1: Psychological Assessment

Definition:
According to APA,

“A psychological Assessment is a comprehensive examination undertaken to answer specific

questions about a client psychological functioning during a particular interval or to predict a
client psychological functioning in the future”.
We can also define as:
“Psychological assessment is the gathering and integration of psychology related data for the
purpose of making a psychological evaluation that is accomplished through the use of tools such
as tests, interviews, case studies, behavioral observation, and specially designed apparatuses and
measurement procedures”.
 It involves the integration of information from multiple sources such as test of normal
and abnormal personality, tests of ability or intelligence, tests of interest or attitude, as
well as information from personal interviews.
 A useful psychological measure must be valid and reliable.
 Process of assessment begins with a referral for assessment from a source such as a
teacher, a school psychologist, a counselor, a judge, a clinician, or a corporate human
resources specialis

Introduction
History:
Witmer, who made significant contributions to the development of clinical, developmental,
and educational psychology, established the first psychological clinic in 1896 (Baker, 1988). The
clinic assessed and treated children who presented with possible mental retardation, learning
disabilities, or emotional concerns that prevented attainment of their academic potential. Witmer
utilized a multidimensional, functional approach that included a comprehensive psychosocial
history taking as well as behavioral observations in multiple environments (e.g., home, school)
over time.
The roots of psychological assessment arose in early twentieth-century France. In 1905, Alfred
Binet and a colleague published a test designed to help place Paris schoolchildren in appropriate
classes. Binet’s test would have consequences well beyond the Paris school district. Within a
decade, an English language version of Binet’s test was prepared for use in schools in the United
States. When the United States declared war on Germany and entered World War I in 1917, the
military needed a way to screen large numbers of recruits quickly for intellectual and emotional
problems. Psychological testing provided this methodology. During World War II, the military
would depend even more on psychological tests to screen recruits for service. Following the war,
more and more tests purporting to measure an ever-widening array of psychological variables
were developed and used. There were tests to measure not only intelligence but also personality,
aspects of brain functioning, performance at work, and many other aspects of psychological and
social functioning.

Use

 We gather and integrate data to evaluate a person’s behavior, abilities, and other
characteristics, particularly for the purposes of making a diagnosis or treatment
recommendation.
 Psychologists assess diverse psychiatric problems (e.g., anxiety, substance abuse) and
nonpsychiatric concerns (e.g., intelligence, career interests) in a range of clinical,
educational, organizational, forensic, and other settings.
Purpose:
First, Assessment can be conducted to screen person for possible behavior problems or
developmental delays.
 Early screening can prevent more severe problems later in development.
 For example, a pediatrician might ask a psychologist to screen a toddler who is showing
delays in language acquisition and social skills despite normal sensory and motor
functioning. The psychologist might conduct a brief evaluation to determine whether the
child has a significant delay that needs attention. Early screening can prevent more severe
problems later in development.

Second, Assessment can be used to reach a diagnosis.

 For example, parents might refer their child to a psychologist because the child is
showing a wide range of emotional and disruptive behavior problems. The psychologist
would likely conduct a detailed evaluation of the child’s strengths and weaknesses in
order to identify the nature of the child’s problems. The clinician would likely assign one
or more diagnostic labels to describe the child’s main problem areas.
 Diagnosis might help parents understand their child’s functioning, allow the clinician to
estimate the child’s prognosis, and help the clinician identify treatment options.

Third, Some assessments are conducted to plan treatment.

 For example, a third-grade teacher might ask a school psychologist to assess a student
who repeatedly bullies younger children during recess. In this case, the purpose of the
assessment is not to assign a diagnosis. Instead, the purpose of assessment is to identify
potential causes of the bullying and to plan an intervention. After careful observation of
the bully’s behavior, the school psychologist might notice that the boy initiates fights
 only with certain peers. She might recommend that the bully be separated from these
peers during recess in order to avoid the problem in the future.

Fourth, Purpose of assessment is to monitor progress in treatment.

 For example, a pediatrician might prescribe methylphenidate (Ritalin) to a boy with
attention deficit/ hyperactivity disorder (ADHD). She might ask the child’s teachers to
rate the boy’s ADHD symptoms for 3 weeks. During the first week, the boy might not
take any medication. During the second week, the boy might take a low dose of the
medication. During the third week, the boy might take a slightly higher dose. The
pediatrician might use teachers’ ratings over the 3 weeks to determine whether the
medication reduced the boy’s symptoms and which dose was more effective.

Testing Verses Assessment:

Term assessment may be preferable to testing. The term assessment acknowledges that tests
are only one type of tool used by professional assessors and that a test’s value is intimately
linked to the knowledge, skill, and experience of the assessor.

Similarity both involve

 identifying areas of concern

 collecting data.
Difference Following table clearly demonstrate the difference between testing and
psychological assessment.
 Difference Between Psychological Testing And Assessment

Basis of Differences Testing Psychological Assessment

Degree Of Complexity Simpler, involves one uniform more complex, involves various
Procedure frequently uni procedures eg interview, testing &
dimentional. Dimensions.

Duration shorter, lasting for few minutes to longer, lasting for few hours to a
a few hours. few days or more.

Sources Of data one person, the test taker. often collateral sources such as
Relatives or teachers are used.

Degree of structure highly structured entails both structures and

Unstructured aspects.

Evaluation of results relatively simple investigation of very difficult due to variability of

reliability and validity based on methods, assessors, nature of
group results. Presenting questions etc.

Purpose Obtaining data for use in making used for decision concerning the
decisions. referral question or problem of
emotional, social, psychological.

Cost inexpensive, mostly when testing very expensive, requires intensive

is done in groups. use of highly qualified
professionals.
Basis of Differences Testing Psychological Assessment

Qualification for use gain knowledge of tests and
testing procedures.
Procedural basis objectivity required
knowledge of testing &
other assessment
methods & specialty
subjectivity in the form
Of clinical judgment

Focus involve nomothetic approach idiographic approach

( How one person or group ( the uniqueness of a
Compares with other.) given individual, group,
Or situation).

Nature provide only quantitative data provides qualitative and

quantitative data.

Process testing is a part of assessment it is a broad process

Tools involve only one tool eg. involve different tools for
tests. evaluation eg interview,
case study, observation.

Role of evaluator tester is not key to the process; assessor is the key to the
practically speaking, one tester process or other tools of
may be substituted for another evaluation as well in
without appreciably affecting drawing conclusions from
the evaluation. the entire conclusion.
Stage 1: Planning and Assessment:

 Classification of Psychological Assessment:

Different assessments methods are applied to therapeutic intervention. Following techniques

are used for this purpose:

 Interviews
 Case history
 Psychological tests
 Observations
 Behavioral and cognitive assessment techniques
 Biological assessments

For a complete psychological assessment of individual, several of these techniques are used,
as various methods compliment each other and provide a more complete picture of the
individual.

Interviews: “An interview as a method of gathering information through direct

communication involving reciprocal exchange.”

The word interview connotes a formal, highly structured conversation. We use the term as
any interpersonal encounter, conversational in style, in which one person uses language as a
principal means of finding out about one another. An interview as a tool of psychological
assessment typically involves more than talk.
The interviewer is taking note of both verbal and nonverbal behavior. Nonverbal behavior may
include the interviewee’s “body language,” movements and facial expressions in response to the
interviewer, the extent of eye contact, and apparent willingness to cooperate. The interviewer
may also take note of the way that the interviewee is dressed. Here, variables such as neat versus
sloppy and appropriate versus inappropriate may be noted.

 Characteristics of Interview:

 Interviews differ with regard to many variables, such as their purpose, length, and
nature.
 Interviews may be used by psychologists in various specialty areas to help make
diagnostic, treatment, selection, or other decisions. So, for example, A psychologist
studying consumer behavior may use an interview to learn about the market for
various products and services as well as how best to advertise and promote them.
 An interview may be used to help human resources professionals make more
informed recommendations about the hiring, firing, and advancement of personnel.
  In some instances, especially in the field of human resources, a specialized interview
called “panel interview” may be employed . Here, more than one interviewer
participates in the personnel assessment. Interviewers differ in many ways: their
pacing of interviews, their rapport with interviewees, and their ability to convey
genuineness, empathy, and humor.

Case History Data: Case history data refers to records, transcripts, and other accounts in
written, pictorials, or other form that preserve archival information, official and informal
accounts, and other data and items relevant to an assessor.

Case history data may include fi les or excerpts from fi les maintained at institutions and
agencies such as schools, hospitals, employers, religious institutions, and criminal justice
agencies. Other examples of case history data are letters and written correspondence, photos and
family albums, newspaper and magazine clippings, and home videos, movies, and audiotapes.
Work samples, artwork and accounts and pictures pertaining to interests and hobbies are yet
other examples.

 Importance of Case history Data:

Case history data is a useful tool in a wide variety of assessment contexts. In a clinical
evaluation, for example, case history data can shed light on an individual’s past and current
adjustment as well as on the events and circumstances that may have contributed to any changes
in adjustment.
Case history data can be of critical value in neuropsychological evaluations, where it often
provides information about neuropsychological functioning prior to the occurrence of a trauma
or other event that results in a deficit. School psychologists rely on case history data for insight
into a student’s current academic or behavioral standing. Case history data is also useful in
making judgments concerning future class placements.

Psychological tests:

Psychological tests structure the process of assessment. Standardized tests provide statistical
norms by which responses of subject can be compared. These basic types of tests can be used
for assessment purposes.

 Self-report personality inventories

 Projective tests
 Intelligence tests
Self-Report Personality inventories: In personality inventories, the person is asked to
complete a self report questionnaire indicating whether statement assessing habitual tendencies
apply to him or her. The best known of these test is Minnesota Multiphasic Personality Inventory
(MMPI).

Projective Tests: A projective test is a psychological assessment device in which a set of

standard stimuli ambiguous enough to allow variations in responses is presented to the
individual. Projective tests are derived from psychoanalytical paradigm. The use of projective
tests assumes that the respondent would not present his true feelings when asked directly.

Intelligence tests: Different intelligence tests can be used to assess the patient's IQ level such
as:
Wechsier Adult Intelligence Scale (WAIS)

Wechsier Intelligence Scale of Children (WISC)

Standford Binet Test (SB

Observations:

Behavioral observation, As it is employed by assessment professionals, may be defined as

monitoring the actions of others or oneself by visual or electronic means while recording
quantitative and/or qualitative information regarding the actions. Behavioral observation is often
used as a diagnostic aid in various settings such as inpatient facilities, behavioral research
laboratories, and classrooms. In addition to diagnosis, behavioral observation may be used for
selection purposes, as in corporate settings. behavioral observation may be used as a tool to help
identify people who demonstrate the abilities required to perform a particular task or job.
Sometimes researchers venture outside of the confines of clinics, classrooms, workplaces, and
research laboratories in order to observe behavior of humans in a natural setting—that is, the
setting in which the behavior would typically be expected to occur. This variety of behavioral
observation is referred to as naturalistic observation. As an example, one team of researchers
studying the socializing behavior of autistic children with same-aged peers opted for natural
settings rather than a controlled, laboratory environment (Bellini et al., 2007).
Self observations These therapists and researchers also have asked individual to observe their
own behavior and to keep track of various categories of responses. This approach is called self-
monitoring. Self monitoring has been used to collect a wide variety of data of interests to both
clinicians and researchers, including moods, stressful behavior, coping behavior and thoughts.
Ecological Momentary Assessment (EMA) is the best example of self observation.

Behavioral and Cognitive Assessment techniques: Usually to assess the individual

behavioral and cognitive level, his underlying personality structures and traits are measured.
Behavioral and cognitively oriented clinicians are guided by a system that leads them to assess
four sets of variables referred by acronym SORC.
 S stands for stimulus, the environmental situation that precede the problem,
 stands for organismic, referring to both psychological and physiological features assumed
to be operating within the individual,
 R refers to overt responses. Behavioral clinicians pay more attention on it.
 C refers to the consequent variables; those events that appear to be reinforcing or
punishing the behavior in question.

Biological Assessment:
Researchers and clinicians have attempted to observe the functioning of brain and other
parts of nervous system to understand normal and abnormal psychological functioning.

 Predictions:
 Clinical prediction (diagnostic, prognostic, or other framework) has outcomes that are
commensurable with, and hence comparable with, output of mechanical predictions.
 It is clarified what activity of the clinician (e.g., data gathering, data combination) is
being compared to the output of mechanical prediction, prognostication, or diagnosis.
 There are limitations of the literature that impair or prevent a full analysis of the issue.

Predictors are method (such as test, interviews or a letter of recommendation) used to

forecast or predict a criterion. High quality predictors must manifest two psychometric standards:
Reliability and Validity. Psychological tests and inventories have been used to predict relevant
workplace criteria for more than 100 years. The most commonly used predictors are tests of
general mental ability, personality inventories, aptitude tests, work samples, interviews and letter
of recommendations. Predictors can be evaluated in terms of validity (accuracy), fairness, cost &
applicability.
“Validity is concerned with getting the right assessment while reliability is concerned with
getting the assessment right.”
 o Reliable but not valid means that you are consistently testing the same thing over and
over again, but it’s not testing what you want to test.

o Valid but not reliable means that the average scores align with the goals of the test, but
individual scores are inconsistent.

o Both reliable and valid means that the test will consistently measure what it is supposed
to over a period of time – it’s consistently hitting the bullseye.

 Validity:

Validity refers to the accuracy of the assessment. In essence, does it measure what it is supposed
to measure? While there are several types of validity to pay attention to, the most important for
our purposes is predictive validity.

 Predictive validity tells us how accurate a tool is at predicting a certain outcome. In the
case of personality assessments, a good tool will be able to predict how well someone
will perform their job.

 Validity is typically measured with a coefficient between -1 and 1 (called the Pearson
correlation coefficient). The closer to one, the more accurate the predictive power of the
test. There are many ways of measuring validity, some more useful than others. Any
assessment provider worth their salt should be able to provide you with evidence of validity.
If they don’t, it’s worth considering why not.

Construct Validity  Used to ensure that the measure is actually measure what it is intended
to measure (i.e. the construct), and not other variables. Using a panel of “experts” familiar with
the construct is a way in which this type of validity can be assessed. The experts can examine the
items and decide what that specific item is intended to measure.  Students can be involved in this
process to obtain their feedback. Example: A women’s studies program may design a cumulative
assessment of learning throughout the major.  The questions are written with complicated
wording and phrasing.  This can cause the test inadvertently becoming a test of reading
comprehension, rather than a test of women’s studies.  It is important that the measure is actually
assessing the intended construct, rather than an extraneous factor.

Criterion-Related Validity: Used to predict future or current performance - it correlates

test results with another criterion of interest.

Example: If a physics program designed a measure to assess cumulative student learning

throughout the major.  The new measure could be correlated with a standardized measure of
ability in this discipline, such as an ETS field test or the GRE subject test. The higher the
correlation between the established measure and new measure, the more faith stakeholders can
have in the new assessment tool.

 Reliability:

Reliability, on the other hand, refers to the consistency of the test. Reliability is a degree to which
an experiment produces similar scores each time it is used. The reliability of an assessment can
be evaluated in four broad types:

 Test-Retest reliability

 Equivalence form reliability

 Internal consistency Reliability

 Inter-Rater Reliability

Test-retest reliability It is a measure of reliability obtained by administering the same test
twice over a period of time to a group of individuals.  The scores from Time 1 and Time 2 can
then be correlated in order to evaluate the test for stability over time

 Example:  A test designed to assess student learning in psychology could be given to a

group of students twice, with the second administration perhaps coming a week after the
first.  The obtained correlation coefficient would indicate the stability of the scores.

Parallel forms reliability  is a measure of reliability obtained by administering different

versions an assessment tool (both versions must contain items that probe the same construct,
skill, knowledge base, etc.) to the same group of individuals.  The scores from the two versions
can then be correlated in order to evaluate the consistency of results across alternate versions. 

 Example:  If you wanted to evaluate the reliability of a critical thinking assessment, you
might create a large set of items that all pertain to critical thinking and then randomly
 split the questions up into two sets, which would represent the parallel forms.

Inter-rater reliability  is a measure of reliability used to assess the degree to which different
judges or raters agree in their assessment decisions.  Inter-rater reliability is useful because
human observers will not necessarily interpret answers the same way; raters may disagree as to
how well certain responses or material demonstrate knowledge of the construct or skill being
assessed.
Example:  Inter-rater reliability might be employed when different judges are evaluating
the degree to which art portfolios meet certain standards.  Inter-rater reliability is especially
useful when judgments can be considered relatively subjective.  Thus, the use of this type of
reliability would probably be more likely when evaluating artwork as opposed to math problems.

Internal consistency assesses the correlation between multiple items in a test that are
intended to measure the same construct. You can calculate internal consistency without repeating
the test or involving other researchers, so it’s a good way of assessing reliability when you only
have one data set.

Stage 2: Data Collection

After clarifying the referral question and obtaining knowledge relating to the problem, clinicians
can then proceed with the actual collection of information. This may come from a wide variety
of sources, the most frequent of which are test scores, personal history, behavioral observations,
and interview data.

Clinicians may also find it useful to obtain school records, previous psychological
observations, medical records, police reports, or discuss the client with parents or teachers. It is
important to realize that the tests themselves are merely a single tool, or source, for obtaining
data.
 The case history is of equal importance because it provides a context for understanding
the client’s current problems and, through this understanding, renders the test scores
meaningful. In many cases, a client’s history is of even more significance in making
predictions and in assessing the seriousness of his or her condition than his or her test
scores.
 For example, a high score on depression on the MMPI-2 is not as helpful in assessing
suicide risk as are historical factors such as the number of previous attempts, age, sex,
details regarding any previous attempts, and length of time the client has been depressed.
Of equal importance is that the test scores themselves are usually not sufficient to answer
the referral question.
 For specific problem solving and decision making, clinicians must rely on multiple sources and,
using these sources, check to assess the consistency of the observations they make.
When data is recorded on paper, the act of writing in ink captures the data. The entries are
somewhat indexed as lines, pages, files and folders with paper as the storage medium. Data is
disseminated by making the folders available at the point of care. The record is then perused and
interpreted by the clinician.
 At present computerized information systems are available to perform these processes in
a more organized manner leading to enhanced benefits. Data capture is done through
typing on a keyboard, selecting using a pointing device or scanning. Data is properly
indexed and stored in a database. Users view the data on a computer screen. Data is
distributed via a network allowing many persons to view it simultaneously.
Actually, information is generated and utilized at every step of the clinical care process including
the activities of investigation, observation, monitoring, diagnosis, planning, treatment and
review. Clinicians also record their plans, orders, procedures performed, observations, test
results, opinions and discussions. Also, unplanned events (incidents) are recorded. Often, this is
considered as ‘clinical documentation’.

Stage 3: Processing of accessed data:

In this stage accessed data is processed different ways like:

 Clinical judgment
 Computer assisted assessment

 Clinical judgment:

Clinical judgment is a special instance of perception in which the clinician attempts to use
whatever sources are available to create accurate descriptions of the client.

Sources: Test data, case history, medical records, personal journals, and verbal and
nonverbal observations of behavior.

Data gathering: The data gathering is a complex process that involves different steps:
Rapport: One of the most essential elements in gathering data from any source is the
development of an optimum level of rapport. Rapport increases the likelihood that clients will
give their optimum level of performance. If rapport is not sufficiently developed, it is
increasingly likely that the data obtained from the person will be inaccurate.

Client’s response: Another important issue is that the interview itself is typically guided by
the client’s responses and the clinician’s reaction to these responses. A client’s responses might
be non-representative because of factors such as a transient condition like stressful day, poor
night’s sleep or conscious unconscious faking. The client’s responses also need to be interpreted
by the clinician. These interpretations can be influenced by a combination of personality theory,
research data, and the clinician’s professional and personal experience. The clinician typically
develops hypotheses based on a client’s responses and combines his or her observations with his
or her theoretical understanding of the issue. These hypotheses can be further investigated and
tested by interview questions and test data, which can result in confirmation, alteration, or
elimination of the hypotheses. Thus, bias can potentially enter into this process from a number of
different directions, including the types of questions asked, initial impressions, level of rapport,
or theoretical perspective.
Primacy effect: Unstructured approaches in gathering and interpreting data provide
flexibility, focus on the uniqueness of the person, and are ideographically rich. In contrast, an
important disadvantage of unstructured approaches is that a clinician, like most other persons,
can be influenced by a number of personal and cultural biases.

For example: Clinicians might develop incorrect hypotheses based on primacy effect.
They might end up seeking erroneous confirmation of incorrect hypotheses by soliciting
expected responses rather than objectively probing for possible disconfirmation. Thus clinicians
might be unduly influenced by their preferred theory of personality, halo effects, expectancy
bias, and cultural stereotypes. These areas of potential sources of error have led to numerous
questions regarding the dependability of clinical judgment.

 Accuracy of Clinical Judgments:

To make a clear judgment it is important to overlook these:

Cultural bias:
Cultural bias can come into play, and clinicians should take into consideration cultural context
and personal beliefs when making clinical judgments. To increase accuracy, clinicians need to
know how errors might occur, how to correct these errors, and the relative advantages of
specialized training.

Base rate:
A possible source of inaccuracy is that clinicians frequently do not take into account the base
rate, or the rate at which a particular behavior, trait, or diagnosis occurs in the general
population. If a person comes in and the test reveals a positive result for schizophrenia, it is not
necessarily a 90% or 95% chance that he or she actually has schizophrenia. Because
schizophrenia has a low base rate e.g if roughly 1% of the population has it, there is actually a
much greater than 10% chance that this individual does not have schizophrenia. It is also rare for
clinicians to receive feedback regarding either the accuracy of their diagnoses or other frequently
used judgments, such as behavioral predictions, personality traits or the relative success of their
recommendations.
Early judgments:
Different starting points in the decision-making process may result in different conclusions. This
error can be further reinforced if clinicians make early judgments and then work to confirm these
judgments through seeking supporting information. The resulting confirmatory bias is especially
likely to occur in a hypothesis-testing situation in which clinicians do not adequately seek
information that could disconfirm as well as confirm their hypotheses. The most problematic
examples occur when clinicians interpret a client’s behavior and then work to persuade the client
that their interpretation is correct.

Research:
Research on person perception accuracy indicates that, even though nobody is
uniformlyaccurate,somepersonsaremuchbetterataccuratelyperceivingothers.Taft (1955) and P. E.
Vernon (1964) summarized the early research on person perception accuracy by pointing out that
accuracy is not associated with age in adults there is little difference in accuracy between males
and females although females are slightly better and accurate perceptions of others are positively
associated with intelligence, artistic/dramatic interests, social detachment, and good emotional
adjustment. Authoritarian personalities tend to be poor judges. In most instances accuracy is
related to similarity in race and cultural backgrounds (P. Shapiro & Penrod, 1986). In some cases
accuracy by psychologists may be only slightly related to their amount of clinical experience and
for some judgments, psychologists may be no better than certain groups of nonprofessionals,
such as physical scientists and personnel worker. Relatively higher rates of accuracy were
achieved when clinical judgments based on interviews were combined with formal assessments
and when statistical interpretive rules

 Steps to improve accuracy:

1. To avoid missing crucial information ,clinicians should use comprehensive, structured, or at

least semistructured approaches to interviewing. This is especially important in cases where
urgent clinical decision danger to self or others may need to occur.

2. Clinicians should not only consider the data that support their hypotheses but they should also
carefully consider or even list evidence that does not support their hypotheses. This method will
likely reduce the possibility of hindsight and confirmatory bias.

3. Diagnoses should be based on careful attention to the specific criteria contained in the
Diagnostic and Statistical Manual of Mental Disorders.

4. Because memory can be a reconstructive process subject to possible errors, clinicians should
avoid relying on memory and rather refer to careful notes as much as possible.
5. In making predictions, clinicians should attend to base rates as much as possible.

 Computer Assisted assessment:

Computer-aided or computer-assisted assessment includes all forms of assessments students'
progress, whether summative i.e. tests that will contribute to formal qualifications) or formative
i.e. tests that promote learning but are not part of a course's marking delivered with the help of
computers. Computers are used mainly for their clerical efficiency in scoring and data storage
and to generate interpretive reports. However, more and more, testing is becoming available in
computer/ tablet-assisted formats. Future uses of computers are likely to continue to experiment
with features such as innovative presentation of items e.g. adaptive testing networked norms,
novel presentation of stimuli(virtual reality) psychophysiological monitoring, and artificial
intelligence (Garb, 2000). Computing in mental health has included not only computer-assisted
assessment but also computer interviews, computerized diagnosis, computer-aided instruction,
direct treatment intervention, clinical consultation, and simulated psychiatric interviews.

 Advances in CAA:

NES:
There have been a number of particular advances in computer-assisted administration and
interpretation in neuropsychology. Batteries have been developed mainly in large organizational
contexts (military, Federal Aviation Authority) and focused on specialized types of problems.
For example the Neuro behavioral Evaluation System (NES) is particularly sensitive to the
impact of environmental toxins.

CANTAB:
The Cambridge Neuropsychological Test Automated Batteries(CANTAB) have been found to
detect and locate brain damage including early signs of Alzheimer’s, Parkinson’s, and
Huntington’s diseases.

 Advantages:
Computer-assisted assessment has a number of advantages. Use of computers can save valuable
professional time, potentially improve reliability and fidelity to standardized administration,
reduce possible tester bias, and reduce the cost to the consumer by improving efficiency.

 Controversies:
A primary issue has been untested reliability and validity. Computer-based reports should not be
used to replace clinical judgment but should instead be used as an adjunct to provide possible
interpretations for the clinician to consider.
  Suggestive measures:
Only person who meet the requirement for using psychological tests in general should use
computer-based assessments. Specifically users should have an understanding of psychological
measurement, validation procedures, and test research. They should also limit their use of
computerized techniques to those areas they are competent to use. They should be
knowledgeable regarding how computer-based scores were generated and how interpretations
have been made. Finally, they should be able to evaluate whether the computer-based procedures
are applicable to how they will be used. .The developers of software should also be encouraged
to provide enough information in the manual to allow proper evaluation of the programs and
should develop mechanisms to ensure that obsolete programs are updated.

Stage 4: Communicating Assessment findings

The psychological report is one of the most important end products of assessment. It represents
the clinician’s efforts to integrate the assessment data into a functional whole so that the
information can help the client improve his or her life, helping to solve problems and make
decisions. It includes methods for elaborating on essential areas, such as the referral question,
behavioral observations, relevant history, impressions (interpretations), and recommendations.
This format is especially appropriate for clinical evaluations that are problem-oriented and that
offer specific prescriptions for change. Additional alternatives for organizing the report are to use
a letter format, give only the summary and recommendations, focus on a specific problem,
summarize the results test by test (though this is discouraged, as discussed later in this chapter),
write directly to the client, or provide client descriptions around a particular theory of
personality.

 Goals

In 2010, the American Psychological Association recognized Personality Assessment as a

specific and distinct proficiency, which means it is a specific, defined skill set within the practice
of psychology that can be evaluated, measured, and ultimately verified in order to protect the
public from poor quality or even harmful services. As part of the proficiency process,
practitioners can apply to be recognized for their personality assessment proficiency, and the
Society for Personality Assessment (SPA) took the leadership in determining the process for
recognition. The core of the recognition process includes the evaluation of a written
psychological assessment report. The five major themes presented in the proficiency rubric:
comprehensiveness, integration, validity, client-centeredness, and overall writing.
 Comprehensiveness
Length: The typical psychological report is between 5 and 7 single-spaced pages (Groth-Marnat
& Horvath, 2006). The more moderate (and frequent) 5- to 7-page report is particularly prevalent
in psychological, educational, and vocational contexts. Although this length is fairly typical in
clinical practice, one of the most frequent complaints related to psychological reports is that they
are too long (Brenner, 2003). The length should depend on ensuring comprehensiveness,
including all necessary and relevant information in a report that is necessary, without including
too much, extraneous, irrelevant, or even distracting information. The clinician should instead
adequately develop each of the various points and focus on the areas that are most relevant to the
purpose of the report.

