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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
A novel integrative approach to psychotherapy targeting various aspects of human functioning across temporal dimensions
The Internal Cohesion Theory and Psychotherapy offers a novel approach to understanding human psychological experiences and fostering internal cohesion to maintain optimal mental health or prevent the development of psycho-emotional and psycho-social disorders. In this groundbreaking book, renowned scholar in psychotherapy research, policy, and practice Dr. Fitim Uka presents a holistic framework—Internal Cohesion Psychotherapy (ICP)—to help practitioners reshape their clients’ connections with their past, present, and future experiences.
Rooted in Internal Cohesion Theory, ICP integrates evidence-based knowledge in the fields of psychology and psychotherapy, seeking to harmonize the intrapersonal, interpersonal, professional, and spiritual to create positive change in people’s lives and support well-being. Dr. Uka provides step-by-step guidance on developing efficient and effective treatment plans in a variety of treatment environments while demonstrating how appreciating the complexity of the therapeutic relationship can minimize the impact of adversity on clients.
Featuring a wealth of real-world insights and concise guidelines for practitioners wanting to implement ICP in their practice, The Internal Cohesion Theory and Psychotherapy an indispensable resource for all clinicians, researchers, social workers, therapists, psychologists, and policymakers devoted to improving individual and collective mental health worldwide.
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Seitenzahl: 292
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
Foreword
Preface
Acknowledgments
1 Toward a New Eclectic Approach
1.1 Introduction
1.2 Psychopharmacology and/or Psychotherapy
1.3 The Dilemma of Choosing Among Hundreds of Psychotherapeutic Approaches
1.4 The Ever‐Present Challenges of Psychotherapy
1.5 Looking for Answers
1.6 Four Conclusions at the Beginning of the Book
2 Internal Cohesion Theory as an Alternative
2.1 The Intersection of Time and Human Experience
2.2 What Is Time?
2.3 Life as a Reflection of Time, and Time as the Source of Problems and Solutions
2.4 On the Past
2.5 On the Present
2.6 On the Future
2.7 On Internal Cohesion as a Prerequisite for Psychological Health
3 Systems of Internal Cohesion Psychotherapy
3.1 The Structure of Internal Cohesion Systems
3.2 How Does the Dynamic System Work?
3.3 Internal Cohesion Systems—A Closer Look
4 An Evidence‐based Theory and Therapy
4.1 Methodology
4.2 Results
5 The Source of Problems and Mental Disorders Through the Lens of ICP
6 How to Intervene? The New Path Deriving from the ICP Perspective
6.1 The Purpose of Therapy
6.2 Intervening in the Client's Relationship with the Systems in the Past
6.3 Intervening in the Client's Relationship with the Systems in the Present
6.4 Intervention in the Client's Relationship with the Systems in the Future
6.5 Time—A Valuable Intervention Asset
6.6 Intervention in the Relationship of the Individual with the Systems
6.7 The Therapeutic Process in ICP
6.8 Internal Cohesion Therapists
7 Therapeutic Techniques of ICP
7.1 Movement in Time
7.2 Honest Intracommunication
7.3 Multiple Reflections
7.4 The Client as the Therapist
7.5 Acceptance and Embrace of the Past
7.6 Embrace and/or Transform
7.7 Functional Scenario Exploration
7.8 Compensation
7.9 Strength‐Based Self‐Evaluation List
7.10 Integrated Processing and Boundary Setting
7.11 Spiritual Reflection
7.12 Listing, Weighing, and Addressing
7.13 Rational Planning
7.14 Time‐Framed Visioning
7.15 The Routine Change
7.16 The New Challenge
7.17 Time Awareness Journaling
7.18 Artistic Exploration for Internal Cohesion
7.19 Narrative Reconstruction
7.20 Relationship‐Centered Communication
7.21 Album Therapy for Family Dynamics
7.22 Worst‐Case Scenarios
7.23 Whole Canvas Perspective
7.24 Prayer, Forgiveness, and Meditation
7.25 “Things I Would Never Do”
7.26 Hypothetical Situations
7.27 Who Are You Today, and to Whom Is It Attributed?
7.28 Achievement Reflection List
7.29 Adversity as Opportunity
7.30 Purposeful Yes or No Assessment
7.31 Emotion Diary
7.32 Psychoeducation
7.33 Homework
7.34 Other ICP Techniques and Strategies
8 Testing the Effectiveness of ICP
8.1 Sample and Procedure
8.2 Research Equipment
8.3 Data Analysis
8.4 Results
8.5 The Influence of ICP on Mental Health Outcomes
9 Application, Limitations, and Perspective of ICP
10 The Ending as a New Beginning!
Appendix A
References
Index
End User License Agreement
List of Tables
Chapter 4
Table 4.1 Demographic Characteristics of the Sample
List of Illustrations
Chapter 4
Figure 4.1 Relationships between the past, present, and future.
