Integrative Therapy Using Clarkson’s Model and Related Approaches Case Study

Background

It is crucial for a therapist to have a personal belief system that aligns with one’s chosen approach when working with a client. This case study integrates Clarkson’s model of integration with other models, such as Carl Rogers’ person-centered, Bowlby’s attachment theory, and Winnicott’s holding and mirroring. I will also briefly describe Sigmund Freud’s psychodynamic approach, Heinz Kohut’s holding self, and Melanie Klein’s theory.

Additionally, I will outline how my personal belief system aligns with my approach and how I have used my countertransference to inform my interventions with MW, a 34-year-old woman who sought therapy due to feelings of sadness, anxiousness, and emotional overload. Finally, I will hypothesize how it might have been different if I had offered an alternative approach, such as CBT or solution-focused therapy.

Client’s History and Presenting Issues

The client in this case study is MW, who is married and thirty-four years old. She has two children, and both are below five years old. For seven sessions now, MW has been coming to therapy because she is dealing with three issues: low mood, anxiety, and overwhelming feelings. Additionally, MW also reports that she has self-harmed in the past.

While her husband has always been supportive in helping deal with her issues, MW and her mother have a rocky relationship; they do not seem to get along. Recently, after the seven sessions, MW stopped coming to therapy, claiming that the sessions are not helping her feel better, and she thinks counseling is not helpful. Without counseling, these issues might overwhelm MW and affect how she relates to people around her, like her children, husband, and mother.

Personal Methods of Integration

As a therapist, I would like to incorporate Clarkson’s integration model in MW’s next therapy session. It will help her attain the desired outcomes and prevent her from quitting due to dissatisfaction. My method of integration in counseling is based on Clarkson’s model of integration, which emphasizes the integration of different models of therapy, including person-centered, cognitive-behavioral, psychodynamic, and transpersonal.

Clarkson’s model suggests that the therapist should be flexible in their approach, adapting to the client’s needs and preferences while remaining grounded in theory and practice. The therapeutic relationship is crucial for mental and emotional growth, and holding and mirroring techniques can foster a secure and encouraging space for clients to reflect on their emotions and life events. In working with MW, I integrated elements of different modalities depending on her presenting issues and responses. Since childhood, I have always believed that a person can solve their problem when they share with others they trust.

Core Model and Modalities

As mentioned earlier, my approach draws on Clarkson’s integrative model, which emphasizes the importance of establishing a strong therapeutic relationship and exploring and integrating a range of therapeutic modalities to best suit the client’s needs. This approach is consistent with my personal belief system, which values the importance of empathy, genuineness, and unconditional positive regard in therapy. I believe that every individual has the potential for growth and change, and the therapeutic relationship can be a powerful tool for facilitating this process.

Core Model: Clarkson’s Model of Integration

Petruska Clarkson’s 5 Relationship Model was her lasting memory in her thesis on human relationships based on the philosophical idea of intersubjectivity presented in Clarkson’s Overview. In her work, she identified five therapeutic relationships: the working alliance, the transpersonal relationship, the reparative relationship, the transference/countertransference relationship, and the real relationship (Clarkson, 1990, p.149). The counseling relationship might contain all five therapeutic partnerships at once. However, more frequently, there is one dominant relationship, or two or three, and the dominant therapeutic relationship tends to vary during therapy.

Clarkson’s integration model is based on the importance of the relationship between a client and a therapist. According to her, an effective relationship between these two individuals often leads to successful therapy. Much research supports Clarkson’s hypothesis in the model on the impact of the therapist-client relationship (Wilmots et al., 2020). For instance, the American Psychological Association affirms that “a number of relationship factors—such as agreeing on therapy goals, getting client feedback throughout treatment, and repairing ruptures—are at least as vital to a positive outcome as using the right treatment method” (DeAngelis, 2019, p. 2).

Since the relationship is the center of this model, every time a therapist is working with a client, Clarkson notes that it is vital to understand all five aspects of the client-therapist relationship. These five elements of a therapeutic relationship serve as an organizing framework that enables therapists to integrate various ideologies into a unified whole. MW stopped coming to counseling after seven sessions, claiming that it was not helpful because she did not get any better. To improve things and help her overcome the issues she is experiencing, the therapist will apply the Clarkson approach to MW.