Topics: The four most common topics are likely to be related to cognitive functioning, emotional
functioning (affect/mood), self-concept, and interpersonal relations. Many reports can be
adequately organized around these four domains. Additional topics include personal strengths,
vocational aptitudes, suicidal potential, defenses, areas of conflict, behavior under stress,
impulsiveness, or sexuality. Often an adequate report can be developed by describing just a few
of these topics. For example, a highly focused report may elaborate on one or two significant
areas of functioning, whereas a more general evaluation may discuss seven or eight relevant
topics.
  Deciding What to Include:
The clinician must strike a balance between providing too much information and providing too
little and between being too cold and being too dramatic. As a rule, information should be
included only if it serves to address the referral question and increase understanding of the client.
The basic guidelines for deciding what to include in a report relate to the needs of the referral
setting, background of the readers, purpose of testing, relative usefulness of the information, and
whether the information describes unique characteristics of the person. Afurther general rule is
that information should focus on the client’s unique method of psychological functioning. A
reader is concerned not so much with how the client is similar to the average person as in what
ways he or she is different.

 Summary:

Because of the lengthiness of most psychological assessment reports, it is customary to include a

summary toward the end of the report. First, it should be comprehensive. The second
consideration for a summary is that the writer should assume that it will be the only section read
by certain people. The summary should be relatively concise.

 Integration

Presenting Test Interpretations: Reports should organize information around specific referral
questions. The result will be a report that is highly focused, well integrated, and avoids any
extraneous material. The interpretations should be organized around specific domains, such as
coping style, memory, personality, or interpersonal relations. This approach is comprehensive,
indicates the client’s strengths and weaknesses, and typically gives the reader a good feel for the
person as a whole.
Key to the process understands that every test comes with measurement error, so any single
data point from any single test should not be overstated. Each data point from each test should be
considered within the context of all other data, from tests, history, and context. Integrating data
from different methods and measures is the work of the evaluator, and the process can take quite
a bit of time to complete and communicate in writing.

 Validity

Emphasis: Careful consideration should be given to the appropriate emphasis of conclusions,

particularly when indicating the relative intensity of a client’s behavior. In addition to discussing
and giving the appropriate degree of emphasis to a client’s pathology, his or her psychological
strengths need to be compared with his or her relative weaknesses.

To achieve proper emphasis, the examiner and the referral source must clarify and agree on
the purpose of the evaluation. Only after this has been accomplished can the examiner decide
whether certain information should be elaborated in depth, briefly mentioned, or deleted. If only
mild supporting data is available or if clinicians are presenting a speculation, phrases such as “it
appears…,” “tends to…,” “probably…,” or “likely…” (when slightly more certain) should be
used. There should be a clear distinction between what the client did and what he or she
anticipates doing, helplessness, not being able to change his current situation or help himself
improve.” Improper emphasis can reflect an incorrect interpretation by the examiner, and this
misinterpretation is then passed down to the reader. Clinicians sometimes arrive at incorrect
conclusions because their personal bias results in selective perception of the data.

Addressing Diversity: Test interpretations and conclusions in the report should be mindful of
issues of culture and diversity. If test interpretations, for example, should be cautiously applied
because of cultural concerns, stating this explicitly is beneficial. If there is no direct purpose for
discussing cultural issues within the report, doing so can be distracting and even potentially
misleading.

 Client-Centeredness

Case-Focused Reports: The case-focused report centers on the specific problems outlined by
the referring person. It reveals unique aspects of the client and provides specific, accurate
descriptions rather than portraying stereotypes that may also be overly theory linked or test
linked. Furthermore, the recommendations for treatment are both specific and practical. The
general approach of the case-focused report is not so much what is to be known but rather why
different types of information are important for the purposes of the report.
 First, the clinician should describe a person rather than merely reporting test data.
 Second, the recommendations in a case-focused report need to directly relate to what
specifically can be done for this client in his or her particular environment. They may
apply to areas such as occupational choice, psychotherapy, institutional programs, or
additional evaluation.

In addition, there should be a focus on that which differentiates one person from another. Making
these differentiations means avoiding discussions of what is average about the client and
emphasizing instead what stands out and is unique to this individual. Case-focused reports also
frequently deemphasize diagnosis and etiology.
Individualization: Reports should present data as coherent, narrative, related ideas about the
individual person being assessed. Individualize the language of that information as it applies
specifically to the individual being assessed. Recommendations should be clear, specific, and
reasonable. For example, though recommending that someone “receive treatment” may be both
clear and reasonable, it is not specific enough for the individual to know exactly what next steps
to take. Client-centered recommendations must take into consideration how available and
accessible resources are for the individual. A clinician may, for example, diagnose a client with
borderline personality disorder, and a recommendation for dialectical behavior therapy (DBT) is
certainly logical, as well as clear and specific.

However, if the client lives in an area where he or she cannot receive such treatment, or if
he or she does not have access to dialectical behavior therapy for financial or other reasons, this
is not a reasonable recommendation. A client-centered recommendation should take into
consideration what is reasonable and realistically doable for the client.

 Overall Writing Style:

The clinician can choose from four general report-writing approaches: literary, clinical,
scientific, and professional (Ownby, 1997; Tallent, 1992, 1993). Each style has unique strengths,
and all have a number of liabilities.

The literary approach uses everyday language and is creative and often dramatic.
Although it can effectively capture a reader’s attention and provide colorful descriptions, it is
often imprecise and prone to exaggeration.

The clinical approach focuses on the pathological dimensions of a person. It describes the
client’s abnormal features, defenses, dynamics involved in maladjustment, and typical reactions
to stress. The strength of the clinical approach is that it provides information about areas in need
of change and alerts a potential practitioner to likely difficulties during the course of treatment.
However, such a report tends to be one-sided and may omit important strengths of the person.
The result is likely to be more a description of a “patient” than a person.

The scientific approach to report writing emphasizes normative comparisons, tends to be

more academic, and, to a lesser extent, relates to the nature of a client’s pathology. It looks at and
describes test findings in an objective, factual manner. A scientific approach is likely to discuss
the person by addressing different, often isolated, segments of personality. Although the
scientific approach is objective and factual, it has been criticized for violating the unity of
personality. A focus on factual data may not address the practical decisions the client and referral
source are facing. An important part of effective report writing is the ability to evaluate the assets
and limitations of each style and to maintain a flexible orientation toward appropriately
combining them. In any one report, there may be a need to use creative literary descriptions,
elaborate on different pathological dimensions, or provide necessary scientific information.

Professional approach is characterized by short words that are in common usage and that
have precise meanings. Grammatically, writers should use a variety of sentence constructions
and lengths to maintain the reader’s interest. The paragraphs should be short and should focus on
a single concept. Similar concepts should be located close to one another in the report. Whereas
Hollis and Donna (1979) urged writers to use short words, short sentences, and short paragraphs,
the Publication Manual of the American Psychological Association (7th ed., 2017) recommended
varying the lengths of sentences and paragraphs. The result should be a report that combines
accuracy, clarity, integration, and readability.

Terminology:
It might be argued that technical terminology is precise and economical, increases the credibility
of the writer, and can communicate concepts that are impossible to convey through nontechnical
language. However, a number of difficulties are often encountered with the use of technical
language. One of the more frequent problems involves the varying backgrounds and levels of
sophistication of the persons reading the report. The most frequent readers of reports, outside of
clients themselves, include teachers, administrators, judges, attorneys, psychiatrists, non-
psychiatric physicians, and social workers (Harvey, 1997, 2006).

Although technical words can undoubtedly be precise, their precision is helpful only in
a particular context and with a reader who has the proper background. Generally, reports are
rated as more effective when the material is described in clear, basic language (Brenner, 2003;
Finn, Moes, & Kaplan, 2001; Groth-Marnat & Davis, 2014; Harvey, 1997, 2006; Ownby, 1990,
1997; Sandy, 1986; Tallent, 1993; Wright, 2010). The use of Basic English allows the examiner,
through his or her report, to communicate with and affect a wide audience. Furthermore, Basic
English is more specific and descriptive of an individual’s uniqueness, whereas technical terms
tend to deal with generalities. Finally, the use of basic English generally indicates that the
examiner has more in-depth comprehension of the information he or she is dealing with and can
communicate this comprehension in a precise, concrete manner.

 Organization of Report

Although no single, agreed-on format exists, every report should integrate old
information as well as provide a new and unique perspective on the person. Old information
should include identifying information (name, birth date, etc.), reason for referral, and relevant
history. New information should include assessment results and impressions,
summary/conclusions, and recommendations. At the top of the report, practitioners should
indicate its confidential nature by writing “Confidential Psychological Evaluation.”

A suggested outline follows.

Name:

Age (date of birth):

Sex:

Ethnicity:

Date of Report:

Name of Examiner:

Referred by:

I. Referral Question

II. Evaluation Procedures

III. Background Information (Relevant History)

IV. Behavioral Observations

V. Interpretations and Impressions

VI. Summary and Recommendations

 Referral Question

The Referral Question section of the report provides a brief description of the client and a
statement of the general reason for conducting the evaluation. In particular, this section should
include a brief description of the nature of the problem. This section should begin with a brief,
orienting sentence that includes essential information about the client. The purpose of testing
should be stated in a precise and problem-oriented manner.

Thus, phrases like “The client was referred for a psychological evaluation is inadequate because
they lack focus and precision.
Examples of possible reasons for referral include:

• Intellectual evaluation: routine, intellectual disability, giftedness

• Assessment of the nature and extent of brain damage

• Evaluation as a component of, and to provide recommendations for, vocational Counseling.

These reasons represent general referral questions that, in actual situations, would require
further clarification, especially regarding the decisions facing the referral source (see Armengol,
2001). The key should be to find out what the referring person really wants from the report. An
effective referral question should accurately describe the client’s and the referral source’s current
problems.

 Evaluation Procedures

The report section that deals with evaluation procedures simply lists the tests and other
evaluation procedure used but does not include the actual test results. Usually full test names are
included along with their abbreviations. For legal evaluations or other occasions for which
precise details of administration are essential, it is important to include the date on which
different tests were administered and the length of time required to complete each one. It may
also be important to include whether a clinical interview or mental status examination was given
and, if so, the degree of interview structure and the amount of time required for the interview or
examination.
 Often evaluation includes a review of relevant records, such as medical reports, nursing
notes, military records, police records, previous psychological or psychiatric reports, o

educational records. Additional material might come from interviews with individuals such as
spouses, children, parents, friends, employers, physicians, lawyers, social workers, or teachers.
Observations may be included as well, such as observing a child in his or her school
environment. If any of these sources is used, the dates and, if relevant, who wrote the material
should be included. This section might end with a statement summarizing the total time required
for the evaluation.

 Background Information (also Referred to as Relevant History)

The write-up of a client’s background information should include aspects of the
person’s history that are relevant to the problem the person is confronting and to the
interpretation of the test results. The background information section be kept to one concise
paragraph. The end product should include a good history of the problem along with areas such
as important life events, family dynamics, work history, personal interests, medical history, daily
activities, and past and present interpersonal relationships. When describing a client’s
background, it is important to specify where the information came from.

The client’s personal history can include information from infancy, early childhood,
adolescence, and adulthood. Each stage has typical areas to investigate and problems to be aware
of. The information from infancy usually either represents vague recollections or is secondhand
information derived from parents or relatives. The degree of contact with parents, family
atmosphere, and developmental milestones may all be important areas to discuss.

The most significant tasks during childhood are the development of peer relationships and
adjustment to school.

 What was the quality of the client’s early friendships?

 How much time did the client spend with others?

 Were there any fights or rebellious acting out?

 Was the client basically a loner, or did he or she have a large number of friends?

 Did the person join clubs and have group activities, hobbies, or extracurricular interests?

In the academic area, it may be of interest to note the client’s usual grades, best or worst subjects,
and whether the client skipped or repeated grades. Furthermore;

 What was his or her relationship with parents, and did the parents restrict activities or
allow relative freedom?

During adolescent years, clients typically face further academic, psychological, and social
adjustments to high school. Of particular importance are their reactions to puberty and early
romantic and sexual relationships.

 Did they have difficulties with sex role, identity, abuse drugs or alcohol, or rebel against
authority figures?

The adult years center on occupational adjustment and establishing marital and family
relationships.

During early adulthood,

  What were clients’ feelings and aspirations regarding romantic relationships or marriage?
What were their career goals?

 Did they effectively establish independence from parents?

 As adulthood progressed, were there any significant changes in the quality of their close
relationships, employment, or expression of sexuality?

 What activities did they engage in during their leisure time?

As clients age, they face challenges in adapting to their declining abilities and limitations, and
developing a meaningful view of their lives. It is important to note that the time the client first
noticed these symptoms, have there been any changes in frequency, intensity, or expression? The
family and personal histories usually reveal information relating to the predisposing cause of a
client’s difficulties, whereas the history of the problem often provides an elaboration of the
precipitating and reinforcing causes.

 Behavioral Observations
A description of the client’s behaviors can provide insight into his or her problem and
may be a significant source of data to evaluate test validity and confirm, modify, or question the
test-related interpretations.

A description of the client’s physical appearance should focus on any unusual features relating
to facial expressions, clothes, body type, mannerisms, and movements. It is especially important
to note any contradictions, such as a 14-year-old boy who acts more like an 18-year-old or a
person who appears dirty and disheveled but has an excellent vocabulary and high level of verbal
fluency.

The behaviors the client expresses toward the test material and the examiner may include
behaviors that reflect the person’s level of affect, manifest anxiety, presence of depression, or
degree of hostility. The client’s role may be as an active participant or generally passive and
submissive; he or she may be very much concerned with his or her performance or relatively
indifferent. The client’s method of problem solving is often a crucial area to note, and it may
range from careful and methodical to impulsive and disorganized. It is also important to pay
attention to any unusual verbalizations that the client makes about the test material.

Level of cooperation is especially important for intelligence and ability tests, because a
prerequisite is that the client be alert and attentive and put forth his or her best effort. It may also
be important to note events before testing, such as situational crises, previous night’s sleep, or
use of medication. If there are situational factors that may modify or bring into question the tests’
validity, they should be noted. Behavioral observations usually should be kept concise, specific,
and relevant.

 Interpretation and Impressions

For many reports, it may not be necessary to list test scores. However, it is often recommended
that, at some point, test scores be included, especially in legal reports or when professionals who
are knowledgeable about testing will read the report. One option is to include test scores in an
appendix. This method has the advantage of removing potentially distracting technical detail
from the narrative portion of the report. Whether or not test results are included, the
Interpretation and Impressions section (sometimes simply called the Impressions section) can be
considered the main body of the report. When actually writing the Interpretation and Impressions
section of the report, the clinician can review all findings in a particular topic and summarize
them in the report.

A client’s level of psychopathology refers to the relative severity of the disturbances he or she is
experiencing. It is important to distinguish whether the results are characteristic of non-clinical
populations, outpatients, or in patients, and whether the difficulties are chronic or more a
reaction to current life stresses.

 Does the client use coping behaviors that are adaptive or those that are maladaptive and
self-defeating?
  Within the area of ideation, are there persistent thoughts, delusions, hallucinations, loose
associations, blocking of ideas, perseveration, or illogical thoughts?

 Can the person effectively make plans, understand the impact he or she has on others, and
judge the appropriateness of his or her behavior?

Discussing clients’ characteristic patterns and roles in interpersonal relationships can also
be extremely useful. Often these can be discussed in relation to the dimensions of
submissiveness/dominance and love/hate, or in relation to the extent to which they orient
themselves around the need to be included, control others, or seek affection.

 Is their style of communicating typically guarded, or is it open and self-disclosing to the

extent that they can discuss areas such as painful feelings and fears?

 Can they deal with the specifics of a situation, or are they usually vague and general?

 Do they usually appear assertive and direct or passive and indirect?

Finally, it is often important to determine the extent to which they are perceptive about
interpersonal relationships and their typical approaches toward resolving conflict.

Summary and Recommendations

The purpose of the Summary subsection is to restate succinctly the primary findings and
conclusions of the report. To do so, the practitioner must select only the most important issues
The ultimate practical purpose of the report is contained in the recommendations because they
suggest what steps can be taken to solve problems. Such recommendations should be clear,
specific, practical, and obtainable and should relate directly to the purpose of the report. The best
reports are those that help the referral sources and/or the clients solve the problems they are
facing (Armengol, Moes, Penney, & Sapienza, 2001; Brenner, 2003; Finn et al., 2001; Groth-
Marnat & Davis, 2014; Ownby, 1997; Tallent, 1993). Often cases will require a wider variety of
recommendations than this, especially in forensic, medical, academic, or rehabilitation settings.
These recommendations may include treatment options, placement decisions, further evaluation,
altering the client’s environment, use of self-help resources, and miscellaneous considerations.
 2: PSYCHOLOGICAL INTERVIEWES AND
RAPPORT

DEFINITION OF INTERVIEW

A situation of primarily vocal communication, more or less voluntarily integrated, on a

progressively unfolding expert-client basis for the purpose of elucidating characteristic patterns
of living of the patients, client, or subject, which pattern he/she experiences as particularly
troublesome or especially valuable, and in the revealing of which he expects to derive benefit.
According to "Bingham" and "Moore" The clinical interview is a conversation with a purpose
but as the purpose differ the area of the interview also differs.

INTRODUCTION OF INTERVIEW

Almost all professions count interviewing as chief technique for gathering data and making
decisions. For politicians, consumers, psychiatrists, employers, or people in general, interviewing
has always been a major tool. As with any activity that is engaged in frequently, people
sometime take interview for granted or believe that it involve no special skills; they can easily
overestimate their understanding of the interview process. Although many people seem awed by
the mystique of projective tests or impressed by the psychometric intricacies of objective tests.
The assessment interview is at once the most basic and the most serviceable technique used by
the clinical psychologists. In the hands of a skilled clinician, its wide range of applications and
adoptability make it a major instrument for clinical decision making, understanding, and
predictions. But for all this, we must not lose sight of the fact that the clinical interview is not
greater than the skill and sensitivity of clinicians who use it.

IMPORTANT THINGS TO KNOW ABOUT CLINICAL INTERVIEWS.

 It is not a cross-examination but rather a process during which the interviewer must be
aware of the client's voice intonation, rate of speech, as well as non-verbal messages such as
facial expression, posture, and gestures.
 Although it is sometimes used as the sole method if assessment, it is more often used along
with several of the other methods.
 It serves as the basic context for almost all other psychological assessments.
 It is the most widely used clinical assessment method.

TYPES OF INTERVIEW

There are many different forms of interviews conducted by psychologists. Some interviews are
conducted prior to admission to a clinic or hospital, some are conducted to determine if a patient
is in danger of injuring themselves or someone else, some are conducted to determine a
diagnosis. Whereas some Interviews are highly structured with specific questions asked for all
patients, others are unstructured and spontaneous. In this section the common forms of clinical
interviews will be briefly discussed.

Some important forms of interview are:

1. The intake / admission interview

2. The crisis interview
3. Mental status examination interview
4. The case study interview
5. Diagnostic interview
1. THE INTAKE/ADMISSION INTERVIEW

According to Watson; "This type of interview is usually concerned with clarification of the
patient's percentage complaints, the steps he has taken previously to resolve his difficulties and
his expectances in regard to what may be done for him". The purpose of the initial intake
interview or admission interview is to develop a better understanding of the patient's symptoms
or concerns in order to recommend the most appropriate treatment or intervention plan. Whether
the interview is conducted for admission to a hospital, an outpatient clinic, private practice, or
some other setting the initial interview attempts to evaluate the patient's situation as efficiently as
possible. Ordinarily a psychiatric social worker conducts this interview; however, upon occasion,
the psychologist, one of the physician, or a psychiatric nurse may serve as intake interviewer.
The basic question to be dealt with is "Why is the patient here? i.e., what does she says is the
matter with him? Important but secondary questions involve information about previous
hospitalization, the name of his doctors, what the patient expect from treatment, his availability
for treatment, and the like. Although typically brief, the intake or admission interview is
extremely important in conserving the time of other professional staff members and in sparing
the clinic or hospital for occasional embarrassing or awkward situations. The patient may in
some instances desire treatment which particular clinic may not be prepared to give. Certain
hospitals, for example, do not handle alcoholic or narcotic addiction cases; thus the patient can
be at once referred to an appropriate institution, saving time for the examining psychiatrist,
psychologist, the various attendants, and for the patient himself. Similarly, the awkward
consequences of an overly casual admission procedure can be avoided by a well-planned
interview. Hospital staff members can relate many anecdotes of relative's who were mistaken for
the patient himself, of surgical patient who were given diagnostic psychiatric interview, or of
salesman who were escorted to a room and confronted with a personality test careful intake
interview will guard against such mistakes. It should be noted that every patient will not be able
to state coherently what the nature of his trouble may be. But even the unclear replies can be
highly revealing, and the astute intake interviewer can report significant observation of the
patient’s behavior which he may not reveal again for some time or which may be missed by later
examiners. Ordinarily, the diagnostic and treatment session which come at some time after the
intake interview are carried out by another, different staff person. This does not mean however,
that therapy begins later. The formal label of "psychotherapy" it is true, is given to the later
procedures, but real therapy, in the sense of patient's attitude and his motivation to get well, and
begins at the time of the patient's admittance. It is no exaggeration to assert that a bungled intake
interview prolong treatment while an effective one can shorten it.

2. THE CRISIS INTERVIEW

A crisis interview occur when the patient is in the middle of a significant and often traumatic or
life threatening crisis. The psychologists or the mental health professionals (e.g., a trained
volunteer) might encounter such a situation while working at a suicide or poison control hotline,
an emergency room, a community mental health clinic, a student health service on campus, or in
many other settings. The nature of the emergency dictates a rapid, "get to the point" style of
interview as well as quick decision making in the context of a calming style. For example, it may
be critical to determine whether the person is at significant risk of hurting him- or herself or
others. Or it may be important to determine whether the alcohol, drugs, or any other substances
are used, so as to make sure that the clinician interviews the person in a calming and clear
headed manner while asking critical questions in order to deal with the situation effectively. The
interviewer may need to be more directive (e.g., encouraging the person to phone the police, un
load a gun, provide instructions to induce vomiting, or step away from a tall building or bridge);
break confidentiality if the person (or someone else, such as a child) is in serious and immediate
danger; or enlist the help of others (e.g., police department, ambulance).

3. MENTAL STATUS EXAMINATION INTERVIEW:

Mental status examination is a medical process where a clinician working in the field of mental
health (usually a psychotherapist, social worker, psychiatrist, psychiatric nurse or psychologist)
systematically examines and then describes the mental state and behaviors of the person being
seen. It includes both objective observations of the clinician and subjective descriptions given by
the patient. It is an important part of the clinical assessment process. Observations noted
throughout the interview become part of the MSE, which begins when the clinician first meets
the patient. It is a structured way of observing and describing a patient’s psychological
functioning and behavior at a given point in time, under the domains of appearance, attitude,
behavior, mood, and affect, speech, thought process, , perception, cognition, insight, and
judgment.

Behavioral components include, appearance and general behavior, level of consciousness and
attentiveness, motor and speech activity, mood and affect, thought and perception, attitude and
insight, and the reaction evoked in the examiner. Cognitive components include alertness,
language, memory, constructional ability, and abstract reasoning. There are many versions of
mental status examination, which differ around the world but there is a broad commonality.

 PURPOSE OF MSE:

The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's
mental state, which, when combined with the biographical and historical information of
psychiatric history, allows the clinician to make a formulation. which are required for coherent
treatment planning. (history is needed including education, cultural and social factors. It is
important to ascertain what is normal for the patient. For example, some people always speak
fast. A Mental Status Exam provides a snap shot at a point in time. If another provider sees your
patient it allows them to determine if the patient’s status has changed without previously seeing
the patient.

 KEY FACTORS THAT SHOULD BE CONSIDERED ALONG WITH MSE:

To assess properly the patient’s mental status, it is important to have some understanding of the
patient’s social, cultural, and educational background. What may be abnormal for someone with
more intellectual ability may be normal for someone with less intellectual ability. Patients for
whom English is a second language may have difficulty understanding various components of
the MSE, such as the proverbs. Age may be a factor. In general, patients over the age of 60 years
tend to do less well on the cognitive elements of the MSE. Often this is related to less education
rather than to aging alone.

 DOMAINS/ COMPONENTS OF MSE:

1. LEVEL OF CONSCIOUSNESS:

The level of consciousness refers to the state of wakefulness of the patient and depends both on
brainstem and cortical components. Levels are operationally defined by the strength of stimuli
needed to elicit responses. A normal level of consciousness is one in which the patient is able to
respond to stimuli at the same lower level of strength as most people who are functioning
without neurologic abnormality. When examining patients with reduced levels of consciousness,
noting the type of stimulus needed to arouse the patient and the degree to which the patient can
respond when aroused is a useful way of recording this information.

2. APPEARANCE AND GENERAL BEHAVIOR:

These variables give the examiner an overall impression of the patient. The patient's physical
appearance (apparent vs. stated age), grooming (immaculate/unkempt), dress (subdued/riotous),
posture (erect/kyphotic), and eye contact (direct/furtive) are all pertinent observations. Certain
specific syndromes such as unilateral spatial neglect and the disinhibited behavior of the frontal
lobe syndrome are readily appreciated through observation of behavior.

3. SPEECH:

Rate (slowed, long pauses before answering questions, hesitant, rapid, pressured), Rhythm
(monotonous, stuttering),Volume (loud, soft, whispered), Amount (monosyllabic, hyper-
talkative, mute), Articulation (clear, mumbled, slurred) and Spontaneity.

4. MOTOR/BEHAVIOR:

Retardation (slowed movements),Agitation (unable to sit still, wringing hands, rocking, picking
at skin or clothing, pacing, excessive movement, compulsive), Unusual movements (tremor, lip
smacking, tongue thrust, mannerisms, grimaces, tics), Gait (shuffling, broad-based, limping,
stumbling, hesitation),Catatonia (stupor, excitement).

5. ATTENTION AND CONCENTRATION:

Attention is the ability of an individual to focus and sustain their thoughts on a specific
task/topic. It can be assessed by asking the patient to spell a word backward or count in twos.

6. MEMORY:

The process of recalling information. Classified according to the length of time a particular piece
of information can be recalled

7. MOOD:

Mood refers to the patient's subjective assessment of their emotions when asked how they feel,
they described using the patient's own words (e.g., happy, ecstatic, sad, guilty, angry, exhausted,
frustrated, frightened) and placed within quotation marks. For example, Patients with depression
may feel “sad” or even state that they feel “nothing at all.” Patients with mania are more likely to
feel “marvelous” or “ecstatic.”

8. AFFECT:

It refers to the physician's objective assessment of a patient's emotions conveyed both verbally
and nonverbally during an interview. It is important to assess a patient's affect during the MSE
because changes in affect are characteristic of a large number of psychiatric conditions.
Individuals with schizophrenia often have a blunt, inappropriate affect.

9. LANGUAGE:

Appropriateness of conversation, rate of speech (> 100 words per minute is normal; < 50 words
per minute is abnormal), reading and writing appropriate to education level.

10. THOUGHT AND PERCETION:

The inability to process information correctly is part of the definition of psychotic thinking. How
the patient perceives and responds to stimuli is therefore a critical psychiatric assessment. Does
the patient harbor realistic concerns, or are these concerns elevated to the level of irrational fear?
Is the patient responding in exaggerated fashion to actual events, or is there no discernible basis
in reality for the patient's beliefs or behavior?

The more seriously ill patient may exhibit overtly delusional thinking (a fixed, false belief not
held by his cultural peers and persisting in the face of objective contradictory evidence),
hallucinations (false sensory perceptions without real stimuli), or illusions (misperceptions of
real stimuli).
 11. INSIGHT/ JUDGEMENT :

Insight: awareness of one’s own illness and/or situation while Judgment is the ability to
anticipate the consequences of one’s behavior and make decisions to safeguard your well-being
and that of others.

4. CASE HISTORY INTERVIEW:

After initial interview in depth information is gathered by case history interview. A case history
is defined as “A planned professional conversation that enables the patient to communicate
his/her symptoms, feelings and fears to the clinician so as to obtain an insight into the nature of
patient’s illness & his/her attitude towards them”. This is life sketch of the person. The
background and the etiological factors are obtained in the process of case history.

In the first part of case history taking, details about demographic information such as name, age,
gender, residential address, education, occupation, marital status etc. are taken in detail. All the
minor things like where he stays and the area, all these things are mentioned in details. Then
details about who has referred him are taken into account.

