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Theoretical Orientation
Running Head: THEORETICAL ORIENTATION
Searching for a Theoretical Orientation: My Journey
Amina Mahmood, B.A.
The University of Iowa
*prepared for Counseling Psychology Portfolio October 2006
Searching for a Theoretical Orientation: My Journey
“You’ll look up and down streets. Look ‘em over with care. About some you will say ‘I don’t choose to go there’,...and you may not find any you’ll want to go down. In that case, of course, you’ll head straight out of town.”
--Dr. Seuss (1990)
This quote from Dr. Seuss’s children’s book Oh, the places you’ll go! succinctly summarizes my search for a theoretical orientation. As a psychologist-in-training I currently have the luxury of looking deeper into various theoretical orientations to therapy. During this journey I am able to try on these orientations, and am at liberty to discard those that don’t fit as I continue searching for the orientation that will be a perfect fit. Before I delve further into the discussion of my theoretical orientation to therapy, I feel that it is important to inform the reader of my journey thus far.
We cannot gain a complete understanding of the here and now without an awareness of our past. Therefore, I will begin the journey into my theoretical orientation by talking about why and how I chose psychology as a career path. In this section I will detail information about my background and the influences which steered me into the direction of psychology. Next I will engage in a discussion about my beliefs of mental health and well-being, as well as my personal beliefs and values. I believe that these beliefs and values provide me with direction in my search for a theoretical orientation. I will then detail the primary theoretical orientations which guide my clinical work. Case examples will be interwoven to illustrate my attempt in bridging the gap between theory and practice. Finally I will outline the strengths and limitations of my approach, including its applicability with diverse populations. In conclusion a summary of my current theoretical approach will be provided along with a prospective glance at the road ahead.
My Journey into the Heart of Psychology
I had never really considered psychology to be my calling; however my life experiences directed me towards a path that led to my enrollment in a Counseling Psychology PhD program.
Travel has been a constant in my life. Most people consider that a ‘normal’ upbringing comprises of graduating high school with the people whom you went to Kindergarten with. This isn’t my definition of a normal upbringing. My definition consists of being constantly on the move, either nationally or internationally. My lifestyle has ingrained wanderlust deep within me. My travels have inculcated in me an understanding of the diverse individuals that inhabit the globe. My family and I lived mostly in multi-ethnic communities and thus became accustomed to celebrating cultural and religious events with our neighbors, who did not share our culture and religious beliefs. I do not know what parenting skills were employed in my upbringing, but at a young age I developed an awareness of the differences that exist between and within cultures, moreover I was able to comprehend that these differences can be used to bring us closer together, or conversely they could be used to create distances between us.
Being exposed to the diversity present in our world most likely played a role in developing my initial career goals. Additionally my love for literature also contributed to my establishing my career goals. Consequently, I decided that I wanted to become a writer and journalist, or join the civil service. Journalism would help support me as I pursued my passion for creative writing. Additionally journalism would also present me with the opportunity of unveiling the multiple perspectives that surround the same issue, and it would allow me to inform and educate the public of interests that are pertinent to them. These could be as simple as the supply of water available to the city for the summer, or global concerns such as pathways to world peace. Journalism would also allow me to travel and interact with different people, therefore, I would not have to change my lifestyle to accommodate a career, I just needed to choose a career which would accommodate me! My reasons for joining the Civil Service were similar. I wanted a career that incorporated travel in it. If I joined the civil service in the capacity of a diplomat I would be posted to different countries once every few years, thereby sufficiently satiating my desire for travel.
In 11th grade, I made a conscious decision to study English Literature. The workload of academics was such that I was unable to keep up my favorite pastime that is, reading books. From 11th grade until the end of college I made conscious decisions to take English classes. My study of English Literature exposed me to various genres (poetry, prose, fiction, non-fiction, and plays) and authors. I studied works of authors from as far back as the Middle Ages, as well as contemporary writers who are just beginning to create a niche for themselves in the literary world.
