Thursday, October 3, 2019
The Role of Emotion Focussed Theory in Functional Assessment Essay Example for Free
The Role of Emotion Focussed Theory in Functional Assessment Essay Introduction            In this essay , I am elaborating on the types of psychotherapy which have persisted for generations and which have undergone favourable changes over the years, conforming to the opinions of great psychoanalysts who have written a large amount of literature from their experience and research. I am concentrating on functional assessment and emotion focussed theory and an integration of the two. I have quoted from a few studies by psychotherapists and researchers. The advantages of the approaches would be obvious from the essay. How an integrated approach scores over the earlier functional assessment is described here with the support of researchers’ views. The Role of Emotion Focussed Therapy in Functional Assessment.            The humanistic or experiential traditional psychotherapy included the Gestalt therapy, client centred therapy and the existential therapy which were practised for a long time. The Gestalt therapy is a holistic, process oriented and field theoretical approach to human change.(Gestalt, Gestalt Global Corporation). The factors of awareness, contact, personal responsiveness and responsibility are built into it. Primacy is ascribed to the uniqueness of the individual. The person is treated in whole rather than in parts. Biological maturation, environmental influences, interaction of the individual and the environment and creative adjustment play a crucial role (Gestalt, Gestalt Global Corporation). Fritz Perls,the founder, considers the method as a congruence of many theories. Freud’s psychoanalysis had an influence on Gestalt therapy. Perls used Freud’s developmental sequence in his theory. The four major concepts are biological field theory, theory of the organism, the need for making contact and relationship and the capacity for making wholes. Biological field theory states that an organism can be understood only in its organised, interactive, interconnected and interdependent totality (Gestalt, Gestalt Global Corporation). The second theory considers that an organism has physical, cognitive, emotional, social, economical, spiritual, aesthetic and interpersonal dimensions; each of equal importance. The third says contact or building of relationships is essential for survival. (Gestalt, Gestalt Global Corporation). A person who cannot make contact with his surroundings or has a blockade requires intervention. The fourth speaks of the human being as having the capacity of organising and reorganising his bodily functions, perceptual functions, cognitive and behavioural aspects. Gestalt therapy is aimed at assisting the client in restoring his own ability to self-regulate as an organism and have successful and fulfilling contact with others in the environment as well as be familiar with one’s own faults. The person is led to cope creatively with himself and the environment (Gestalt, Gestalt Global Corporation) What is normal human nature?                The psychologically healthy human being whose organismic self-regulation is functioning well is a normal person. He is able to respond properly to his wants and needs and the environment (ID functions). He is able to respond to situations realistically according to his behaviour (Personality functions) (Gestalt, Gestalt Global Corporation ). He is proactive instead of reactive, recognised by his ability to respond immediately and his willingness to take responsibilty. He lives with awareness in the present, is very aware about the past and is looking forward to the future (Gestalt, Gestalt Global Corporation). When do you call a person abnormal?            In psychological dysfunctioning there is a loss of awareness of needs, wants and desires. Free flowing and flexible contact with the environment is blocked or distorted. (Gestalt, Gestalt Global Corporation). He becomes reactive and simply unable to gauge events in their correct perspective. He is unable to take responsibility. His self –support is limited and he seeks help from outside. His ID and personality functions are disturbed. The style of contact changes (Gestalt, Gestalt Global Corporation). The work of the Therapist            The therapist focusses on improving the client’s contact and relationships. He establishes a dialogic relationship with the client. Limitations of Gestalt therapy            It lacks a distinct, elaborate and well defined theory. The developmental causes of psychological suffering are not addressed. There are no definite and constructive theories on how to effectively bring about a change in the client ( Gestalt, Gestalt Global Corporation). Psychoses and personality disorders are not represented. It has a reduced potential in treating acute cases with suicidal tendencies. The therapist needs to be present for the sessions for maximum benefit to the client. Many a time this may not be possible due to limitations in time. The client suffers then (Gestalt, Gestalt Global Corporation) Client centered therapy            The client-centered approach defined feeling as the union of emotion and cognition. The concept of experiencing and everything that is occurring within an organism at any given moment that is available to awareness are important. (Gendlin, 1962; Rogers, 1959). Extending deep understanding, empathy, congruence, caring are