The next part is about the referral. Who has referred this person? The next information is about
the actual problem that the person is facing right now is taken. Details about how these
symptoms started, how they progressed and what is the duration of this, etc., are all mentioned.
To understand if the person had difficulty in developmental years, the details about this are
taken.

By the time the counselor reaches this point he is oriented to the kind of personality the person
has. This is clinical evaluation of the personality. Then the interviewer asks about the medical
history if any. As is known physical illnesses also have an impact on the mental status of the
client. The next issue relates to the person’s interest and attitude towards life and other related
aspects. This is mentioned in the case history.

The other important aspect of history taking is Mental Status Examination. This is also called
Present Status Examination. In this the examiner tries to confirm the information that he has
gained in the previous part of the case history. The points like persons’ appearance, his speech
and thoughts are at the beginning of this section. It is also essential to assess if the person is
suicidal if he has had any previous attempts.

The other important aspect is regarding the pathology. The speech sample is mentioned. The
examiner also asks specific questions to evaluate if the thinking normally. According to the
phenomenology certain questions about the hallucination and delusion are asked. The person is
evaluated on this dimension.
 Objectives
1. To establish a positive professional relationship.
2. To provide the clinician with information concerning the patient’s past dental, medical &
personal history.
3. To provide the clinician with the information that may be necessary for making a
diagnosis.
4. To provide information that aids the clinician in making decisions concerning the
treatment of the patient.
 Case History Taking (Format)
1. Identification Data:
 Name
 Sex: This helps to understand the person with better cultural perspective.
 Age: The age of the person helps the clinician to understand the developmental phase
that he goes through.
 Education
 School / Institute
2. Problem:
 Stated by:
i) Client: What does the client think about the problem is very important. Others may
perceive the problem in different ways than how the client looks at it.
ii) Informant: This information is given by the person who accompanies the client.
iii) Others: In certain cases it is important that the information has to be gained on some
additional aspects.
 Duration of the Problem: The details of the problems are taken into account. The
onset and duration of the problem. In most of the cases the problem arises after there
is some stressor. So the details of how the problem started are asked to the client.
 Intensity of the Problem: The intensity of the problem will decide the actual
therapy that is to be used. This also tells us the urgency that the client has for the
intervention.
3. Personal History:
 Birth and Development: Delays in attaining the developmental milestones are the
good indicators of the intellectual sub normality. The ordinal position that the person
has born with affects the development of the personality.
 School History: This is the institute that the child first time faces in his life. The
school experience does have an impact on the further education of the person most of
the times
 Medical History: The person may develop certain symptoms as a result of some
other physical illness.
  Social History: The social development of the person tells us many things. To what
extent the client is related to the community. His position in the community is
indicated by this. This also is a good indication of the social support that the person
has.
 Emotional Development: This aspect tells us the person’s capacity to deal with his
problem when the counselor suggests it. This is the basis of the person’s personality.
 Premorbid Personality: This is the personality of the person before the actual onset
of the problems faced by the client. It includes his interests that he had and what was
his attitude towards himself. These assess what are the ways in which the person
copes with the stress. This becomes the basis for the counselor to design the
intervention for the client.
 The clients’ fantasy life: This is one more aspect on which information is obtained.
This tells us about the motivations and deprivations of the persons’ life.
 Sexual / Occupation History: This is the information that is taken carefully from the
client. The client may not be able to talk comfortably about the sexual content. It will
depend upon the rapport that is established with the client. The occupational history
throws light on the client’s overall personality.
4. Family History
Family is essential source of personality and development, and also in many cases source
of frustration. Therefore what are the family ties, what is structure of the family?
 Family Constellation: Relation, Age Education Occupation
 Socio-Economic status
 Relationship with Parents: This can be asked to the client and should be
confirmed with the parents also. Because it may happen that the client perceives
his parents in a misconstrued manner and thus forms an image of them as
supportive or non-supportive towards self.
 Interpersonal Relationship (within family): How the family members relate to
each other is important. The client may not be the victim of the conflict, but he
may witness it with some other family members.
5. DIAGNOSTIC INTERVIEWS:

An interview in which a health or mental health professional explores a patient’s presenting

problem, current situation, and background, with the aim of formulating a diagnosis and
prognosis as well as developing a treatment program.

Structured diagnostic interviews improve the diagnostic process by better organizing the
collection of clinical data and eliminating biases when applying diagnostic criteria. Available
interviews generally fall into two categories. Highly structured (or respondent-based) measures
use a set script and record subject's responses without interpretation. Thus, they are useful for
epidemiologic surveys or other settings in which nonclinical interviewers are used. Semi-
structured (or interviewer-based) tools allow clinical interpretation of responses as well as the
incorporation of other sources of information, thereby making them more relevant for clinicians.
Structured diagnostic instruments are currently most often used in research settings, but
potentially are useful for clinical settings as well.

A clinical diagnostic interview takes about two and a half hours, and the mental health
professional doing the interview will likely take notes as you talk. A symptom checklist might
also be used along with the CDI to help the interviewer make a diagnosis.

The purpose of the screening or diagnostic interview is to assist the clinician in his attempt to
understand the patient. If the level of diagnostic understanding required is merely a separation of
the fit from the unfit, as in military neuropsychiatric examinations, the interview task is one of
screening. That is, after a brief interview the interviewee be adjusted fit for specific duties, such
as a regular military assignment, or he may be referred for prolonged observation and extended
psychological testing. Occasionally, limit or trial duty may be recommended as an alternative to
regular duty of psychological observation. Up another occasions the diagnostic task is highly
specific, and a detailed level of understanding is required. This may involve a diagnostic label as
categorized as "paranoid schizophrenia" and a description of personality dynamics. In the later
case primary dependence is not placed upon the interview alone, for psychological tests play a
most important role in such detailed diagnostic procedures.

In the diagnostic interview, while the examination progresses; the interviewer observes the
interviewee's behavior as well as noticing the content of his answers. Thus thighs pressed
together, a mincing walk, and fluttery feminine gestures in a male should lead the interviewer to
suspect and investigate the possibility of homosexuality. The bubbling, enthusiastic replies and
exaggerated gestures in another interview should lead the interviewer to hypothesize tentatively a
manic condition and seek further evidence. Similarly, as Wittson, et al. noted, the psychopath
often gives evidence of his deviation by his utter impersonality or even belligerence towards the
interviewer. Ordinarily, brief neuropsychiatric interviews are not oriented towards future
psychotherapeutic activity because most of the interviews have no need of therapy. However, it
is not difficult to adopt the procedure of the brief interviews so that those who seem in need of
treatment are rendered more receptive to the idea. Thus this kind of interview is used to describe
that whether an individual needs help or not.

 Methods used to conduct diagnostic interviews:

1. Questionnaires and Behavior Rating Scales
2. Obtaining a developmental history (i.e. background information/current concerns)
3. Symptoms interview and mental status exam
4. Diagnose according to DSM-IV-TR
 Importance of diagnostic interviews:

Diagnostic interviews can help you determine why you’re not feeling like yourself, why your
child is struggling, or why you or a loved one may be in crisis. If you know that something is
troubling you or a loved one, but you’re struggling to define it, then it may be time to come in for
a diagnostic interview.

Therapists and psychologists will meet with you in the relaxed, comfortable environment of our
offices to talk with you about your concerns. Our evaluations are conducted in a professional, but
informal, manner where we ask questions to give us a better understanding of your concerns,
lead us toward a diagnosis, if appropriate, and determine a plan of action.

Unlike some evaluation methods that can feel one sided, our therapists seek to create a real
dialogue during the interview process. It is important to us that you leave the evaluation feeling
that you’ve been heard, and that the process gives you an insight, a strategy or a clearer level of
understanding that moves you in a positive direction from your very first visit.

WHAT IS RAPPORT?

Report is the word often used to characterize the relationship between patient and clinician.
Rapport involves a comfortable atmosphere and a mutual understanding of the purpose of the
interview. Good rapport can be primary instrument by which the clinicians achieve the purpose
the interview. A cold, hostile or adversarial relationship is not likely to be constructive. Although
a positive atmosphere certainly not the sloe ingredient for a productive interview, it is usually a
necessary one.

This skill is never more important than in an interview, where someone’s immediate impression
of you is critical. Rapport is an essential basis for successful communication – where there is no
rapport there is no (real) communication. To create rapport, we need to know how to connect
with others regardless of their age, gender, ethnic background, mood, or the situation. We tend to
be attracted to people that we consider similar to ourselves. When rapport is good, similarities
are emphasized and differences are minimized. We naturally experience rapport with close
friends or with those with whom we share a common interest. However we can learn to create
rapport and use it to facilitate our relationship with anybody, even with those with whom we
profoundly disagree.

 IMPORTANCE OF RAPPORT

The goal of developing a good rapport is to improve your chances for a successful outcome,
along with developing mutual trust and respect, to foster an environment in which you, the client,
feel safe. To develop a good rapport, your therapist must, among other things, demonstrate
empathy and understanding. Rapport is important because: It builds trust. It creates common
ground. It develops good relationships between clinicians and clients.

 The Importance of Rapport in Counseling:

Rapport is defined as a harmonious relationship between people while understanding each other's
feelings and ideas. It is extremely important that you as the client feel comfortable and safe with
the counselor. One of a counselor’s first objectives when meeting with a client is to build some
form of trust. If clients don’t have confidence in their relationship with their counselor, they are
less likely to open up about the challenges that they’re facing, much less be open to discussing
these challenges with the person with whom they are meeting.

Trust is vital. This means developing a good rapport, gaining a sense of confidence and feeling
that your counsellor is really able to listen and understand your needs. From the very first
session, you need to be able to trust your instincts and pay attention to your gut reaction.

 The Importance of Rapport in Therapy:

Good rapport is probably the most important ingredient to successful therapy and it is even
suspected in some quarters, if the rapport is good enough, then the therapist does not need to be
particularly skilled – I wouldn’t necessarily agree with that, but when it comes to hypnotherapy
there is no doubt that rapport is extremely important.

As a hypnotherapist I want my clients to feel as relaxed and comfortable with me as they can
with their loved ones so that they can open up about their feelings, as if they have known me for
years. At a deeper level, any client in this good rapport situation will have a strong belief that he
or she will get better and stay better, and that the therapy is going to help them change their life
as necessary. Rapport will also ensure that whilst they instantly understand and accept my
advice, they will also understand it still requires them to share the work. As such, they will start
to actually try to heal themselves, which means they will start to search for signs of
improvement, rather than indicators of failure – and before long they will find such a sign and
then we are on our way. Or rather, they are!

If rapport cannot be established then this would obviously be highly counterproductive to any
type of therapy. With hypnotherapy it is essential that the person can relax and trust whoever it is
that is guiding them through the hypnotic state. In one to one therapy you have to be able to open
up and be honest about your feelings and certain details of your life. It is obviously much easier
to tell someone about your personal thoughts and feelings if there is good rapport. It all comes
down to trust. When there is trust in place, then you are able to feel safe and secure in the
relationship. Good rapport removes any potential blockages between a client and therapist,
allowing communication to flow freely. The better the rapport, the more effective the
hypnotherapy will be. It is simple; hypnotherapy works best when the hypnotherapist has a clear
picture of what the client needs and wants to achieve.

3:interventions

What is intervention in psychology?

Interventions are actions performed to bring about change in people. A wide range of

intervention strategies exist and they are directed towards various types of issues. Most
generally, it means any activities used to modify behavior, emotional state, or feelings.
Psychological interventions have many different applications and the most common use is for the
treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind
these interventions is not only to alleviate symptoms but also to target the root cause of mental
disorders.

To treat mental disorders psychological interventions can be coupled with psychoactive

medication. Psychiatrists commonly prescribe drugs to manage symptoms of mental disorders.
Psychosocial interventions have a greater or more direct focus on a person's social environment
in interaction with their psychological functioning.

Psychological interventions can also be used to promote good mental health in order to prevent
mental disorders. These interventions are not tailored towards treating a condition but are
designed to foster healthy emotions, attitudes and habits. Such interventions can improve quality
of life even when mental illness is not present.

Interventions can be diverse and can be tailored specifically to the individual or group receiving
treatment depending on their needs. This versatility adds to their effectiveness in addressing any
kind of situation.

Psychotherapy, also known as talk therapy, promotes a relationship between a trained

psychotherapist and a person suffering from a psychological disorder.

Positive activity interventions (PAIs) are a part of positive psychology. PAIs can be used in
psychotherapy as well as outside of it. Examples include helping clients to focus on good things,
the future self, gratitude, affirmation of the self and kindness towards others.
Componenets of psychological intervantions

 To make sure the effects are long-term

 An intense focus on increasing a person’s level of happiness through positive emotions
and thoughts.
Types of psychological intervantions

1) Interventions that concentrate on gratitude

This is accomplished through two main methods: self-reflection, which includes writing in a
journal regularly; and the use of interactive methods such as giving tokens of appreciation,
saying “thank you,” and so on.

2) Interventions based on empathy

Healthy social bonds are one way to achieve this because they strengthen interpersonal
relationships and positive feelings towards others, which naturally increases positive feelings
towards oneself.

3) Interventions based on strengthening how powerful you feel

This practical wisdom experienced by patients gives them a better sense of power and control,
which can automatically reduce symptoms associated with depression and other illnesses.

4) Interventions based on determining what is meaningful to you and why

Examples of encouraging this type of intervention include setting realistic goals for yourself,
utilizing the best ways to achieve those goals, and even reflecting on emotions and thoughts in
order to make them more positive.

5) Interventions based on Cognitive Behavior Therapy, or CBT

This is an old but very effective method that identifies and concentrates on the strengths of the
patient. Every exercise that is used with CBT enables the therapist to concentrate on the more
positive characteristics the patient exhibits.

6) Interventions based on mindfulness

These are usually used in conjunction with other methods, and they include activities such as
breath control, guided meditation, and sensory awareness. A clear mind is the first part of being
more mindful of your surroundings, which is why it is stressed in this intervention.

7) Interventions based on some type of non-secular practice

This most often involves encouraging the patient to enroll in some type of yoga class. Yoga is a
Buddhist method of growing spiritually and emotionally by following a set of physical
techniques that concentrate on proper breathing and the mind-body connection.
8) Stress management exercises
Most workers are experiencing some type of stress. When the employer offers specific
opportunities to reduce some of that stress, it affects employees in a very positive way. There are
many PPIs to reduce workplace stress.

9) Making sure people have strong support socially

This often takes the form of community-based groups specifically designed to help people in
certain situations have more control over those situations. Improved social support always seems
to eliminate many of the depressive episodes that people experience.

10) . Concentrating on more positive emotions

Positive engagement and increasing positive emotions have been proven to have a great effect on
people who are depressed, both those taking medication and those who are not. It also increases
their overall satisfaction with life and reduces their symptoms of the illness.

11) Concentration on resilience and coping skills

Being better able to cope with things decreases the chances of suffering with depression. These
interventions concentrate on regulating emotions and better coping with disappointments and
tragedies. One such program is called “Strong Minds” and was developed by Burckhardt and
Colleagues.

5 Therapeutic Intervention Strategies

Strategies will vary for the type, severity, and duration of therapeutic needs. Being well versed in
intervention strategies gives therapists a full palette from which to paint their approach to helping
clients heal. Here are a few of the most well known.

1. For Addiction

A commonly utilized approach to help an individual who has in the past refused to participate in
changing habitual and harmful behavior is group intervention. A mediated, supportive, and
gentle meeting is often staged to support this individual. Members of a client’s family, friends,
and others from their environment will voice their concerns directly to the client.

2. Individual Behavioral Interventions

Strategies commonly utilized when working with youth. They include, but are not limited to
positive reinforcement, time-limited activities, and immediate behavior reinforcement. When
attempting to help a youth who has had difficulty with inappropriate reactionary behaviors in the
past, these strategies are vital for safety and growth.
3. Crisis Intervention

When someone has suffered a trauma, a therapist or qualified professional can support a healthier
processing of an extreme situation. Helping someone after a crisis occurs helps them to gain a
clear perspective and support when it is most needed. This type of intervention takes special
training and skills.

 4. Psychopharmacology Interventions

These are typically used in patients presenting with more severe symptoms, although they seem
to be used broadly. When in combination with effective psychotherapy, improvements can be
made in a significant number of presenting psychological disruption. It does require the
participation of a licensed prescriber.

5. Positive Psychology Interventions

A great deal of research has been done in supporting a patient in applying interventions in
positive psychology into their life. Therapists with a deeper understanding of the benefits of
these types of interventions can not only help patients return to health. They can also help
patients lead lives that are more fulfilled. Here are the best Positive Psychology Interventions.

What is psychotherapy?

A psychologist can help you work through such problems. Through psychotherapy,
psychologists help people of all ages live happier, healthier, and more productive lives.In
psychotherapy, psychologists apply scientifically validated procedures to help people develop
healthier, more effective habits. There are several approaches to psychotherapy—including
cognitive-behavioral, interpersonal, and other kinds of talk therapy—that help individuals work
through their problems.

Psychotherapy is a collaborative treatment based on the relationship between an individual and a

psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk
openly with someone who’s objective, neutral, and nonjudgmental. You and your psychologist
will work together to identify and change the thought and behavior patterns that are keeping you
from feeling your best.

Research has shown that only 25% of the population is flourishing (Niemic, 2017). A call to
action has helped to shift mental health care, but not nearly enough. A deeper and widespread
understanding of the benefits of therapy is called for in schools, workplaces, and medical
facilities.
Some examples of where this action is already happening are:

 Inclusion of stress and depression related questionnaires in primary care offices.

 School counselor expansion of mindfulness and mental wellness education for students.
 Office place wellness benefits.
 Availability of apps to increase mental well being.

The Psychotherapy Relationship: Theory, Research, and Practice

The highly complex process of psychotherapy can be viewed as consisting of two major parts:
the relationship and the technique. The relationship part is hard to define, even harder to grasp
clinically, and difficult to study empirically. Although there are different schools of
psychotherapy, few would disagree that a good therapeutic relationship is a necessary condition
for the favorable outcome of psychotherapy.

The central focus of this book is, in the authors' words, “what that relationship consists of, how it
develops during treatment, how it varies for different systems of psychotherapy, how it operates
in and affects treatment.” As they have acknowledged, the book is an extension of the theoretical
formulations on psychotherapy relationship originally developed by Gelso and Carter.1,2 The
focus is on individual psychotherapy, although the discussions and the propositions can be
generalizable to other formats like group or family work.

In today's world of evidenced-based treatments and, in the absence of evidence, expert opinions,
the authors have done a fairly good job of combining theory and practice with research. They
start by defining a successful psychotherapy relationship and discuss how such a relationship is
defined in four major schools of psychotherapy: psychoanalytic, cognitive-behavioral,
humanistic-existential, and feminist. In each of these sections, the authors draw upon both the
literature and their own clinical experience.

The first half of the book is focused on the components of the psychotherapy relationship:

1) the working alliance,

2) the “unrealistic” relationship in psychotherapy (transference and counter transference), and
3) the “real” relationship. The authors see all psychotherapy relationships as consisting of these
three components. After introducing the three components at length, the authors examine and
explore how each of them operates in different types and schools of psychotherapy. They further
discuss the interaction of these components with each other and with therapists' techniques as the
therapy progresses. Throughout, they discuss how the propositions are informed by theory,
practice, and research.
This first section prepares the reader to delve into the second half of the book, in which the
authors discuss and analyze the conceptualizations of psychotherapy relationship in the four
major theoretical clusters. With each, they approach this on four dimensions:

1) whether the relationship is seen as central or otherwise (“as an end in itself or as a means to
an end”);
2) whether the relationship is seen as curative in itself;
3) the relative emphases on “real” relationship versus transference and countertransference; and
4) the therapist's conceptualization and use of power in the relationship.

A particular strength lies in the effort to bring in findings from research, when it exists. In the
first section of the book the authors review the available empirical research findings on the
definition of psychotherapy relationship, the importance of working alliance to treatment
outcome, and the area of transference configuration. Along with the evidence, they present their
own views, developed from their practice and supervision of psychotherapy, and provide case
material to clarify certain points. This dual emphasis on science and practice is, I think, the real
strength of this book.

An area where Gelso and Hayes's book seems to differ from most others on psychotherapy is in
the authors' presentation of feminist therapy as one of the four main clusters of psychotherapy.
They do raise the question of whether feminist therapy is a unique theoretical approach to
clinical work or a system that possesses tenets of its own but also shares attributes with other
approaches and hence can be combined with them. After discussing related aspects, the authors
conclude that feminist therapy “constitutes a singular approach to therapy that nonetheless may
be integrated with other distinct theoretical systems.” This conclusion seems less than strongly
supportive of their including feminist therapy as one of the four major clusters of psychotherapy.
It also appears to be an all-accommodating conclusion, which is, perhaps, more reflective of the
field than of one particular book or opinion.

The Ideal Psychotherapy Client

In the 60's the perfect therapy client was described as YAVIS:

(Y) youthful, (A) attractive, (V) verbal,(I) intelligent and (S) successful. Do therapists still
believe this?
In 1964, University of Minnesota professor William Schofield (1921-2006) wrote
Psychotherapy: The Purchase of Friendship presenting his views on the state of the mental health
profession. It's a we're headed in the right direction, but have a long way to go sort of
commentary with recommendations for better training for therapists, more rigorous selection of
therapy candidates and clearer distinction between "mental illness" and the normal problems of
human experience.
Schofield's Psychotherapy is a bit dated, but the many illuminating, critical research findings and
insights make this a fine addition to any "paid friend" library. It's peppered with cutting tidbits
such as this from his Introduction to the 1986 edition:

Take that, CBT. Schofield pointed his critical spotlight on the entire field of psychotherapy and
researched many biases and inconsistencies within the profession. For example, he surveyed 377
psychiatrists, psychologists and social workers and asked about traits of their ideal client, defined
as: "the kind of patient with whom you feel you are efficient and effective in your therapy" (p.
130). The majority stated a preference for married women, aged 20-40 with at least some post-
high school education and a professional/managerial occupation. Hence his formulation of the
"YAVIS syndrome," critiqued here:

What is there in the general theory of psychodynamics or psychotherapy to suggest that the
neurosis of a 50 year-old commercial fisherman with an eighth-grade education will be more
resistant to psychological help than a symptomatically comparable 35 year-old, college-trained
artist? ... It seems more likely that there are pressures toward a systematic selection of patients,
pressures that are perhaps subtle and unconscious in part and that, in part, reflect theoretical
biases common to all psychotherapists. These selective forces tend to restrict the efforts of the
bulk of [therapists] to clients who present the YAVIS syndrome - clients who are youthful,
attractive, verbal, intelligent and successful. (p. 133)

The YAVIS syndrome points to the biases therapists hold about rewarding, successful
psychotherapy. Therapists tend to want to work with clients with whom they can achieve
success, and these characteristics seemed to lend themselves toward a better prognosis in
therapy.

So what about today? Are therapists still looking for YAVIS? I decided to tackle this myself, on
a much smaller scale. Schofield did his research 45 years ago and I did mine last month. He
surveyed 377 psychotherapists and I surveyed 20 psychologists (mostly), social workers (one),
marriage and family therapists (a couple) and psychology graduate students (a few). I'm sure his
sample was fairly representative of the population at the time. Mine is not, consisting of some
friends and colleagues from my address book. I won't even pretend my friends are representative
of therapists as a whole.

Schofield had a detailed questionnaire, but I simply asked 20 colleagues for three adjectives
describing their ideal client. Here's what they said (combining synonyms):

 Motivated, ready to work

 Open-minded, flexible, adaptable
 Introspective, contemplative, curious about self
 Consistent (with payment & appointments)
 Verbal, communicative
 Honest
 Trusting
 Creative
 Sense of humor
 Intelligent
 Enough symptoms to keep things interesting
 Spiritual
 Non-resistant
 Cash pay
 Gracious
 Tolerance for ambiguity
 Will tolerate pain for growth
 Neurotic
 Sparring
As you can tell, it's not quite Schofield's findings. Youthful, attractive and successful aren't even
mentioned, intelligent gets one vote and verbal barely cracks the top five.

I'm not terribly surprised by these results. They point to a theme I often hear from therapists: we
want clients to be as invested in the process as we are. We like it when they're motivated to work
in and out of the session, ready to try new things and willing to look deep inside. When these
ideal elements are in place, therapy tends to progress nicely. Pulling teeth to motivate,
collaborate and communicate is much harder work. But that's why we go to school and earn a
paycheck.

A large part of our job is helping clients learn what motivates and discourages them, what rigid
beliefs and harmful paradigms they cling to and how to become curious about the self. So there's
good news: motivation, open-mindedness and introspection can develop over time, which gives
everyone the potential to be the ideal client. At least these qualities are easier to achieve than
YAVIS.

On a final note, after I sent my bulk email a few therapists wondered if I was sneaking them a
projective test. Shrinks are paranoid like that. I didn't have that goal in mind but did observe that
several therapists shared characteristics with their ideal client. Or maybe they were reporting
their own ideal traits, the qualities they wish they embodied. Why would a therapist want to work
with their own ideal self? A question for another blog.
Apparently, therapists aren't looking for YAVIS. We want clients who invest in the process and
share the traits we highly value: motivation, openness and introspection.

Therapy Techniques You Can Apply Today

Therapists develop their skills to serve their patients best, using any of a multitude of techniques
to reach each patient as an individual. Some of these techniques can, however, be used in your
own life too.Some clients are comfortable just being heard by their therapist. Others might be
seeking a transformative process utilizing tools that are unique and come from other modalities.
Therapists having open minds and consistently improving their approach, with an increased
variety of techniques, will help more clients due to their individuality and personalized needs.

In Solution Focused Therapy, the Miracle Question is a powerful way for therapists to help
their clients understand what they need on a deeper level. The technique can be used across types
of therapy and is also used in coaching. We all want to believe in miracles, and they are
incredibly subjective, yet powerful ways for clients to internalize what it would be like if their
miracle occurred.

Like the use of the miracle question, open-ended questions are crucial in therapy. These types
of questions allow clients to explore their minds without therapist presumptions. Along with
open-ended questions, the following are communication techniques that should be in every
therapist’s toolbox:

 appropriate use of silence

 rephrasing or paraphrasing

 Reflection

 summarizing

 Acknowledgment

An intriguing technique developed from the theory by psychologists Hal and Sidra Stone is
called Voice Dialogue. From their theory of Psychology of the Selves, we all operate from a
multitude of selves working for or against us all the time. You’ve heard of the inner critic, the
self-saboteur, and the inner child. This technique allows for these inner selves to have a voice.

By becoming aware of the presence of these alternate selves and allowing them to be heard, a
client may find a more manageable balance in finding a new way of being in the world. Allowing
for a dialogue with an inner self who has continuously been problematic can allow another self to
stand up and be heard. It’s a creative and powerfully introspective technique that can help clients
overcome self-limiting beliefs and behaviors.

The Hunger Illusion is an interesting technique that can be used across many forms of positive
psychotherapy. It is a technique that anyone can use at home too. It helps clients to overcome
habitual behavior. This helps clients become aware of unconscious motivations for behaviors by
tuning into thoughts.The technique works like this:

 Notice the moment you tend to act automatically.

 Don’t act automatically

 Keep track of thoughts and feelings that pop up in those “Don’t” behaviors

In Gestalt Therapy, the Empty Chair is an interesting way to allow clients to communicate their
abstract thinking effectively. Gestalt Therapy focuses on the whole client, including their
environment, the people in it, and the thoughts around the whole.This technique opens up the
ability to speak to a problem in a safe and supported way. It is especially useful for clients who
are not verbalizing their abstract thinking concerning people in their environment. It is not as
helpful for a client who is already adept at dramatically presenting their emotions.The idea is
creating a cue for a client to unleash their inner thoughts on an imaginary person sitting in an
empty chair. The technique brings the client into a present moment experience. It offers clients a
new way to interact with personal conflicts.

11 Must-Have Skills in Therapy

Therapists go through many hours of training to develop special skills to treat their patients. The
following skills should be considered a “must-have” list.

1. Empathy

Therapists must possess the ability to understand or feel what their client is experiencing.

2. Self-Management

Therapists sit with uncomfortable emotions regularly. Deeply understanding how providing
therapeutic services might influence one’s emotional state is vital.

The ability to compartmentalize the emotions that are experienced in a therapeutic setting from
one’s personal experience is important to the therapist’s well being.

