Assessment of Human Needs

Saving, Supporting, Defining and Discerning Life

                These are my main goals for a client who is seeking therapy. I believe that every theory, technique and practice can fall into one of these categories when working with the human condition. Abraham Maslow defined the Hierarchy of Needs, a concept that articulates the different levels a person can thrive at dependent upon how the world they know (nurture) has impacted them.

                Nature versus Nurture has been discussed for years. The idea questions how much of a person’s being is directly related to the person themselves, and how much is caused by the person’s interactions with the environment they are exposed to.

                When a therapist conducts and initial assessment of a client seeking therapy, they are hoping to learn why the person is seeking out services. The client has a story that is unique to their perspective and beliefs about the world around them. Subsequently, the perspective a client offers is biased and a therapist can assume that the client is not cognizant of the whole “picture” regarding why life has played out the way it has for them. Ultimately, there are at least three sides to every story: yours, mine and theirs.

                A therapist should study and gain skills from a wide array of therapeutic models if they are to help the maximum amount of clientele. Dependent upon where a client is currently experiencing life, a therapist must decide if they are to help the client by saving life, supporting life, defining life or discerning life. Once the therapist determines which category the client is currently falling into, they can choose the therapeutic model that will meet the needs of the client with the greatest effect.

Saving Life

SSDD… Saving Life

                When a client has been affected by severe trauma or has been impacted by the lack of basic human needs for survival, their therapeutic needs fall into the saving life category. This category of client should be considered at a greater risk for experiencing chronic and acute crisis, personal injury and untimely death. Therefore, it is necessary for a treating specialist to identify this client’s needs accurately, expeditiously and provide therapeutic techniques that will help break the current cycle of behaviors.

                Often times, the client who falls into the Saving Life category is one who has been referred to therapy by an outside agency such as law enforcement, medical/ emergency response personnel or welfare providers. The law enforcement agency may have come in contact with the client when the client was actively engaging in behaviors considered detrimental to the surrounding community or environment. If the client is suffering physical health impairments or active suicidal intentions, the local emergency room may be who refers the client to therapy. Welfare agencies may also provide a referral to therapy if the client has been found to suffer from abuse or neglect to a level that has caused the person to suffer from a failure to thrive. Each of these referral types tends to produce clients who are highly reactive to the environment and who have displayed behaviors which put them or other others in immediate and imminent danger. Therefore, therapeutic techniques should rely heavily upon methods which bring about behavior modification.

                As a therapist, I would rely heavily upon theoretical skill sets which modify current behaviors the client is presenting with. Saving Life is aimed at providing immediate intervention between the client and the environment in order to keep the client alive and safe, even from themselves.

                Behaviorism found that a person’s behavior can be modified and sometimes extinguished with the help of environmental controls which reward, punish and ignore the detrimental behaviors. Because the client is moving through repetitive, crisis-producing behaviors, a therapist must not concern themselves too much with “why” the client is behaving in an undesirable manner, they simply must help the client discontinue the behavior and ultimately save their life.

Behaviorism is a theoretical approach to psychology that can provide life-saving skills to the client.

Theorist: B.F. Skinner & J.B. Watson

Focus: Behavior Therapy requires a functional assessment of the client, identifying and targeting specific behavior and building a therapeutic plan that measures and modifies the targeted behavior.

Strengths: If a person cannot behave in a manner that is safe, lawful and copasetic with life sustaining goals, then it is necessary to modify or eradicate problematic behaviors. Behaviorism provides a method which clearly identifies faulty behaviors and serves to change those behaviors for the sole purpose of keeping a person in check with societal expectations.

Weaknesses: Behaviorism is the purest essence, disregards the thoughts and feelings of the client. Therapeutic techniques seek to simply modify the behaviors a client exhibits without the concern of how the client feels about their behaviors. This could be considered a weakness if the client is existing within one of the other three categories; however, is arguably in the best interest for the client whose immediate need is Life-Saving tactics.

Technique(s) I use:  

In some instances, exposure therapy can be useful to a client who is clinging to irrational beliefs about the world around them. Exposure therapy can help the client to recognize healthy levels of discretion for events and situations that cause them to behave in a self-defeating manner.

Operant conditioning can provide direct results by punishing unlawful behaviors with consequences such as jail time or punitive actions imposed on the client. Operant conditioning can also reward positive behaviors that a client initiates thus reinforcing a more positive life for the client.  