Although the works of literature I studied varied greatly one commonality remained. Regardless of whether the literary piece in question is from the Middle Ages, whether it is imbued with John Milton’s Puritanism, or Jane Austen’s Sensibility, or a work of a modern day novelist, all literary works concern themselves with issues important to the human existence. All of the literary works I have come across concern themselves with the struggles of life, the emotions and actions of human beings which have remained consistent despite the changes that have occurred since time immemorial.
A turning point in my exploration of English Literature was Joseph Conrad’s novella Heart of Darkness. This novella is literally the story of a journey into the heart of the continent of Africa, but figuratively it is the story about the psychological journey of human beings into their soul. Conrad’s works in general and this novella in particular emphasize the psychological aspects of human beings. Conrad’s work has an existential flavor to it, which immediately drew me in. He grapples with questions such as: how does the individual function? Is society important? Can we exist in the absence of societal rules and regulations which guide our every day existence? For Conrad there is no single dimension of meaning, facts and labels do not succeed in revealing anything of much importance “the meaning of an episode was not inside like a kernel but outside, enveloping the tale which brought it out only as a glow brings out a haze, in the likeness of one of these misty halos that sometimes are made visible by the spectral illumination of moonshine (p.3, Conrad, 1902).” Thus for Conrad, the question of ‘how to be’, of human existence, has many ambiguous answers and those answers can only be reached by unwrapping the various layers of mist surrounding the individual. Heart of Darkness has had an indelible impact on my life, and it encouraged me to question our reality, our existence. Although Heart of Darkness served as an impetus for me to enroll in a psychology class in college it was Conrad’s novel Lord Jim that motivated me to pursue psychology as a major. In particular the following quote from Lord Jim which reveals Conrad’s contemplation of the human condition has had an enduring effect on me in my daily life, as well as in my role as a psychologist-in-training:
“It is when we try to grapple with another man’s intimate need that we perceive how incomprehensible are the beings that share with us the sight of the stars and the warmth of the sun. It is as if loneliness were a hard and absolute condition of existence; the envelope of flesh and blood on which our eyes are fixed melts before the outstretched hand, and there remains only the conscious, unconsolable, and elusive spirit that no eye can follow, no hand can grasp.” (p.132, Conrad, 1917)
Is the utter intimacy of personal experience incommunicable? Or are we so engrossed in our existence that we seek only to know others on a superficial level, as Virginia Woolf’s (1927) protagonist in To the Lighthouse says we seek only “to know the outline, not the detail (p. 195).” Is social isolation a key factor in understanding the struggle of our daily existence? I acknowledge that fiction is a distorted representation of reality, but it is this distortion that brings to light issues that otherwise go ignored. For me the journey into the ‘heart’ of literature led me to the gates of psychology as I grappled with trying to understand others’ ‘realities.’
I wanted my study of psychology to help answer the questions posed by the authors I studied in my English classes. I wanted to discover the reasons behind why we do what we do. I wanted to understand what leads to psychological health and illness, and how to maintain psychological well-being. My undergraduate classes in psychology succeeded in nurturing my interest and upon graduation I decided to pursue a doctorate in psychology. This decision was further solidified by my experiences with a non-profit organization where I served as a Counselor for individuals with chronic psychological illnesses.
Finding My Path: Developing a Theoretical Orientation to Therapy
Our theoretical orientation to therapy is constantly evolving. I believe that we continually develop our theoretical orientation during our professional lifespan. The theoretical orientations we adopt inevitably reflect our worldview, experiences, as well as other environmental and contextual factors. Our orientations are also dependent upon our views regarding health and illness.