3. Listening Skills
Therapists’ listening skills are finely tuned. Utilizing intuitive and active listening is necessary to
serve patients in a transformative way. Through observation and fully attending to patients, a
therapist creates an environment where they feel safe and heard.

4. Ability to set boundaries

Providing appropriate parameters within which a therapist works with a patient is foundational to
therapeutic success. This skill enables professionalism to exist in the therapist/client relationship.

5. Authenticity

Once the boundaries are set, a therapist can show up for their client as their best self. With a
warm and nurturing approach, a therapist can utilize humor and deep understanding to hold
space for a patient to create change.

6. Unconditional positive regard

A good therapist cultivates the ability to attend sessions with their patients in a non-judgmental
and caring capacity.

7. Concrete Communication

Making sure that the client is the focus of communication without a great deal of self-disclosure
is important. Staying in a task-oriented communication focus will help the client move forward.

8. Interpretation

Interpretation is a skill that takes some practice to cultivate well. It is utilized to give clients
perspective but should be used sparingly.

9. Solution collaboration

Considering self-determination theory (Deci & Ryan, 2012), a good therapist will know that
solutions coming from a client are more effectively created.However, once a client has exhausted
their personal resources for finding a solution, a collaborative approach is helpful when forging
solutions for behavior change.

10. Business management

Most therapists don’t get into this type of work to become millionaires. They begin their practice
to help people. It is imperative to understand the business of therapy, however. You don’t have
to become an MBA, but knowing how to run a successful business is necessary for a practice to
survive.

11. Cultivated interest in others

A therapist who shows up as an arrogant “know it all” will likely have an empty waiting room.
Developing an authentic interest in others will aid in creating a safe and trusted environment for
clients.

Goals Of Psychotherapy

The primary goals of Psychotherapy are:

1) To know yourself better.

2) Alleviate emotional pain or confusion.

3) Assist you in developing a more complete understanding of your psychological issues.

4) Establish more effective coping mechanisms.

5) Foster a more accurate understanding of your past and what you want for your future.There
are

THREE FUNDAMENTAL PROCESSES in psychotherapy that will facilitate your reaching

these goals.

1. To develop trust or a “therapeutic alliance” with your therapist. During this period the
treatment goals are defined and mutually agreed upon. The purpose at this point is to fashion a
method of doing therapy that fits best with your personality.

2. In the second phase or “working through” process, the emphasis is on resolving confusions
about past experience, and developing ideas about what you want and who you are. The desired
outcome is to trust your intuitive process, feel unobstructed about the direction your life is
taking, and to advance your efforts to enjoy a more healthy and productive life. The expected
outcome from psychotherapy should be that you feel more “at home” in the world, more
accepting of yourself and with your life choices.

3. The third or termination phase of therapy is to evaluate your progress, solidify what you have
learned, resolve any remaining conflicts, and hopefully feel satisfied with your life and yourself.
All three phases are essential to maintaining your psychological gains.
The more interested and involved you are in your therapy the more you will progress.
Psychotherapy can at times evoke anxiety, fear, anger, frustration, loneliness and dependency
feelings. if faced, can be worked through. The emphasis is in replacing fantasy, myth, and
untruths with reality. Reality and truth can at times, be painful, but will ultimately lead to more
personal happiness and healthier relationships. The goal of psychotherapy is not to change you,
change is your choice, but it is to build awareness, compassion, understanding, respect, empathy
and acceptance toward yourself and others.

LENGTH OF SESSIONS

The sessions are 50 minutes in length. You will not be charged for phone calls unless otherwise
arranged. I encourage you to call me when necessary as I want you to feel that you can contact
me easily to promote progress in therapy. If phone calls are longer than 25 minutes, there may be
some charge and you will be informed of this at the time

CONFIDENTIALITY

All communications are confidential and will be treated as such. You own the information, and I
cannot under law give that information to anyone without your expressed written permission.
There are certain exceptions. Those exceptions are: child abuse, or the expressed imminent
danger to your self or others. It is required by law that I inform a relative, a designated friend or
the authorities of these circumstances.

MY COMMITMENT TO YOU

I promise to help you in your efforts to gain a healthier life. I will endeavor to give you my
utmost attention, protection, support, honesty, integrity and respect. My intention is to help you
to achieve your personal goals. I am on your side, and will not be pressing to make my points at
the expense of yours. I believe that there are reasons for all behavior and if understood can lead
to important insight and health. Please feel free to ask questions and discuss any aspect of
therapy that you feel unsure of. Please correct me if you feel that I am not understanding you.
Most difficulties in the therapeutic process are due to misunderstandings, so please express any
complaints that you may have, however small they may be. To resolve any and all conflicts,
misunderstandings, and differences allows for deeper understanding and healing.

PAYMENT, FEES AND INSURANCE

Your fee will be arranged at the time of the first session. Unless otherwise arranged, fees are
payable at the end of the therapeutic hour. Please have your check written in advance for greater
efficiency. Cash is acceptable. At the end of each month if you are filing an insurance form, you
will receive, free of charge, an insurance statement. If at any time you have questions about
billing or fees please feel free to discuss this with me as they may affect the progress of therapy.
The emphasis here is to be open and honest. There may be from time to time a cost of living
increase. The proposed increase will be discussed at that time.

RESCHEDULING

Emergencies may arise which make it impossible for you to come to your regularly scheduled
appointment. I will try to give you another appointment as my schedule permits within the week.
If the time is available, I will schedule an appointment with you, and you will not be charged for
the missed session. If I do not have a time available and you do not give me at least 12 to 24
hours notice, you will be held responsible for payment of the fee for therapy.

Does psychotherapy work?

About 75 percent of people who enter psychotherapy show some benefit from it. Psychotherapy
has been shown to improve emotions and behaviors and to be linked with positive changes in the
brain and body. The benefits also include fewer sick days, less disability, fewer medical
problems, and increased work satisfaction. Studies have found individual psychotherapy to be
effective at improving symptoms in a wide array of mental illnesses, making it both a popular
and versatile treatment. It can also be used for families, couples or groups.

Types

There are several styles of and approaches to psychotherapy. The sections below will outline
these in more detail.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps a person understand and change how their thoughts
and behaviors can affect the way they feel and act.

CBT can help people with many issues, including:

Depression

Anxiety

Post-traumatic stress disorder

Eating disorders
Low self-esteem

Interpersonal therapy

Under this approach, a person learns new ways to communicate or express their feelings. It can
help with building and maintaining healthy relationships.

For example, if someone who responds to feeling neglected by getting angry, this may trigger a
negative reaction in others. This can lead to depression and isolation.

The individual will learn to understand and modify their approach to interpersonal problems and
acquire ways of managing them more constructively.

Psychodynamic therapy

Psychodynamic therapy addresses the ways in which past experiences, such as those during
childhood, can impact a person‘s current thoughts and behaviors. Often, the person is unaware
that this influence is even present.

Identifying these influences can help people understand the source of feelings such as distress
and anxiety. Once they identify these sources, the psychotherapist can help the person address
them. This can help an individual feel more in control of their life.It is similar to psychoanalysis
but less intense.

Family therapy

Family therapy can provide a safe space for family members to:

 Express their views

 Explore difficult feelings
 Understand each other
 Build on existing strengths
 Find solutions to problems
This form of psychotherapy can be useful when problems stem from family relationships, or
when a child or young person is facing difficulties.

In fact, one 2019 article suggests that family therapy may help adolescents with mental health
problems. It may also improve family cohesion and enhance parenting skills.
Relationship therapy is another type of psychotherapy. It is very similar to family therapy, but a
person may instead wish to present to therapy with their partner to address issues within a
relationship Group therapy Group therapy sessions usually involve one therapist and around 5–
15 participants with similar concerns, such as:

Depression

Chronic pain

Substance misuse

The group will usually meet for 1 or 2 hours each week, and individuals may also attend one-on-
one therapy.

People can benefit from interacting with the therapist but also by interacting with others who are
experiencing similar challenges. Group members can also support each other.

Although participating in a group may seem intimidating, it can help people realize that they are
not alone with their problem.

Online therapy

Many people are now opting for online therapy, otherwise known as telehealth. This can have
many benefits, especially for someone who:

 Has mobility problems

 Cannot find a suitable specialist in their area
 Has difficulty fitting therapy into their schedule
 Does not feel comfortable with face-to-face communication
 Tools include video meetings and messaging services.
Although online services have helped “normalize” psychotherapy, making it easier to integrate
into daily life, a person should check carefully before choosing a provider.

For example, they should consider:

The qualifications and experience of the therapist

The online and other security measures the provider has in place
Using a company that psychologists run and that has links with professional associations

Meta-analysis is a quantitative, formal, epidemiological study design used to systematically

assess the results of previous research to derive conclusions about that body of research.
Typically, but not necessarily, the study is based on randomized, controlled clinical trials.

For example, a systematic review will focus specifically on the relationship between cervical
cancer and long-term use of oral contraceptives, while a narrative review may be about cervical
cancer. Meta-analyses are quantitative and more rigorous than both types of reviews.

Why Do a Meta-Analysis?

Medical research can be confusing. How would you make a decision if you read 30 studies that
said a weight loss treatment worked and 30 that said it didn’t work? What if I told you there was
a better way than just flipping a coin? The reason people do meta-analyses is that research from
several studies with conflicting results can be combined to make decisions about the
effectiveness of a medication on a person’s risks for developing a disease that is more informed
than using a Magic 8-ball

.1. Define Research Question and Review Literature

Meta-analyses begin with defining the research question. A defined research question identifies
the population affected by the intervention and the potential outcome(s) of treatment

. For example

, Are women who use oral contraceptives for 10 or more years at greater risks for cervical cancer
than women who have never used oral contraceptives? This question defines the population, and
it identifies cervical cancer as the outcome of the intervention, long-term contraceptive use.
Reviewing the literature for studies that answer your research question comes after your question
has been defined. When you review the literature, it is kind of like using Google to search for
information, except you look in places like PubMed, Medline, EMBASE, or Google Scholar.
Throughout this step, you’re looking for scholarly papers that are relevant to your research
question

2. Select Appropriate Studies

Selecting the appropriate studies is probably the most important step of a meta-analysis. The
studies selected to be included add strength to the analysis. There is no exact process for
choosing papers, but in general, papers that are duplicates, that are written in a language you
can’t understand, or that are not clinical studies, can be eliminated.
After eliminating papers that are clearly not useful, screen the rest of the papers a bit more deeply
for eligibility. Several elements can be used to determine a paper’s eligibility for the analysis, but
it is important that all of the studies you include have the information that you need in order to
do your analysis. This data may include characteristics of the population, such as age, race,
health status, and appropriate statistical analyses.

3. Extract Data

The next step in the process is extracting the data for analysis and synthesis. Creating a
spreadsheet, table, or some other form to record the information makes this part of the process
easier. The extracted data depends on the research question, but it may include information such
as sample size, patient characteristics, length of study, and a statistical measure, such as
confidence interval, odds ratio, risks ratio, mean difference, or hazard ratio.

4.Develop and use clear inclusion/ exclusion criteria

5.Develop and use an explicit search strategy

6.Critically assess the validity of the findings in included studies

7.Analyses of findings across the studies – statistical analysis would involve decisions
related to:

The dependent and independent variables under review

How studies will be weighted according to sample size

How to conduct sensitivity analysis (the extent to which study results stay the same given
different approaches to aggregating data)
 4: Psychodynamic psychotherapy
Psychodynamic psychotherapy is a method of verbal communication used to help a person find
relief from emotional pain. It is based on the theories and techniques of psychoanalysis.

Psychodynamic psychotherapy is a time-honored mode of in-depth exploration of the patient's

internal world and the derivatives of that internal world in the patient's world and daily life. There are
a variety of theoretical models that are typically used by psychodynamic therapists, and these models
are tailored to the specific characteristics of the patient with the notion that no one conceptual
framework explains all the psychopathology.

A critical aspect of psychodynamic psychotherapy is to use what transpires within the therapeutic
relationship as primary data to understand what happens in relationships outside the therapy.
Psychodynamic psychotherapy has now accumulated sufficient empirical evidence through
randomized controlled trials to support it as an efficacious treatment modality. Both STPP and LTPP
have been shown to be useful in a range of psychiatric disorders.

History

Psychodynamic therapy grew out of the theories of Sigmund Freud. However, it has evolved
considerably from the 19th-century model. Early leaders in the field who contributed to the
development of this approach include Carl Jung, Melanie Klein, and Anna Freud. In its earlier
stages, therapy could last for years, with a person even having several therapy sessions per week.
Practitioners typically had a medical background and a paternalistic approach

How does it work?

There are several theories as to why psychodynamic therapy is efficacious as a treatment

modality, including:

 Making the unconscious conscious

 Supporting weakened ego function

 Reactivating mental and emotional development

Efficacy

Short-term psychodynamic therapy is effective and has modest to large effect sizes for
common mental disorders, including anxiety and depressive disorders. Psychodynamic
therapy should not be limited to adults, and can be used in children (e.g. - play therapy) and
adolescents as well.
Time range

Short-term psychodynamic therapy generally lasts for 25–30 sessions over a period of 6–8

months, while long-term psychodynamic therapy — according to one study — may last for
longer than a year or span more than 50 sessions.

It is used for;

 Depression: Studies indicate that it can help people address recurring life patterns that
play a part in their depression.
 Social anxiety, social phobia, and panic disorder: Studies have found promising results
and improved remission.
 Anorexia nervosa: Strong evidence suggests that it promotes recovery from anorexia
nervosa.
 Pain: Unexplained chronic and abdominal pain responds well to this therapy, data
suggest.
 Borderline personality disorder: Studies have found structured, integrated, and
supervised treatment to be effective.
 Psychopathological issues in children and adolescents: Researchers have found
psychodynamic treatment to be effective overall in reducing symptoms of
psychopathological issues in children aged 6–18 years.

Limitations

Although psychodynamic therapy can be an effective form of treatment for many mental health
conditions, the researchers behind one report found that it may be less effective for the
following conditions:

 post-traumatic stress disorder (PTSD)

 obsessive-compulsive disorder
 drug addict
Sigmund Freud psychoanalytical psychotherapies

Sigmund Freud was an Austrian neurologist. Sigmund Freud (1856 to 1939) was the founding
father of psychoanalysis, a method for treating mental illness and also a theory which explains
human behavior.

Psychoanalysis
Psychoanalysis is defined as a set of psychological theories and therapeutic methods which have
their origin in the work and theories of Sigmund Freud. The primary assumption of
psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and
memories.
According to psychoanalysis human personality is divided into two parts:

 Conscious
 Unconscious
Conscious refers to the ideas and sensations of which we are aware. It operates on the surface of
personality and plays a relatively same role in personality development. In contrast, unconscious
operate on the deepest level of personality. It consists of those experiences and memories of
which we are not aware. Such mental states remain out of awareness because making them
conscious would create tremendous pain and anxiety for us. These two parts conscious and
unconscious are in conflicts and human behavior is compromise between these two domains.
Psychoanalysis purposes that human psyche mind divided into three parts;

 Id
 Ego
 superego

According to Freud psychoanalytic theory, the id is the primitive and instinctual part of the

mind that contains sexual and aggressive drives and hidden memories, the super-ego operates as
a moral conscience, and the ego is the realistic part that mediates between the desires of the id
and the super-ego.

According to psychoanalysis says that conflict between desires to ravage and social order result
in the development of defense mechanism. The concept derives from the
psychoanalytic hypothesis that there are forces in the mind that oppose and battle against each
other. The term was first used in Sigmund Freud’s paper “The Neuro-Psychoses of Defense”
Defense mechanism keep us safe from guilt and anxiety we would feel in order to gain desires.
The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make
the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person
be helped and "cured."
In psychoanalysis (therapy) Freud would have a patient lie on a couch to relax, and he would sit
behind them taking notes while they told him about their dreams and childhood memories. 
Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst
Due to the nature of defense mechanisms and the inaccessibility of the deterministic forces
operating in the unconscious, psychoanalysis in its classic form is a lengthy process often
involving 2 to 5 sessions per week for several years This approach assumes that the reduction of
symptoms alone is relatively inconsequential as if the underlying conflict is not resolved, more
neurotic symptoms will simply be substituted

The psychoanalyst uses various techniques as encouragement for the client to develop insights
into their behavior and the meanings of symptoms, free association, interpretation (including
dream analysis), resistance analysis and transference analysis.

The History of Psychoanalytic Therapy

Freud began developing his therapeutic techniques in the late 1800s. In 1885, he began to study
and work with Jean-Martin Charcot at the Salpêtrière in Paris. Charcot used hypnosis to treat
women suffering from what was then known as hysteria. Symptoms of the illness included
partial paralysis, hallucinations, and nervousness.

Freud continued to research hypnotism in treatment, but his work and friendship with colleague
Josef Breuer led to the development of his most famous therapeutic technique. Breuer described
his treatment of a young woman, known in the case history as Anna O., whose symptoms of
hysteria were relieved by talking about her traumatic experiences.

Freud and Breuer collaborated on a book called Studies on Hysteria and Freud continued to

develop his use of this "talk therapy." This approach proposed that simply talking about
problems could help relieve psychological distres .

Psychoanalytic therapies

1. Dream Analysis

Freud said, “Dreams are the royal road to the unconscious. In dreams the ego’s defenses are
lowered so some of the repressed material comes to awareness, in distorted from through
dreams. Dreams perform important functions for the unconscious mind and serve as
valuable clues to how the unconscious mind operates”.
Another technique used by Freud to unravel the secrets of his patient’s unconscious was
dream analysis. Freud task, as he saw it, was to analyze and interpret the symbols present in
the manifest content of their dreams, in an attempt to discover the latent or hidden meanings.
As a result of his extensive clinical experiences, Freud believed that these symbols had
universal meanings. Sticks, tree trunks, umbrella, and snakes, for example, were to
symbolize the penis; boxes, doors, and furniture chests represented the vagina.
In Freud view, dreams are always diagnosed attempts at wishfullment. The wishes are
unconscious motives that are unacceptable to the individual and nearly always neurotic in
nature.
 2. Free Association
Sigmund Freud  was in the process of developing free association from 1892 to 1898. He
planned on using it as a new method for exploring the unconscious. It would
replace hypnosis in this respect. Freud claimed free association gave people in therapy
complete freedom to examine their thoughts
Free association is a practice in psychoanalytic therapy, in which a patient talks of whatever
comes into their mind. This technique involves a therapist giving a word or idea, and the patient
immediately responds with the first word that comes to mind. 
It is hoped that fragments of repressed memories will emerge in the course of free association,
giving an insight into the unconscious mind. Free association may not prove useful if the client
shows resistance, and is reluctant to say what he or she is thinking.  On the other hand, the
presence of resistance (e.g., an excessively long pause) often provides a strong clue that the
client is getting close to some important repressed idea in his or her thinking, and that further
probing by the therapist is called for.
Freud reported that his free associating patients occasionally experienced such an emotionally
intense and vivid memory that they almost relived the experience.  This is like a "flashback"
from a war or a rape experience.
Such a stressful memory, so real it feels like it is happening again, is called an abreaction.   If
such a disturbing memory occurred in therapy or with a supportive friend and one felt better--
relieved or cleansed--later, it would be called a catharsis. Frequently, these intensely emotional
experiences provided Freud a valuable insight into the patient's problems,
3. Transference
Besides free association and dream analysis, Freud relied heavily on transference to facilitate
movement toward cure for his patient. In the course of treatment, he discovers that patients
inevitably began to relive their old conflicts and interactions with authority figures in their
relationship with him.
In general, he maintained, patients begin to see their therapist as a reincarnation of important
figures in their past. As a result, they transfer to their therapist the kinds of feelings and
behaviors previously directed toward these early authority figures. In Freud view, this
transference phenomenon could be of inestimable value in helping therapists cure their patients.
Yet it could also be as possible source of danger if the patients decided to act out their old
feelings of hostility and anger toward their parents.
In general, according to Freud, the transference process is characterized by ambivalence; that is
patients, typically have attitudes of both affection and hostility toward their parents, and these
positive and negative feelings are displaced onto therapist. Freud found that positive feelings
were displaced onto him first and that negative feelings followed later.
In positive Transference can be a good thing. You experience positive transference when you
apply enjoyable aspects of your past relationships to your relationship with your therapist. This
can have a positive outcome because you see your therapist as caring, wise and concerned about
you.
In negative transference, sounds bad but actually can enhance your therapeutic experience.
Once realized, the therapist can use it as a topic of discussion and examine your emotional
response. This type of transference is especially useful if your therapist helps you overcome an
emotional response that is out of proportion to the reality of what transpired during the session.

In Sexualized Transference, Are you feeling attracted to your therapist? You might be suffering
from sexualized transference if your feelings for your therapist are:

 Intimate and sexual

 Reverential or worship

 Romantic and sensual

In counter-Transference, the therapist must always be aware of the possibility that their own
internal conflicts could be transferred to the client as well. This process, known as counter-
transference, can greatly muddy the therapeutic relationship

Conditions Treated by Psychoanalysis

Psychoanalysis may be used to treat a number of different psychological conditions, including:

 Obsessive-compulsive disorder
 Depression
 Psychosomatic disorders
 Phobias
 Anxiety
 Identity problems
 Emotion struggles or trauma
 Self-destructive behavior
 Relationship issues
 Sexual problems

People who are likely to benefit from this form of therapy are often those who have been
experiencing symptoms for some time. People might choose psychoanalytic therapy when they
have long-term symptoms of anxiety, depressed mood, and behaviors that have a negative impact
on functioning and enjoyment of life

Critical Evaluation
 Therapy is very time-consuming and is unlikely to provide answers quickly.
 People must be prepared to invest a lot of time and money into the therapy; they must be
motivated.
 They might discover some painful and unpleasant memories that had been repressed,
which causes them more distress.
 This type of therapy does not work for all people and all types of disorders.
 The nature of Psychoanalysis creates a power imbalance between therapist and client that
could raise ethical issues.
Fisher and Greenberg (1977), in a review of the literature, conclude that psychoanalytic theory
cannot be accepted or rejected as a package, 'it is a complete structure consisting of many parts,
some of which should be accepted, others rejected and the others at least partially reshaped.
Carl Jung’s Analytical Psychotherapy

Introduction
Carl Jung, in full Carl Gustav Jung, (born July 26, 1875, Kesswil, Switzerland and died June
6, 1961, Küsnacht), Swiss psychologist and psychiatrist who founded analytic psychology, in
some aspects a response to Sigmund Freud’s psychoanalysis.

Jung proposed and developed the concepts of the extraverted and the
introverted personality, archetypes, and the collective unconscious. His work has been influential
in psychiatry and in the study of religion, literature, and related fields.

Carl Jung believed that for a person to become whole they must have a forming together of the
ego, unconscious and conscious complexes. In this form of therapy, the symptoms that are a
result of these neuroses point to things that are happening to our unconscious which is believed
to be more powerful. By paying attention to these symptoms we can see what parts of our
wholeness needs to become balanced.

Jung’s Analytical Therapy

Jungians view humans in a positive sense and believe they are inherently predisposed to make
their individual mark in the world. However, this individuation process is not accomplished by
merely obtaining fame and glory through material achievement or notoriety.
Rather, to become truly individualized, human beings must become transcendent and come to
grips with the unconscious part of their personalities. Individuals who fail to integrate fully the
many oppositional forces of conscious and unconscious components of their personality will
never fully develop to optimal capacity or achieve self-realization.

Individuation is the process through which people move toward self-realization and is the
penultimate goal of living and of therapy. It is a complex and difficult process that calls for
reconciliation and integration of a variety of forces, traits, and attitudes, and it may be beyond
the scope of many individuals. Therefore, the process of therapy may be twofold. In a minimal
sense, it may be enough for the client to experience affective catharsis of a problem, gain insight
into it, and then learn new ways of coping or solving the problem.
At a far deeper level, some clients may go beyond the immediate problems of their lives and
plunge into a transformation of their psychic processes and their total being. If successful, they
may emerge as very different and changed individuals who have achieved a higher
consciousness and a clearer picture of their distinctiveness and separateness from the rest of
humanity.

The analytical psychotherapy attempts to create a communicative 4 link between the conscious
and unconscious and make understandable through debate and interpretation what may appear to
the individual as very illogical and completely undecipherable.

Carl Jung’s Psychotherapy Concepts

 Active Imagination: Jung created the concept of active imagination  as a way to

describe bridging the gap between unconsciousness and consciousness. Using
imagination, fantasy, dreams and meditation, a client is able bring their unconscious
into the present through narrative or action. Active imagination relies on a client’s
undirected observation of their imagination or dreams, not an intended image of their
desires.
 Individuation: Individuation  is a process of analytical psychology, by which an
individual develops into who they truly are intended to be. Individuation involves
integrating all of a person’s past positive and negative experiences in such a way that
the person can live a healthy, productive, and emotionally stable life.
 Collective Unconscious: Jung was the first to use the term collective unconscious  as
a means for describing an expression of the unconscious that is exhibited by every
living being with a nervous system. Jung believed the collective unconscious was
inherited and inherent to each being, rather than a result of specific events. The
collective unconscious holds mental images that cannot be explained historically or
through experience, but exist only as an evolutionary by-product.
  “Logos” in Jung’s Theories: Jung also used the term logos in his philosophical
theories. Logos, according to Jung, represented fact or reason. Jung often referred to
the contrast between conscious versus unconscious as logos versus mythos.
Therapeutic Process
Analytical therapy typically involves four stages of treatment: confession and catharsis,
elucidation, education, and transformation. While each stage seems final and may be sufficient
for a return to mental health, none is complete in itself. Even transformation is not an endpoint.

Confession and Catharsis

Confession is the emotional side of mental distress and affirms that intellectual insights alone are
rarely sufficient to effect change. By beginning to own feelings, the client establishes contact
with the feeling tone of the unconscious complexes that cause maladjustment. This form of
catharsis functions in much the same manner as the religious confessional.

Elucidation

Elucidation is the dynamic interpretation by the therapist of the client's past and also the
projection or transfer of important complexes to the therapist. Therefore, for elucidation to be
effective, the therapeutic dynamics of transference and countertransference need to occur and be
dealt with by client and therapist.

Education

The therapist must now help clients to educate themselves in all aspects of life that have been
found lacking. Jung proposes no particular way of doing this, except to say that whatever needs
doing will be made plain by this stage of therapy, and the therapist will need to act as would any
friend, by lending moral support and encouragement to the client's effort.

For many clients, the first three stages will be enough, and therapy will be terminated by clients
who are armed with the necessary knowledge and insight to attain some resemblance of balance
to their lives. Yet some individuals have potential beyond the average; for these people, to
educate them to normality would be their worst nightmare because their deepest need is to march
to the tune of a different drummer. Understanding their “abnormal” lives calls for therapists and
clients to plunge into the fourth and most complex stage of therapy.

Transformation

The final stage of transformation is unlike any other in psychotherapy and is necessary for self-
realization or individuation. It is the shadow complex, which triggers the individuation process.
Clients do not relish this stage because of their fears that it may overwhelm them. The shadow
provides a fearsome but necessary contrast to the conscious realm of personality.

It is necessary to the extent that it allows for the tension of opposites from which psychic energy
is generated. Character is actually enriched through this constant interplay between the shadow's
intrusion and the compensating measures we take to control it. Thus clients must see it, confront
it, and learn to live with it.

Jung's method in psychotherapy

Jung's method in psychotherapy follows the Freud's one, as he often admitted. In rare cases, when
the Freudian is not sufficient, Jung would apply also a complementary method that should guide
the patient to a personal confrontation with the archetypes of the collective unconscious.
This confrontation aims at the assimilation of the archetypal information leading to the extension
of consciousness. This is what Jung himself calls the individuation process aiming at directing
one to the realization of the psychic wholeness.
In short, the Jungian wholeness consists in the conjunction of the consciousness and unconscious
leading to the birth of a new personality that borrows from both ingredients.

On the plane of the psychotherapy, this new personality is better fit to cope with the outer and
inner developmental requests.

Jungian psychotherapy makes use of the following techniques:

Word Associations Test

Test used in psychotherapeutic treatment that consists of recording the average response time to
certain stimulus-words. The patient is asked to answer to the inducted words pronounced by the
analyst with any word that comes to his mind. The response time can be an indicator of the
activated unconscious complexes.

