgemental and genuine in his or her approach to the client. Humanistic’s theory deals with the here and now instead of trying to unravel the past or the client trying to projecting their lives to a future time. It also focuses on the client taking ownership or responsibility for their actions through self actualization the counsellor promote this by the use of unconditional positive regard whilst reflecting feelings and empathy within the session. Humans are basically good they all have the capacity to solve their own problems. Humanistic theory also looks at how the client perceives themselves by using the self and self concept. The increase in awareness allows the clients to look at their own blocks to development so they can gradually reduce them and move forward towards growth. For the process to work the counsellor has to be empathetic, congruent and have an unconditional positive regard towards the client. It’s actually how the counsellor works with the client that can promote change within the client, rather than their technique or theories. The therapeutic relationship is seen as a source healing. Carl Rodgers encourages therapy to be warmer than psychodynamic and behavioural therapists. If the therapist offers a space where the client is not judged, accepted, offered empathy, then the client will feel safe enough to show the vulnerability and accept their self defeating behaviour. When they do accept they exist, then it can be looked at the root of the behaviour, when the patterns started and why' As the client experiences acceptance and empathy they start to be on the journey of self actualisation. As they have been accepted by another, they can now muster the courage to face their thoughts, feelings and behaviours. This will then lesson their self defeating behaviour. I think cognitive behavioural therapy excels in dealing with self defeating behaviours. So much so that the NHS supports this type of therapy as it is result driven. For example in dealing with an agoraphobia, after CBT is used, the client will have been desensitised to some level, they would be leaving their home and not being home bound. The strengths of Cognitive behavioural theory are that they are scientific and can be used in practise. Its limitations are that it does not deal with the root of the issue instead it is putting a plaster on it. If cognitive behavioural therapy is taken on the NHS, it is most likely to be six sessions, which is not long enough to get to the root of the issue. I would use Cognitive Behavioural Therapy with a client as starting point, once we have reached the desired goal, I would then use a person centred approach to get to the root of the neurosis. Bibliography: 1) Mark Goulston, Phillip Goldberg Get Out of your Own Way Penguin Books. 2) Esteem threat, self-regulatory breakdown, and emotional distress as factors in self defeating behavior. Review of General Psychology, 1, 145-174 – Roy F Baumeister 1997. 3) E. B. Foa, Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies, Guilford, New York, NY, USA, 2nd edition, 2009. 4) Gatchel, Robert J.; Rollings, Kathryn H. (2008). "Evidence-informed management of chronic low back pain with cognitive behavioral therapy". The Spine Journal 8 (1): 40–4. doi:10.1016/j.spinee.2007.10.007. PMC 3237294. PMID 18164452. 5) http://www.minddisorders.com/Br-Del/Cognitive-behavioral-therapy.html 6) David J.Lieberman, PHD Instant Analysis 1997 7) Dr Windy Dryden, Coping with Life’s Challenges 2010 Sheldon Press.