I believe that a person is born into a context; race, sex, family, country. The interplay between personal traits and external circumstances makes a person the way they are. The same person born to a different family or a different culture would suffer from different kinds of hardship or distress.
Optimal Functioning
In my eyes, optimal mental health does not necessarily mean happiness at all times; optimal mental health, in my view, is flexibility and the ability to look at one's thoughts and feelings, examine their viability and how they may be affected by factors such as thought patterns, bias and faulty perceptions.
Mental Health Problems
I believe that at the core of human struggles and distress one can find a combination of situational and internal factors. Moreover, I believe that a large part of adult psychopathology, mainly affective and personality disorders, are affected by conflicts between temperament and environment. Thomas and Chess (1974) posited that while the congruence between child and parental temperament lays the foundations for good mental health, and incongruence can be the basis for poor mental health.
Temperament, according to Rothbart and colleagues (2000) consists of “constitutionally based individual differences in reactivity and self-regulation, in the domains of affect, activity and attention”. Temperament is thought to be present already at birth, and is quite stable throughout life. It determines the individual's reactions, perceptions and behavior. One can say that it serves as the basis for the individual's personality, maybe the more biological inclinations contributing to the personality as a whole.
In addition, I think that one of the reasons for poor mental health is a deficient ability to correctly 'mentalize' another person. As Peter Fonagy and Mary Target have posited, mentalization is the process in which one understands that the other is a separate human being with his or her own thoughts and motives, that are not necessarily what you yourself think they are (Fonagy& Target, 1998). This concept of mentalization coincides with my outlook on mental health, in that the ability to examine one's thoughts and emotions is a key component of mentalization. By acquiring the mere understanding that thoughts and emotions are subject to an assortment of factors that can change and vary between individuals and even within each individual, one makes a significant step towards better mental health and interpersonal relationships.
The Process of Change
I think the most important contribution of any counseling process is the personal and intimate relationship formed between therapist and client. Through this relationship, the client can safely explore facets of their own personality or behavior that they find troubling, or cannot even think of. The lack of full reciprocity allows the client to lean on the therapist, or otherwise try and understand why he or she avoids doing so. I think that every meaningful relationship we have changes us; aside from explicit information gained, there are implicit things we learn- whether through imitation or otherwise negation. We may learn that we dislike a certain aspect in another person, and try to avoid or alter such aspects in ourselves.
As I believe that each person is formed by the interplay between biological and emotional factors, as well as the interplay between the inside and outside world, so is every therapeutic dyad for5med from the meeting between two persons. I think that a therapist must be as open minded as possible, adjusting to the patient in a way that resembles what Daniel Stern called the 'dance' (Stern, 2009).
Interpersonal psychology seems the most similar to this approach. This is a time-limited psychotherapy rooted in the psychodynamic approach, focusing on interpersonal relationships. Being evidence-based and concise, it resembles Cognitive Behavioral Therapy and its premise of examining events in-vivo. Through observing the therapeutic relationship formed during treatment, patient and therapist can then try and understand the patient's patterns of relating to others find the weaker spots and work on them, or otherwise come to terms with what cannot be changed. Interpersonal psychology focuses on the 'interpersonal context', meaning the relational aspects that create, enhance and perpetuate the patient's distress. Other than aiming to improve the patient's ability to form and sustain relationships, the patient is encouraged to improve their social support network, in preparation for facing their distress after therapy has ended (Robertson et al., 2008).
Applying Theory to Practice
Personally, I believe that in order to truly try and understand a client and relate to him or her, one need at least several assessment sessions before determining a course of action and treatment goals. In these assessment sessions, I think that ideally the therapist should try and see the client in different situations. Personally I think that the therapist should observe the client in his or her natural setting without their knowledge of being examined, in order to obtain a direct impression of his or her behavior, attitude, coping mechanisms and interpersonal relationships. There is no 'one' self. We each have different aspects of our 'self' express themselves in different social and occupational situations. Similarly, the patient in the treatment room is not the person dealing with his peers or family members. More classical approaches would posit that one needs to focus on reality as brought to the session by the patient, regardless of their grounding in the 'real world'. Though I do believe that there is no one truth and each phenomenon generates unique accounts, I do not think that a therapist should only rely on the patient's account of events or significant people in their life.
Unfortunately, psychological well-being is as hard to operationalize in regards to treatment goals as it is hard to operationalize in scientific research. Therefore, I think the therapeutic goal should be to understand what is in the core of the patient's distress and try to either change it, or more often, find along with the patient the tools to better cope with it.
Strengths and Weaknesses
The theory posited in this essay is not without faults. First, it is not so easy to translate into practice. For instance, though I do believe in the importance of the clinician's observation of the client outside the therapeutic setting, this would be difficult to achieve. Not only would it possible create tension and anxiety for the client, but one cannot observe natural setting without being seen, and the knowledge of being observed necessarily alters behavior.
In addition, many patients may find the vague treatment goals difficult. We all need concreteness and clarity, and even though the tolerance of ambiguity may be a treatment objective, one cannot expect a client to tolerate it so soon in the relationship. In addition, my view of therapy as an 'interpersonal dance' may be difficult for members of a more collectivist culture, who are also used to altering their stance and behavior to accommodate the group. Moreover, such treatment may not be suitable for clients with more practical daily hardships, as they might view therapy as 'luxury' or wasted time.
Self-Reflection
In the course of the semester, I feel that I have learned to tolerate ambiguity to a better degree. If at first I felt like I needed to know the 'bottom line', what do I actually do in the room, as a therapist, I can now more readily accept that, in essence, psychotherapy is, as Bion stated, two frightened people in a room (French, 1997). I feel that I am more equipped to be frightened while still feeling adequately confident of my ability to help.
References:
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31.
Fonagy, P., & Target, M. (1998). Mentalization and the changing aims of child psychoanalysis. Psychoanalytic dialogues, 8(1), 87-114.
French, R. B. (1997). The teacher as container of anxiety: Psychoanalysis and the role of teacher. Journal of management education, 21(4), 483-495.
Robertson, M., Wurm, C., & Rushton, P. (2008). Interpersonal psychotherapy: an overview. Psychotherapy in Australia, 14(3), 46.
Rothbart, M. K., Ahadi, S. A., & Evans, D. E. (2000). Temperament and personality: origins and outcomes. Journal of personality and social psychology,78(1), 122.
Stern, D. N. (2009). The first relationship: Infant and mother.
Thomas, A., & Chess, S. (1984). Genesis and evolution of behavioral disorders: From infancy to early adult life. The American journal of psychiatry.