Dream Analysis

Up to a point, Jung's dream interpretation method follows the Freud's one, including the free
associations, subject level, retrospective approach. But he later added several new concepts, such
as the amplification of dream content, the idea that the dream brings a compensation to the one-
sided individual ego, and its finality that aims at the psychic wholeness.

Method of amplification

Jung utilized the amplification method to interpret the meanings of dreams. He states that there
are elements of the dream to which the dreamer cannot provide personal associations.
(1) These elements are symbols.

(2) In this case, the analyst should intervene with his knowledge and complete the dreamer's gaps
related to them. The associative material comes from various cultural areas: mythology, religion,
alchemy, folklore and so forth.

Active Imagination

Jung invited his patients to let all the things flow in their mind. That is, the inner fantasies must
flow freely while the patient must proceed not as a detached and contemplative viewer, nor as a
psychotherapist, but as an actor that takes part in his/her fantasies, that plays a role in them. The
fantasies are products of the unconscious and must be fully integrated consciously. Learn more.

Symbol Analysis

A large part of dream interpretation technique at Jung consists in symbol analysis. It aims at the
integration of the unconscious contents and the extension of conscious mind.

Playing, painting, building and other such activities may lead one to explore and manifest his
unconscious contents. In painting one may express a visual representation of the wholeness. Also
in building, one may relieve his inner creative forces blocked or inhibited by his one-sided moral
or ethical values.

Jungian therapy can be helpful in the treatment of many mental health problems and other issues,
including:

 Anxiety
 Depression
 Substance abuse and addictions
 Personality disorders
 Trauma, including post-traumatic stress disorder
 Low self-esteem
Critics on Jung’s Psychotherapies
 Jung advocated no universal methodology for treatment. He believed that everyone given
treatment should be looked on as an individual with a unique personality. There is no one
size-fits-all approach in Jung’s therapeutic framework.
 Jung said, “Each patient is a new problem for the doctor, and he will only be cured of his
neurosis if you help him to find his individual way to the solution of his conflicts.
 Nevertheless, Jungian therapy has a few characteristic techniques that its therapists
employ to guide a person toward mental health, or what Jung called individuation.
  The primary techniques used are dream analysis, active imagination, analysis and
interpretation of transference and counter transference, and others. These techniques do
not take the place of basic skills in psychotherapy, but Jungian therapy builds upon this
foundation by adding to it “analysis”, that is, the “attempt to work with unconscious
material as it emerges in dreams, fantasies, slips-of-the-tongue, etc.
The main criticism of amplification has been that it can make analysis a very intellectual
process and sometimes leads patients to an inflation by which they equate their personal situation
with something much bigger, therefore, not only avoiding the transfer, but also having a
rewarding omnipotent fantasies
Alfred Adler’s individual psychotherapy
Main concept
Individual psychology is the personality theory that was developed by Adler after he broke from
Freudian psychoanalytical ideas. The main concepts of Adler's theory are social interest, holism,
lifestyle, birth order, goals or directionality and equality. Adler believed that we all have one
basic desire and goal: to belong and to feel significant.
Adlerian psychotherapy
Adler’s theory led to explanations of psychological normality and abnormality: although the
normal person with a well-developed social interest will compensate by striving on the useful
side of life (that is, by contributing to the common welfare and thus helping to overcome
common feelings of inferiority), the neurotically disposed person is characterized by increased
inferiority feelings, underdeveloped social interest, and an exaggerated, uncooperative goal of
superiority, these symptoms manifesting themselves as anxiety and more or less open aggression.
Accordingly, he solves his problems in a self-centered, private fashion (rather than a task-
centered, common-sense fashion), leading to failure. All forms of maladjustment share this
constellation. Therapy consists in providing the patient with insight into his mistaken life-style
through material furnished by him in the psychiatric interview.
He believed that a person will be more responsive and cooperative when he or she is
encouraged and harbors feeling of adequacy and respect. Conversely, when a person is
thwarted and discouraged, he or she will display counterproductive behaviors that present
competition, defeat, and withdrawal. When methods of expression are found for the positive
influences of encouragement, one’s feelings of fulfillment and optimism increase.
According to Adler, when we feel encouraged, we feel capable and appreciated and will
generally act in a connected and cooperative way. When we are discouraged, we may act in
unhealthy ways by competing, withdrawing, or giving up. It is in finding ways of expressing and
accepting encouragement, respect, and social interest that help us feel fulfilled and optimistic.
Adler believed strongly that “a misbehaving child is a discouraged child,” and that children’s
behavior patterns improve most significantly when they are filled with feelings of
acceptance, significance, and respect.
Adler believed that feelings of inferiority and inadequacy may be a result of  birth order,
especially if the person experienced personal devaluation at an early age, or they may be due
to the presence of a physical limitation or lack of social  empathy for other people. This
method of therapy pays particular attention to behavior patterns and belief systems that were
developed in childhood.
One of Adler’s other key ideas was the concept of the social interest. According to this idea,
people are at their best their psychologically healthiest and most fulfilled when they act in ways
that benefit society. For example, a person high in social interest might go out of their way to
help others, while a person with lower levels of social interest may bully others or act in
antisocial ways. Importantly, levels of social interest can change over time. A therapist can help
their client increase his or her levels of social interest.
The 4 stages of adlerian therapy
An Adlerian therapist assists individuals in comprehending the thoughts, drives, and
emotions that influence their lifestyles. People in therapy are also encouraged to acquire a
more positive and productive way of life by developing new insights, skills, and behaviors.
These goals are achieved through the four stages of Adlerian therapy:
1. Engagement: A trusting therapeutic relationship  is built between the therapist and the
person in therapy and they agree to work together to effectively address the problem.
2. Assessment: The therapist invites the individual to speak about his or her personal
history, family history, early recollections, beliefs, feelings, and motives. This helps
to reveal the person's overall lifestyle pattern, including factors that might initially be
thought of as insignificant or irrelevant by the person in therapy.
3. Insight: The person in therapy is helped to develop new ways of thinking about his or
her situation.
4. Reorientation: The therapist encourages the individual to engage in satisfying and
effective actions that reinforce this new insight, or which facilitate further insight.
Assessment techniques
Like Freud Adler sought to understand the individual’s personality by focusing on early
childhood experiences. He used three major techniques: early recollections, dream analysis, and
birth order analysis.
Early recollections
 In Adlerian psychology, cooperation is not only a contextual matter or a higher level
aspiration.  The three life challenges that Adler saw as essential for human survival
(love/intimacy, work/occupation, and fellowship/friendship) can only be solved
cooperatively.
  In a process of attaining a sense of perfection and completion, humans need a lot of
courage.  The best of Adlerian courage is one’s willingness to risk imperfection in a
process of self-perfecting.  We see lack of such courage, or discouragement, at the heart
of pathology of all sorts from minor neurosis to severe psychosis.  We also see the
therapist’s discouragement as a core element in a non-working therapy and a source of
therapeutic impasses.
 From these assumptions, we view one’s maladjustment being characterized by increased
inferiority feelings, underdeveloped social interest, and an exaggerated uncooperative
goal of personal superiority. Accordingly, problems are solved in a self-centered “private
sense” rather than an others-centered “common sense” fashion
 In neurotic Lifestyle, we should see symptoms that are generated by a discouraged person
following her or his attempt to measure self against the life tasks, concluding her or his
own inferiority in relation to a subjectively measured complexity of a task, and then
attempting to use symptoms to “solve” life challenges that to her or to him seem
impassable.  So, the symptoms, subjectively, will serve as a barrier preventing a person
from fulfilling the tasks of life. That complex dynamic is often accompanied by
safeguarding tendencies and a dance of what Adlerians call hesitating attitude.

 Cooperation is not only an essential ingredient in communal survival.  It is a prerequisite

of a useful therapy.  Exploration of one’s ERs is a cooperative endeavor, aimed to
unearth and clarify client’s convictions about self, others, and the world; to define the
client’s view on therapeutic relationships in order to build an alliance; and to find client-
generated metaphors that will start working immediately.
Dream Analysis
Adler also utilized dream analysis as a major technique for understanding each patient’s
personality. Unlike Freud, however, he did not focus on sexual interpretations of manifest dream
content. Instead, he believed that a person’s dreams are determined by his or her goal of
superiority. More specifically, dreams reflect the individual’s unconscious attempts to achieve
personal goals in accordance with his or her unique style of life. The student who is courageous
and unafraid of examinations, for example, may dream of climbing a mountain and enjoying the
view from the top, whereas the student who is a quitter and wants to postpone examinations may
dream of falling off the mountain. Each student’s are controlled by his or her unique style of life.
For Adler, dream also provide glimpses of the future, and thus suggest potential solutions to the
person’s problems. For example, Adler cites the case of a man who was very disappointed in his
wife. His primary complaint was that she did not take adequate care of their two children. Adler
saw the complaint as a symptom of a deeper, underlying hostility toward her because he believed
she had not married him out of love.
In the course of analysis, the man reported a dream in which he had three children, the youngest
of whom got lost and could not be found. The man interpreted his dream as a warning not to
have more children because his wife would neglect them. While acknowledging the plausibility
of this interpretation, Adler pointed out that the dream about the three children might suggest
instead a desire to reconcile with his wife and develop a more satisfying relationship with her.
Birth-order-Analysis
Adler’s third technique for understanding the patient’s personality was birth order analysis. Adler
believed that a correct analysis of the effects of patient’s birth positions on their subsequent
behavior would help win their confidence. This emphasis on unavoidable childhood
circumstances also helps patients to stop blaming themselves for developing a faulty style of life.
Reducing self-blame and resistance, in turn, enables patients to adopt more constructive goals
and behavior.
Neo Freudian
Neo Freudians are referring to modifications extensions or revision of Freud s original
psychoanalytic theory most commonly to those that emphasize social cultural and interpersonal
elements rather than innate biological instincts such as sexuality and aggression. Major theorist
described as neo Freudians are;

 Alfred Adler (1870-1973)

 Erich Fromm (1900-1980)
 Karen Horney (1885-1950)
 Harry Stack-Sullivan (1892-1949)

Alfred Adler

Social interest;

“Human are primarily social not sexual creature”

 Motivated by social urges

 Inherently social beings place social welfare above selfish interest and acquire a style of
life that is predominantly social in orientation.
 The person is embedded in a social context from the first day of life.

“Society interest is the true and inevitable compensation for all the natural weakness of
individual human beings”

Karen Horney

Basic Anxiety: Children naturally experience anxiety helplessness and vulnerability.

Without loving guidance to help children learn to cope with threats imposed by nature and
society they may develop the basic anxiety.

Basic evil: Domination in difference erratic behavior lack of respect for the Childs individual
needs lack of respect for the children lack of real guidance and reliable warmth disparaging
attitude too much admiration or the absence of it parental disagreements too much or too little
responsibility overprotection isolation injustice discrimination unkept promises hostile
atmosphere.

Erich Fromm

 Personality theory

Two central facts dominate human behavior

 The inevitability of separateness.

 Historical and social moment into which the person is born

Baby is born

Recognize it as separate being

Harry Stack –Sullivan

Interpersonal theory of psychiatry

Personality is the relatively enduring pattern of recurrent interpersonal situations which

characterize a human life.

 Hypothetical entity that cannot be isolated from interpersonal situations and interpersonal
behavior is all that can be observed as personality.
 The unit of study is the interpersonal situation and not the person.

Interpersonal psychotherapy (IPT)

Psychotherapy (IPT) was developed by Gerald Klerman and Myrna Weissman in the 1970s and
based on the work of Harry Stack Sullivan, Adolf Meyer, and John Bowlby. IPT is a type of
therapy that utilizes a uniquely structured model for the treatment of mental health issues. Based
on attachment and communication theories, IPT is designed to help people address current
concerns and improve interpersonal relationships.

Conditions treated with interpersonal psychotherapy

Interpersonal psychotherapy was initially developed as a brief therapy for depression. Because
people with depressive symptoms often experience problems in their interpersonal relationships,
IPT is a common treatment option for people experiencing depression. Although the depression
itself is not always a direct result of negative relationships, relationship issues tend to be among
the most prevalent symptoms during the initial stages of depression. Once addressed,
strengthened relationships can serve as an important support network throughout the ensuing
recovery process.

In general, interpersonal therapists provide active, non-judgmental treatment in order to help

people in therapy successfully handle challenges and improve mental health. Things that might
be addressed over the course of treatment can include roles disputes, interpersonal shortcomings,
life stage transitions, relational conflict, grief, and other attachment issues. IPT is well researched
as an effective treatment for depression and has been modified to treat several other mental
health issues. These include:

 Anxiety
 Disordered eating
 Dysthymia
 Substance abuse issues
 Bipolar
 Postpartum depression
 Social phobia
 Posttraumatic stress

Interpersonal psychotherapy processes

Within a fairly short amount of time—usually 20 weeks or less—the person in therapy may be
able to experience relief from symptoms and begin work on any underlying issues more quickly
than is often possible in other forms of therapy. Therapists might utilize various techniques, such
as role-playing, to help people in therapy adjust how they relate to their world. An interpersonal
therapist will typically focus on the most pressing relational problems in order to support the
person wishing to make changes.
IPT is an adaptive form of therapy. It lends itself to modifications that make it suitable for the
treatment of several mental health concerns. In addition, IPT can be conducted individually or in
a group setting with children, adolescents, and adults.

Limitations of interpersonal psychotherapy

Most research on IPT includes very few limitations for IPT. Nonetheless, there are some things
to keep in mind if you are trying to find a therapist that offers IPT. First, IPT's therapeutic
process is based on the assumption that the person in therapy is motivated to change. For IPT to
be effective, the person in therapy must be willing to examine his or her own role in the problem.
Additionally, people in treatment must have a level of awareness and understanding of
interpersonal relationships in order to work on them. This is not always possible in some
populations or for some individuals with certain mental health conditions.

IPT can be an attractive therapy option for some because it is a short-term therapy model. For
therapists, this means there may be less of a chance that people in therapy will drop out of
treatment. Overall, interpersonal psychotherapy is a reputable treatment option for many mental
health issues and populations.

5: Humanistic Approach

The term Humanism in psychology are relating to an approach which studies the whole person
and the individuality of each person. Humanistic psychology is a perspective that highlights
looking at the whole person, and the individuality of each person. Humanistic psychology begins
with the existential assumptions that people have free will and are motivated to achieve their
potential and self-actualize.

The Humanistic approach is also commonly known as “The third force” in psychology,
as it was developed as a rebellion against behaviorism and psychodynamic approaches.
Humanistic Psychology expanded its influence throughout the 1970s and the 1980s. It provided
three following major areas to understand its terms:

- It offered a new set of values for understanding human nature.

- It offered an expanded perspective of methods of review to study the human behavior.
- It offered a more broad range of effective methods in professional practice of
psychotherapy.
Basic Assumptions:

The basic assumptions of humanistic approach are as followings:

- Humanists claimed that humans have a free will, not all behavior is pre-determined.
- All individuals are unique and are motivated to achieve their own potential. That is why
we all have individual differences.
- A proper understanding of human behavior can only be attained by studying the humans
themselves, not animals.
- Psychology should be studying each individual cases rather than group performances.

Strengths

1. This approach shifted the focus of behavior to the individual rather than the conscious mind,
genes etc.
2. It has really helpful real life applications. (e.g., therapy)
3. It is recorded in Qualitative data and it gives genuine insight and a complete information
into behavior.
4. It highlights the importance of individual differences and values idiographic and
individualistic methods to study.

Limitations:

1. It ignores biology, and the effects of hormones and bodily chemicals.

2. It mostly gives subjective concepts, which are difficult to test.
3. It completely ignores behaviorism, however some of the human and animal behavior can be
compared.
4. The belief in the free will is in obstruction to the deterministic laws of science.

Humanistic Psychotherapy

Humanistic Psychotherapy is the therapeutic model based on humanistic psychology. It is

completely client-centered and distinguishes the relationship between therapist and client as
substantial in creating conditions for growth and betterment. It is inclusive of all aspects of
human experience and works directly with the individual’s own experience as a reference point
for setting on the therapy.

Humanistic Psychotherapy brings to the therapy room a variety of models for managing
change including transformational and excellent approaches for problem solving and
overcoming psychological issues in pursuing new possibilities and a fulfilling life.
Contributors

Abraham Maslow:

Abraham Maslow the pioneering humanist, studied people who he considered to be healthy,
creative, and productive, including Albert Einstein, Eleanor Roosevelt, Thomas Jefferson,
Abraham Lincoln, and others. Maslow (1950, 1970) found that such people share similar
characteristics, such as being open, creative, loving, spontaneous, compassionate, concerned for
others, and accepting of themselves. He presented one of the well-known humanistic theory
hierarchy of needs. He explained in his theory that every human being has some cetin needs in
common- every need holds its value/worth, and these needs must be met. The highest need is the
need for self-actualization, which is the achievement of our fullest potential.

When all the lower needs (physiological, safety, belongingness and love, and esteem) are
satisfied, we may still feel restless and discontented unless we are doing what is right for
ourselves. “What a man can be, he must be” (pg. 46; Maslow, 1970). Thus, the need for self-
actualization, which Maslow described as the highest of the basic needs, can also be referred to
as a Being-need, as opposed to the lower deficiency-needs [ CITATION lum \l 1033 ].

Self-actualization

Maslow explained some characteristics of self-actualized people. He studied mentioned above

people; who he thought to be evolving towards or were already self-actualized. Maslow believed
that self-actualizing people accept themselves as they are, including their errors and the
differences between their personal reality and their ideal image of themselves. Self-actualizing
individuals are problem-centred; they focus more on problems outside themselves, on important
causes they would describe as necessary. They have deeper and more profound personal
relationships than other people. According to Maslow, self-actualizing people are universally
creative. Maslow supposed that this creativity was a natural potential given to all humans at their
birth, but that the constraints on behaviour inherent in most cultures lead to its suppression
[ CITATION Mar10 \l 1033 ].

Carl Roger (1902-1987)

Carl Roger was also a humanistic psychologist who agreed with the concepts of Abraham
Maslow. One of Rogers’s main ideas about personality regards self-concept, our thoughts and
feelings about ourselves. He further said that to “grow” a person also needs an environment that
provides him them with genuineness (openness and self-disclosure), acceptance (being seen with
unconditional positive regard), and empathy (being listened to and understood). A healthy
personality and good relationships can only develop in that environment. Rogers believed that
every person could achieve their goals, wishes, and desires in life. When, or rather if they did so,
self-actualization took place. To reach his potentials these factors must be fulfilled
[ CITATION Sau14 \l 1033 ].
The Fully Functioning Person:

Roger believe that fully functioning person in a process which continued throughout the life. It is
not like an ideal self which a person can ultimately achieve rather it is a process of always
becoming and changing. Rogers believed that every person could achieve their goal. This means
that the person is in touch with the here and now, his or her subjective experiences and feelings,
continually growing and changing. The five characteristics are:
1. Open to experience: both positive and negative emotions accepted.
2. Existential living: in touch with different experiences as they occur in life, avoiding
prejudging and preconceptions. Being able to live and fully appreciate the present, not
always looking back to the past or forward to the future (i.e., living for the moment).
3. Trust feelings: feeling, instincts, and gut-reactions are paid attention to and trusted.
People’s own decisions are the right ones, and we should trust ourselves to make the right
choices.
4. Creativity: creative thinking and risk-taking are features of a person’s life. A person does
not play safe all the time. This involves the ability to adjust and change and seek new
experiences.
5. Fulfilled life: a person is happy and satisfied with life, and always looking for new
challenges and experiences.

For Rogers, fully functioning people are well adjusted, well balanced and interesting to
know. Often such people are high achievers in society [ CITATION Sau14 \l 1033 ].

Existential therapy

Existential therapy is a unique form of psychotherapy that looks to explore difficulties from a
philosophical perspective. Focusing on the human condition as a whole, existential therapy
highlights our capacities and encourages us to take responsibility for our successes. Emotional
and psychological difficulties are viewed as inner conflict caused by an individual's
confrontation with the givens of existence. Rather than delve into the past, the existential
approach looks at the here and now, exploring the human condition as a whole and what it means
for an individual.

Existential therapy background:

Existential therapy developed out of the philosophies of Friedrich Nietzsche and Soren
Kierkegaard. As one of the first existential philosophers, Kierkegaard theorized that human
discontent could only be overcome through internal wisdom. Later, Nietzsche further developed
the theory of existentialism using concepts such as the will to power and personal responsibility.
In the early 1900s, philosophers such as Martin Heidegger and Jean-Paul Sartre began to explore
the role of investigation and interpretation in the healing process. Over the next several decades,
other contemporaries started to acknowledge the importance of experiencing in relation to
understanding as a method to achieving psychological wellness and balance.

Otto Rank was among the first existential therapists to actively pursue the discipline, and
by the middle of the 20th century, psychologists Paul Tillich and Rollo May brought existential
therapy into the mainstream through their writings and teachings, as did Irvin Yalom after them.
The popular approach began to influence other theories, including logotherapy, which developed
by Viktor Frankl, and humanistic psychology. At the same time, British philosophers expanded
existentialism further with the foundation of The Philadelphia Association, an organization
dedicated to helping people manage their mental health issues with experiential therapies. Other
institutions that embody the theory of existentialism include the Society for Existential Analysis,
founded in 1988, and the International Community of Existential Counselors, created in 2006.

Theories of the existential approach:

A key element of existential counselling is that it does not place emphasis on past events like
some other therapy types. The approach does take the past into consideration and together, the
therapist and individual can understand the implications of past events.

Instead of putting blame on events from the past, however, existential counselling uses
them as insight, becoming a tool to promote freedom and assertiveness. Coming to the realisation
that you are not defined by your history and that you are not destined to have a certain future is
often a breakthrough that offers liberation.

Practitioners of existential therapy say that its role is to help facilitate an individual's own
encounter with themselves and to work alongside them as they explore values, assumptions and
ideals. An existential therapist will avoid any form of judgement and instead help the individual
speak from their own perspective.

The therapist should enter sessions with an open mind and be ready to question their own
biases and assumptions. The goal of the therapist is to understand the individual's assumptions
with a clarity that the individual themselves may not be able to muster.

A belief that lies at the heart of existential counselling is that even though humans are
essentially alone in the world, they long to be connected with others. This belief can help to
explain why certain concerns appear and may help the individual understand why they feel the
way they do sometimes.
 Another interesting theory is that inner conflict stems from an individual's confrontation with
the givens of existence. These givens were noted by influential psychotherapist Irvin D. Yalom,
and include:

 freedom and responsibility

 existential isolation
 meaninglessness
 death

A confrontation with any of the aforementioned conditions, or givens, fills an individual

with a type of dread commonly referred to as existential anxiety. This anxiety is thought to
reduce a person’s physical, psychological, social, and spiritual awareness, which may lead to
significant long-term consequences.

For example, the fact that each one of us and each one of our loved ones must die at some
unknown time may be a source of deep anxiety to us, and this may tempt us to ignore the reality
and necessity of death in human existence. By reducing our awareness of death, however, we
may fail to make decisions that can actually safeguard or even enrich our lives. At the other end
of the spectrum, people who are overly conscious of the fact that death is inevitable may be
driven to a state of neurosis or psychosis.

The key, according to existential psychotherapy, is to strike a balance between being aware
of death without being overwhelmed by it. People who maintain a healthy balance in this way
are motivated to make decisions that can positively impact their lives, as well as the lives of their
loved ones. Though these people may not know how their decisions will actually turn out, they
do appreciate the need to take action while they can. In essence, the reality of death encourages
us to make the most of opportunities and to treasure the things we have.

Like death, the threat of isolation, the perceived meaninglessness of life, and the weighty
responsibility of making life-altering decisions may each be a source of acute existential anxiety.
According to the theories of existential therapy, the manner in which a person processes these
internal conflicts, and the decisions they make as a result, will ultimately determine that person's
present and future circumstances.

The four realms:

Within existential psychotherapy, there is a description of four different levels of experience

and existence with which people are inevitably confronted. These can often help individuals
understand the context of their concerns. It is believed that a person's orientation towards the
world and the four realms define their reality. There are various names for the four realms within
existential therapy, however, the following are perhaps the best-known:

1. The physical realm

This world or realm is centred around physicality. It is the world we share with animals, the
world of bodily needs. It is the world that stores desire, relief, sleep/wake cycles and nature.
Birth, death and physical feelings/symptoms are also part of this realm.

2. The social realm

Within the social realm lies everything to do with relationships. Culture, society and language
are here as well as work, attitudes towards authority, race and family. Emotions, friendships and
romantic relationships are also part of the social world.

3. The personal realm

The personal realm is concerned with issues of the self. This includes intimacy (with self and
others), identity, personal characteristics and overall sense of self. Personal strengths and
weaknesses are also important as well as the question of being authentic.

4. The making realm

The final realm is considered our 'ideal' world. Included within it are religion, values, beliefs and
transformation. This is the dimension where we make sense of our lives and is considered the
realm of transcendence.

Accepting Fears and Overcoming Them

Existential psychotherapy encourages people to not only address the emotional issues
they face through full engagement but to also take responsibility for the decisions that
contributed to the development of those issues. People who participate in this form of therapy are
guided to accept their fears and given the skills necessary to overcome these fears through action.
By gaining control of the direction of their life, the person in therapy is able to work to design
the course of their choosing. Through this work, people often come to feel both a sense of
liberation and the ability to let go of the despair associated with insignificance and meaningless.
Thus, existential psychotherapy involves teaching people in therapy to grow and embrace their
own lives and exist in them with wonder and curiosity. Developing the ability to view life with
wonder can help people be able to view the life experience as a journey rather than a trial
and can also help eradicate the fear associated with death.
Existential Therapists' Process

Therapists who practice existential psychotherapy do not focus on a person's past. Instead, they
work with the person in therapy to discover and explore the choices that lie before them.
Through retrospection, the person in therapy and therapist work together to understand the
implications of past choices and the beliefs that led those to take place, only as a means to shift
to the goal of creating a keener insight into the self. In existential therapy, the emphasis is not to
dwell on the past, but to use the past as a tool to promote freedom and newfound assertiveness.
By coming to the realization that they are neither unique nor destined for a specific purpose, the
person in therapy is able to release the obligatory chains that may have been preventing them
from existing in fullness from moment to moment. When that happens, they then achieve the
ability to become truly free.

How existential counselling could help

One of the primary aim of existential therapy is to help people face anxieties of life and to
embrace the freedom of choice humans have, taking full responsibility for these choices as they
do so. Existential therapists look to help individuals live more authentically and to be less
concerned with superficiality. They also encourage clients to take ownership of their lives, to
find meaning and to live fully in the present.

Individuals who are interested in self-examination and who view their concerns as issues of
living rather than symptoms of a psychiatric illness are more likely to benefit from this approach.
Existential therapy is also well suited to those facing issues of existence, for example, those with
a terminal illness, those contemplating suicide, or even those going through a transition in their
life.

Common Concerns and Limitations

Existential psychotherapy, much like other types of therapy, may be misunderstood by

people who do not have a thorough grasp of the fundamental principles or scope of the
associated theories. It can help to develop awareness of the principles, theories, and givens
before and while participating in treatment.

Common misperceptions of existential psychotherapy include the following beliefs:

 One distinctive, united existential theory, free of internal tension, covers all the basic
assumptions of existential psychology. 
 In fact, there are at least five categories of the approach, and most scholars view this as a
strength of the approach, as it leads to consistent examination of the basic assumptions of the
approach and allows for greater adaptability. 

 There is no difference between existential psychology and existential philosophy. 

Though there are points of agreement between existential philosophy and existental
psychology, there are also points of difference, and the variation in perspectives of the leading
pioneers and scholars of the two fields help contribute to the development of each approach.

 Existential psychology takes an antireligious or anti-spiritual approach, for

example, denying the existence of God.

Though existential psychology is not innately religious and does discourage people from
following one person or religion without question, it is also not anti-relgious, and many of the
leading scholars and pioneers were Christian theologists. 

 Existential and humanistic theories are the same thing. 

Though there is agreement between the two theories, they are not identical. However,
disagreements between these two schools of thought tend to be more degrees of emphasis and
less complete divergences. 

 Existential psychotherapy takes a negative, dark, or pessimistic view of life. 

