Anorexia nervosa is a problem that sometimes impels clients to seek therapy and support. Although eating disorders may be difficult to overcome, experts acknowledge the importance of psychological support, often long term, for those who suffer with such disorders. It is important to identify the underlying cause for the conflict with food and to explore the factors that mitigate the maladaptive eating patterns. O has been under her Doctor for two years had has made no progress with her condition. This might indicate that she has difficulty engaging in a therapeutic relationship and has lead to a state of depression; which is understandable given the length of her suffering, reinforcement of maladaptive cognitions and useless emotions providing a continuous saga of unhappiness. We would need to explore the connection with putting food in her mouth and the pain caused by tonsillitis to establish if it is the thought of this process and the response created by the cognition that is the problem or is it psychosomatic pain. I have decided for this case to use the Humanistic approach and in particular, person centred theory and Cognitive and Behavioural Therapy.
The person centred approach was devised by one Carl Rogers (1902-1987) was designed to provide a catalyst for personal growth and trigger the instinctive movement of accomplishing of a persons’ inherent potential. The therapist would do this by helping O to connect with her inner resources to confront, explore her fears; providing scope for self fulfilment/actualisation. The goals for this model would be to create awareness of the underlying problem and motivate O towards overcoming the issues present to us as a result of guided exploration. This approach should encourage O to develop a trust relationship with a therapist; encouraging her to engage in the process and be as honest with her self as possible. The process can be empowering and give O the courage to face the demands and efforts required within the next stage of therapy adapting and embracing the required changes. O should inherit a sense of autonomy and become self functioning. Mearns and Thorne describe Roger’s theories and ideas.” It is the client who knows what is hurting and in the final analysis it is the client who knows how to move forwards.. ..the therapist’s task is to enable the client to make contact with his own inner resources rather that to guide, advise or in some way influence the direction the client should take; thus emphasising the central importance of the client’s phenomenological world”. (Mearns & Throne, 1988, as sited in Dryden, P1).
Rogers suggests that there are three main therapeutic elements that a therapist using this method should develop and be able to convey to their client. These core conditions are ‘congruence’, ‘unconditional positive regard’ and ‘empathy’. Rogers states that if these core conditions are present then a trust relationship can be formed. A positive regard and advanced empathy may help O to break down the barriers that has stopped her from disclosing and working with her doctor for the last two years. The genuineness displayed by the therapist may encourage O to be more congruent and open about her underlying fears and anxieties. Once O starts to feel accepted and more aware of her self she may feel more in control of her life and future. His could provide the means or vehicle to lift the depression and develop a more positive sense of self. Once O becomes more aware of her self concept and confronts negative conditions of worth, she in her self will become more positive about her potential and ability. If a person’s self actualising tendency can be harnessed, human beings can solve their own problems and heal their own psychological hurts (Abraham Maslow 1908-1970 as sited by Hough, P: 41). Maslow designed the hierarchy of needs in 1954 providing a structure for the elements of our life that need to be present and embraced in order to self actualise or reach our potential. This has been integrated in to the person centred approach, subsequently, helping O to identify and explore these needs. Awareness of these needs can trigger O’s self actualising tendency and her instinct to grow as a functioning adult.
This model will help O to move to the next level, connecting her to the skills and courage required to move forward with her therapy. It will not assist her with the skills to change the way she thinks and acts. It will not challenge her perceived reality or correct a distorted reality, but provide a foundation/platform, giving her the drive and trust in her-self and in the therapeutic process required to achieve her goals.
Cognitive behavioural approaches can be seen as a synthesis of many diverse frameworks. Although they differ in their detail from one another they share many common assumptions and generally regarded as being sufficiently similar to be grouped together. “Many people have mistakenly thought of CBT as a single approach. All have their origins from early behaviourists such as Watson (1931) and Skinner (1953) and modified somewhat by more contemporary theorists such as Ellis (1962), and Meichanbum (1977)”, (Margaret Hough, P: 117).