My undergraduate psychology courses exposed me to the assortment of theories available in the arena of psychology, however it was during the first year of my graduate education that the idea of adopting a theoretical orientation was introduced to me. A class assignment encouraged us to talk to a practicing psychologist at the University Counseling Services (UCS) regarding their theoretical orientation, and the techniques they employ during therapy and why. I conversed with Dr. Emmanuel Enekwichi for this assignment and a comment he made during our conversation remains salient. Dr. Enekwichi said that theories are ways of explaining things, and that they can be overturned as soon as a better explanation comes along (Personal Communication, 3/6/2003). According to Dr. Enekwichi theoretical differences occur due to personal preferences. We choose theories based on our understanding of the world. I walked away from this conversation with an appreciation for technical integration. Dr. Enekwechi explained to me that although we use different theories to conceptualize client issues, the techniques that we use to resolve the presenting problem do not necessarily derive from the same theory but are drawn upon because we have evidence either experiential or empirical that they work (Personal Communication, 3/6/2003).
To understand my developing theoretical orientation it is imperative that the reader be aware of my conceptualization of psychological health and illness, and my personal beliefs and values, as these are primary factors in determining the theories that I lean towards.
My Conceptualization of Psychological Health, Illness, and Distress
The definition of psychological well-being is culture-bound. The context within which we exist places the boundaries on normal behavior. It is only when we cross these boundaries that our behavior becomes pathological. For example, Kubler-Ross’s (1970) model of bereavement is widely accepted in United States’ popular culture as the standard for grieving. An individual who does not follow the pattern of grief suggested by this model (that is, denial, anger, bargaining, depression, and acceptance) is considered to be dysfunctional.
Although culture is an important variable to recognize when defining psychological health and illness, some psychological illnesses are universal. These include Schizophrenia, Bipolar Disorder, Major Depression, and Anxiety Disorders (Comas-Diaz, 1996). I believe that the universality of these four diagnoses is due to biological factors. The Diagnostic and Statistical Manual of Mental Disorders (DSM, American Psychiatric Association, 2000) is by and large a consensus document (Goodheart, 4/9/2005), however there is empirical evidence available for the diagnoses stated above which gives credence for their universality.
Although it is helpful to be aware of the universality of some psychological illnesses, we also need to be cognizant of the specificity of other illnesses. For example, in some cultures it is acceptable for the expression of psychological distress to occur via somatization. Various cultures have specific ways of dealing with psychological distress and expression of mental illness, for example, it is very common in Pakistan to attribute an individual’s dissociative symptoms to spirit possession. Culture-specific psychological illnesses also exist within our society, of which one of the more common ones encountered by psychologists are Eating Disorders. Eating Disorders can be conceptualized as an illness specific to western and industrialized cultures (Thakker, Ward, & Strongman, 1999). Culture-specific psychological illnesses may also have a genetic component to them. The challenge with culture-specific psychological illnesses is how to correctly identify these illnesses, and next determining a culturally relevant treatment for the illness. The universality of the psychological illnesses mentioned above does not mean that symptom expression will be similar, or that treatment approaches can universally applied. Psychologists need to consider the influence of the client’s cultural context and cultural beliefs and values, in order to provide the most appropriate treatment.
The origins of psychological distress and illness need not derive from biological causes. Psychological distress can be due to maladaptive coping mechanisms (Worell & Remer, 2003). This could be a result of applying an adaptive coping mechanism to a novel situation only to discover that it does not work. For example a client who discovers that his technique of tuning out others which was helpful when he was growing up in a large family and needed to concentrate on schoolwork is obsolete when it comes to sustaining his romantic relationship. He discovers that he cannot ‘tune out’ his partner whenever he would like as that causes problems in the relationship.
Psychological distress also emerges when one attempts to find meaning in life, and/or queries the purpose of one’s existence (Yalom, 1980). The quest for meaning can occur at any stage in life, and it does require insight on behalf of the individual. One case example includes a neuropsychological assessment which I conducted on an elderly client, who was concerned that she was experiencing the onset of Alzheimer’s disease. My impressions of her from the clinical interview and subsequent interactions during the assessment indicated that she was going through a process of self-evaluation. She repeatedly made mention of her accomplishments and the contributions she had made to the society at large. She appeared to be grieving the fact that she could no longer contribute to society as much as she would like due to biological factors, that is, the natural wear and tear of physical aging which required her to slow down. Doing volunteer work, and teaching had helped her find meaning in her life. Although she still participates in some volunteer work, she is no longer teaching, and is struggling with finding meaning in life after retirement. This has caused significant distress for her, and has resulted in depression.