Because writings on existential psychology can be read as pessimistic, due to their view
that suffering can be embraced as part of the human existence. This is not an encouragement of
suffering, though, only recognition of the fact that it is an inescapable part of being human. What
existential therapy does do is encourage people to embrace the reality of suffering in order to
work through and learn from it. 

 The approach is fundamentally an intellectual one and, as such, is only beneficial to

people of high intellect, who are not experiencing chronic behavioral or mental
health conditions.

People of any intelligence level are capable of the awareness of their own humanity and
able to make meaning of their emotions and anxieties. It is not necessary for a person to be a
philosopher or scholar to benefit from the prinicples of existential therapy, and many people who
are actively struggling with mental health issues can also be helped by the approach. 
Because existential psychotherapy targets the underlying factors of perceived behavioral and
mental health concerns, an existential approach may not directly address the primary issue
a person in treatment is experiencing. Because of this, existential therapy, which is quite
adaptable, is often used along with other approaches to treatment. Combining approaches can
help maximize the effectiveness of both and promote greater recovery. Additionally, the in-
depth, penetrative approach used in existential psychotherapy may not appeal to people who do
not wish to explore their intrapsychic processes, or who are solely interested in finding a quick
fix for their mental health challenges.

Client- Centered Therapies

Client-centered therapy, which is also known as person-centered, non-directive, or Rogerian

therapy, is a counseling approach that requires the client to take an active role in his or her
treatment with the therapist being nondirective and supportive. In client-centered therapy, the
client determines the course and direction of treatment, while the therapist clarifies the client's
responses to promote self-understanding.

The goals of client-centered therapy are increased self-esteem and openness to

experience. Client-centered therapists work to help clients lead full lives of self-understanding
and reduce defensiveness, guilt, and insecurity. As well as have more positive and comfortable
relationships with others, and an increased capacity to experience and express their feelings.

Functioning of therapy:

Mental health professionals who utilize this approach strive to create a therapeutic environment
that is conformable, non-judgmental, and empathetic. Two of the key elements of client-centered
therapy are that it:

 It's non-directive. Therapists allow clients to lead the discussion and do not try to steer
the client in a particular direction.
 It emphasizes unconditional positive regard. Therapists show complete acceptance and
support for their clients without casting judgment.

According to Carl Rogers, a client-centered therapist needs three key qualities:

Genuineness:

The therapist needs to share his or her feelings honestly. By modeling this behavior, the therapist
can help teach the client to also develop this important skill.

Unconditional Positive Regard:

 The therapist must accept the client for who they are and display support and care no
matter what the client is facing or experiencing. Rogers believed that people often develop
problems because they are accustomed to only receiving conditional support; acceptance that is
only offered if the person conforms to certain expectations.

Empathetic Understanding:

The therapist needs to be reflective, acting as a mirror of the client's feelings and thoughts. The
goal of this is to allow the client to gain a clearer understanding of their own inner thoughts,
perceptions, and emotions.

By exhibiting these three characteristics, therapists can help clients grow psychologically,
become more self-aware, and change their behavior via self-direction. In this type of
environment, a client feels safe and free from judgment. Rogers believed that this type of
atmosphere allows clients to develop a healthier view of the world and a less distorted view of
themselves.

Effectiveness

Several large-scale studies have shown that the three qualities that Rogers emphasized,
genuineness, unconditional positive regard, and empathetic understanding, are all beneficial.
However, some studies have suggested that these factors alone are not necessarily enough to
promote lasting change in clients.

One evaluation that looked at the effectiveness of person-centered therapy suggested that
this approach was effective for individuals experiencing common mental health problems such as
depression and anxiety, and may even be helpful to those experiencing more moderate to severe
symptoms.

Gestalt Therapies

Gestalt therapy is a humanistic, holistic, person-centered form of psychotherapy that is focused

on an individual's present life and challenges rather than delving into past experiences. This
approach stresses the importance of understanding the context of a person’s life and taking
responsibility rather than placing blame.

Gestalt, by definition, refers to the form or shape of something and suggests that the
whole is greater than the sum of its parts. There is an emphasis on perception in this particular
theory of counseling. Gestalt therapy gives attention to how we place meaning and make sense of
our world and our experiences.

History:
Gestalt therapy, developed by Fritz Perls, Laura Perls, and Paul Goodman in the 1940s, is an
experiential and humanistic form of therapy that was originally designed as an alternative to
conventional psychoanalysis. Gestalt therapists and their clients use creative and experiential
techniques to enhance awareness, freedom, and self-direction. The word gestalt comes from the
German word meaning shape or form, and it references the character or essence of something.

Principles of Gestalt Therapy:

At the core of gestalt therapy is the holistic view that people are intricately linked to and
influenced by their environments and that all people strive toward growth and balance. Gestalt
therapy is similar to person-centered therapy in this way, as well as in its emphasis on the
therapist’s use of empathy, understanding, and unconditional acceptance of the client to enhance
therapeutic outcomes.

According to gestalt therapy, context affects experience, and a person cannot be fully
understood without understanding his or her context. With this in mind, gestalt psychotherapy
recognizes that no one can be purely objective—including therapists whose experiences and
perspectives are also influenced by their own contexts—and practitioners accept the validity and
truth of their clients’ experiences.

Gestalt therapy also recognizes that forcing a person to change paradoxically results in
further distress and fragmentation. Rather, change results from acceptance of what is. Thus,
therapy sessions focus on helping people learn to become more self-aware and to accept and trust
in their feelings and experiences to alleviate distress.

Uses and Benefits:

There are a variety of conditions that Gestalt therapy may be used to treat, including:

 Anxiety
 Depression
 Low self-efficacy
 Low self-esteem
 Relationship problems

Gestalt therapy can also be useful for helping people gain greater self-awareness and a greater
ability to live in the present moment.

 Other potential benefits may include:

 An improved sense of self-control
  Better ability to monitor and regulate mental states
 Better awareness of your needs
 Better tolerance for negative emotions
 Improved communication skills
 Improved mindfulness
 Increased emotional understanding

Gestalt Exercises / Techniques:

1. Focus on "Here and Now"

Gestalt therapy places emphasis on gaining awareness of the present moment and the
present context. Through therapy, people learn to discover feelings that may have been
suppressed or masked by other feelings and to accept and trust their emotions. Needs and
emotions that were previously suppressed or unacknowledged are likely to surface as well.
Through this process, a person gains a new sense of self as overall awareness increases.

The focus on the here and now does not negate or reduce past events or future
possibilities; in fact, the past is intricately linked to one’s present experience. The idea is to avoid
dwelling on the past or anxiously anticipating the future. Experiences of the past may be
addressed in therapy sessions, but the therapist and client will focus on exploring what factors
made a particular memory come up in this moment, or how the present moment is impacted by
experiences of the past.

2. Words and Language:

The attention to language and tone is important in Gestalt therapy. As clients learn to
accept responsibility, they learn to use language that reflects a sense of personal ownership rather
than focusing on others. For example, rather than say, "If he didn't do that I wouldn't get so
mad!" a client might be encouraged to say, "I feel mad when he does that because it makes me
feel insignificant and I don't like that."

3. Empty Chair:
This is a role-playing exercise that allows a client to imagine and participate in a
conversation with another person or another part of themselves. Sitting across from the empty
chair, the client enters into a dialogue as if they were speaking with that other person or that
other part of themselves.

Empty chair can be very helpful in drawing out important perceptions, meanings, and
other information that can help clients become more aware of their emotional experience and
how to start healing.
 4. Body Language:
During a session, it might be noticed by a Gestalt therapist that the client is tapping their
foot, wringing their hands, or making a certain facial expression. The therapist is likely to
mention their observation of this and ask what is happening for the person at that moment.

5. Exaggeration:
In addition to giving body language a voice, a Gestalt therapist may inquire about the
client's body language. If it is difficult for the client to find words to put to what is happening,
they may be asked to exaggerate that motion or repeat it several times in a row for a period of
time during the session to draw out some of their experience in the counseling room in that
moment.

6. Locating Emotion:
During a session, it is common for people to talk about emotion. Talking about emotion
is different than experiencing an emotion, which is what the Gestalt therapist is wanting the
client to do in sessions. As a client talks about emotion, the therapist may ask them where they
feel that emotion in their body.

An example of this could be, "a pit in my stomach," or "my chest feels tight." Being able
to bring the emotional experience to awareness in the body helps the client stay present and
process their emotions more effectively.

7. Creative Arts:
Additional activities such as painting, sculpting, and drawing can also be used to help
people gain awareness, stay present, and learn how to process at the moment. It is generally
noted in this style that any technique that can be offered to the client, other than traditional sitting
still and talking, can be quite helpful in allowing them to become more aware of themselves,
their experiences, and their process of healing.

Strengths:

1. There is empirical research to support Gestalt Therapy and its techniques (Corsini &
Wedding, 2000). Specifically,

2. Gestalt Therapy is equal to or greater than other therapies in treating various disorders,
Gestalt Therapy has a beneficial impact with personality disorders, and the effects of
therapy are stable.

3. Works with the past by making it relevant to the present (Corey, 2005).
 4. Versatile and flexible in its approach to therapy. It has many techniques and may be
applied to different therapeutic issues.

Weaknesses:

1. For Gestalt Therapy to be effective, the therapist must have a high level of personal
development (Corey, 2005).

2. Effectiveness of the confronting and theatrical techniques of Gestalt Therapy is limited

and has not been well established.

3. It has been considered to be a self-centered approach which is concerned with just

individual development.

4. Potential danger for therapists to abuse the power they have with clients (Corey, 2005).

5. Lacks a strong theoretical base.

6. Deals only with the here and now.

7. Does not deal with diagnosis and testing.

Conclusion:

Gestalt Therapy focuses on the integration between the “whole” person and his or her
environment. This therapy sees a healthy individual as being someone who has awareness in his
or her life and lives in the here and now rather than focusing on the past or future. Gestalt
Therapy has a number of successful techniques that are applicable in therapy today and may be
utilized across a broad spectrum of emotional issues.

6: ECLECTIC Treatment Combination

Central concepts of Eclectic therapy

Eclectic psychotherapy, or eclectic therapy, is an approach that draws on multiple theoretical
orientations and techniques. Eclectic therapy is a flexible and multifaceted approach that allows
the therapist to use the most effective methods available to address their client's individual
needs
Eclectic psychotherapy is a short-term form of psychotherapy using an eclectic approach. It
often consists of a combination of cognitive-behavioral and psychodynamic approaches over a
limited number of sessions, often sixteen or fewer.
The heart of eclectic therapy involves understanding each client as a unique person with their
own particular problems and then selecting research-based techniques from across different types
of therapy in order to help that client grow in a personally meaningful way
 Eclectic approach to abnormality
Eclectic therapy is when therapists employ elements from a range of therapeutic techniques, with
the goal of establishing a pragmatic course that is personally tailored to the patient or
client. Abnormal psychology, A branch of psychology that deals with psychopathology
and abnormal behavior.
 How Eclectic Therapists Select Their Techniques and Underlying Beliefs
Despite the fact that it is flexible and pulls from multiple therapeutic approaches depending on
the needs of the client, eclectic therapy is a very intentional approach to mental health therapy.
Therapists purposefully select techniques based on established criteria.
There are three general concepts that define how therapists choose what they do:
 Theoretical integration
 Technical eclecticism
 Common factors
An eclectic therapist using the theoretical integration method of therapy adheres to two or more
established, researched based theoretical approaches and combines them to draw from the best of
each according to each client’s needs.
For example, a counselor might combine person-centered therapy with CBT to help clients
overcome obstacles. This mental health professional would select strategies and ideas from these
two theories when working with all clients, and the specific tools used would vary according to
an individual client’s needs.
 Technical (think “technique”) eclecticism means that a therapist, rather than adhering
to a small number of therapeutic approaches, selects techniques from a wide variety of
different therapies depending on what is needed. The clinician selects a technique that is
shown by research to help a particular issue. Often, therapists use Systematic Treatment
Selection (STS), a research-based system developed by Larry BEUTLER and JOHN
CLARKIN consisting of 18 principles and guidelines to help determine the very best
techniques for a given client and problem.
Common factors eclectic therapy is based more on core elements essential to healing than on
specific tools and techniques. Therapists gravitate toward the underlying belief systems of
therapies, such as unconditional positive regard, hope, trust, and empathy as well as driving
factors like correcting emotions, changing beliefs, or providing honest feedback to clients to help
them see themselves more clearly.
Regardless of how INTEGRATIONAL therapists choose their approach, everything they do is
customized for an individual client and the difficulties they are dealing with. Some practitioners
use a specific type of eclectic therapy in their work with clients.
 Types of Eclectic Therapy
Over time, practitioners and researchers have created specific types of eclectic therapy. All have
in common the fact that they draw from multiple approaches in order to meet the specific needs
of an individual client.
Brief Eclectic Therapy
Brief eclectic therapy (BET) is a specific approach to helping clients deal with and overcome a
traumatic event.5 It combines elements of CBT and psychodynamic therapy (a focus on
interpreting and processing emotions and thoughts). A focus of brief eclectic therapy is on the
emotions of guilt and shame that often occur in the aftermath of a traumatic experience.
Multimodal Therapy
Developed by Aaron Lazarus, multimodal therapy is based on social and cognitive learning
theory, and it draws on techniques from numerous different mental health therapies. Eclectic
therapists using a multimodal approach determine their client’s needs by assessing a number of
criteria in seven modalities of being, which can be remembered by the acronym BASIC ID:
behavior, affect (emotions), sensations (senses), imagery (visualization and imagination),
cognition (language-based thinking), interpersonal relationships, and drugs/biology (including
physical bodies and health). This way, they can help each client in specific and personal ways.
Cognitive-Interpersonal Therapy
This helping approach combines cognitive therapies like CBT with interpersonal therapy. It’s a
methodical approach to helping people become aware of and understand their distorted thoughts
about themselves and their relationships that cause problems in their lives.
Trans-theoretical Therapy
JAMES PROCHASKA and CARLOS DICLEMENTE developed this approach that pulls
concepts across theories to explain how people change.1 It combines theories about stages of
change, levels of change, and the process of change. 3 Working from their understanding of how
people create positive, effective change in their lives to accomplish their goals, therapists select
techniques from a variety of therapies to help clients grow.
THREE-STAGE MODEL
This form of eclectic therapy is newer than the others, developed by Clara Hill around 2014. The
three-stage model provides therapists a framework of three stages of the therapeutic
process. Knowing what happens during each stage helps professionals select techniques that will
work for an individual client during each stage of therapy. The first stage is the exploration stage
and is based on Carl Rogers’ Person-Centered Therapy. The second stage is the insight phase,
based on psychoanalytic therapy, and the third stage is the action phase, based on cognitive-
behavioral therapy.
Cyclical Psychodynamics
Another newer type of eclectic therapy, PAUL WACHTEL’S cyclical psychodynamics is a
therapeutic approach driven by a strong therapeutic relationship. This therapy combines
psychodynamic therapy, CBT, systemic therapy, and experiential therapy to improve a client’s
emotional experiences and help them develop new interpersonal relationship skills.8
Most therapists won’t bog their clients down with technical names for their specific approaches.
What’s important to know is that integrational therapy in general is a purposeful healing
approach that is based on sound methods and research-based techniques. Knowing that there are
different types of eclectic therapy can help you have peace of mind and confidence that your
therapist isn’t simply using a trial-and-error approach consisting of techniques drawn randomly
from one theory or another.
 What Can Eclectic Therapy Help With?
Because it is so flexible and meets each client’s needs and personality, eclectic therapy can help
with a wide range of challenges. It can be used in individual as well as group therapy. Further,
this approach is useful for overcoming stressors and difficulties like relationship problems or
general life stressors as well as mental health disorders.
Eclectic therapy has been shown to be helpful for people with the following mental health
concerns:
 Major depression
 DYSTHYMIC disorder
 Postpartum depression
 Bipolar disorder
 Eating disorders
 Personality disorders
 Marriage, family, or other relationship struggles
 Developmental challenges and issues related to specific stages of life
 Complicated pregnancy
 School-related problems in kids and teens
 Coping skills for medical problems or health issues
ECLECTIC Therapy examples
The following examples of eclectic therapy illustrate how therapists might approach treatment
for clients living with anxiety, depression, or PTSD.
Because this type of therapy is highly individualized, your own work with an eclectic therapist
will likely look a bit different.
As noted, eclectic therapy is quite versatile. Because a therapist creates a unique process and
selects individualized treatments for each client, no two people seeing the same therapist will
have identical therapy. This is because each challenge is different for every person who
experiences it. For example, anxiety disorders are extremely common, but because people have
different personalities, backgrounds, and current life experiences, anxiety is different for
everyone. To an integrational therapist, a single method of helping every client with anxiety
would be inadequate.
With this caveat in mind, here’s a look at how an integrational therapist might approach therapy.
Eclectic Therapy for Anxiety
After learning more about the client and their experience with anxiety, an eclectic therapist
would create a plan that draws from acceptance and commitment therapy (ACT), cognitive
behavioral therapy, and positive psychology.
 Techniques from ACT, such as acceptance and mindfulness, would help a client stop
struggling against anxiety and begin living fully in their present moment rather than stuck
in worries about the past or future.
 The therapist would select specific CBT techniques like learning about automatic
negative thoughts and thought stopping, to help clients change unhealthy thinking that is
contributing to anxiety.
 As treatment progresses, the therapist would eventually add techniques from positive
psychology such as identifying and using character strengths to help the client increase
self-confidence.
Eclectic Therapy for Depression
Depression has roots in long-term problems, and it frequently involves struggles with
interpersonal relationships. (F3) Therefore, an eclectic therapist might use psychodynamic
therapy and interpersonal therapy to help a client overcome depression.
Techniques from psychodynamic therapy would help clients explore emotional difficulties and
come to terms with problematic experiences from the past. Once a client was ready, the therapist
would then select specific treatments from interpersonal therapy to help them develop insights
and interpersonal skills to improve relationships and interactions with others.
Brief eclectic therapy for PTSD
To help people face, address, and overcome painful thoughts and feelings in the aftermath of a
traumatic event, a brief eclectic therapist combines CBT and psychodynamic therapy. 2,5 Select
CBT techniques help clients recognize their particular negative thoughts about the trauma and
change their thought patterns, while specific psychodynamic techniques allow people to process
difficult emotions.
Brief eclectic therapy involves 16 weekly sessions that typically last 45 minutes to one hour.
Each session has a specific objective in helping clients deal with the trauma.
Brief eclectic therapy for more difficulties
Regardless of the problem that leads an individual to seek therapy, CBT is the most common
therapeutic approach that therapists draw from.5
Other common techniques that are selected from multiple approaches and used in eclectic
therapy to help a variety of problems include:1
 Skill-building exercises
 Problem-solving tools
 Relaxation techniques
  Exploration to increase insight and awareness
 Identifying personal themes that may be interfering in life
What to Expect at Your First Appointment
Your first appointment with an eclectic therapist will be largely centered on the two of you
getting to know each other and beginning to form a strong, trusting therapeutic relationship.
Rather than diving directly into the problem or challenge that led you to therapy, the first session
lays the foundation for the work to come.
Your therapist will ask you questions to begin to understand you. They might ask about your
background, current problems and exactly how they are affecting your personal life, your family,
social life and support system, level of satisfaction with your career or job, and your goals. In
doing so, the therapist is learning what approaches will be most helpful to you.
You’ll likely also be given the chance to ask questions about the process and the therapist.
Because of the nature of eclectic therapy, your therapist probably won’t be able to provide a
detailed treatment plan with predetermined goals and strategies for every session. They will,
however, be able to give you an idea of what to expect in general.
Is Eclectic Therapy Effective?
Eclectic therapy is an established and proven approach to therapy that uses purposefully selected
techniques which research has shown to be helpful for a specific problem. 4 When helping clients,
therapists choose research-supported strategies for a specific problem.
Eclectic therapy is indeed science-based and proven effective as indicated by the existence of
two dedicated peer-reviewed, scholarly journals: the American Psychological
Association’s Journal of Psychotherapy Integration and the International Integrative Therapy
Association’s International Journal of Integrative Psychotherapy.
Eclectic therapy has been found to be effective even in difficult cases (such as clients who are
resistant to treatment or for complex and challenging problems). Therapists at the Daytona
Institute for Family Therapy engaged in a five-year project called The Impossible Cases Project
(results reported in 2002) to study which factors were most helpful in difficult therapy cases.3
They discovered that the two most important factors for success in these cases were:
1. the therapeutic relationship between counselor and client
2. the ability of the therapist to adapt treatment techniques to the client’s perspective of the
problem and finding solutions workable to the client. These two factors are the heart of
eclectic therapy.
Risks of Eclectic therapy
Systemic eclectic therapy (the intentional, thoughtful selection of treatments that has been the
subject of this article) conducted by qualified therapists (those that have advanced degrees in
their field and are licensed), poses little risk. However, poorly executed therapy that wantoly
pulls techniques from various theories in an attempt to find something that might work—known
as unsystematic eclectic therapy—can be ineffective or even harmful to the client.3
As with any other type of therapy, it’s crucial to ensure that your therapist is properly qualified.
You can discover a therapist’s credentials in online bios or by calling or visiting their office. It is
okay to ask a potential therapist about their credentials and background, and a good therapist will
gladly answer your questions. Most openly display their certificates and other credentials to be
open and transparent.
Criticism of Eclectic therapy
No therapeutic approach is for everyone, eclectic therapy included. Some criticisms of this type
of therapy include
 The lack of a set structure or procedure means that clients won’t always know what to
expect at each session or how many sessions they can expect to have
 Some people find the use of techniques from multiple disciplines to be confusing or
disorienting
 It can be difficult for a therapist to clearly explain what the process will be like from start
to finish
 If the therapist doesn’t clearly explain what they are doing and why, it can seem syncretic
like a random grab-bag of strategies with no united purpose
The Pros & Cons of Eclectic Therapy
Like all types of mental health therapy, eclectic therapy has advantages and disadvantages.
Considering both the pros and cons can help you decide if this integrative approach to healing is
right for you.
Pros of an Eclectic Approach:
Some advantages of eclectic therapy include
 It’s flexible to accommodate different clients’ needs rather than a one-size-fits all
approach to therapy
 It is useful for multiple and complex problems (usually, people see a therapist for more
than one issue or a single issue that is multifaceted)
 The techniques used are research-based and shown to be effective
 The therapy is adapted to the client rather than the client having to fit into a set model
Cons of an Eclectic Approach
Disadvantages may include such issues as
 It can feel unpredictable or confusing
 It might seem like the therapist is using a trial-and-error approach
 There isn’t a clear, obvious, or predictable structure
History of Eclectic Therapy
Until the 1970s, therapeutic theories were separate from each other, and therapists adhered to a
specific approach. Very little overlap occurred, and professionals were loyal to their chosen
method. As time passed, research continued, and as more therapeutic approaches were
developed, people began to see that more than one type of therapy was effective, and by the
1970s, therapists began to use multiple approaches in their work with clients.
One of the earliest proponents of an integrated approach to therapy was Arnold Lazarus with his
multimodal therapy. Through the 70s and 80s, different types of eclectic therapy were developed,
and they continued to evolve.3 Still today, new eclectic therapies are emerging as research
continues into what makes psychotherapy effective for different people with unique challenges
Process Experiential Psychotherapy:

In Process Experiential Psychotherapy: An Emotion-Focused Approach, Dr. Leslie S. Greenberg

demonstrates this deeply empathic, emotion-focused approach to treatment. In process
experiential psychotherapy, the therapist works to guide the client's affective and cognitive
processing of experience through the use of appropriate active interventions that facilitate the
resolution of painful emotions.
In this session, Dr. Greenberg works with a 34-year-old man who is depressed. Using empathy
and in-session activities, they explore the sources of the client's current affective state.
This video features a client portrayed by an actor on the basis of actual case material.
Experiential therapy is a type of therapy technique where patients use expressive tools, or
activities to re-enact and recreate situations from past and present relationships.
Precipitating Event
The client, Todd, made an appointment to see Dr. Greenberg on the basis of a referral from his
self-initiated contact with the Employee Assistance Program (EAP) at the company where he
works.
Over the past 2 months, Todd has taken 15 days of "sick leave" from his job, usually because of
exhaustion, an inability to concentrate, and a sense that he "just could not face it." During that
time, he felt that he couldn't "face things at work, or anyplace for that matter." Afraid that his job
might be jeopardized by all his absences, Todd talked to his supervisor about his problems. She
recommended that he contact the EAP.
Todd has tried to force himself to get up and go to work in spite of his increasing desire to
"hide." He knows he should "just do it" as his wife, Mary, "tells him to." But, his usual sense of
duty and responsibility seems to have dissipated. He has begun to dread each new day because it
only brings him a new sense of "inadequacy and a fear that he will never pull out of this."
Todd has been struggling with this for at least 6 months, although the last 2 months have been
the worst. About 8 weeks ago, Mary called Todd's father because she thought that even when she
couldn't help Todd, his father always seemed to be able to "force him out of these moods." His
father called one day when Todd was home from work and started in his usual "shoot-from-the
hip, matter of fact way," by telling Todd that he should "snap out of it, and be a man; don't
indulge your feelings; you have kids of your own now; do you think you are still a child who can
just sit home and cry?" After the call from his father, Todd "just wanted to die." He felt like he
was a total "wash out" in both his wife's and his father's eyes.
These feelings were not new, neither the feelings of inadequacy nor the feeling of being
"depressed."
He recalled another time when his father had mocked him and made him feel like a "loser."
When Todd was about 13 or 14, he went on a ski trip with his father and his brother. Todd didn't
want to go. Todd knew that he was "awkward and clumsy," but he tried anyway. He would fall
down and get up over and over. His father kept pushing him to try bigger and bigger slopes.
Finally, after one really painful fall, Todd just broke down and cried. "I can't do it, Dad. I am just
no good at this." Todd's father shouted at him to "Buck up; don't be a quitter.
Take your spills like a man for a change." Lots of people were around when his father yelled
at him. He felt humiliated and diminished. The ski trip finally did come to an abrupt end when
Todd broke his arm trying to break a fall.
About a year ago, Todd was up for a good promotion. Although he was clearly qualified for the
job, and it was the obvious "next step up" from his position, the department chief decided to go
"outside" of the firm to hire. Todd wondered if he had been unfairly passed over or if this was
another case of him being "unable to cut the mustard." "Nothing turns out how I hope,
"Todd thought "Always a loser always second best and in second place."
Preceding Sessions
Session 1: Todd related "his story" emphasizing the events of the last 2 months: his lack of
energy, lack of concentration, sense of despair and growing pessimism. He talked a little about
his childhood, specifically the death of his mother and the long-standing criticalness of his father.
Dr. Greenberg's primary interventions were geared to establishing an empathetic connection with
Todd by emphasizing how awful his life feels for him right now.
Session 2: Dr. Greenberg opened by restating some of the affective domains and psychological
issues from Session 1, letting Todd go where his feelings and present mood took him. Todd
elaborated on his sense of a deteriorating condition over the past 6 months, the failure of his
previous way of coping, the disappointment at work about 1 year ago, and Mary's attempt to
elicit his father's help 8 weeks earlier.
Dr. Greenberg continued to emphasize the affective elements of what Todd discussed, working
to further strengthen the empathetic connection and to build an alliance between the patient and
the therapist. The session ended with mutual agreement that they would have two broad goals: to
explore Todd's feeling of inadequacy and his distress about his childhood (particularly his
unsatisfying relationship with his father).
Session 3: Began by working on the agreed goals. Midway through the session the "two chair
technique" was introduced, with Todd beginning the process of dialoging with his "internalized
critic" around messages that "you're inadequate; you're no good." In this session, material about
the ski trip when Todd was 13 years old emerged.

Why can patients benefit from experiential therapy?

