Counsellors and psychotherapists play a significant role in alleviating mental disorders in society. The definition, organisation, and intervention of mental health are dependent upon the present context of a culture and society. There are various professional roles in the mental health sector such as psychiatrists and psychologist who are responsible for different aspects of alleviating mental health; however psychotherapists and counsellors mainly take on the professional helper role in the biopsychosocial context.
Mental health and wellbeing is an essential part of an individual’s life and the community that they re a part of; alleviating mental disorders is part of supporting and helping an individual live a meaningful life. Definitions of and Approaches to Mental Health The World Health Organisation (2001) define mental health as a state of well-being in which every individual is aware of their potential, is capable of working efficiently, can cope with ‘normal stresses’ of life, and contribute to their community.
Moreover, WHO describe mental health as interconnected with physical health and more than the absence of illness, (2005 as cited in Mehta, Croudace & Davies, 2015, p. 1472; WHO, 1948 as cited in Huber et al. 2011, p. 1; Bowler, 2008 as cited in Fitzpatrick, 2010, p. 61). A biomedical approach to mental illness would suggest that a disorder such as depression is the result of a genetically induced imbalance of neurotransmitters (Berk, 2014, p. 421). However, this approach falls short in the fact that it views the physical body as independent of social and cultural influences (Holmes, Hughes & Julian, 2015, p. 159).
That being the case, Straub like many others suggests that mental health is a multi-dimensional state which branches out into the domains of biological and psychological processes, and social influences y which all three effect one another, otherwise known as the biopsychosocial model, (2002, pp. 6-7). The biopsychosocial model strives to explain why one individual may experience a ‘mental illness’ while another individual may consider it as a ‘problem of living,’ by evaluating the contribution of biological, psychological and social factors to mental dysphoria, (Engel, 1997 as cited in Kerridge, Lowe & Stewart, 2013, p. 12).
Engel argues that the biopsychosocial model is merely a shift in how the biomedical framework is perceived by physicians in the sense that “the model serves to counteract the often wasteful eductionist pursuit of what often prove to be trivial rather than crucial determinants of illness,” (1980, p. 543). Therefore a biopsychosocial model is more inclusive than a biomedical model and well suited to social work, psychotherapy and counselling. Nature: Biological causes One of the main focuses of the biology behind mental illness is the neurochemical and genetic influence.
Passer and Smith propose that depression may be a result of the underactivity of neurotransmitters such as dopamine and serotonin within the brain that produce reward and pleasure, (2013, p. 564). In a imilar notion, Brown (2007) suggests that neuroticism, a behavioural inhibition system (BIS) and extraversion, a behavioural activation system (BAS) are both activated by cues that generate pleasure. Depression can be predicted by high BIS sensitivity and low BAS activity, (Lonnqvist et al. , 2009 as cited in Passer & Smith, 2013, p. 564).
Weiner, in his theory of human attribution explains that the negative stigma around mental illness may lead to social avoidance and irritation which could be avoided if the ‘biological roots’ of mental illness are considered, (1995 as cited in Patrick, Corrigan & Watson, 2004, p. 77). However, studies such as those of Mehta and Farina (1997) as well as Phelan (2002) argue that if only biology alone is considered, social behaviour towards the mentally ill become ‘harsher’ and that stigma in the past has been linked to execution, sterilization and marriage restrictions as a result, (as cited in Patrick et al. 2004, p. 478).
Fortunately, contemporary society has found reasonable ways of handling mental illness. While anti-depressant medication has shown to improve the activity of neurotransmitters (Gotlib et al. , 2004 as cited in Passer & Smith, 2013, p. 2013, p. 564), the ‘dominance of the harmaceutical approach’ to mental health which is underpinned by the biomedical approach, has converted the social construction of disease into “political explanations for health problems and for valuing free-market victories over social justice goals,” (Moynihan et al. 2002; Brezis, 2008 as cited in Jenkins, 2013, p. 5).