Firstly, MW’s dissatisfaction can be blamed on the failure of the first and second therapeutic relationships in Clarkson’s model. While we had been together for seven sessions, there seemed to be a lack of a strong bond between us, and that is why MW claimed that the process was not helpful to her. Therefore, I must utilize Clarkson’s model’s first, second, and third therapeutic relationship aspects to amend this.

In Clarkson’s model’s second aspect of the therapeutic relationship, I will avoid transference and positively utilize countertransference. However, after the seven sessions failed and MW felt dissatisfied, we did not build a shared understanding and foundation; hence, we needed to repair their alliance again (Clarkson, 1990, p. 152). Therefore, the two must begin by recreating their working partnership, ensuring they meet during all session times, and making the client feel safe again.

Once the alliance is rebuilt, there is a high possibility of maladaptive transference in the second relationship aspect, which might affect the therapeutic relationship. However, as Clarkson notes, I must be much more vigilant and avoid being unjust to the client because something they have or have said relates to their past. Therefore, based on Kohut’s theory, to help the MW through the transference, I will empathize with her by echoing, affirming, celebrating, valuing, and honoring clients’ pride in their achievements. I will avoid maladaptive transference by being interested in MW’s issues, asking about her past, how she feels talking about it, and how she feels about sharing it with the therapist.

Patient-Centered Approach

Carl Rogers’s person-centered approach is a non-directive approach to talk therapy. It is based on the belief that the client is the expert on their life and experiences. The therapist creates a non-judgmental and empathetic environment, enabling the client to explore their feelings and experiences freely. This approach requires the therapist to act as the main guide or source of hope to the client, as the client takes the reins during each session (“Week 6: Person-centered approach”).

In my work with MW, I created a safe and supportive environment where she could express her feelings without fear of judgment. I will use active listening, empathetic responses, and open-ended questions to help her explore her thoughts and emotions. This is unlike Clarkson’s integration model, which requires the therapist to take the lead and build a relationship with the client rather than let them run all the sessions.

Attachment Theory by John Bowlby

The attachment theory suggests that humans naturally need to form ties with their caregivers while young. Early connections can still impact attachments later in life (Wilson-Ali, Barratt-Pugh, and Knaus, 2019). Additionally, they are essential for emotional and psychological development and influence how we relate to others in adulthood.

In my work with MW, I will explore her attachment style and how it affected her relationships with others, particularly her mother. I will use the therapeutic relationship as a secure base to help her feel safe and supported. In relation to Clarkson’s approach, his theory allows clients to move from relating insecurely to relating more positively to their therapist.

Winnicott’s Holding and Mirroring

Winnicott’s holding and mirroring approach emphasizes the importance of the therapist’s attunement to the client’s needs and experiences. The therapist “holds” the client emotionally and provides a safe space for them to explore their feelings while also “mirroring” their experiences and validating their emotions (Winnicott, n.d.). In my work with MW, I used elements of holding and mirroring by validating her emotions, providing emotional support, and attuning to her needs.

Self-Psychology by Heinz Kohut

Self-psychology theory strongly emphasizes the discovery of the essential building blocks of effective development and growth, as well as the development of empathy for the patient. Therapists may use self-psychology theory to guide patients in thinking about how their early experiences may have shaped who they are today (Baker, 2021). In relation to Clarkson’s transference relationship, the therapist aids the client in working through this transference by imitating, praising, applauding, appreciating, and respecting the client’s sentiments of pride in their accomplishments (Kohut, 2022). If a therapist is empathetic, the client starts viewing them as a “self-object,” which reawakens their met needs, and the client opens up.

Sigmund Freud’s Psychodynamic Approach

The psychodynamic theory, as proposed by Freud, emphasizes the role of the unconscious mind in shaping a person’s behavior and emotions. Freud believed that early childhood experiences and conflicts could affect an individual’s psychological development, leading to emotional distress in adulthood (“Week 5: Counselling theories”). In MW’s case, her rocky relationship with her mother may have contributed to her low mood and anxiety. Using psychodynamic techniques, such as free association and dream analysis, I would explore her past experiences to help her gain insight into her current difficulties.