Experiential therapy can be used to treat trauma behavioral disorders, destructive

anger, grief, eating disorders, compulsive behavior, and drug addiction. This type of treatment
can also be beneficial for people who are struggling with the pain from a past, harmful
experience, or for people who want to change their current or future relationships. Patients can
attend experiential therapy sessions in clinical, medical, or individual psychology practices.
Sometimes, experiential therapy is offered in rehab programs as an additional therapy method to
other talk therapy treatments, such as CBT or DBT.
Studies on experiential therapy  have found that it is useful for improving patient’s
psychological coping skills, and is on par with the efficacy of CBT.
At its core, experiential therapy is patient-based. The principle behind the effectiveness of
experiential therapy is that by re-enacting the experience in a safe and controlled setting, patients
can release their repressed, negative emotions. In the place of these emotions, patients can
experience love, forgiveness, and calmness, which can change their perception of reality.
Experiential therapy can help people in recovery for addiction who may turn to drugs or alcohol
to cope with painful memories or shame from a past event. Experiential therapy is not meant to
take the place of medications, or other talk therapy methods for mental health disorders or
addiction.
If you or a loved one are struggling with addiction, therapy techniques such as experiential
therapy can help you. The dedicated and experienced counselors at Mission Harbor Behavioral
Health are standing by to answer your questions about their different therapy techniques .
Please contact Mission Harbor today  to explore your customized treatment options.
The facilities at Mission Harbor are staffed with trained experts to best assist patients with their
mental health issues. We are capable of dealing with any and all cases with a licensed staff,
equipment, and approved techniques. Our mission is to help those who want to help themselves,
and we support your decision in seeking help.
2# EXPERIENTIAL THERAPY:
Experiential therapy is a therapeutic technique that uses expressive tools and activities, such as
role-playing or acting, props, arts and crafts, music, animal care, guided imagery, or various
forms of recreation to re-enact and re-experience emotional situations from past and recent
relationships. The client focuses on the activities and, through the experience, begins to identify
emotions associated with success, disappointment, responsibility, and self-esteem. Under the
guidance of a trained experiential therapist, the client can begin to release and explore negative
feelings of anger, hurt, or shame as they relate to past experiences that may have been blocked or
still linger.
When It's Used:
Experiential therapy is often used in the treatment of trauma, eating disorders, behavior
disorders, anger management, grief and loss recovery, substance abuse, and various types of
physical and behavioral addictions and compulsive behavior such as gambling. It is also
recommended for those who wish to be free of painful, unhappy, or otherwise bad feelings from
past experiences, to change the nature of their current and future relationships, and to live up to
their full potential. Experiential therapy is offered in individual, clinical, and medical settings,
including various recovery, treatment, and rehabilitation programs, in conjunction with different
styles of traditional talk therapy.
How It Works:
A fundamental premise of experiential therapy is that one’s perception determines one’s
behavior. By re-experiencing and releasing repressed negative emotions from the past, the client
is better able to experience positive feelings such as love, forgiveness, and calm in the present,
changing their perception of reality. In practice, experiential therapy can take a variety of forms,
and is client-centered—in that the client’s preferences for certain interventions should be
honored. For instance, one client may be more attracted to animal-assisted therapy, while another
is more interested in sculpture or drama as a form of expression.
History of Experiential Therapy:

Emerged from humanistic-existentialist movement of the 1960’s

Drew from:
● Gestalt Therapy
● Psychodrama
● Encounter-group movement

Innovators and History:

Carl Whitaker (1912-1995)

● Among the first to do psychotherapy with families
● Encouraged family members to be themselves
● Intuition
Virginia Satir (1916-1988)
● Communication
● Individual self-expression

Theoretical Formulations
● Root cause of family problems is emotional suppression.
● Parents regulate their children’s actions by controlling their feelings; as a result, children learn
to blunt their
emotional experience to avoid criticism.
● From this perspective, attempts to bring about positive change in families are more likely to be
successful if
family members first get in touch with their real feelings- their hopes and desire as well as their
fears and
anxieties.
● Treatment is designed to help family members find fulfilling roles for themselves, with less
concern for the
family as a whole.
● The assumption is that opening up individuals to their experience is a prerequisite to breaking
new ground
for the family group.
● When people express their vulnerability directly, they’re are likely to elicit a compassionate
response from
their partners.

Normal Family Development

● Experiential therapist share the humanistic faith in the natural wisdom of
honest emotion.
● According to this point of view, if people are allowed to follow their own
instincts they tend to flourish.
● Society enforces repression to tame people’s instincts and make them fit
for group living.
● Parents appreciate their children, accept their feelings, and validate their
experience.
● Healthy families offer its members the freedom to be themselves.
Development of Behavior Disorders
● Denial of impulses and suppression of feeling are the root of family
problems.
● Dysfunctional families
fearful of conflict
cling to routines
lack of warmth
parents find children to be annoying/children don’t respect themselves
or parents
Development of Behavior Disorders Cont’d
● 4 Dishonest ways to communicate
Blaming
placating
Being irrelevant
Super reasonable
● Attachment injuries: traumatic occurrences that damage the bond between
partners and, if not resolved, maintain negative cycles and attachment
insecurities.
Goals of Therapy
Experiential Therapist believe that the way to emotional health is to uncover deeper levels of
experiencing. Satir (1972) puts it this way:
Through Experiential Therapy, Therapist attempt to make three changes within the family
system
1. First, each member of the family should be able to report congruently, completely, and
honestly
on what he sees and hears, feels and thinks, about themselves and others, in the presence of
others.
1. Second, each person should be addressed and related to in terms of their uniqueness, so that
decisions are made in terms of exploration and negotiation rather than in terms of power.
3. Third, differentness must be openly acknowledged and used for growth.

Conditions for Behavior Change

● Breakthroughs occur:
o more separate
o divergent
o angrier
o closer/intimate
● Therapist must be genuine (provocative and warmly supportive/give and
receive criticism)
● Clients come in wanting to change but thinking they can’t
● Satir believed: Caring and acceptance were key
Therapy
● Experiential therapists believe that there are no real techniques, only
people.
● Evocative Techniques
-Family sculpting
-Family Puppet Interview
-Animal Attribution
-Family Art Therapy
-Conjoint Family Drawings
-Play Therapy
-Role Playing
-Gestalt Technique
Family Sculpting Technique
An activity in which family members place themselves in postures symbolic of the family
dynamics.
- Each person – the mother, father and each child - sculpted how they see the family at that
moment.
- They followed by showing how they wanted it to be.
- The ‘physical movements’ between the two scenarios show the possible
changes people could make to create their ideal family.
Experiential Family Therapy Technique
Family puppet interviews- Ask a family member to make up
a story using puppets. It is useful in determining conflicts
and alliances.
Animal attribution- A story-telling technique that requires
family members to attribute an animal counterpart to each
member of the family and then tell a short story about the
animal protagonists.
- The use of art and creativity may lead to greater self-knowledge.
- Accessing creativity may be helpful in identifying emotional issues and can
help in the healing process.
- Art therapy is a serious technique that uses the creative process to help
improve the mental health of clients.
- Art therapy can be used on children and adults to treat a wide range of
emotional issues.
Family Art Therapy Technique
Conjoint Family Drawings Technique
“Draw me a picture of your family, make sure everyone is in the picture, have everyone
doing something.”
- Following this would be discussion by the family and the therapist of what was
drawn and why, what these may show of how different family member’s perceive
the family, and possible alternative patterns the family might wish to explore.
Play Therapy Technique
Generally for children ages 3 to 11, although adults can benefit also. Using puppets,
playhouses, dolls, sandboxes, finger paints or other media to assist children in
expressing their thoughts and emotions.
Role Playing- Technique
Past events or hoped for or feared future developments can be made more immediate
by role-playing them in the “now” of therapy.
Gestalt Technique
Use of techniques such as the “empty chair” to address emotional content surrounding
those not present in the therapy.
Two recent emotive approaches to family therapy that represent a more
sophisticated understanding of family dynamics are emotionally focused
couples therapy and the internal family systems model
❖ Emotionally Focused Couples Therapy (Johnson, 1998)
● Emotionally focused couples therapy works on two levels in succession:
A. Uncovering the hurt and longing beneath defensive expressions of anger and withdrawal.
B. Helping couples understand how those feelings are played out in their relationship.

❖ Internal Family Systems Therapy (Schwartz, 1995,2001)

In the Internal family systems model, conflicting inner voices are personified as
●
sub personalities or parts.
● Founded on the belief that underneath peoples’ emotionally reactive parts lies a healthy
core self.
The Process of Therapeutic Intervention
(Johnson, Hunsley, Greenberg & Schindler, 1999)
1. Assessment- or creating an alliance and explicating the core issues in the couple’s
conflict using attachment theory.
2. Identifying the problematic interaction cycle that maintains attachment insecurity and
relationship distress.
3. Uncovering the unacknowledged emotions underlying interactional positions.
4. Reframing the problem in terms of a problematic cycle with underlying emotions
and attachment needs
5. Encouraging acceptance and expression of disowned needs and aspects of the self.
6. Encouraging acceptance of the partner’s new openness.
7. Encouraging the expression of specific needs and wants and creating an intimate emotional
engagement.
8. Facilitating new solutions to unresolved relationships issues.
9. Consolidating new positions and more honest expression of attachment needs.
Pros and Cons of Experiential Family Therapy
● Pons
Helps individual discover inner thoughts, feelings, and fears
Committed to emotional well-being
Discussing feelings can help family members get pass the defensiveness
Help families re-connect and relate on a more genuine level
● Cons
Limited appreciation for role of family structure
Less concerned with problem solving
May be more suited for encounter groups
3# Family Therapy:

Definition

Family therapy is a type of psychotherapy that involves all members of a nuclear family or

stepfamily and, in some cases, members of the extended family (e.g., grandparents). A therapist
or team of therapists conducts multiple sessions to help families deal with important issues that
may interfere with the functioning of the family and the home environment
Purpose
The goal of family therapy is to help family members improve communication, solve family
problems, understand and handle special family situations (for example, death, serious physical
or mental illness, or child and adolescent issues), and create a better functioning home
environment. For families with one member who has a serious physical or mental illness, family
therapy can educate families about the illness and work out problems associated with care of the
family member. For children and adolescents, family therapy most often is used when the child
or adolescent has a personality, anxiety , or mood disorder that impairs their family and social
functioning, and when a stepfamily is formed or begins having difficulties adjusting to the new
family life. Families with members from a mixture of racial, cultural, and religious backgrounds,
as well as families made up of same-sex couples who are raising children, may also benefit from
family therapy.
Description
Family therapy is generally conducted by a therapist or team of therapists who are trained and
experienced in family and group therapy techniques. Therapists may be psychologists,
psychiatrists, social workers, or counselors. Family therapy involves multiple therapy sessions,
usually lasting at least one hour each, conducted at regular intervals (for example, once weekly)
for several months. Typically, family therapy is initiated to address a specific problem, such as
an adolescent with a psychological disorder or adjustment to a death in the family. However,
frequently, therapy sessions reveal additional problems in the family, such as communication
issues. In a therapy session, therapists seek to analyze the process of family interaction and
communication as a whole and do not take sides with specific family members. Therapists who
work as a team can model new behaviors for the family through their interactions with each other
during a session.
Family therapy is based on family systems theory, in which the family is viewed as a living
organism rather than just the sum of its individual members. Family therapy uses systems theory
to evaluate family members in terms of their position or role within the system as a whole.
Problems are treated by changing the way the system works rather than trying to fix a specific
member. Family systems theory is based on several major concepts.
Concepts in family therapy
 THE IDENTIFIED PATIENT The identified patient (IP) is the family member with the
symptom that has brought the family into treatment. Children and adolescents are
frequently the IP in family therapy. The concept of the IP is used by family therapists to
keep the family from scapegoating the IP or using him or her as a way of avoiding
problems in the rest of the system.
 HOMEOSTASIS (BALANCE) Homeostasis means that the family system seeks to
maintain its customary organization and functioning over time, and it tends to resist
change. The family therapist can use the concept of homeostasis to explain why a certain
family symptom has surfaced at a given time, why a specific member has become the IP,
and what is likely to happen when the family begins to change.
 THE EXTENDED FAMILY FIELD The extended family field includes the immediate
family and the network of grandparents and other relatives of the family. This concept is
used to explain the intergenerational transmission of attitudes, problems, behaviors, and
other issues. Children and adolescents often benefit from family therapy that includes the
extended family.
  DIFFERENTIATION Differentiation refers to the ability of each family member to
maintain his or her own sense of self, while remaining emotionally connected to the
family. One mark of a healthy family is its capacity to allow members to differentiate,
while family members still feel that they are members in good standing of the family.
 TRIANGULAR RELATIONSHIPS Family systems theory maintains that emotional
relationships in families are usually triangular. Whenever two members in the family
system have problems with each other, they will "triangle in" a third member as a way of
stabilizing their own relationship. The triangles in a family system usually interlock in a
way that maintains family homeostasis. Common family triangles include a child and his
or her parents; two children and one parent; a parent, a child, and a grandparent; three
siblings; or, husband, wife, and an in-law.
In the early 2000s, a new systems theory, multisystemic therapy (MST), has been applied to
family therapy and is practiced most often in a home-based setting for families of children and
adolescents with serious emotional disturbances. MST is frequently referred to as a "family-
ecological systems approach" because it views the family's ecology, consisting of the various
systems with which the family and child interact (for example, home, school, and community).
Several clinical studies have shown that MST has improved family relations, decreased
adolescent psychiatric symptoms and substance use, increased school attendance, and decreased
re-arrest rates for adolescents in trouble with the law. In addition, MST can reduce out-of-home
placement of disturbed adolescents.
Preparation
In some instances the family may have been referred to a specialist in family therapy by their
pediatrician or other primary care provider. It is estimated that as many as 50 percent of office
visits to pediatricians have to do with developmental problems in children that are affecting their
families. Some family doctors use symptom checklists or psychological screeners to assess a
family's need for therapy. For children and adolescents with a diagnosed psychological disorder,
family therapy may be added to individual therapy if family issues are identified as contributing
factors during individual therapy.
Family therapists may be either psychiatrists, clinical psychologists, or other professionals
certified by a specialty board in marriage and family therapy. They usually evaluate a family for
treatment by scheduling a series of interviews with the members of the immediate family,
including young children, and significant or symptomatic members of the extended family. This
process allows the therapist(s) to find out how each member of the family sees the problem, as
well as to form first impressions of the family's functioning. Family therapists typically look for
the level and types of emotions expressed, patterns of dominance and submission, the roles
played by family members, communication styles, and the locations of emotional triangles. They
also note whether these patterns are rigid or relatively flexible.
Preparation also usually includes drawing a genogram, which is a diagram that depicts
significant persons and events in the family's history. Genograms include annotations about the
medical history and major personality traits of each member. Genograms help uncover
intergenerational patterns of behavior, marriage choices, family alliances and conflicts, the
existence of family secrets, and other information that sheds light on the family's present
satuation.
Precautions
Individual therapy for one or more family members may be recommended to avoid volatile
interaction during a family therapy session. Some families are not considered suitable candidates
for family therapy. They include:families in which one, or both, of the parents is psychotic or has
been diagnosed with antisocial or paranoid personality disorderfamilies whose cultural or
religious values are opposed to, or suspicious of, psychotherapyfamilies with members who
cannot participate in treatment sessions because of physical illness or similar limitationsfamilies
with members with very rigid personality structures (Here, members might be at risk for an
emotional or psychological crisis.)families whose members cannot or will not be able to meet
regularly for treatment
Risks
The chief risk in family therapy is the possible unsettling of rigid personality defenses in
individuals or relationships that had been fragile before the beginning of therapy. Intensive
family therapy may also be difficult for family members with diagnosed psychological disorders.
Family therapy may be especially difficult and stressful for children and adolescents who may
not fully understand interactions that occur during family therapy. Adding individual therapy to
family therapy for children and adolescents with the same therapist (if appropriate) or a therapist
who is aware of the family therapy can be helpful.
Normal results
Normal results vary, but in good circumstances, they include greater insight, increased
differentiation of individual family members, improved communication within the family,
loosening of previously automatic behavior patterns, and resolution of the problem that led the
family to seek treatment.
Parental concerns
Stepfamilies , which are increasing in prevalence, are excellent candidates for family therapy.
Children and adolescents in stepfamilies often have difficulties adjusting, and participating in
family therapy can be beneficial. Stepfamilies, increasingly referred to as "blended families,"
experience unique pressures within each new family unit. Stepfamily researchers, family
therapists, and the Stepfamily Association of America (SAA) view the term as inaccurate
because it seems to suggest that members of a stepfamily blend into an entirely new family unit,
losing their individuality and attachment to other outside family members. Because other family
types (biological, single-parent, foster, adoptive) are defined by the parent-child relationship, the
SAA believes that the term "stepfamily" more accurately reflects that relationship and is
consistent with other family definitions. Viewing the stepfamily as a blended family can lead to
unrealistic expectations, confused and conflicted children, difficult adjustment, and in many
cases, failure of the marriage and family. Family therapy can help family members deal with
these issues. Children and adolescents and, in some cases even the parents, may be reluctant to
participate in family therapy. Home-based family therapy has in the early 2000s become
available as an option for families with severely disturbed adolescents and family members
reluctant to see a therapist. In home-based therapy, a therapist or team of therapists comes
directly to the family's home and conducts therapy sessions there.
KEY TERMS
 Blended family —A family formed by the remarriage of a divorced or widowed parent. It
includes the new husband and wife, plus some or all of their children from previous
marriages.
 Differentiation —The ability to retain one's identity within a family system while
maintaining emotional connections with the other members.
 Extended family field —A person's family of origin plus grandparents, in-laws, and other
relatives.
 Family systems theory —An approach to treatment that emphasizes the interdependency
of family members rather than focusing on individuals in isolation from the family. This
theory underlies the most influential forms of contemporary family therapy.
 Genogram —A family tree diagram that represents the names, birth order, sex, and
relationships of the members of a family. Therapists use genograms to detect recurrent
patterns in the family history and to help the family members understand their
problem(s).
 Homeostasis —The balanced internal environment of the body and the automatic
tendency of the body to maintain this internal "steady state." Also refers to the tendency
of a family system to maintain internal stability and to resist change.
 Identified patient (IP) —The family member in whom the family's symptom has emerged
or is most obvious.
 Nuclear family —The basic family unit, consisting of a father, a mother, and their
biological children.
 Stepfamily —A family formed by the marriage or long-term cohabitation of two
individuals, where one or both have at least one child from a previous relationship living
part-time or full-time in the household. The individual who is not the biological parent of
the child or children is referred to as the stepparent.
 Triangling —A process in which two family members lower the tension level between
them by drawing in a third member.
THE FAMILY SYSTEMS MODEL
The Family Systems Model operates on the belief that a family unit tends to arrange itself around
substance abuse, in spite of its destructive consequences. The goal of this model is to teach the
family members how to build healthier organizational patterns. For example, if an addicted
family member is encouraged to continue drinking because alcohol helps him work more
productively, therapy would be directed towards helping the family correct this maladaptive
behavior.
THE FAMILY DISEASE MODEL
The Family Disease Model is based on the concept that addiction is a disease, and that this
disease can affect a whole household unit. Family members who aren’t addicted may
become codependent on the addict for their emotional or material stability. This model aims to
treat the entire family by approaching addiction as a condition that can be cured through
modifications in behavior or environment.
MULTI-DIMENSIONAL FAMILY THERAPY
Multi-Dimensional Family Therapy draws from a number of therapeutic techniques to help
families become stronger and healthier. Behavior, emotion, cognition and the household
environment may be addressed as part of multi-dimensional family therapy, or MDFT. Each of
the factors that contribute to addiction may be approached from a different perspective in this
multi-faceted approach.
COGNITIVE BEHAVIORAL FAMILY THERAPY
Cognitive Behavioral Family Therapy, or CBT, aims to improve family relationships and
promote sobriety by correcting the destructive behaviors and thought patterns that contribute to
addiction. Family members are taught to identify the trigger events that prompt addictive
behavior and to find healthier ways to resolve conflict. CBT is widely used in personal therapy,
as well, to help the addicted individual correct negative, self-defeating thoughts and habits.
What Makes Family Therapy Effective?
The family therapy model that is used to heal a home may not be as important as the family’s
motivation to change. In spite of the devastating consequences of addiction — conflict, abuse,
financial troubles, social isolation, legal difficulties — families may be attached to the status quo
and might be afraid to see their situation change.
If abuse or violence is taking place in the home, there could be a fear of having these situations
exposed in therapy. If a couple has developed a codependent relationship, the emotional
symbiosis may seem too powerful to break.
A family therapist must address the fact that addiction serves a real purpose, albeit a
dysfunctional purpose, in many homes. In families that have been torn apart by addiction,
therapy may help parents and children reunify after a legally enforced separation.
What do all successful approaches to addiction family therapy have in common? In all of the
major family therapy models, addiction is addressed not just as an individual problem, but as a
disease or maladaptive behavior that affects everyone who shares the home. In order for family
therapy to be effective, family members must take the treatment seriously and must just as
committed to sobriety as the person entering rehab.

4# CITISICM ON ECLECTIC TRATMENT COMBINATION

Eclectic therapy isn’t always right for everyone with every type of problem. Perhaps eclectic
therapy worked well for a person who has depression, but does not for anyone else even though
he also has depression. When considering starting therapy, it makes sense to look at both sides of
this issue before selecting a therapist.
 Requires a highly skilled therapist
Getting therapy from a counselor who is not highly skilled is never a good idea. It’s even worse
with eclectic approach psychology practitioners. Eclectic therapy demands the therapist is well
trained in not just one but many different types, styles, and techniques. A therapist with therapist
with poor skills might turn their eclectic therapy style into a trial and error project, leading you
down many paths but never concluding one of them. They might not use the therapies that are
right for patient, but instead, choose whatever therapy comes to mind. It’s important to know that
the therapist is licensed and knowledgeable.
 Can seem confusing
When an eclectic therapist moves too quickly from one type of therapy to another, patient might
feel confused about what’s happening in the sessions. A skilled therapist can eliminate that
confusion by letting know at the end of one therapy session what you’ll be doing in the next
session, explain it briefly, and ask of you have any questions.
 Cultural differences
Due to cultural differences, it is difficult to integrate different approaches to suit the needs of
each specific culture. Some approaches may not work best for others. Mulaq and Chaleby
(1995): applied to Arab cultures- there are strict gender roles, deference to members in the group
based on age or tribal status, and the misperception that the therapy session is simply another
social activity. In this case, group therapy is proven ineffective.
 Complex treatments
In order to properly and correctly administer an eclectic therapy, it requires that the clinician
have sufficient knowledge and skill to do so. Lebow (2003) stated that sometimes eclectic
approaches are too complex for one clinician too manages; a second point he makes is that there
is always a danger that clinicians may call themselves eclectic when they have no clear direction
for treatment.
 Practical difficulties
There are some practical difficulties in investigating the integration of approach when
providing eclectic therapy. It may be too complex for one clinician to manage.
 It does not lend itself to prediction and control of behavior.
 It seems to be unsystematic and unfocused.
 The lack of a set structure or procedure means that clients won’t always know
what to expect at each session or how many sessions they can expect to have
 Some people find the use of techniques from multiple disciplines to be confusing
or disorienting
 It can be difficult for a therapist to clearly explain what the process will be like
from start to finish
 If the therapist doesn’t clearly explain what they are doing and why, it can seem
syncretic, like a random grab-bag of strategies with no united purpose
 References:
Nichols, M., (2013). Family therapy concepts and methods (10th ed.). Boston: Pearson
Education.

7: Group Therapy

Group Therapy

Group therapy, as the name implies, is a type of psychological therapy that is conducted with a
group of people, rather than between an individual and mental health professional. Usually,
people in the group are facing similar issues, like anxiety or addiction. Group therapy is a form
of psychotherapy that involves one or more therapists working with several people at the same
time. This type of therapy is widely available at a variety of locations including private
therapeutic practices, hospitals, mental health clinics, and community centers.

Group therapy is sometimes used alone, but it is also commonly integrated into a
comprehensive treatment plan that also includes individual therapy and medication.

Principles of Group Therapy:

In The Theory and Practice of Group Psychotherapy, Irvin D. Yalom outlines the key therapeutic
principles that have been derived from self-reports from individuals who have been involved in
the group therapy process:

Instills Hope: The group contains members at different stages of the treatment process. Seeing
people who are coping or recovering gives hope to those at the beginning of the process.

Universality: Being part of a group of people who have the same experiences helps people see
that what they are going through is universal and that they are not alone.

Imparting information: Group members can help each other by sharing information.

Altruism: Group members can share their strengths and help others in the group, which can boost
self-esteem and confidence.

The corrective recapitulation of the primary family group: The therapy group is much like a
family in some ways. Within the group, each member can explore how childhood experiences
 contributed to personality and behaviors. They can also learn to avoid behaviors that are
destructive or unhelpful in real life.
Development of socialization techniques: The group setting is a great place to practice new
behaviors. The setting is safe and supportive, allowing group members to experiment without
the fear of failure.

Imitative behavior: Individuals can model the behavior of other members of the group or observe
and imitate the behavior of the therapist.

Interpersonal learning: By interacting with other people and receiving feedback from the
group and the therapist, members of the group can gain a greater understanding of
themselves.

Group cohesiveness: Because the group is united in a common goal, members gain a sense of
belonging and acceptance.

Catharsis: Sharing feelings and experiences with a group of people can help relieve pain, guilt, or
stress.

Existential factors: While working within a group offers support and guidance, group therapy
helps members realize that they are responsible for their own lives, actions, and choices.

How Group Therapy Works

Groups can be as small as three or four people, but group therapy sessions often involve around
eight to twelve individuals (although it is possible to have more participants). The group
typically meets once or twice each week, or more, for an hour or two.

According to author Oded Manor in The Handbook of Psychotherapy, the minimum number of
group therapy sessions is usually around six but a full year of sessions is more common. Manor
also notes that these meetings may either be open or closed. In open sessions, new participants
are welcome to join at any time. In a closed group, only a core group of members are invited to
participate. In many cases, the group will meet in a room where the chairs are arranged in a
large circle so that each member can see every other person in the group.

A session might begin with members of the group introducing themselves and sharing why
they are in group therapy. Members might also share their experiences and progress since
the last meeting.
The precise manner in which the session is conducted depends largely on the goals of the group
and the style of the therapist. Some therapists might encourage a more free-form style of
dialogue, where each member participates as he or she sees fit. Other therapists instead have a
specific plan for each session that might include having clients practice new skills with other
members of the group.

Effectiveness

Group therapy can be effective for depression. In a study published in 2014, researchers
analyzed what happened when individuals with depression received group cognitive behavioral
therapy. They found that 44% of the patients reported significant improvements. The drop rate
for group treatment was high, however, as almost 1 in 5 patients quit treatment.

An article published in the American Psychological Association's Monitor on Psychology

suggests that group therapy also meets efficacy standards established by the Society of Clinical
Psychology (Division 12 of the APA) for panic disorder, bipolar disorder, obsessive-compulsive
disorder, social phobia, and substance use.

Benefits

The principal advantages of group therapy include:

Group therapy allows people to receive the support and encouragement of the other
members of the group. People participating in the group can see that others are going through
the same thing, which can help them feel less alone.

Group members can serve as role models for other members of the group. By observing
someone successfully coping with a problem, other members of the group can see that there is
hope for recovery. As each person progresses, they can, in turn, serve as a role model and
support figure for others. This can help foster feelings of success and accomplishment.

Group therapy is often very affordable. Instead of focusing on just one client at a time, the
therapist can devote his or her time to a much larger group of people.

Group therapy offers a safe haven. The setting allows people to practice behaviors and actions
within the safety and security of the group.
By working in a group, the therapist can see first-hand how each person responds to other
people and behaves in social situations. Using this information, the therapist can provide
valuable feedback to each client.

Group Analytic Psychotherapy

• What is Group Analytic Psychotherapy?

Group Analysis is a method of group psychotherapy originated by S.H. Foulkes in

the 1940s’. It combines psychoanalytic insights with an understanding of social and
interpersonal functioning. There is an interest, in group psychotherapy, on the relationship
between the individual group member and the rest of the group resulting in a strengthening of
both, and a better integration of the individual with his or her community, family and social
network. Deriving from psychoanalysis, Group Analysis also draws on a range of other
psychotherapeutic traditions and approaches: systems theory psychotherapies, developmental
psychology and social psychology. From this emerges a powerful psychotherapeutic technique.
Group Analysis also has applications in organisational consultancy, and in teaching and training.
Group Analysts work in a wide range of contexts with a wide range of difficulties and problems.
Group Analysis explores the theory, practice and experience of analytical group psychotherapy,
embracing concepts derived from psychoanalytic psychology, social psychology, group
dynamics, sociology and anthropology.

