Introduction
This paper looks at the application of counseling theories in the management of alcoholics. Alcoholism is defined as a primary disorder in which a person loses control over drinking and is habituated or addicted to alcohol (Gifford, 2010). If a person continues to drink even when the drinking affects his/her physical, mental and social health or compromises job and/or family responsibilities he/she is said to be an alcoholic (Clinebell, 1990). An alcoholic has physical dependence on the alcohol and the person may develop withdrawal symptoms should the alcohol be withheld from them. Genetic factors, psychological factors, and cultural influences contribute to the development of alcoholism (Clinebell, 1990). Alcoholics need counseling to help them stop the dependence and get their lives back.
The case of John M
John M., a twenty nine year old man, presents with a drinking behavior which his friends think is alcoholism. He reports to have started drinking at the age of sixteen years. His father, who drinks daily, was the one who introduced him to alcohol (Bryant-Jefferies, 2001, p 35). There was a constant stock of alcohol for his father at home and he could drink anytime since his parents never objected. His peers were also into drinking alcohol and john was under pressure to start drinking so as to fit in. John then joined his peers in their drinking exploits and he has never stopped drinking since then. He reports that he takes at least six drinks per session on several occasions in a week (Gifford, 2010). The amount of alcohol he needs to get drunk has been increasing over the years and he spends much of his income on alcohol. Currently he experiences episodes of shaking on mornings after a night of drinking and he has to take some alcohol to calm down. Whenever his friends tell him to reduce his alcohol intake he reacts angrily and can even get violent. John cannot sustain a relationship for long and he says that the break-ups are due to his excessive drinking habits. He even feels sorry for himself at times and wishes that he could stop drinking but according to him it is beyond his control. His boss at work has cautioned him severally for going to work while drunk and failing to carry out his duties but he has continued to drink despite his job being at risk. Though initially he used to drink with his friends currently he drinks alone and even avoids them because he feels they distaste his excessive intake of alcohol. He does not get involved in activities with others but prefers to sit alone and drink. John drinks even at the expense of food and this has affected his physical health. He has been admitted twice in a hospital on account of alcohol intoxication. His drinking has become so bad that he needs a drink daily to get him started (Gifford, 2010). He cannot function well without alcohol. He has had to make excuses on several occasions at work to go and drink. John reports of blackouts after episodes of heavy drinking.
John M. belongs to a group of people who grow up in social settings with high acceptance of alcohol use. Easy access to alcohol and peer pressure also contributed to the development of his drinking habits.
Theories of psychotherapy for treating alcoholics
Psychotherapy is defined as a practice of treating sick people by influencing their mental life and it entails techniques which are believed to help solve or cure behavioral and psychological problems (Mnsterberg, 2010, p. 1). These techniques involve direct contact between the therapist and the patient. The contact is mainly through talking and thus issues to do with client confidentiality and also patient privacy have to be observed (mnsterberg, 2010, p. 1)
Many theories on psychotherapy and counseling have been advanced and used for therapeutic purposes. These theories include; psychoanalytic, analytical/Jungian, adlerian, self-psychology, time limited dynamic, client-centered, existential, gestalt, behavioural, cognitive, reality, family systems and biofeedback (Chan, Berven, & Thomas, 2004). This paper looks at two theories of psychotherapy suitable for treating alcoholics. These theories are client-centered theory and psychoanalytic theory.
Client-centered theory
It is also called the Rogerian theory. This theory requires that the psychological recovery process is directed by the client (Peele, 1984). It is centered on self-esteem enhancement, expansion of self awareness and increased self-reliance. The client is valued for what they bring to sessions and is regarded as expert. The therapist guides sessions non-directly. Heavy emphasis is put on not telling the client what to do but enabling and empowering him/her to discover his/her own solutions. With a proficient therapist using this approach, clients feel understood and thus drop their guard and talk (Peele, 1984, p. 415). This theory draws from the postulation that ‘if I accept myself just as I am, then I can change’. In this theory, therapists use reflection mirroring back to the client to see if his/her words capture what the client feels. The therapist should have non-possessive warmth, a process in which the therapist cares and values the client without imposing their will or passing judgment on them, and they should also have empathy and hence see life from the perspective of the client (Gray, 2007, p. 73)The client needs to achieve self discovery and actualization. The client centered theory has been useful in treatment of drug addictions and in alcohol rehabilitation centers (Gray, 2007, p. 96).
Psychoanalytic theory
The psychoanalytic theory is based on a concept that states that individuals are not aware of the factors that lead to their emotions. It is an interpretive discipline and the work of psychoanalysts is usually linked to patient’s relations and interactions with other people. In psychoanalysis, the patient talks to someone, the psychoanalyst, and his/her relation with and understanding of that person to whom he/she is talking shapes his/her communication (Greenberg & Mitchell, 1983, p. 9). In psychoanalysis, the objective of treatment is for both psychoanalyst and patient to bring out the constituents of relational ties which lead to their psychological state and reformulate them for recovery (Greenberg & mitchell, 1983, p. 9). Seen in this light then, the needs for treatment of alcoholics can be met by the psychoanalytic theory. The analyst’s interventions involve confrontation and clarification of a patient’s pathological defenses.
Treatment plan for John M
The goal of treatment of alcoholism is to achieve abstinence or moderation (Gifford, 2010). To achieve total abstinence, family support and a social background which is very strong are necessary. These will help the patient avoid high risk situations which may tempt him/her to take alcohol. Moderation is simply reduction of the amount of alcohol that the patient takes (Gifford, 2010). Psychotherapy and alcoholism counseling are useful in the treatment of alcoholism (Maltzman, 2008, p. 25-26). Both the client-centered theory and the psychoanalytic theory can be used in the treatment of alcoholics. The treatment of John M. who is an alcoholic can be achieved by any of the two theories. This is to be achieved through group therapy sessions and sessions between John and the therapist. During the group therapy sessions, Psychoanalysis will be used to try identifying the psychological ties which would have lead to alcoholism and then reformulating them to suit recovery from alcoholism.
The client centered theory comes in as the therapist lets John guide his own process of recovery (Client-centered therapy, 2010). This is done during sessions between john and his therapist where the therapist listens to and reflects what John says (Client-centered therapy, 2010). In these sessions the client comes up with his own solutions which are not imposed on him by the therapist.
John’s cultural background is essential in formulating the treatment plan as drinking styles and attitudes towards alcoholism vary from culture to culture (American psychologist, 1984). Disparities in race and ethnic groups affect alcoholism treatment as they may give an idea as to the need of, access to, appropriateness and quality of care (Schmidt, Greenfield and Mulia, 2006). The counselor’s own cultural perspective may influence his/her perception of the progress and response of the patient to treatment (Chapman, 1988). Coupling the counselor’s sensitivity to cultural issues affecting the client with professional skills, proficiency at his/her work, appropriate technique and a good understanding of the patient’s needs best serves the interests of doing therapy to a patient who is culturally different from the therapist (Chapman, 1988). John M will therefore be managed in group therapy sessions and visits to a therapist who understands his cultural background.
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