2.)Name of the film and why you chose it as a case study? (100 words)The title of my chosen film is Shame,directed by Steve McQueen (13th of January 2012). I am interested inits central theme of addiction as it relates strongly to me due to pastexperiences and I appreciated how authentic and raw Shame is, a true reflectionof addiction and I found myself feeling sorry for the addict. However, I wasdisappointed by the ending of the film, I wanted to see how Sissy’s actions influencedBrandon’s addiction. I have grown up with various addictions and mental healthproblems in my family; I have insight into the many layers of addiction andbehavioural outcomes, impacting on home-life and working life, break-down ofrelationships- the core themes during Shame. 3.) Client presenting issue (200 words)On the outside Brandon lives acomparatively privileged life as a bachelor in New York.
However, Brandon is asex addict and he battles with this on a daily basis; to the point that evenwhenever he is not having sex, he is surfing the web for porn, or eyeing upwomen in any situation, even at work, in the hope of making a connection withthem. Brandon’s relationship with sex isvery meaningless; he shows no emotional connection whilst engaging in the act.His longest relationship lasted only four months and Brandon appears to havelittle friends or social circle, outside of sexual encounters or his workenvironment. Brandon has come for counselling as he is a struggling addict andwants control of his life; he is constantly trying to peruse sex encounters withwomen wherever he goes.
He engages in a lot of casual sex and even pays women,however he cannot commit to a sexual act with a potential girlfriend once theybecome close. Brandon becomes increasingly frustrated at the arrival of hissister, Sissy, and has also come to counselling due to their turbulentrelationship and her suicide attempt. Brandon hides his sex addiction from thefew people in his life; however, his addiction begins unravelling to Sissy whenshe moves in with him. 4.
)Client history and current situation (500 words)Brandon is Irish, however moved toJersey and was raised there with his sister. He now lives alone in NewYork. There is no mention of Brandon’sparents, however it is indicated several times that Brandon feels the need to”look after” his sister, Sissy, and she expects this from him too. Sissy statesthat they are supposed to “help each other.”It is suggested through the silenceof their childhood that it may have had a troubled. Brandon lives alone andlives a concealed life.
Brandon is currently battling a sex addiction.Brandon’s life spirals out of control when Sissy re-enters his world and movesin with him, despite him ignoring her calls for quite some time. He loses hisprivacy and his sex addiction becomes harder to manage. Sissy begins anintimate relationship with Brandon’s boss, enraging Brandon and fuelling hisdesire for her to move out of his apartment. He cannot bear when they engage ina sexual encounter in his apartment, and therefore leaves to go out for a runin the early hours of the morning, later tearing off the bed sheets when hereturns and finds them gone.
Sissy’s emotional baggage, combined with Brandon’saddiction, weighs heavily on their relationship. It is obvious to the audiencethat Brandon lives an extremely private life, and cannot handle Sissy invadinghis space. On one occasion Sissy walks in on Brandon in the bathroom, andBrandon becomes violent towards her and accuses her of spying on him. Sissyalso finds a pornographic webcam site on Brandon’s laptop, thisfrustrates/embarrasses Brandon and he disposes of his laptop and pornography. He describes Sissy as a “burden” to him.
There is the obvious issue of Brandon’sdependence, but Sissy also displays symptoms of addiction as she is drawn tomen and situations that are unreliable and potentially harmful. Both of these behaviours areself-destructive, leaving the characters in vulnerable situations. During the film, Brandon goes on adate with a co-worker which ends unsuccessfully. His date, Marianne, mentionsher recent divorce and describes commitment positively; meanwhile Brandonmentions his dislike of marriage and relationships, stating that his longestrelationship only lasted four months. They both go home separately.
Brandonattempts to connect with Marianne again at work, by taking her to a hotel.However, Brandon is unable to engage sexually with Marianne, proving his fearof commitment. Towards the end of the film we see Brandon engage in a finalargument with Sissy, and then leave his apartment. Brandon goes to bars andmakes advances to women. Going from bar to bar, Brandon is refused entry and endsup in a gay bar where he engages in sexual contact with a male. Sissy attemptsto ring Brandon and leaves a voicemail; at this point Brandon is nearingwithdrawal from his addiction and ends up in a threesome with two other women.Afterward, Brandon arrives home and feels something is not right, he findsSissy covered in blood in his bathroom after she has slit her wrists, she isunconscious and Brandon is distraught. It is at this point Brandon comes tocounselling, and it is clear that that Brandon has realised he is in a personalcrisis.