Note:
This ...
Figure 4.2 Relationships between past, present, and future interpersonal re...
Figure 4.3 Relationships between past, present, and future professional rel...
Figure 4.4 Effects of past, present, and future relationships in the spirit...
Figure 4.5 Interconnection of systems in the past.
Note:
This figure illust...
Figure 4.6 Interrelationships among intrapersonal, interpersonal, spiritual...
Figure 4.7 Interdependent relationships among intrapersonal, interpersonal,...
Figure 4.8 Patterns of interconnections among different systems over time.
Figure 4.9 Correlation between intrapersonal communication and spiritual be...
Figure 4.10 Interplay between intrapersonal and professional systems over t...
Figure 4.11 Interaction between spiritual and interpersonal systems over ti...
Figure 4.12 Interaction between interpersonal and professional systems over...
Figure 4.13 Interaction between spiritual and professional systems over tim...
Chapter 8
Figure 8.1 Changes in the client's intrapersonal system before and followin...
Figure 8.2 Graph that demonstrates a substantial increase in self‐regulation...
Figure 8.3 Graph that illustrates a noteworthy increase in self‐esteem after...
Figure 8.4 Observed change in motivation levels among clients undergoing IC...
Figure 8.5 Pre‐ and‐post‐assessment results for the interpersonal system fol...
Figure 8.6 The relationship with the family before and following treatment w...
Figure 8.7 The relationship with friends before and after treatment with IC...
Figure 8.8 The relationship with others before and after treatment with ICP....
Figure 8.9 The professional system. The figure illustrates the professional ...
Figure 8.10 Alterations in the spiritual system before and after ICP.
Figure 8.11 Mental health outcomes of clients before and after undergoing IC...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Foreword
Preface
Acknowledgments
Begin Reading
Appendix A
References
Index
WILEY END USER LICENSE AGREEMENT
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The Internal Cohesion Theory and Psychotherapy
Fitim Uka
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Dedication
To my mother and her pure soul.
Foreword
Human beings are more than just “themselves.”Not only the way one sees, knows, and speaks with oneself but also the way one creates relationships with others, the goals one sets for oneself in life, and even (in)explicable spirituality are the relationships that accompany a person at every step. Only when establishing genuine communication with each of these systems and at each time can psychological peace or internal cohesion be achieved.
For each human being, today is more than just today.Human beings are always a reflection of their past, present, and future. The thoughts and emotions we experience, as well as our behaviors, are the property of the thoughts and emotions we had yesterday and the hopes and plans we have for tomorrow.
Internal cohesion is not a utopia.Nobody can claim peace in the present if there are conflicts in the past and/or a lack of hope for the future. Internal cohesion entails open communication with one's past, addressing and resolving conflicts from the past; accepting and making peace with each system (intrapersonal, interpersonal, professional, and spiritual) in the past; (re)building and maintaining a healthy relationship with each system in the present; and constructing realistic expectations and beliefs related to the individual's relationship with each system in the future.
Only when we create harmony among our psychological systems across all temporal perspectives will we find the type of peace that can act as an adaptive shield against psychological problems and offer a path out of them.
Preface
Humans have consistently asked two fundamental questions: “Who am I?” and “What is my world?” To find a way to answer such questions and the attendant dilemmas, thousands of written and spoken answers, ideas, and theories have emerged to explain human nature and just as many that deal with the world in which we live. However, no single theoretical approach stemming from early philosophical thought or modern scientific multidisciplinary efforts can come close to the ultimate solution to the human enigma. This is why theories often collide, contradict, and reject each other. Theorists' and researchers' different views on themselves (using introspection) and others (using observation) have only added to the dilemmas. For every answer provided, dozens of new questions and conundrums are raised. However, all this “dust of ignorance,” perhaps unintentionally, has revealed a truth, an undeniable knowledge—both new and old—that humans are complex beings.