Melanie Klein’s Theory

According to Klein’s triangle of insight theory, the therapy connection is crucial in providing a secure environment in which clients can examine their emotions. The client, the therapist, and the client’s inner world make up the triangle of insight. The therapist’s job is to help the patient talk to their inner selves and develop an understanding of their feelings and actions. In MW’s case, I would focus on building a collaborative relationship with her and exploring her internal world to help her gain insight into her emotional difficulties.

Working Repetitively Using Countertransference

While working with MN, it is possible that some of her stories might remind me of a given experience, making me angry or frustrated. Sometimes, these moods can relate to my unresolved past and affect how I behave with MW. However, I can utilize my countertransference to inform my interventions. I may explore my feelings and experience with a past event to help me empathize with MW’s experience. Additionally, with an influence from my transference, I can also be attuned to MW’s unconscious feelings towards her past.

Progression of the Relational Modalities

The Working Alliance modality progresses linearly because it includes some elements, including setting goals for the therapy. However, it also involves some non-linear elements, like the continuous building of trust between the therapist and client and the adjustment of goals. The Transference/Countertransference Relationship modality progresses mirroring the beginning because it involves the client bringing up their experiences, which might trigger unresolved therapy issues. However, since the reparative modality involves revisiting the past, it only progresses linearly but cyclically. Lastly, the last two modalities have a linear progression.

Alternative Approach: Cognitive Behavioral Therapy (CBT)

For a long time, therapists have often utilized CBT to address many issues, including alcohol and drug abuse, anxiety, depression, eating disorders, marital problems, and severe mental health issues. While working with clients, CBT therapists often emphasize helping their clients learn to be their own counselors. This is achieved by assisting clients in developing skills to solve problems they encounter and by giving them exercises. They tend to emphasize what is happening in the client’s life rather than what led to the issue (David, Cristea, and Hofmann, 2018). When incorporated into MW’s intervention, CBT will help her develop the relevant skills for coping with low mood, anxiety, and extreme emotions.

Impact of Long-Term or Short-Term Working with Clarkson’s Model

Long-term work with Clarkson’s model would give the client enough time to trust the therapist and begin receiving the necessary interventions. On the other hand, short-term work with this model might not give MW enough time to bond with the therapist and make her dissatisfied again with the services.

• Hypothesis 1: Short- rather than long-term. CBT will offer better outcomes.
• Hypothesis 2: Long- rather than short-term. Clarkson’s approach would have offered better outcomes for MW.

Reference List

Week 5: Counselling theories: Humanistic philosophy. NCFE CACHE Level 3 Award in Counselling Skills and Theory. Lecture Notes.

Week 6: Person-centered approach. NCFE CACHE Level 3 Award in Counselling Skills and Theory. Lecture Notes.

Baker, A. (2021) ‘A defense of Kohut’s “self“,’ Psychoanalysis, Self and Context, 16(1), pp.85-93. Web.

Clarkson, P. (1990) ‘A multiplicity of psychotherapeutic relationships,’ British Journal of Psychotherapy, 7(2), pp. 148-163. Web.

David, D., Cristea, I. and Hofmann, S.G. (2018) ‘Why cognitive behavioral therapy is the current gold standard of psychotherapy,’ Frontiers in Psychiatry, p.4. Web.

DeAngelis, T. (2019) ‘Better relationships with patients lead to better outcomes.’ [Online] Web.

Wilmots, E. et al. (2020) ‘The therapeutic relationship in cognitive behaviour therapy with depressed adolescents: A qualitative study of good‐outcome cases,’ Psychology and Psychotherapy: Theory, Research and Practice, 93(2), pp. 276-291. Web.

Wilson-Ali, N., Barratt-Pugh, C. and Knaus, M. (2019) ‘Multiple perspectives on attachment theory: Investigating educators’ knowledge and understanding,’ Australasian Journal of Early Childhood, 44(3), pp.215-229. Web.

Winnicott, D. (n.d.) Child development & the therapeutic relationship. Lecture Notes.