the various manners that a therapist can offer a client. Existential therapy            This takes into consideration the human condition. It has many similarities to the psychodynamic, humanistic, experiential and relational approaches to psychotherapy. Rollo May is considered the Father of Existential therapy. Yalom in his book, Existential Psychotherapy, 1980, speaks of 4 themes: death, freedom (responsibility), isolation and meaninglessness. These four issues are central to the human experience (Existential therapy, Hoffman) Functional Assessment            The philosophy behind functional assessment has been linked to the behaviourist tradition. It is an assessment-based approach to psychological therapy Functional analysis, behavioural assessment, antecedent consequent assessment, contextual assessment are terms used in it. Sequences form the basis of this therapy used by psychotherapists Cognitive behavioural assessment, systems focussed models, emotion focussed therapy and psychodynamic therapy are utilised to bring the mentally disturbed back into reality.            The presenting problem, precipitating factors, predisposing factors, perpetuating factors and protective factors are taken into consideration for functional assessment. The precipitating factors may instigate a problem in the presence of predisposing factors. The presenting problem takes the patient to a psychotherapist who sees him with the problem. What predisposed and what precipitated the problem have to be investigated into by the psychotherapist.  The therapist studies the case and comes up with an idea about the perpetuating factors and the protective factors. Emotions are not given much consideration here. The Emotion focused theory            Emotion research has come out with positive ideas on emotion. This kind of research has been done by many psychotherapists. Emotion theory and research say that emotion awareness, regulation and transformation are 3 important principles of emotional change. Recognising the part of the brain involved in the distress, the type of affect dysregulation and the type of change process that could be used form the basis for therapy (Greenberg, 2002). An integrated approach with stress on affect, cognition and behaviour is what is recommended by most psychotherapists. This approach affects the system at a desired level; cognitive, emotional, behavioural or interactional. Emotions are given their due importance as a fundamentally adaptive resource. They are a primary signalling system from birth and regulate our selves and give life its meaning (Greenberg, 2002). Healthy adaptation requires learning to be aware of, to tolerate and to regulate negative emotionality (Frijda, 1986) as well as to enjoy positive emotions (Frederickson, 1998).            Response to a fight-flight stimulus is said to be mediated by two pathways for producing emotion in the brain: a fast emotional response to a distress signal and a slower thinking-brain response which is usually unable to stop the reflex emotional response (Le Doux, 1996). The earlier response occurs based on previous experience. Similarly we can expect two kinds of learning; one a more conceptual one and the other a more perceptual, associative one (Pascual-Leone, 1987). Two types of memory too are described: one factual and the other emotional (van der Kolk, 1994). So two levels of processing are also possible: a conscious conceptual system and a tacit experiential system. Two systems of knowledge are thereby spoken of: knowledge by description and knowledge by experiencing (Greenberg, Rice and Elliot, 1993).            Scientists agree that the emotional response to an event is a constructive sequence of events (Greenberg, 2002). They could be described as stimulus appraisal, physiological appraisal, expressive behaviour, impulses to instrumental behaviour, interpretation, subjective feeling and visceral and motor responses.            Freud purported the theory of excess energy being discharged as affect and its dysfunction. Modern psychoanalysts have discarded this idea. Psychodynamic analyst, Stolorow (1994) believes that the dynamic unconscious consists not of repressed instinctual drive derivatives but of affect states that have been defensively walled off because they failed to evoke attuned responsiveness.            Behavioural and cognitive theories state that negative emotion is seen as a disturbance and disorganisation that interfered with behaviour (Greenberg, 2002). These negative emotions are seen as symptoms and therapy is directed towards them Behaviourists and cognitive behaviourists seem to be increasing their focus on automatic-unconscious, cognitive-affective structures in theory and treatment (Young, 1990) Beck (1996) believes that the fight-flight mode involves a whole range of systems in its response; perception of threat (cognitive system), feelings of anxiety or anger (affective system), that motivates the person to act (motivation system), the action itself (behavioural system) and physical mobilisation (physiological system). An orienting schema is activated to trigger off the rest of the sequence and that too rapidly. Therapy aimed at the dysfuntional modes has 3 parts; deactivation, construction of neutralising adaptive modes and changing the structure and content. Beck believes in the third method. Beck’s theory has seen changes but his combination of behavioural and rational intervention persists. Emotion in experiential therapy.            