The complexity of human beings and the impossibility of deciphering them have often been described as the starting point and the end of the tangle of understanding and predicting their thoughts, feelings, and behaviors. Therefore, without a deep understanding of human beings, it is almost impossible to understand the rest of the equation and to explain their experiences. Despite this fundamental challenge, efforts continue, and new ideas are presented. Many ideas and theories about humans have not stood the test of time when they faced the opposition of stubborn scientific facts. Others continue to be part of the scientific discourse today or serve as the foundations of modern theories. But the final result of almost all efforts in this direction has reaffirmed that we do not know how much we know, and we do not know how far from the truth we are.
Because so much has been debated about human beings, it seems almost impossible for today's ideas to be innovative, unique, and original. Inevitably, new theories are offered here and there with some of the famous postulates of scientific thought through time, but it's the combinations, conceptualizations, and rationalizations that render them unique. Therefore, this theory is another attempt to provide an alternative perspective on humans, emphasizing the psychological domain. This important dimension of each human's life is sometimes explained using the knowledge created by the collision of other ideas and theories, thus presenting an eclectic and integrative approach. No theory possesses the absolute truth about human beings, and even this theory is far from such claims. At best, this theory can be seen as a modest effort to: (a) make sense of humans' psychological experiences; (b) explain and provide treatment for psychological disorders; and (c) give impetus to efforts that help modern humans to (re)find internal cohesion and, in this way, maintain optimal mental health or prevent the development of psycho‐emotional and psycho‐social disorders.
This theory is built on a triangle consisting of: (a) rational thought; (b) scientific evidence; and (c) clinical experience, which can easily be challenged by other rational thoughts, other scientific evidence produced by different research approaches and methods, and broader and more diverse clinical experiences. But in the end, this theory holds merit even if it encourages contradictory thinking, as it is through such contradictions that an even better and more useful theory or explanation may come, surpassing the one you are currently reading. Therefore, the main purpose of this theory is not to invalidate other efforts, ideas, and theories but to enrich the existing thought about human nature and stimulate a broader discussion from which new dimensions of psychological life can be understood.
This theory has a profoundly human approach and is driven by the desire to help people who are going through difficult times in their lives. Mistakes are inevitable within this framework, but when made with good intentions, they can be understood and justified. This theory generally attempts to explain human psychological functioning from a dynamic (ever‐changing) and systemic perspective. Time is the main element, and the theory explains and argues this dimension's importance for psychological health. Meanwhile, systems within the framework of this theory represent the key relationships of humans, which are considered necessary for proper psychological functioning: the intrapersonal relationship (the individual's relationship with themselves), interpersonal relationships (social; the individual's relationships with others), professional relationships (goals in life, academic development, profession, work, and career), and the spiritual dimension. In this elaboration, the cohesion that individuals create between their past, the evolving present, and the future that they believe or project for each system (or the interactions between the systems) is considered the healthiest (adaptive) protective mechanism against adverse events affecting mental health.
Based on a theoretical–logical model that has been proven and supported by scientific research and clinical trials, a new psychotherapeutic approach has been proposed, aiming to (re)build the internal cohesion of clients who seek psychotherapeutic services. The current version of the Theory of Internal Cohesion presented in this book requires genuine criticism, implementation, and evaluation of its effectiveness, as well as continuous modification and updating to address mental health concerns. An ideal theory and psychotherapy, although unattainable in perfection, is nothing but a constant effort to enhance and meet the needs of clients.
Acknowledgments
Just as a simple cup of coffee takes on new flavor when shared, the journey of this book has been enriched by the involvement of many remarkable individuals. I extend special thanks to those who patiently engaged in lengthy discussions, delved into its pages, and offered unwavering support for the ideas and concepts underlying this theory. Gratitude is also extended to those who provided criticism, posed challenges, and expressed doubts, as their input has played a crucial role in refining this psychotherapy and shaping the book’s final form.