Other reasons for psychological distress are systemic barriers or contextual factors; these include racism, sexism, and oppression. Systemic barriers also include the stressors of dealing with health care disparities, harmful work and living conditions due to one’s socioeconomic status.
Lacking interpersonal skills also contributes to the deterioration of psychological well-being (Stuart & Robertson, 2003). We are social beings, and cannot exist in a vacuum. Inability to communicate and interact with others adaptively will inevitably result in dissonance.
In addition to biological factors I believe that psychological distress or mental illness is caused by the application of maladaptive coping responses to a stressful situation, an attempt to find meaning in life, the stressors of systemic and contextual factors that negatively effect the person’s health and well-being, and a lack of interpersonal skills. My conceptualization of the causes of psychological distress or pathology as outlined above are heavily influenced by my worldview, my values and beliefs, which in turn influences my clinical work. I believe that psychotherapy seeks to help the individual reinstate psychological well-being by helping her/him develop a set of coping tools to help with current and future stressors.
Theoretical Orientation and My Worldview: The Intersection
A pervasive influence in my life is that of faith. I lean on my religious/spiritual (the two are intertwined for me) beliefs in daily decision making. The theoretical framework which I adopt needs to be in concordance with my spiritual beliefs. Three primary theories which I feel are directly linked to my spiritual beliefs are existential, multicultural and feminist theories. Existentialism appeals to me as it is concerned with finding meaning in one’s life (Yalom, 1980). Feminist theories appeal to me due to their emphasis on egalitarian relationships and recognition of systemic barriers (Worell & Remer, 2003). Finally, multicultural theories acknowledge and are tolerant of diverse cultures and ways of being (Sue & Sue, 2003).
Interpersonal relationships are very important to me. We are social beings, and the maintenance of a social support network is imperative to our psychological well-being. Socialization begins at birth and spans throughout our lifespan. Involvement in a maladaptive interpersonal relationship and/or lacking interpersonal skills negatively affects our psychological well-being. The importance I place on interpersonal relationships suggests that I concur with the Interpersonal Therapy (IPT) approach as postulated by Stuart and Robertson (2003).
Past events and experiences leave indelible marks on our psyche and it is important to recognize their impact on current functioning. The consideration given by psychodynamically oriented theories is therefore an element that I can relate to. Finally, I also believe that we have the power to influence our actions via our thoughts and vice versa. This belief is reminiscent of cognitive behavioral theory (DeRubeis, Tang, & Beck, 2001), and is summed up nicely by Satan in Book IV of John Milton’s epic poem Paradise Lost:
“The mind is its own place, and in itself
Can make a Heav’n of Hell, a Hell of Heav’n.”
The theories that have had an influence on the development of my theoretical orientation consist of existential, feminist, multicultural, interpersonal, psychodynamic, and cognitive behavioral theories. Dr. Enekwechi was right, theories are mere explanations! For me the medley of these theories helps to explain the complete psychological experience of an individual. It is important to note that my clinical practice does not fully coincide with the theories that I have outlined above. Rather than relying on the theories outlined above in practice my primary theoretical orientation is solution-focused therapy, and it is evident in the majority of my clinical work. I still ‘try on’ theoretical orientations mentioned above. For instance, I have used IPT with a client who was experiencing significant distress in her primary relationship. However, using orientations other than solution-focused is an intentional process for me. I believe that solution-focused therapy is a natural fit for me, due to its emphasis on client strengths and focusing on creating solutions (Miller & deShazer, 2000). Also, I believe that the development of my orientation has been influenced by the context of the settings I have worked in.