Emotion has always been part of the humanistic or experiential therapy. In the Gestalt therapy, emotion was a vital regulator (Greenberg, 2002). Gestalt therapy may be seen as a form of training in emotional awareness. Blocking was interpreted as fueled by the wish to avoid painful or unwanted emotion. Feeling, in the client centred therapy, was defined as the union of emotion and cognition which were experienced inseparably. Emotion in the experiential therapy is now understood to be a biologically adaptive, rapid action tendency and a meaning system that provides feedback on the states of body and mind. It forms the basis of an adaptive growth system in the organism (Greenberg, 2002). The process of symbolisation creates conscious meaning.            Greenberg has classified emotion into primary adaptive feelings which provide the information behind the problem, maladaptive emotions which need to be evoked and modified and secondary adaptive emotions which need to be investigated to reach the primary (Greenberg, 2002 ). Cognitive emotion schemes form the personality characteristics. They are focussed upon in therapy. The maladaptive ones are to be changed in therapy (Greenberg, 2002). Theories that have met concurrence among psychotherapists.            There is recognition that emergence of emotion is an important signal that material being discussed is significant to a person’s well-being. The second point is that awareness of emotion and attention to it in therapy are important to access the information in emotion ( Greenberg, 2002).  The third says that desynchronies or incongruence among cognition, emotion and physiology can occur and is pathogenic. The fourth point of agreement says that emotion has to be aroused and processed in therapy to bring about change. The final point of agreement says that it is important to promote emotion regulation and emotional experience. (Greenberg, 2002)            An integrated psychotherapy involves the 3 major change processes: awareness of emotion, regulation of emotional arousal and changing emotion with emotion. Maladaptive emotions are changed by using another maladaptive one. Functional Assessment in a school            Functional assessment has been done to examine the factors related to the challenging behaviours of students. Much literature has been written on this. Whether Functional assessment is sufficient to study the behaviours of schoolchildren who had problems is a question raised by many psychotherapists. Functional assessment is defined as a set of assessment procedures used to identify variables that promote and maintain challenging behaviour and based on this assessment, interventions are then selected to alter some of these variables (Lennox and Miltenberger, 1989). Functional assessment is based on some assumptions a) specific contextual variables are directly related to target behaviour b) these variables are identified by assessing how they trigger and maintain the behaviour c) systematic manipulation of the variables can either reduce the challenging behaviour or support the development of appropriate fuctional skills (Carr and Durand, 1985; Durand and Carr, 1987).            5 reasonable hypotheses for poor academic performance have been discussed a) the student does not want to do work b)the student has not spent enough time on the work c) the student has not had enough help to successfully complete the work d) the student has not had previously to do the work in the requested manner. e) the work is too hard for the student. If the function of the difficulty is identified, matching interventions can be developed. If the child does not want to do the work, incentives may be offered to stimulate him to work (Merrell, 2006)  The various studies that have been conducted appear incomplete in different ways. Only a few studies have examined their usefulness. Most of the study on behaviour was done out of school and not on the pro-social behaviour in school (Ken, Choutka and Sokol, 2002). Only some studies included class adaptive behaviours like on task behaviour and on task compliance Interviews, observation and hypothesis are useful only for ordinary students. For disruptive behavior other methods have to be adopted. Researchers have suggested that the link between the functional assessment and the intervention implemented are not always clear in the research. Only 16 studies had referenced various procedures that were actually used to form hypotheses from which interventions were planned (Stichter and Conroy, 2005). Of the 16, only 5 could actually verify the hypotheses before intervention. The change agents in the literature were the researchers. Very few teachers or peers participated in the implementation of the functional assessment and interventions. All the reviews discovered that the assessments were done outside the students’ classrooms where the problematic behaviours occurred. Also a standard functional assessment has not emerged (Stichter and Conroy, 2005). The natural conclusion was that they were not adequate.            