Although the list of individuals deserving thanks is extensive, I must first express my appreciation to Veronë Perçuku, the editor of this book, whose exceptional contributions have ensured that the essence of Internal Cohesion Psychotherapy (ICP) shines through in this English edition. I am also grateful to Rineta Maliqi and Arian Musliu for their valuable input, edits, and insightful comments.
Additionally, I wish to express my profound gratitude to my dearest friends, Besnik Peci, Ramiz Dukaj, Liridon Aliu, and Agron Kryeziu, esteemed psychologists and companions of my generation, who have steadfastly supported me since the inception of this theory. Their unwavering encouragement has been a beacon of strength throughout this journey.
I am also indebted to my former students, Vanesa Sopjani, who led the quantitative study on effectiveness, and Vesa Turjaka and Bleona Bicaj, for their invaluable assistance in the online administration of the questionnaire, a pivotal early step in this project. Special thanks to Ramiz Dukaj for his translation efforts and to Fiona Muhaxheri for her presentation of the results. The intricate hypothesis testing and data analysis would have been insurmountable without the invaluable contribution of my colleague and friend Arian Musliu.
I extend my gratitude to Aliriza Arënliu and Dashamir Bërxulli for their review, as well as to Naim Telaku, Lirie Lokaj, and Sulltana Aliaj for their positive feedback on the book. The insights provided by reviewers and editors have greatly enhanced the value of this approach.
Most notably, my deepest gratitude is reserved for all those who embraced the theory and contributed to the advancement of ICP through various valuable contributions: Arlinda Gashi, Arvesa Studenica, Arnisa Aliqkaj, Greta Imeri, Florent Osmani, Dorentina Podrimqaku, Velsa Shabani, Vanesa Sopjani, Lum Zharku, Shkurtë Bajgora, Vlera Bajrami, Renisa Beqiri, Lirim Berisha, Kosovare Bunjaku, Almeida Cekoviq, Diellza Gllogu, Albina Krasniqi, Gresa Dashevci, Leotrim Edipi, Donjeta Gashi, Elona Gashi, Alba Hajdini, Njomza Halimi, Nerxhivane Haziri, Ardiana Hetemi, Vlerë Hyseni, Venera Imeri, Ajnur Ismaili, Drilona Kabashi, Arjeta Markaj, Halime Mehmedaliu, Dorentina Murturi, Nita Hoti, Erblina Ramadani, Xhemile Ramadani, Marigona Sadiku, Shkëndije Selmanaj, Gresa Selmani, Kestrina Shabani, Blerina Syla, Nafie Sylejmani, Sabrie Tefiki, Blerina Ukzmaili, Qëndresa Zendeli Mamuti, Burim Blaka, Festim Çunaku, Veronë Perçuku, Lira Baliu, Adela Bajrami, Rineta Maliqi, Egzona Maxhuni, Suzana Baftiu, Antigona Imeri, Loretë Tovërlani, Fjolla Rexha, Albina Statovci, Drin Shehu, Erëza Vitija, Altina Limani, Shkumbin Gashi, Irma Sadikovic, Betim Bregovina, Lenarda Cana, Syzana Baftiu, Meritë Dembogaj, Fatime Rrahmani, Verona Gashi, Festina Krasniqi, Mirlinda Kutleshi, Liridona Lahi, Merita Matoshi, Nurtene Mulaku, Valdet Plakolli, Toska Pruthi, Jeta Rexha, Urtina Sopi, Arbesa Sahiti, Donjeta Spahiu, and Sabit Salihu.
Finally, I extend my sincerest apologies and heartfelt gratitude to my family. Although nothing excuses my absence, the unwavering support of Yllka, Bind, and Mart, as well as my father Ruzhdi, brothers and sisters Sami, Naim, Afërdita, Lulzim, Zahide, and Antigona, as well as my nieces and nephews, has been invaluable.
As I wrote at the beginning, this book is dedicated to my mother and her pure soul that rests somewhere in peace. May any help that comes out of this book, and any inspiration it provides for anyone, be an eternal light for you, Mother!