5.)Summary of counselling approach (700 words) I have chosen to use CognitiveBehavioural Therapy as my counselling approach on this client. CBT is adirective and active approach that was first discussed by Aaron Beck in the1960’s who is known as the pioneer of Cognitive Behavioural Therapy.
While hewas a psychiatrist at University of Pennsylvania, he designed and carried out variousexperiments to test psychoanalyticconcepts of depression. However the research did not validate the fundamentalconcepts he expected, however what Beck discovered was that by identifying andevaluating a person’s automatic thoughts, they were able to think morerealistically. As a result, they felt better in the emotional sense and wereable to behave more rationally and with greater function. His therapy helpedpatients to change their underlying self-beliefs about many aspects of life,such as themselves, their world and other people, which resulted inlong-lasting change.
This approach was called “cognitive therapy”, later tobecome known as “cognitive behavioural therapy.” Cognitive principles date backthousands of years.It is widely recognised that manypsychological issues develop into addiction and can be influenced by habitualthoughts and inner dialogue (Corey, 2012), therefore this psychotherapeuticprocess may play a crucial role in re-tuning the thoughts of the Brandon’saddictive mind-set and address other issues accompanying it. This cognitive Restructuring is apsychotherapeutic process of learning to identify and dispute irrational ormaladaptive or cognitive distortions.
For example: all-or-nothingthinking, magical thinking, over-generalization, magnification and emotionalreasoning. CBT coincides along a psycho-educationaldimension, using collaborative principles with the purpose of reorganisingtheir cognitive processes (McLeod, 2013), this involves various techniques,such as, clients learning, and obtaining skills, to modify automatic thoughtsand cognitive processes (Wright, Brown, Thase, Basco, 2017; Toner, 2012).During CBT sessions client’s issues are revealed through conversations with thetherapist, a treatment plan is then devised early on in therapy but is reviewedand added to as sessions continue. The issues that a client presents arerecognised and how these issues are not only affecting the client emotionallybut also physically, as well as how their relationships with others areaffected and their general daily functioning. CBT Techniques include Socraticquestioning, thought recording, identifying cognitive errors, examining theevidence, labelling distortions, ‘decatastropizing’, reattribution, cognitiverehearsal, guided imagery, and being able to list rational alternatives. It isa structured approach that is often time-limited. Some of the various methods includecollaborative empiricism, completing homework assignments, collecting data onthinking mechanisms and incorporating new skills (Corey, 2013).
This could workwell with addicts because it provides an opportunity to address and communicatehow they feel and their areas of distress and concern (Corey, 2013). CBTfocuses on current problems and methods to improve an individual’s state ofmind, rather than centring on issues from the past. The therapy is based uponan open relationship between the client and therapist, the therapist works withthe client using explorative questions and various distinctive techniques andmethods. CBT involves taking a step back and seeing what is happening to you asan individual and how a situation has been perceived. The therapy is based onthe perception that an interaction of feelings/ behaviour will be dependent onhow an individual interprets at any given situation, and not everyone willinterpret a situation in the same way. As CBT is goal orientated which can bebeneficial for certain clients, and not others but in Brandon’s case I feel hewould benefit from this learning premise and it would suit the nature of hisneeds. 6.)If you had to critique one thing about the counselling approach you havechosen, what would it be? (300 words) There arelimitations with Beck’s cognitive theory; some would argue it is not based uponbasic cognitive science.
Others would claim that negative thinking can be a consequence not antecedentof mental health problems. Also there can be aproblem with engagement and compliance with requirements of CBT approach, notevery client wants to carry out the homework element, some components of CBT donot suit a particular personality type or their issues and life circumstances. This individual understanding and reaction toa situation can be explained when considering what an individual has beenthrough in their lives, such as their beliefs about themselves and others, aswell as their experiences. CBT works on the premise that what people believeimpacts on how they feel and how they act, it embodies the fundamental premiseof behavioural therapy and psychology, and has become a popular academic pointof reference among psychologists (Szymanska& Palmer, 2015). However treating addictions can be very complex,and what forms the basis of addiction may be rooted in and compounded by otherco-morbid disorders, this all needs to be taken into consideration.