O’s fears, anxiety and mal-adaptive behaviour has formed a handicap that has become detrimental to her health, to which she has not developed any coping skills. The generic goals of this model is to unlearn faulty and abnormal thinking and behaviour and re-lean new adaptive strategies or coping skills to overcome her deviations form normal thinking and behaviour. The thought of food entering her mouth creates anxiety and angst that subsequently results in avoidance. In order to change cognitive distortions with regards to food, relentless positive reinforcement is required. The aim to abolish anxiety is generally impossible, so the aim is to help O put her anxiety into perspective so the incapacitation is reduced. Various treatment techniques such as self control therapy, self monitoring, self evaluation, self reinforcement and assertiveness training can be provided in this model to help O take her confidence to another level and gain the skills required to achieve her goals, Dryden (1995), P: 268.
One of the fundamental gaols will be to help O disassociate food with the pain, sensation, taste or consequence that she fears when she puts food in her mouth at present. There are a number of structures that can be used within this model to help O, however the prominent ones include: classic conditioning which is a form of that was first demonstrated by Ivan Pavlov. The typical procedure for inducing classical conditioning involves presentations of a neutral along with a stimulus of some significance to evoke a response. The objective is to develop or learn a desired response based on a stimulus of significance in this case food.
Operant condition is a process of behaviour modification in which the likelihood of a specific behaviour is increased or decreased through positive or negative reinforcement each time the behaviour is exhibited, so that the subject comes to associate the pleasure or displeasure of the reinforcement with the behaviour. This type of conditioning is usually reward/feedback based, marking achievement and adaptation to the desired response, for example putting food in her mouth and eating it. This again may be an appropriate approach to motivate and sustain O’s enthusiasm and determination to change and stay in control.
Aversion therapy may be too harsh and not normally used in eating disorder cases. Due to O’s anxiety levels systematic desensitisation my work as a form of counter conditioning to help her replace fear with relaxation. The therapist could construct an anxiety hierarchy of all the situations O may be faced with until the most provoking situations are mastered. Modelling or social learning theories can be used if O’s fear of eating is more prominent within the company of others or in public.
One of the drawbacks of this approach is that it is medium to long term and O will have to endure the pain and stress in order to overcome her problems. Compliance will be paramount, hence the reason to provide a person centred model to begin with to prepare her for the impact it will have on her, however some people do find this approach stressful and a little too directive. Because the model is goal orientated it could reduce O’s self esteem and leave her with the sense of failure and hinder future efforts, should she not achieve or relapse. This approach more than others is one that you have to build into you daily life and it requires consistency and will power. If the commitment to change is missing it can have an adverse affect on O and potentially cause psychological harm.
In conclusion the two models chosen should provide the tools and support that O needs to deal with her anxiety, eating disorder, depression and her reluctance to discuss her condition or impairments. The humanistic therapist will recognise the significance of the past, but work within the here and now; connecting any relevance or significance of the past and how it might be affecting O in the present. The sessions will provide self exploration time and help to develop a sense of self worth. This sense of self worth may contact her self actualising tendency and help her to grow as a person. The CBT therapist will help her to learn new skills for the future and help to dispel bad habits and negative thoughts. If the model works it could prevent the prescription and consumption of anti-depressants and help O to regain full control over her life, controlling her food consumption and mental well-being.
Words . 2172
Bibliography:
Casement, P. (1985) On learning from the Patient, London: Tavistock.
Dryden, W . (1995) Individual Therapy, Buckingham: Open University Press.
Hough, M. (1998) Counselling Skills and Theory, London: Hodder Arnold.
Hough, M (1994) A Practical Approach to Counselling, Essex: Longman.
Lomas, P. (1981) The case for a Personal Psychotherapy, Oxford: Oxford University Press.
Accessed 30/1/09
Accessed 30/1/09
Accessed 30/1/09
Accessed 30/1/09