1Toward a New Eclectic Approach
1.1 Introduction
In recent years, there has been a notable transformation in societal dynamics impacting daily existence. The paradigm shift has engendered a confluence of challenges, precipitating an emergent concern regarding mental health vulnerabilities. The fast‐paced nature of life, reliance on smartphones and social media, limited social interactions, and decreased physical activity often contribute to various psycho‐emotional issues. Although mental health disorders have been present throughout history, even in the distant past, their prevalence has significantly risen in modern times, garnering increased attention, discussion, and treatment options. For instance, in 2018, an estimated 322 million people, roughly between 3.4% and 4.4% of the global population, were reported to be living with depression. Additionally, it's reported that 60 million people live with bipolar emotional disorder, and 21 million live with schizophrenia or other psychoses (World Health Organization, 2017, 2018). Moreover, findings indicated that 1% of the world's population experienced drug addiction. Furthermore, according to the World Health Organization (2018), various mental disorders are increasingly becoming the leading cause of poor health in the global population and one of the main contributors to mortality.
With COVID‐19 in the background, the global prevalence of mental health disorders has changed drastically. A recent meta‐analysis summarizing the results of 46 different studies has shown that the prevalence of stress among the world population has increased to 29.6%, the prevalence of anxiety to 31.9%, and the prevalence of depression to 33.7% (Salari et al., 2020). Practically, every third person who populated the earth in 2021 has experienced stress, anxiety, or depression. These alarming figures have intensified efforts to identify the causes of various mental disorders. Such exertions have ranged from studies at the genetic level to those exploring environmental influences. However, modern theories seem to have established a consensus that mental disorders are the result of the interaction of (a) genetic predispositions, (b) factors related to the family system (e.g., attachment to parents), (c) the social or economic system (e.g., poverty or poor living conditions), and (d) ecological system (e.g., pollution). Nonetheless, etiology is only a part of the equation, as there are many unknowns to unravel. Addressing treatment remains another challenging enigma.
1.2 Psychopharmacology and/or Psychotherapy
Scientific evidence for the determinants of mental disorders has significantly influenced treatment methods. For instance, ever since neuropsychological research suggested that depression may be a result of poor neural connections and growth or functioning of neurons (e.g., Krishnan & Nestler, 2008), pharmacotherapy has emerged as one of the preferred and most commonly utilized methods for treating depression (Prescott & White, 2017). Evidence has shown that pharmacological treatment enables the development and effective functioning of neurons, with meta‐analytic studies supporting its positive effects (see Williams et al., 2018). However, even though medications can significantly reduce depression symptoms, they may not be sufficient for complete recovery. Often, pharmacological treatment does not show great results when depression coexists with other disorders (Cuijpers et al., 2008). Also, intolerance, side effects of antidepressants, and efficacy that vary by client and type of depression symptoms are some of the other challenges and drawbacks that cast doubt on this form of treatment as an independent modality of intervention (Penn & Tracy, 2012).
Pharmacotherapy is a valuable asset in the hands of the clinician and greatly aids in managing challenging mental health symptoms, but it may not be enough to provide a system to fortify psychological immunity against various potential risks to mental health, including the potential recurrence of symptoms and disorders (Cuijpers et al., 2014). Consequently, similar situations or events (traumatic or with strong emotional content) may reactualize the same kinds of thoughts and bring back the unwanted emotional state. The limitations of pharmacotherapy have paved the way for psychotherapy, a treatment method that aims to treat various mental disorders through words, speech, or communication (e.g., Beck et al., 1979). Psychotherapy is a perfect combination of the art of communication and the scientific evidence of treating mental disorders. It is considered an appropriate form of symptom elimination or control that enables a person to function better and increase well‐being. A meta‐analytic study by Cuijpers et al. (2013), has compared the effectiveness of psychotherapy and pharmacotherapy in treating various emotional disorders and found negligible statistical differences in this regard. However, there were some important differences between the two types of treatment. Although psychotherapy was shown to be more successful in the treatment of obsessive‐compulsive disorder, pharmacotherapy yielded better outcomes for dysthymia (Cuijpers et al., 2013).
1.2.1 What Is the Solution?
Interventions that focus solely on the neurobiological level and try to treat clients only with medication do not address the problem in its entirety and, as a result, risk ineffective outcomes. A typical example is the case of individuals struggling with substance use disorders. Treatment that relies solely on the pharmacological approach may have the effect of reducing the signs and symptoms of addiction, but the lack of challenging underlying thought patterns and fostering internal cohesion makes long‐term success elusive (Ray et al., 2020). Consequently, this may increase the possibility of the resurgence of maladaptive drug use behaviors. Meanwhile, when pharmacotherapy is complemented with psychotherapy, which aims to enhance self‐understanding, strengthen interpersonal relationships, and promote the pursuit of meaningful life goals, success becomes more attainable (Ray et al., 2020).