Reinforcement can provide a person who suffers with suicidal ideation a reason to reject suicidal attempts and self harm by rewarding more positive behaviors.

Personal example:  

Currently, I am working with a young lady who has suffered severe sexual, physical and emotional trauma and has spent the past five years of her life in and out of psychiatric units. I found that she has placed great value upon her ability to attend religious services and weekly activities. I worked with her and her residential team to outline safety goals and weekly behavior expectations that are aimed directly at her self-harm tendencies. By rewarding her weekly efforts with greater access to optional religious functions and treating her to personal time in the community, she has begun to work toward greater personal safety and she has had a marked decrease in self harming incidences.

Supporting Life

SSDD... Supporting Life
                Another group of clients seek out therapy in an effort to maintain their current lifestyle. The idea of supporting a client in their life can help a client to adapt to aspects of life they are powerless to change. These clients may suffer with chronic illness, physical malaise, mental illness, addiction or dysfunctional interpersonal relationships. As the treating therapist, I would need to assess the client for stability and some level of cognitive understanding about why they are seeking therapy. This client group is more likely to be a self-referral rather than involved in a behavior-induced third party referral. Although the client may have behaviors they wish to change, these behaviors are not as critical as the Life-Saving category. Ultimately, the client is stable and aware that life can be lived at a higher level of functionality if they can find a way to remove the current barriers they perceive to be blocking them.

                Although the client in the Supporting Life category is seeking to modify behaviors, they are able to do so at a more complex level of understanding and the cognitive theories can provide greater results for the client than can be provided by the straight Behaviorism Theory.

Cognitive-Behavioral Therapy is one therapeutic method that builds on the need to modify behavior but does so because the client perceives the need to change behavior rather than an environmental need to do so.

Theorist: Albert Ellis, Albert Bandura, Aaron Beck

Focus: To change behavior, the client must recognize and isolate irrational thoughts and beliefs. Change the belief, we change the behavior.

Strengths: Allows the client to take ownership of their therapy by providing feedback about weekly events, homework to help focus the client toward goals outside of the therapeutic setting and a way to measure progress made. As it pertains to the Support Life group, CT and CBT can offer a willing participant a broad array of therapeutic skills to help them learn to rethink the way they are doing things. Because the client in this group is willingly seeking out therapy, they are able to enjoy the benefits that cognitive adaptation to life can offer them.

Weaknesses: CT and CBT work only if the client perceives that there is an issue and that issue needs to be addressed. If the client is unwilling to take ownership and accountability for their therapy, then CT and CBT are powerless to help the client work through the issues.

Technique(s) I use:  

The ABCs of CT and CBT are fantastic. When educating a client about the way thoughts, feelings, actions and consequences relate to each other, this tool helps provide a way to slow down the thoughts, discern the event and manipulate the consequences of the event. This skill is crucial to the client because it provides foresight into future, similar experiences.

“Disputing and Challenging” the irrational beliefs can help the client place logic into the actions they wish to change. These disputes ultimately empower the client to make sound, rational commitments to change.

Psychoeducation provides the client who is willingly and actively seeking out treatment the empirical data needed to justify their desire to change. When working with an individual who is reactive and “stuck” because of mental illness or addiction, a therapist can provide comfort and hope to the client who wants to move past a label and take back their life.

Personal example:  

I have truly enjoyed opportunities to engage in CBT. One method I have found to be quite powerful is commonly referred to as Illness Management and Recovery Education. In this role, I help the client understand what their diagnosis means to them. We then, set personal goals and seek out appropriate supports that will help the client meet their expectations of life after diagnosis. The IMR specialist provides the client with community, individual and group support during their transition back to ‘the real world’. More importantly, the IMR specialist provides the client with hope.

Defining Life

SSDD…Defining Life

                Many people seek out therapy in order to understand why they view their life circumstances the way they do. This type of client is seeking to discern, or to make sense of the experiences they have encountered throughout their life. For these clients, the therapeutic aim is to help them raise their quality of life through professional analysis of their actions. When I help a client define life, I am not overly concerned with changing a specific behavior or belief. I am merely providing them with a tool that will ultimately help them validate who they have become thus far on their journey.