It does nottake into account historical factors, family background, why he has adysfunctional relationship with women. Cognitive therapy doesn’t draw anydifferences between intellectual beliefs and emotional beliefs. As in alltherapeutic considerations there could be the application of the biological-psychological-socialmodel into the understanding of Brandon, his condition and circumstances.
Psychological treatment is for the person and all associated influences and notjust for a condition or diagnosis ( Engal,1977). CBT may too one-dimensionaland therefore ignore impotent factors in his addiction and environment. Theremay be a need for incorporation of various therapeutic modalities andtechniques which may better ensure a positive long-term outcome. 7.)How do you think your choice of counselling approach might help this person? Choosetwo concepts from the counselling approach you have chosen and outline (1,000 words)Therapists help the client torecognize the thoughts that trigger their addictive behavioural patterns; thisis a very useful strategy for an addict. The psycho-educational elements can beeffective in delving into inner conflict, which can be the root cause ofaddiction. As Brandon’s therapist I will need to take every aspect of Brandonand his addiction into account.
As research has proven not all are sex addictssex offenders, and vice versa, but the need for an excessive number of sexualexperiences may place the sex addict at a greater risk of crossing the legal borderline (Tays, Earle, Wells, Murray, Garrett, B.,1999). Therefore the therapist must address the core themes thatcontribute to his unhealthy lifestyle and addiction in an attempt to secure along-term positive outcome. An addiction is a condition which ispresented by the persistent maladaptive use of a substance or behaviour and isultimately linked with considerable distress and disability.
An addiction is a brain disorder, rangingalong the craving and compulsion continuum seeking a reward stimuliin spite of adverse consequences. For thatreason the choice of treatment has many considerations and perspectives, andcreating an effective response to substance abuse is truly a challenge. Thebio-psycho-social model is multi-dimensional, and many psychologists believethat addictive behaviour is influenced by all three factors (Engal, 1977). Cognitive principles date back thousands ofyears, using beliefs from the stoic philosophers such as Epictetus, Cicero andSeneca. It also shares characteristics with doctrine from Eastern religions suchas Buddhism, carrying the belief that the power of our conscious cognitiveprocesses can be mentally renewing and life-changing (Beck, 1963). However treating addictions can be verycomplex, and what forms the basis of addiction may be rooted in and compoundedby historical factors or other co-morbid disorders (Kranzler , 2003).
These may include other stressors such as Brendan’s childhood, his distortedattitude and relationships, his lack of interest in having a properrelationship with his sister and so on. I believe CBT would provide an adequate treatment for many aspects ofthe complex condition of addiction.Contextual factors in addictions playa part, for instance, the societal and environmental dynamics of people’s lives(Kendler & Gardner, 1998).
It is widely recognised that many psychologicalissues develop into addiction and can be influenced by habitual thoughts andinner dialogue (Corey, 2012), thereforethis psychotherapeutic process may play a crucial role in re-tuning thethoughts of Brandon, thought recording,and seeking rational alternatives. It has core dimensions of problem-solvingcoming from a change-focused position, this is very necessary in Brandon’scase, his thought processes and attitudes particularly towards women are verynegative and destructive, and he rarely sees positive solutions or resolutions. CBT provides cognitive restructuring of mentaldistortions including ‘all or nothing’ thinking, destructive thoughts andnegative over-generalisations. It is a problem-orientated therapy, withstructured, present-centred, and time-limited components (Corey, 2013). CBTworks along a psycho-educational dimension, using collaborative principles withthe objective of reorganising their cognitive processes (Fjermestad, McLeod, Tully, Liber, 2016), thisinvolves clients learning, and obtaining skills, to elicit and modify automaticthoughts and cognitive processes (Wright, Brown, Thase, Basco, 2017; Toner,2012). Some of Brandon’s automatic thought processes towards women and sexualactivities have become distorted and very unbalanced.