1.3 The Dilemma of Choosing Among Hundreds of Psychotherapeutic Approaches
Backed by scientific research data, psychotherapy has become easy “prey” for theorists and practitioners of psychology, who have generated various ideas, approaches, and forms of psychotherapy. It can be a tremendous asset or even a problem, but psychology currently counts over 400 different psychotherapeutic approaches (Malocco, 2015). Today, more than ever, psychotherapists are rich and poor at the same time. Such a large number of approaches in psychotherapy allows each therapist to choose but also significantly increases the doubt about whether the chosen approach is the most effective. It may be very difficult to choose among 500 approaches, but the choice may be made easier by the fact that all therapeutic approaches fall into one of five main categories: (a) psychoanalysis and psychodynamic therapies, (b) behavioral therapies, (c) cognitive therapies, (d) humanistic therapies, and (e) integrative therapies, which are a combination of different psychotherapeutic approaches (American Psychological Association [APA], 2018). These five categories of psychotherapy differ substantially in terms of conceptualizing the source of the problem. Psychoanalytic theories, for example, attribute problems to conflicts between conscious and unconscious content, particularly rooted in early childhood experiences (e.g., Busch & Milrod, 2010; Freud, 1915). Behaviorist theories, on the other hand, highlight learning processes as the primary drivers of disorders, focusing on stimulus‐response relationships and reinforcement principles (Reimann, 2018). In contrast, cognitive therapy emphasizes patterns of thought, identifying cognitive distortions and automatic thoughts as key factors influencing emotions and behaviors (Hofmann et al., 2013). Humanistic therapy takes a positive view of human nature, explaining problems as stemming from a gap between our actual and ideal selves and the quest for self‐actualization (Block, 2011). Integrative therapies, a more recent development, draw from multiple approaches (Zarbo et al., 2016). Ultimately, clinicians may choose an approach based on their belief in its effectiveness, training, or the evidence supporting its use. The Theory of Internal Cohesion falls into the category of integrative approaches. Apart from a new form of thinking and innovative approach in clinical practice, Internal Cohesion Psychotherapy (ICP) aims to integrate the best knowledge of all theories and approaches in psychology, specifically in psychotherapy, thereby enhancing the treatment of a wide range of mental disorders.
1.4 The Ever‐Present Challenges of Psychotherapy
The ongoing development and transformation of psychotherapy have attracted a lot of critical attention. Serious challenges raised by research results highlight the large number of clients who do not respond successfully to psychotherapy as the primary form of treatment for mental health issues (Kazdin, 2008). The accumulated evidence shows that psychotherapy often fails to provide help to clients: 30% of individuals with clinical symptoms do not show positive changes after receiving psychotherapy (Hansen et al., 2002), and the prevalence of those who do not benefit from psychotherapeutic treatment in routine care is as high as 60% (Lambert, 2017). These statistics may also be influenced by the fact that 20–57% do not return to psychotherapy after the first session (Lambert, 2017). Likewise, the large number who return to psychotherapy after completing a cycle of treatment adds to the dilemma of the effectiveness of existing approaches. So, some essential questions remain: What happens to the client after the treatment is over? When depression has subsided, and some symptoms have vanished, is there a risk of symptoms recurring? Thus, the challenges for psychotherapy extend beyond achieving immediate success to addressing the broader question of post‐treatment outcomes. It is certain that no single approach can solve this problem; however, each mono‐approach acknowledges the limits of other existing psychotherapies and this can be considered as an added value. By doing so, we confront existing dilemmas and enhance the likelihood of providing meaningful answers.
1.5 Looking for Answers
The ultimate test of any theory applied in psychotherapy is the client. All therapeutic approaches in psychology only make sense when they address the concerns or challenges of clients. Only when a therapeutic approach manages to find a solution to the client's perceived “problem” can we consider it effective. Because the issues raised by clients in psychotherapy differ and each client is unique, our approach must vary accordingly. However, we should not forget that clients also share commonalities. A case study will help demonstrate how our theoretical framework and interventions function in practice.