Nurture: Environmental causes It is not to say that biology does not play a part in mental health but that it is not a factor that stands alone. Schmidt explains that the mental health of an individual may be altered by psychological stressors interacting with genetic vulnerability and ence whether in combination or alone, psychosocial and physiological stressors can interact with brain chemistry (2007, p. A406). Straub (2002, p. 1) suggests that behaviour and biology often interact and are the reason behind why one individual may develop mental illness more than another. In support of this, Berk (2014, pp. 421-422) puts forward that parents with psychological disorders ‘often engage in maladaptive parenting’ which can impact their child’s ’emotional self-regulation, attachment, and self-esteem’. Considering this, genetic predisposition to mental illness may also be triggered by ife events rather than genetics alone.
Bowlby and Ainsworth have developed the ethological theory of attachment which strives to explain how important an infant’s relationship and ‘security’ with its caregiver is to its psychological development, (Bretherton, 1985 as cited in Knabb & Emerson, 2013, p. 827). Children form perceptions of themselves and others by the ‘working model which they develop throughout childhood suggesting that securely attached children develop positive expectations while insecure children perceive themselves as ‘incompetent’ (Bowlby, 1973 as cited in van der Voort, Juffer & Bakermans-Kranenburg, 2014, p. 169). However, Uher proposes that genetic influence to mental illness has caused stigma and “left little room for preventative or curative interventions short of extreme measures” in the same way that psychosocial contribution has involved ‘parent blaming’ and “obscure therapies leading patients to search for non-existent traumata,” (2013, p. 67).
Considering the negative implications of a one sided approach, Rutter has proposed that the events that an individual experiences in life affects their mental perceptions and “models of themselves and of their environments,” (2005, p. ). Similarly, Michael Meaney’s study has found that the environment affects genes (Weaver et al. , 2004 as cited in Rutter, 2005, p. 5). Psychotherapy: Approaches, goals and culture Across all cultures are different beliefs and perceptions of mental illness and what it means.
When comparing India to the United States, Marrow and Luhrmann put forward that the beliefs around moral responsibility, access to psychiatric services, and the perceptions of family honour push Indian families to “hide family members with severe psychosis within their homes” meanwhile American individuals with psychosis re ‘abandoned’ and left homeless or within a mental institution, (2012 as cited in Cifti, Jones & Corrigan, 2013, p. 22).
Additionally, Mandel states that within the extremes of Christianity, “all religious experience has been labelled as psychosis” in psychiatry until it was introduced in the DSM-IV in 1994 that mental health professionals should respect client’s beliefs and rituals (1980 as cited in Dein, 2010, p. 28). Therefore, throughout history, the mental health sector constantly changes and adapts to contemporary attitudes and openness. One of the key components of psychotherapy is to tailor counselling oals and techniques around each individual including their cultural and religious beliefs without prejudice (McLeod & McLeod, 2011, p. 08). Psychotherapy plays an important role in alleviating mental health as well as management or recovery from mental disorder. The term recovery attempts to “shift the narratives from symptom reduction to a focus on overcoming difficulties and living more meaningful lives,” (Anthony, 1993 as cited in Atkins, Colville & John, 2012, p. 183).
Additionally, psychotherapy could be seen as a form of teaching an individual the skills to cope with day to day life and make them feel a part f their community, starting at the level that the client is on and working towards a better lifestyle (Watkins, Lewellen & Barrett, 2001, p. 59). A psychotherapist or counsellor may collaborate with other human service professionals such as psychiatrists, nurses, psychologists and occupational therapists, (Chenoweth & McAuliffe, 2015, p. 171). The Transtheoretical Model was developed by Prochaska and DiClemente (1984) who have identified the ten core principles of therapeutic change within psychotherapy, regardless of method.