                When delving into a client’s motivation and inspiration for their current life choices, it is important to assess for the events that the client attributes meaning to. As a therapist, I am seeking out clues and parallels between the events from the past and current life choices the client is engaging in. These symbols can be shared to the client who is seeking my expertise and the client can choose to accept the meaning I place on the symbols, or reject it as an insignificant facet. To accept my ‘expert’ interpretation is to accept theoretical ideals of stage theory. To reject my assessment is a way the client may grasp greater ownership of their life choices. Both acceptance and rejection of my interpretation can offer the client with acceptance of who they are because both avenues provide a greater awareness for the client.

                Psychoanalysis can provide the client with a deeper understanding of the developmental stages he or she has progressed through. This greater understanding can provide peace of mind or inspire the client to change the way they have learned to view life. Both the acceptance of who the client feels they are and motivation to change beliefs are acceptable goals of therapeutic work for the client who is currently working toward defining life.

                Feminist Therapy helps the client who is biologically female and the client who adheres to the feminine gender to define what life looks like for the woman they wish to be. Feminist theory is unique to psychotherapy in that the acceptance of current beliefs is not the goal, rather the desire to change the way females are viewed and treated by the rest of society. When a client is working to define life, it may be that they are seeking to understand where the expectations they hold for themselves are accepted without any supporting reasoning. The woman who accepted the traditional female roles and has experienced a lower quality of life in that role can benefit greatly from the ideal that they can change how they view themselves and how society treats them. For the woman who wants to understand why life has handed her the experience she perceives, feminist theory can educate her historically and help her to decide a different life course.

Theory: Feminist Theory is a tool for defining life rather than supporting life because the therapeutic goal is not based upon specific behaviors of the client but upon the desire to change the personal and social philosophy and belief about the minority group.

Theorist: Karen Horney, Alfred Adler, Carol Gilligan, Nancy Chodorow

Focus: To provide the client with a deeper understanding of the current and past definition of woman. To help the client change the way woman is accepted, viewed and treated by herself and society. To offer a therapeutic environment that is not based off traditional male perspective.

Strengths: For some women, traditional beliefs have defined limitations and oppressive environments. To the client who have been negatively impacted by limitations, feminist theory can provide avenues for growth and a higher quality of life by changing the current beliefs the client has about the female sex and feminist gender expectations. For the client who perceives life to be limited, the therapist can provide options to help them expand their definitions of the women’s impact in their lives.

Weaknesses: Sex role differentiation is not always negative or oppressing. Feminist theory challenges traditional beliefs that can provide self-identity and security within their boundaries. Some clients may not be in an emotional state of mind where deconstruction of their foundational views is appropriate of helpful. When changing the beliefs a client holds about female and feminine gender roles, the dynamics of community and division of social duties will also change. This social change can deconstruct communal harmony for the benefit of individualistic pursuits.

Technique(s) I use:  The client must be properly assessed for openness to fundamental changes in perspective. If the client perceives a lower quality of life because of the beliefs she either has or has been subjected to, I would access tools within the feminist theory that can help her define life.

Consciousness-raising and Education is used to disrupt and dispute current beliefs the clients holds about how society views them and how they are measured by societal standards. I would rely heavily upon pin-pointing faulty or detrimental self measurements and provide education which can be used to foster new philosophies within the client’s self image.

Empowerment techniques can provide a client with something more concrete than a faith-based perspective on change. To empower is to provide a conduit for the client to gain greater strength and courage during their journey.

Assertiveness Training can provide the client with appropriate levels of emotionality and action when faced with social roadblocks and power struggles.

Personal example:  

When a client is assessed for appropriate levels of distress with their current beliefs about the feminine roles in society, they are ready and willing to seek change. Personally, I am a therapist who is cognizant of the greater societal impact of fluidity in gender roles and would be cautious of the greater life scenario of the client before advocating change. A woman who is seeking therapy because of events that she is helpless to control (such as the choices of loved ones that do not directly impact her) I would progress slowly with any notion to reject her current roles. But, if the same woman were limited spiritually, educationally, vocationally or in any other way by the control of an outside influence, I would use feminist skills to help her emerge from the life patterns which hinder her growth.

A final note about feminist theory: I sincerely believe in the concept, “If it ain’t broke, then don’t fix it”. If the client has found happiness and fullness within the beliefs and roles they currently adhere to, then change is not the correct therapeutic goal.