1.5.1 A Case Study
Bato, a 25‐year‐old man, lives in a village with his mother and younger sister. He faces poor living conditions, compounded by the loss of his father during his teenage years, which had a profound impact on him. His mother reports a difficult life for Bato as a teenager, marked by frequent conflicts at school, mainly because he was bullied for his appearance. However, she does not rule out the possibility that Bato initiated some of these conflicts. Being busy with work, Bato's mother could not help him overcome his challenges during childhood and adolescence. Furthermore, Bato had to take care of his younger sister, in addition to other obligations at home and school. Despite these difficult life experiences, Bato is described by his family as an energetic, happy, sociable person; he is perceived as a self‐assured young man who enjoys life. Until recently, Bato maintained an excellent relationship with his family. However, according to his mother, there has now been a noticeable shift in Bato's behavior and demeanor.
He was on the verge of finishing his bachelor's degree while working in a bar as a manager. His work was not related to his studies and profession and seemed unstimulating, but Bato liked to be active. Then, two months ago, he reported a lack of will to work and a rapid decrease in his will to study. Although he had only two more exams to complete his studies, he decided to quit school. Suddenly he also lost interest in social interactions and preferred to be alone. His mother reports radical changes in Bato's emotional well‐being, particularly evident in the form of mood swings. He has become a different person, increasingly withdrawn and refusing to converse with others. His family members describe recent situations when he was overcome by emotions and could not control them, exploding in anger and self‐blame. On at least two occasions, family members reported that he raised his voice and shouted in protest about perceived noise, even when the room was silent, raising their concerns. Soon after, he apologized and expressed remorse. In an electronic message, he told his best friend that he was thinking about suicide. When his mother and uncle searched his room, they also found a farewell letter, prompting them to take him to see a psychologist against his wishes.
1.5.2 More than One Solution
Even with so little information about the case, you have already formed your own idea of how you would intervene. If you are a psychiatrist, the diagnosis is in your mind, as well as the medications you would prescribe, the dosage, the approach, and the number of sessions. Some of you who study or enjoy psychoanalysis may have focused on Bato's early childhood, his conflicts with his parents, the death of his father, or his experiences of bullying by peers, which were repressed in the unconscious and have resurfaced and triggered this emotional reaction in the form of depression. Those of you who prefer cognitive‐behavioral therapy may have developed a grounded belief that there are cognitive distortions, automatic thoughts, dysfunctional hypotheses, and core beliefs that need serious challenging. Meanwhile, you who are humanists by principle may imagine the essence of the problem in non‐fulfillment, the client's inability to find himself, and the fact that he is far from self‐actualization. Ultimately, the approach you choose will shape your starting point and guide your strategies for addressing Bato's depression. All of you may be right, and every approach mentioned is reasonable to apply in this case. However, a critical view may harshly judge psychoanalytic therapy that focuses primarily on the past and unconscious influences on the client's current behavior (Busch & Milrod, 2010). Similarly, Gestalt or cognitive‐behavioral therapy, which primarily addresses present issues through behavior modification, may be subject to similar criticism for downplaying the significance of the client's past experiences and underlying determinants. Even the humanist view, which primarily looks to the future and emphasizes the client's ongoing search for fulfillment, may be criticized for disregarding the importance of the past and the client's formative experiences. Other theories and therapies, such as problem‐solving‐focused therapy, while aiming to address psycho‐emotional and social challenges, may offer only a partial solution by narrowly focusing on specific timeframes. The more we know the theories and the more objective we try to be in analyzing them, the more critical we will be. The dilemmas multiply when we have the client in front of us in clinical practice and need to choose a certain approach for treatment. Often, specializations in a certain form of psychotherapy limit the psychologist to offering only one type of psychotherapy, more or less the same techniques (the ones they know), even when they are not appropriate for the problem the client brings. In this case, we can say that the focus is on what the therapist knows and not on what the client needs. Such an approach is destined to fail.
This is why a combined approach using various psychotherapeutic techniques tailored to the client's unique personality and case history may be most beneficial (e.g., Norcross & Goldfried, 2019). Although all psychotherapies have one goal—to help clients—they differ in the way they conceptualize the problem and its source,