Students with Emotional Behavioural disorders could not be assessed with these used formats. IDEA 1997 which was the legislative impetus for conducting FA in schools did not have the necessary baselines or standard process for this. The reactive policies did not require an assessment unless the child is disruptive or commits an offense. Teachers were lacking the knowledge and skills to perform the functional assessment (Stichter and Conroy, 2005). Originally only individuals identified with severe developmental disabilities (Kahng and Iwata, 1999) had FA. This was conducted in clinical settings. This assessment format was found inadequate for students with lesser disability who lie unnecesarily or indulge in drug abuse or carry weapons or threaten classmates. There has been a general call for appropriate functional assessments to be done differently for normal children, children with mild emotional behavioural disorders and the really disruptive ones. The assessment needs to be done in natural settings (classrooms). Peers or teachers who can assess their own students are the best assessors. Hypotheses are to be derived and the right intervention planned accordingly before it is executed (Stichter and Conroy, 2005)            Structural analysis is the hypotheses driven model that addresses the current challenges (Carr and Carlson, 1993). This method has been successfully used in natural settings with natural change agents to identify instructional variables that contribute to the acquisition of proactive responses as well as specific variables that contribute to problem behaviour. Preventing problem behaviour by supporting instructional and contextual factors that contribute to adaptive behaviour while designing interventions to increase skill acquisition is a practical extension of the functional assessment literature base for students with emotional behavioural disorders (Stichter and Conroy, 2005). Conducting classroom functional assessments will be more reflective of actual activities and naturally occurring environmental variables, providing a clearer assessment of the impact of various change agents. Proposed interventions may be tested in natural settings through implementation of hypotheses to increase adaptive behaviour. The applied nature of the structural analysis helps the teacher see the change in adaptive behaviour (Stichter and Conroy, 2005)            A study conducted by Richard van Acker et al examined the Functional Behaviour Assessments and Behaviour Intervention Plans of current practices developed by school teams in Wisconsin Findings suggested serious flaws (Acker et al, 2005). There was a lack of clarity in the identification of and operational definition of the target behaviour or behaviours under investigation (Acker et al, 2005). There was a failure to identify the efforts taken by the team members to verify the hypothesised function of the behaviour before intervention. Most surprisingly, the team members just neglected their findings on a behaviour when considering the Behaviour intervention plans. Teams with members who had undergone intensive training for the research produced better results. Team based FBA has been found to be a good proposition according to a study by Scott et al, (2005). Emotion focussed therapy Research on couples’ therapy also shows the role of emotional awareness and expression in a satisfying relationship. Expression of underlying attachment-oriented emotions leads to a satisfying marital life in a couple who get the therapy. (Johnson and Greenberg, 1985). Showing more emotional experience in the therapy along with softening of blaming partners, the couple ended up being more satisfied than couples who showed lesser experiencing (Greenberg, Ford, Alden and Johnson, 1993).  Expression of emotion is useful for terminating family conflicts too (Diamond and Liddle, 1996). One study demonstrated that an emotional cycle in the relaxation treatment, increase in arousal, arousal with reflection, more abstract reflection and then relaxation, following one upon the other finally results in a good outcome Mergenthaler, 1996). All personality disorders described in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) are considered as disturbances of affect regulation Descriptions have been included about borderline personality disorder where difficulty to control anger is the problem and schizoid disorder where extreme coldness is the problem. Conclusion            Psychotherapy has undergone a major change from the days of the primitive man. The days of chaining to restrict their movements and putting them away in far off institutions have gone. The humanistic approach has given way to the integrated approach which includes functional assessment and the emotion focussed theory. Psychotherapists now vouch for this integrated approach as one. Schoolchildren in the United States have come under the legislative impetus whereby their performance in school is assessed based on their behavioural and emotional functions. The lax manner that was assumed earlier for this assessment has now been flayed. Researchers have advised that the children are assessed no matter whether they are disruptive or not and different techniques used for the normal, those with minimal disorder and those with disruptive behaviour. They have opined that teachers are the best people to assess the children in their own surroundings. Teams which underwent training are also recommended. Another advice is that interventions should only be undertaken after reaching a hypothesis based on the assessment of children. Hopefully functional assessment integrated with emotion focussed therapy will turn out the best assessment after upgrading the assessment procedures. 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