Psychoanalysis

Theorist: Sigmund Freud

Focus: By delving into the client’s unconscious thoughts, the client can be provided with a deeper understanding of why they act the way they do. The use of symbolism, free-association and stage analysis can help provide a client a way to define why they do what they do and justify current actions and beliefs.

Strengths: For the client who is seeking to define why they act in a specific manner, psychotherapy can help form associations to prior life events which could influence current choices. Clients who suffer from post traumatic stress or acute trauma can find comfort in the professional explanations for their current life hold patterns.

Weaknesses: Psychoanalysis does not account for a client’s free agency, the ability to choose their actions on a case-by-case basis. This theory expects that everything we do is driven by past experiences and unconscious desires. This lack of free will degrades the client to a mere victim of circumstance and can limit the client’s potential for personal growth.

Technique(s) I use:  

Dream Analysis. If it is assumed that dreams are created by the overly-developed synaptic connection of specific thoughts and memories, then a dream can show significant meaning a client holds for specific events. Although dreams lack the executive functionality of the frontal lobes, they can provide insight into thoughts and events the client thinks about regularly.

Interpretation of consciousness. Assessment regarding the developmental integrity of the ego can help a client to discern the level of morality and virtue they currently hold. As a therapist, I can help guide a client to define the way they measure their internal drives and motivations.

Personal example:  

Post Traumatic Stress can cause a client who is usually well adjusted to social norms to react to environmental stimuli in a way that is destructive to their lives. When a client is currently gripped by PTSD, they succumb to triggers in a manner that produces inappropriate responses to current situations. The more the client can discern from prior trauma, the more they are able to lengthen the time between event and reaction. This time between the event and the reaction can be supplemented with skills that can soothe and degrade the potency of the initial reaction.

Discerning Life

SSDD… Discerning Life

                Some clients have reached a place in their life where they have separated concepts often spoken about among religious sects, but hold a deep personal meaning. These clients are seeking out their spirituality. This client group is searching for deeper meanings to life, death, choice and human nature. They are seeking to complete themselves with themselves. The therapeutic goals are stated by the client and sought out by the client. The therapist is a companion along the journey and provides the client with respect, love, unconditional positive regard and affirmation. The process of sorting through life is done in an effort to gain understanding about whatever comes before and after the human state of being. Not many answers can be provided to the client and the journey remains unique to the person.

Client-Centered Therapy and Existentialism

Theorist: Carl Rogers, Abraham Maslow, Rollo May

Focus: With the support of a genuine human relationship between the client and therapist, Humanistic psychotherapies offer the client who is working toward an understanding of the greater human purpose, vocation and creationism.

Strengths: For the client who has developed a secure and centered sense of being, they can begin to explore more abstract concepts and begin developing personal philosophies about creation and human purpose. This client is generally regarded with respect and unconditional positive regard. They are more peaceful beings and can experience growth and greater creativity by the gentle and provocative nudging of their therapeutic mentor.

Weaknesses: According to Abraham Maslow and his hierarchy of human needs, clients must have previously established strong foundations of their basic human needs, security, love and acceptance. Existentialistic approaches tend to work well for clients who do not encounter a great deal of crisis. For those clients who are in crisis, the ideals that the humanistic approach focuses upon are not appropriate goals for individuals struggling through ‘worldly’ difficulties.

SSDD... It's all Life

Saving, Supporting, Defining and Discerning Life

                To simply buy into one theoretical approach over another is not how I would align myself as a counselor. After studying the different forces in therapy, I find that there is an appropriate response based upon the needs that the client presents during their initial assessment. Once the needs have been assessed, then the therapeutic model should adapt to the conditions predetermined by the client.
                 The theory I feel is the most useful in an overall professional model is the Biopsychosocial theory. When a therapist take the time to gain information about the the physical condition of the client, the social impact affecting them as well as the client's view of their dispositions, the therapist is more prepared to meet the client's overall needs as a human being.
                A therapist should study and gain skills from a wide array of therapeutic models if they are to help the maximum amount of clientele. Dependent upon where a client is currently experiencing life, a therapist must decide if they are to help the client by saving life, supporting life, defining life or discerning life. Once the therapist determines which category the client is currently falling into, they can choose the therapeutic model that will meet the needs of the client with the greatest effect.