The cognitive approach explores the thoughtprocesses behind an addiction, these cognitions can be badly distorted, andtherefore CBT may be beneficial for the addict to explore the validity of theirold belief systems, and restructure and replace them with more realistic andpositive cognitions and coping mechanisms when faced with sex addiction (Corey,2012). Some of the various methods of CBT include collaborative empiricism,homework assignments, collecting data on thinking mechanisms and incorporatingnew skills (Corey, 2013). This should suit Brandon’s needs, his thinkingmechanisms and relationships are at a very low level and to incorporate newskills would bring a much needed sense of achievement and fulfilment if he isable to carry them out. This can work well with addicts because it provides anopportunity to address and communicate how they feel and their areas ofdistress and concern (Corey, 2013). The directive and active position, andworking alliance premise may help to gain Brandon’s trust and cooperation, anissue of major importance to those in the grip of an addiction, (Andrusyna, Tang,DeRubeis, Luborsky, 2001) and also an issue that Brandon appears to grapplewith. The homework element of CBT would suitBrandon as it is more than an ordinary talking therapy. A purely talking approachwould not entirely suit Brandon, as he appears to speak little to his sisterand have limited interpersonal skills. So the practical element of homeworkassignments would suit his situation.
Whilst there are various CBTtechniques, I have chosen the CBT technique self monitoring, which can be alsoknown as diary work. This technique isused to record the amount and the degree of thoughts and behaviours. This ishelpful for the client and therapist as it illustrates the degree of a client’sissues. Because CBT is an active interventionwith an interactive approach, the client will be asked to do homework orpractice outside of sessions.
As Brandon’s life at the moment appears to lackstructure and direction, this will perhaps suit his needs and give his dailyroutine some a sense of organisation and purpose. Incorporating CBTprinciples by substituting old interpretations, and faulty beliefs with selfinstructional, stress management training and Socratic questions (Toner, 2012). The second technique chosen for Brandonis the CBT technique Socratic questioning (SocraticDialogue) this would also help Brandon because this process starts out as an exploratory process, andgradually becomes a more testing, change-oriented development, encouraging morepurposeful and adaptive ways of interpreting the important aspects of his life,his attitudes to women and sexual activities and his relationship with hissister and his circle in general. It helps to tease out answers particularly ifBrandon himself comes to his own personal answer and conclusion, it would be abetter one suited to him, and more empowering and fulfilling (Kazantzis,Fairburn, Padesky, Reinecke, Teesson, 2014). 8.)What difficulties do you think you might experience if you were to work withthis client in psychodynamic counselling, and why? (300 words)I feel that if I was to work with thisBrandon in psychodynamic counselling it would be difficult. However,therapeutic practices would provide a useful approach for Brandon in terms ofdiscussing his childhood, as the theory states that events which occur in ourchildhood shape our future and our future personalities.
It would be useful andinsightful to explore Brandon’s childhood with him as it is not always revealedduring the film. Nonetheless, as Brandon is such a closed character, this maynot have been easy or successful, perhaps proving more harm than good.Psychodynamic is a less intense approach, and focuses on immediate problems inorder to find a quicker solution. As a counsellor, I also am concerned that thisapproach may not be effective for Brandon and I during sessions, an addictunfortunately cannot often find a quick solution. However the other side of this is that itwould engage him for a time as addicts may lose interest very quickly if notpurposively engaged. I would have found it challenging to work with Brandon ashe is a cold character and at times I found him hard to relate to as anindividual.
I sense that Brandon could be a manipulative character; and thiscould make me uncomfortable during a session. As a counsellor, feelinguncomfortable with a client is not in the best interest of anyone in the room,as I am not giving my best to the client and distressing myself in the process.This could compromise my therapeutic relationship with Brandon and affect histreatment. As I never work in completeisolation I can ask my supervisor advice, and if the connection with Brandonremains an issue then I would have to consider referring him onto anothercounsellor.
9.)Concluding remarks (200 words) To conclude, my counselling knowledgeallowed me to view the film in a different light as I normally would. I becameaware of how I would attempt to treat Brandon’s addiction and what would be thebest counselling techniques quite quickly as I watched the film. However, I wasaware that I shouldn’t be so quick to make decisions, and so watched the filmseveral times, analysing Brandon and picking up on new characteristics eachtime. I believe this is why CBT is the correct counselling approach forBrandon, as at the beginning of a CBT session, myself as a counsellor wouldcompose a treatment plan, however keep adding to it as the sessions go on andadditional information about Brandon becomes available, just as I did whilstre-watching the film. I would adapt andmodify the treatment as the session’s progress.