Watkins and colleagues propose that a higher chance of therapeutic success is prevalent he more processes are used together, (2001, pp. -8). The ten processes of change include: consciousness raising, self- liberation, social liberation, counterconditioning, stimulus control, self-re-evaluation, environmental re-evaluation, contingency management, dramatic relief, and helping relationships, (Watkins et al. , 2001, pp. 6-8). The key goal of psychotherapy is to help clients identify their strengths, assist in clarifying who they want to be, gain an honest outlook on their own behaviour, and modify their life (Corey, 2005, p. 33).
Corey states that the professional role of a psychotherapist is largely ependent upon the client population, particular therapeutic interventions used, and the work setting, (2005, p. 33). Furthermore, Alfred Adler in defending therapy placed emphasis on understanding the ‘interpersonal nature of behaviour’ and assisting in change processes more so than analysing ‘intrapsychic processes,’ ( Watts & Carlson, 1999, p. 17). Despite the efforts within the counselling space, the outcome of psychotherapy may be determined by external circumstances such as inconsistent goals, stigma, criminalisation, and waiting lists, (Miller & Carroll, 2006, pp. 0-211).
Goffman defines stigma as “the situation of the individual who is disqualified from full social acceptance,” (1963, p. 9) and stigma prevents individuals from seeking help and makes them feel alienated from their community and wider society. Additionally, particularly with substance abuse disorders, one of the barriers would be admissions criteria where in some cases, individuals seeking help after visiting multiple professionals may be denied treatment because they are perceived as ‘incurable,’ (Miller & Carroll, 2006, p. 2). However, according to the Australian Association of Social Workers (AASW), human services workers like that of psychotherapy and counselling are required to work with integrity and uphold professional policies and procedures rather than personal views and so, stigma within the setting of psychotherapy is unethical, (McDonald, Craik, Hawkins & Williams, 2011, p. 266).
In the case of a complex traumatic stress disorder; Fosha, Paivio, Gleiser, and Ford propose that experiential and emotion-focused therapy involves traditions from various therapeutic styles such as those of client-centred, existential, Gestalt, cognitive behavioural, psychodynamic, and relational analytic therapy, (2009, p. 287). Coupled with therapeutic techniques, Fosha and associates (2009, p. 7) suggest that: “An empathy-based therapeutic relationship is the foundation to enlarging the trauma survivor’s perspective from preoccupation with danger and damage to a fuller experiencing on oneself as alive and of one’s life and relationships as having fundamental worth and meaning. ” Similarly, Steenkamp, Litz, Hoge & Marmar found in their study that cognitive processing therapy (CPT) and exposure therapy were the most helpful therapy in alleviating military related post-traumatic stress disorder; however, 60-72% of participants retained symptoms post therapy and nonresponse was large, (2015, p. 9).
Considering this, it could be said that an integrative approach within psychotherapy “overcomes the limitations of a single model,” (Boswell, Nelson, Nordberg, McAleavy & Castonguay, 2010 as cited in PACFA, 2013). Wampold considers an integrative approach as the ‘common factors approach’ in which therapeutic techniques do not hold as much importance to positive outcomes as much as the counsellor-client relationship, promoting support and acceptance, and facilitating new perspectives (2010 as cited in PACFA, 2013).
Supporting mental health and wellbeing within the community is an important aspect of each individual’s life. Supporting mental health can prevent prejudice, stereotypes, bullying and alienation where a community can gain knowledge on an important part of life and make wider society a more accepting, understanding and an empathic environment for everybody, (Corey, 2005, p. 33; McLeod & McLeod, 2011, p. 18). Conclusion As a final point, psychotherapy and counselling is one of the various aspects of mental health work alongside psychologists and psychiatrists.
Regardless of techniques used and frameworks, the role of a psychotherapist is to help individuals become stronger and live a fulfilling and meaningful life (Corey, 2005, p. 33). The cultural context is an important aspect of how society and the community view mental health and how this impacts perceptions, acceptance and the availability of services. While there have been an endless amount of changes within a psychotherapeutic approach to mental health, they are important in reflecting upon, maintaining and progressing the quality of knowledge and service to the community and thus, society as a whole.