Group analytic psychotherapy is an effective form of personal therapy that takes place in a
group setting. This approach supports the idea that many of our beliefs and actions are outside
our conscious awareness and uses the group to promote insight and deepen understanding of
the nature of human relating. In this way, each individual can gain relief from difficulties and be
supported to enjoy a better quality of life. In addition to exploring their own individual
concerns, the work of group uncovers the significant impact of social influences such as gender,
class, race and culture.

A fictional example of a weekly therapy group:

Each member comes from a different background and has different reasons for
joining the group. In the weekly group there is no set theme and members are invited to work
at their own pace, say what is on their mind and speak to each other in a meaningful way. As a
result a group culture develops that can mirror relationships of everyday life. Thus the group
can then work to resolve the underlying issues each individual experiences in their personal life.
The Group analytical model :

Group Analysis (or group analytic psychotherapy) is based on the view that deep
lasting change can occur within a carefully formed group whose combined membership reflects
the wider norms of society. It is rooted in psychoanalysis and the social sciences. Groups begin
with a relatively high level of leadership activity, referred to as dynamic administration. This
approach integrates important aspects of group as a whole and individually-oriented models.
The conductor (therapist) is encouraged to address individuals as well as the whole group. This
concept is developed by an integrated set of concepts of structure, process and outcome. In a
typical group analytic group, a process evolves from which everyone gains at the same time. A
stimulating interaction between group members becomes the focus of treatment and
therapeutic work so that understanding group interactions, conversations and events becomes
a powerful way of learning about the self. Any fears that it will be too difficult to talk about your
problems in the group soon disappear in the animated and helping atmosphere of the group.
Sharing feelings and experiences in an intense, lively and supportive group creates an
atmosphere in which mutual confidence and support can develop. Past patterns of attitudes,
feelings and behaviour then appear in the group and analysis and thought about these patterns
opens the path of growth and development. Group members see themselves through the eyes
of others. They gain new insights about themselves and learn about themselves and others
through the work others do in the group to gain insight about their behaviour and relationships.
Deep and lasting change can thus occur and the effects of traumatic life experiences can be
resolved. Personal issues are explored in an atmosphere of trust and confidentiality. Through
the relationships that develop within the group a living demonstration is provided of how past
patterns of behavior can reproduce themselves in the present and block growth and creativity.
Analysis of this process opens the way for change.

Why join Psychotherapy Group?

Psychotherapy groups can be very helpful for any of the following issues:

 Repeated problems in close relationships

 Difficulties relating to others generally
 Social anxiety
 Low self-esteem
 Depression
 Anxiety
 Past/current difficult family dynamics
 Problems tolerating or expressing certain feelings
 Shame
 Questions about identity
 Alienation and conflicts around belonging
 Attachment issues
 Existential or life-stage struggles
 Difficulties with groups

How does Group Psychotherapy help?

Personal development:

As well as being effective as a therapeutic treatment for all kinds of difficulties, group

psychotherapy can also be used for personal growth. Psychotherapy groups offer a profound

existential experience by creating an environment where members can engage with others on a

deep and meaningful level.

Sharing and Breaking Isolation:

New members are often surprised at the relief in hearing others share
feelings and experiences that are very familiar to them and this gives confidence and trust to
share back. Being ‘seen and validated’ helps participants manage difficult emotions such as
anxiety.They often learn quickly that many of the difficulties they thought isolated them are
identified with very easily by others in the group.

Making Bonds :

Therapy groups allow and create strong bonds between members, which heighten
feelings of belonging and attachment.The group is experienced as more than the individuals
who comprise it and so can feel a robust and stable container.

Groups as a mirror And microcosm :

 As group members trust the group and the therapist more, they can venture into
giving and accepting more challenging feedback about the way others experience them. They
see themselves mirrored in others and vice versa. The group helps members embrace and
engage with difference.In this way, it is a microcosm of life that can be used to help tolerate
and deal better with the frustrations in everyday lives and relationships.

Different emotional experience:

Most people join a group expecting their relationships to develop in a familiar,

habitual way which are generally negative and unhelpful. These expectations are usually based
on negative or traumatic childhood experiences. Groups generally confound these kinds of
expectations, providing a different experience and offering the chance for relationship patterns
to change. This is critically important as a major part of how we manage emotions such as
anxiety is through relationship.

Opportunity for new roles :

Analytic groups directly tackle the kinds of constricted relational roles people can
take up in their lives – often at the heart of their difficulties. Usually, these roles have begun
earlier in the family or at school and often operate unconsciously. Being in a therapy group
provides an opportunity to challenge –with the help of other members and the therapist –
habitual roles as they are taken up in outside life and in the group. The group offers the chance
to try out alternative relationships and roles in a safe therapeutic environment.

Social Context :

A key idea in group analysis is that we are born out of our social contexts and
these are at the very core of us and how we operate.This means that there is an emphasis on
understanding our past and present, social and cultural contexts.In this way, members are
encouraged to not just see their lives in isolation but in context and connected to others.
Struggles are therefore not just seen as solely belonging to the individual but in the group as a
whole.

Helping Others :

In psychotherapy groups, time and attention are shared and this means members
develop ways of both attending to others needs as well as allowing others to attend to theirs.
Tackling other people’s problems can provide helpful insight into one’s own situation.Helping
 others in the process of group psychotherapy develops interpersonal skills, provides a genuine
sense of self-worth and social value and increases confidence and self-esteem.

Role of the Therapist :

The therapist in a group analytic group is called a ‘conductor’.

The conductor does not lead the group or decide on the direction or topic of discussion.
They participate in the group discussions and preoccupations but also stay in an observing role,
at times commenting on how they are viewing individual and group struggles and
developments.

It is the therapist’s responsibility to put into place and oversee important boundaries for
the group, ensuring a safe and confidential environment.

What is behavioral therapy?

Behavioral therapy is an umbrella term for types of therapy that treat mental health disorders.
This form of therapy seeks to identify and help change potentially self-destructive or unhealthy
behaviors. It functions on the idea that all behaviors are learned and that unhealthy behaviors
can be changed. The focus of treatment is often on current problems and how to change them.

Who can benefit from behavioral therapy?

Behavioral therapy can benefit people with a wide range of disorders.

People most commonly seek behavioral therapy to treat:

 depression
 anxiety
 panic disorders
 anger issues
 It can also help treat conditions and disorders such as:
 eating disorders
 post-traumatic stress disorder (PTSD)
 bipolar disorder
 ADHD
 phobias, including social phobias
 obsessive compulsive disorder (OCD)
 self-harm
 substance abuse

This type of therapy can benefit adults and children.

Cognitive behavioral therapy

Cognitive behavioral therapy is extremely popular. It combines behavioral therapy with

cognitive therapy. Treatment is centered around how someone’s thoughts and beliefs influence
their actions and moods. It often focuses on a person’s current problems and how to solve
them. The long-term goal is to change a person’s thinking and behavioral patterns to healthier
ones.

Cognitive behavioral play therapy

Cognitive behavioral play therapy is commonly used with children. By watching children play,
therapists are able to gain insight into what a child is uncomfortable expressing or unable to
express. Children may be able to choose their own toys and play freely. They might be asked to
draw a picture or use toys to create scenes in a sandbox. Therapists may teach parents how to
use play to improve communication with their children.

System desensitization

System desensitization relies heavily on classical conditioning. It’s often used to treat phobias.
People are taught to replace a fear response to a phobia with relaxation responses. A person is
first taught relaxation and breathing techniques. Once mastered, the therapist will slowly
expose them to their fear in heightened doses while they practice these techniques.

Aversion therapy

Aversion therapy is often used to treat problems such as substance abuse and alcoholism. It
works by teaching people to associate a stimulus that’s desirable but unhealthy with an
extremely unpleasant stimulus. The unpleasant stimulus may be something that causes
discomfort. For example, a therapist may teach you to associate alcohol with an unpleasant
memory.
 Is behavioral therapy effective?

Behavioral therapy has successfully been used to treat a large number of conditions. It’s
considered to be extremely effective.

About 75 percent of people who enter cognitive behavioral therapy experience some benefits
from treatment.

One studyTrusted Source found that cognitive behavioral therapy is most effective when
treating:

 anxiety disorders
 general stress
 bulimia
 anger control problems
 somatoform disorders
 depression
 substance abuse

Studies have shown that play therapy is very effective in children ages 3 to 12. However, this
therapy is increasingly being used in people of all ages.

Behavioral therapy for children

Applied behavior therapy and play therapy are both used for children. Treatment involves
teaching children different methods of responding to situations more positively. A central part
of this therapy is rewarding positive behavior and punishing negative behavior. Parents must
help to reinforce this in the child’s day-to-day life. It may take children some time to trust their
counselor. This is normal.

They’ll eventually warm up to them if they feel they can express themselves without
consequences.

 Children with asexual

disorders sleep disorders

 social skill problems

substance abuse

Cognitive behavioral therapy may be combined with other treatments to help with depression
autism and ADHD often benefit from behavioral therapy.

How to find a behavioral therapist

Finding a therapist can feel overwhelming, but there are many resources that make it easier.

When finding a provider, you can choose from:

 social workers
 faith-based counselors
 non-faith-based counselors
 psychologists
 psychiatrists

You should make sure that the provider you choose has the necessary certifications and
degrees. Some providers will focus on treating certain conditions, such as eating disorders or
depression.

If you don’t know how to get started finding a therapist, you can ask your doctor for a
recommendation. They may recommend you to a psychiatrist if they think you might benefit
from medication. Psychiatrists are able to write prescriptions for medication.
Most insurance plans will cover therapy. Some providers offer scholarships or sliding-scale
payment for low income individuals.
A therapist will ask you many personal questions about yourself. You will know you have found
the right therapist if you feel comfortable talking to them. You may have to meet with several
therapists before you find the right one.

What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy (CBT) is a type of psychotherapy. This form of therapy modifies
thought patterns in order to change moods and behaviors. It’s based on the idea that negative
actions or feelings are the result of current distorted beliefs or thoughts, not unconscious forces
from the past.
 CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses on your
moods and thoughts. Behavioral therapy specifically targets actions and behaviors. A therapist
practicing the combined approach of CBT works with you in a structured setting. You and your
therapist work to identify specific negative thought patterns and behavioral responses to
challenging or stressful situations.

Treatment involves developing more balanced and constructive ways to respond to stressors.
Ideally these new responses will help minimize or eliminate the troubling behavior or disorder.

The principles of CBT can also be applied outside of the therapist’s office. Online cognitive
behavioral therapy is one example. It uses the principles of CBT to help you track and manage
your depression and anxiety symptoms online.

How CBT works ?

CBT is a more short-term approach than psychoanalysis and psychodynamic therapies. Other
types of therapies may require several years for discovery and treatment. CBT often requires
only 10 to 20 sessions.

The sessions provide opportunities to identify current life situations that may be causing or
contributing to your depression. You and your therapist identify current patterns of thinking or
distorted perceptions that lead to depression.

This is different from psychoanalysis. That type of therapy involves working backward through
your life history to discover an unconscious source of the problems you’re facing.

You may be asked to keep a journal as part of CBT. The journal provides a place for you to
record life events and your reactions. The therapist can help you break down reactions and
thought patterns into several categories of self-defeating thought. These include:

all-or-nothing thinking: viewing the world in absolute, black-and-white terms

disqualifying the positive: rejecting positive experiences by insisting they “don’t count” for some
reason automatic negative reactions: having habitual, scolding thoughts magnifying or
minimizing the importance of an event: making a bigger deal about a specific event or moment
overgeneralization: drawing overly broad conclusions from a single event personalization:
taking things too personally or feeling actions are specifically directed at you mental filter:
picking out a single negative detail and dwelling on it exclusively so that the vision of reality
becomes darkened
You and your therapist can use the journal to help replace negative thought patterns or
perceptions with more constructive ones. This can be done through a series of well-practiced
techniques, such as: learning to control and modify distorted thoughts and reactions

learning to accurately and comprehensively assess external situations and reactions or

emotional behavior practicing self-talk that is accurate and balanced using self-evaluation to
reflect and respond appropriately

You can practice these coping methods on your own or with your therapist. Alternately you can
practice them in controlled settings in which you’re confronted with challenges. You can use
these settings to build on your ability to respond successfully. Another option is online CBT. This
allows you to practice these methods in the comfort of your home or office.

What disorders can CBT treat?

Cognitive behavioral therapy is widely used to treat several disorders and conditions in children,
adolescents, and adults. These disorders and conditions include: antisocial behaviors (including
lying, stealing, and hurting animals or other people) disorders deficit hyperactivity disorder
disorder conduct disorder depression eating disorders such as binge eating, anorexia, and
bulimia general stress personality disorders phobias schizophrenia sexual disorders sleep
disorders social skill problems substance abuse Cognitive behavioral therapy may be combined
with other treatments to help with depression.

Humanistic group therapy:

Humanistic group therapy as we know it to-day has its roots in three areas: the human potential
movement, third force psychology known as the Humanistic school and a move to greater use
of group therapy in the psychodynamic and psychoanalytic schools after the Second World
War. Humanistic therapy is an umbrella term for a group of therapies that share a common
approach. Humanistic therapists believe that humans are inherently good and have potential to
grow in positive ways.
The humanistic approach to therapy arose after the more traditional behavioral and
psychoanalytic approaches, such as those pioneered by Freud or Jung, for example. These more
traditional approaches focus on symptoms and reducing distress. In contrast, humanistic
approaches work on the idea that you have the potential to be as you choose; that your
thoughts, feelings and behaviors do not need to be prescribed as a result of your past
experiences. Humanistic therapies help you to identify and develop your unique strengths to
become the best person you can be and create a sense of meaning in life. Because they can be
applied to a wide range of mental health challenges, many people choose to work with a
humanistic therapist because they find the nature of the approach appealing.

Types of humanistic therapies:

Numerous types of therapy are based on the therapeutic approach,

1-Gestalt therapy: This is one of the most common humanistic therapies, which focuses on
identifying your current thoughts and feelings (not the causes of thoughts). You can learn more
about gestalt therapy here.

2-Person-centered therapy: This is also one of the more common humanistic therapies. Here,
the therapist is less directive. They create a supportive environment in which you are able to
develop your true identity.

3-Compassion-focused therapy: The aim here is to help you to be kinder to yourself and others.

4-Phenomenological therapy: You are encouraged to question your assumptions and

perspectives, and then develop new beliefs and paths forward.

5-Transactional analysis: This approach helps you become aware of how you think, feel, and
behave, and use this information to change the way you relate to yourself and others.

6-Existential therapy: The therapist helps you to identify your values and use them to create a
meaningful life. You can learn more about existential therapy here.

7-Transpersonal therapy: This therapy has an emphasis on connections: to yourself, others, and
to a more spiritual sense of a greater whole. You can learn more about transpersonal therapy
here.

Issues that humanistic therapist can help:

Humanistic therapies can be applied to help with an array of issues, including:

. Stress . Anxiety

. Self-esteem . Trauma
. Depression . Relationship challenges

. Family difficulties . Addictions

. Grief or bereavement . Eating disorders

. Communication problems . Identity issues

. Existential crises

. Problems at school or work

How humanistic therapy works

Humanistic approaches have a holistic approach to wellbeing, where the focus is on the person,
not the symptoms. These therapies foster creativity, growth and free will to help you to
develop a stronger sense of self and create meaning in life. Humanistic approaches help you to
identify and develop your unique strengths. They help you to identify unmet needs and fulfill
them yourself, and develop to your full potential. Humanistic therapists call this
‘selfactualization’.

Frequency and length of Humanistic therapy sessions

The frequency and length of humanistic therapy sessions depend on the specific type of therapy
you choose, as well as your individual circumstances and the problems that you are
experiencing. You are your therapist will decide together when the appropriate time is to end
therapy.

Structure of humanistic therapy sessions

These therapeutic approaches, by nature, tend not to be structured in a specific way. Each
person is considered a unique individual and therapy is therefore equally as unique. The
structure of therapy then depends more on your own particular preferences and goals.

What happens in a typical humanistic therapy session?

Humanistic therapists create a supportive and non-judgmental environment for you to develop
insight. They listen to you speak about your experience and try to understand your point of
view with warmth and acceptance. This unconditional positive regard is an important aspect of
the humanistic approach.

Generally, your therapist helps you to focus more on positive aspects of your experience and
reduce the focus on negatives. They help you become more confident; to believe that you have
the resources available to meet fulfill your needs and become the best person you can. The
focus is on becoming aware of your thoughts and feelings as they are in the here and now; less
on the past or identifying the causes of your thoughts or feelings.

Depending again on the particular type of humanistic therapy you choose, your therapist might
use specific techniques to help you develop insight and change. The ‘empty chair’ technique is
one of the most well-known, where you speak to an empty chair as though you are speaking to
a particular person in your life. This is believed to help identify inner conflicts or unmet needs
and be healing and transformative.

Most common features of group therapy

Self-disclosure: Opportunity to tell group about one's personal problems and concerns

Acceptance and support: Feeling a sense of belongingness and being valued by the other group
members.

o Norm clarification
o Social learning
o Vicarious learning
o Self-understanding

SELF- DISCLOSURE
Self-disclosure is a process of communication by which one person reveals information about
themself to another. The information can be descriptive or evaluative, and can include
thoughts, feelings, aspirations, goals, failures, successes, fears, and dreams, as well as one's
likes, dislikes, and favorites.

CENTRAL CONCEPT
Self-disclosure is a central concept in Social Penetration Theory proposed by Altman and Taylor
(1973). This theory claims that by gradually revealing emotions and experiences and listening to
their reciprocal sharing, people gain a greater understanding of each other and display trust.

DIMENSIONS

Self-disclosure has two dimensions: breadth and depth. Social Penetration Theory uses an
‘onion metaphor’ to describe these dimensions: at first, people often share a lot of information
about certain aspects of themselves (depth), but consider some topics to be ‘off-limit’
(breadth). As they build trust in their partner’s understanding, breadth increases and then
depth also increases. In the beginning, people only disclose superficial details about
themselves, such as their music taste, hobbies and interests, and gradually move to revealing
more intimate details, such as religious and political beliefs, family values and difficult
experiences.

Why Is Self-Disclosure Important?

Research suggests that self-disclosure plays a key role in forming strong relationships. It can
make people feel closer, understand one another better, and cooperate more effectively.
Emotional (rather than factual) disclosures are particularly important for boosting empathy and
building trust. And sharing your feelings with colleagues can allow you to manage your stress
and even to avoid burnout. There may also be times when you need to inform your manager or
HR department about highly personal information – such as a serious medical diagnosis,
financial difficulties, or a family issue. As well as keeping you in line with company policies, this
type of self-disclosure is essential for accessing the support that you need.

Research Examining Self-Disclosure

The concept of self-disclosure has been investigated in numerous studies. For example,
Sprecher and Hendrick (2004) studied heterosexual couples who were dating, and found that as
self-disclosure increased, so did relationship satisfaction. This was supported by another study
of dating couples, conducted by Laurenceau et al. (2005). They asked participants to write daily
diary entries about progress in their relationships and found that self-disclosure and perception
of disclosure in a partner led to greater feelings of intimacy in a couple. The reverse was true as
well – couples who complained about lack of intimacy self-disclosed less often. Has and
Hartford (1998) studied homosexual couples and found that 57% of gay men and women
considered open self-disclosure a main way to maintain close relationships.
Moving from Control and Discipline to Acceptance and Support

Some parents and managers revel in the power they have over their children or employees.
They might view their job as important to keep someone in line, or to discipline them so they
learn right from wrong, or to control their actions so they do what they are supposed to do. The
problem with this approach is that it doesn’t work. Rather than instill confidence, build
capabilities, and encourage someone to participate and learn, it shuts a person down – leaving
them often feeling badly about themselves and sometimes unable to cope.

The desire to exert this sort of discipline or pressure on someone is not because the person
who “needs” the discipline is bad, but because the person meting out the discipline is insecure
and needs to show they are “the boss." It’s a lose-lose situation all around.Unfortunately, many
people who need to have this level of control over another human being aren’t always open to
self-reflection or feedback on their behavior. They will dig their heels in and say they are right
no matter what the evidence might be to the contrary. If you grew up with a parent like this, or
work in an environment with a boss like this, you might wonder if the problem is you. The
constant barrage of orders can leave you feeling like you don’t have a mind of your own and
can’t take steps to emerge as your own person with your capabilities and even your foibles.

Recognize the emotional abuse is not about you.

The person who cannot say a kind word, doesn’t know how to identify your strengths and build
on them, and will not give you the benefit of the doubt and, would prefer to emotionally beat
on you, has a problem within themselves. It seems like you, it feels like it is you, but you could
be anyone on the other end of their wrath. When someone is so insecure as to take a position
of power and wield it over someone, they are acting from a place of weakness and pain.
Gaining control over you might temporarily make them feel in charge, so your first step is to
understand why this is happening. Most people who have been emotionally abused start to
believe it is them. It is not. The person who can maintain their control and stay open to learn is
always the most powerful.

Identify your strengths on your own.

There have been times you have done things very right. You have succeeded, pulled through,
overcome, learned, taught and supported someone else. Everyone has snippets of this
somewhere in their lives. Identify these, however small they might be, in your life and write
them down. When someone is pointing out your weaknesses and your need to change, remind
yourself you are perfectly okay just where you are. Life is a learning journey and even if you
have areas to work on — as we all do — you have areas of strength, too.

Learn to be intellectually curious about the person or people who try to direct and control you.

What makes them so harsh? What are they really trying to accomplish? What drives their
forceful behavior? Sometimes if you can step back and be clinical – which is very difficult to do
– you can look at them as an experiment and their behavior as giving you clues to what’s really
going on. This can allow you to separate yourself from the emotional response and view them
as separate from you.

Seek out other people to support you.

When you are constantly told you are not good enough and you need to do better, or change,
or stop doing what you are doing, it can be isolating and depressing. Find friends, family
members close or extended, co-workers present or past, or even a good therapist to help you
to remember that you are a work in progress, just like everyone else, but you are doing many
things right. When the burden of being the person someone else needs to emotionally direct in
order to feel important becomes too much, you can find solace and support in someone who
sees what’s going on and helps you to step back and be more objective.

Social Support

Social support refers to the psychological and material resources provided by a social network
to help individuals cope with stress. Such social support may come in different forms, and might
involve:

Helping a person with various daily tasks when they are ill or offering financial assistance when
they are in need
Giving advice to a friend when they are facing a difficult situation

Providing caring, empathy, and concern for loved ones in need

Social Integration
Social integration is the actual participation in various social relationships, ranging from
romantic partnerships to friendships.4 This integration involves emotions, intimacy, and a sense
of belonging to different social groups, including being part of a:

 Family
 Partnership
 Religious community
 Social activity

Experts suggest that being integrated into such social relationships confers a protective benefit
against maladaptive behaviors and damaging health consequences.

NORM CLARIFICATION

A criticism of mediation and informal techniques generally is that they lack the symbols of
morality offered by the retributive paradigm. Criminal law is characterized by norms and values
affirmed by society. Since mediation focuses on individuals and the settling of personal conflict,
it fails to symbolically express the violation of societal norms and values. Therefore, it fails to
clarify societal norms and values. Bussman further questions whether individual parties to
mediation can act on their own behalf and as representatives of the community. To the extent
that they do not, communally-held norms and values will be absent from those processes.

Others argue that informal processes foster moral development as the parties to the mediation
work on making things right out of what is/was wrong. The value of the process is in mutual
conflict-resolution. The outcome can sustain and express the moral order, but more
importantly the process itself leads to norm-setting. Restricting the process to what meets the
narrow legal definition of unacceptable conduct and the facts relevant to that discussion
undermines the process' ability to provide opportunities for norm-clarification. Although
restorative justice may offer a less effective means of expressing community outrage about
crime than the retributive paradigm, it may be better suited to furthering moral development.
With its emphasis on mutual problem-solving, restorative justice promotes communication,
negotiation, compromise and responsibility. In other words, while criminal justice expresses in
brood terms many of the universal norms held by a society, restorative processes help the
parties understand and clarify those norms and values. Restorative justice reinforces both
communal traditions and universal norms, while the traditional system through formal
processes tends to exclusively perpetuate the latter. Unlike the traditional system, restorative
justice creates a space where consensus can be reached; which, in turn, promotes community
moral learning. The educative function of law is satisfied by this community moral
development, as parties learn from one another. Community moral development provides the
educating function that proportionality, for a retribution-oriented system, seeks to achieve.
This moral development is increased as representatives of the community are included as
parties.

Parties to the conflict represent the interests of the community to which they belong--defined
as a group of persons linked by a network of common interests. The value of the restorative
process is the moral education achieved through the active participation of the parties in the
absence of formal rules and procedures. For law is not simply a set of rules and procedures,
although many who participate in juvenile and criminal justice will experience it as that. Law is
also an expression of values and norms. It is as those universal norms are tested, reinforced and
adapted in the context of particular conflicts and communal traditions that moral education
occurs; we learn better what it means to do justice.

Albert Bandura - Social Learning Theory

Social learning theory, proposed by Albert Bandura, emphasizes the importance of observing,
modelling, and imitating the behaviors, attitudes, and emotional reactions of others. Social
learning theory considers how both environmental and cognitive factors interact to influence
human learning and behavior. In social learning theory, Albert Bandura (1977) agrees with the
behaviorist learning theories of classical conditioning and operant conditioning. However, he
adds two important ideas: Mediating processes occur between stimuli & responses. Behavior is
learned from the environment through the process of observational learning.

The Theory

It was Albert Bandura‘s intention to explain how children learn in social environments by
observing and then imitating the behaviour of others. In essence, be believed that learning
could not be fully explained simply through reinforcement, but that the presence of others was
also an influence. He noticed that the consequences of an observed behavior often determined
whether or not children adopted the behavior themselves.

Through a series of experiments, he watched children as they observed adults attacking Bobo
Dolls. When hit, the dolls fell over and then bounced back up again. Then children were then let
loose, and imitated the aggressive behavior of the adults. However, when they observed adults
 acting aggressively and then being punished, Bandura noted that the children were less willing
to imitate the aggressive behavior themselves.

Bandura’s 4 Pinciples Of Social Learning

From his research Bandura formulated four principles of social learning.

Attention

We cannot learn if we are not focused on the task. If we see something as being novel or
different in some way, we are more likely to make it the focus of their attention. Social contexts
help to reinforce these perceptions.

Retention

We learn by internalizing information in our memories. We recall that information later when
we are required to respond to a situation that is similar the situation within which we first
learned the information.

Reproduction

We reproduce previously learned information (behavior, skills, knowledge) when required.

However, practice through mental and physical rehearsal often improves our responses.

Motivation

We need to be motivated to do anything. Often that motivation originates from our observation
of someone else being rewarded or punished for something they have done or said. This usually
motivates us later to do, or avoid doing, the same thing.

What is Vicarious Learning?

Vicarious learning is a way of learning that allows individuals to learn from the experience of
others. It is a conscious process that involves sensing, feeling, and empathizing with what
people are doing and taking notes, and evaluating. Rather than direct, hands-on instructions,
vicarious learning is derived from indirect sources such as hearing and seeing. Examples of
indirect sources include: when an individual sees or hears a live situation, watches a video,
listens to a story, reads a book, or imagines a situation.
 Benefits of Vicarious Learning

Implementing a vicarious learning approach in any learning environment is an effective strategy

for expanding personal and professional knowledge. This approach is based on the idea that
individuals pick up new information and learn from seeing others’ experiences g. Learning from
other individuals’ indirect experiences is memorable and fun and, therefore, useful.

The following are the benefits of vicarious learning:

Easy to obtain an experience

Seeing or listening to others’ experiences helps you to understand new experience patterns and
behaviors. It is also relatively fast and easy to obtain information on any new experiences.
Vicarious learning equips you with unique experiences that have either positive or negative
effects. One example, when employees see how others performing something it’s easier to
learn this rather than just doing it on your own.

You can watch first what to do, and then copy steps or movements to achieve the same result
and learn through both experiences: vicarious (observational part) and real practical
experience. Another example, one person can explain and describe his experience to another
person, so a person who is learning will get new knowledge and experience through
visualization. The real-world example most people face is an exam. Students often ask others
how an exam was, what the teacher asked you, what was the subject/topic, and other
questions related to the exam. And most often they get knowledge and experience that might
help them to pass the exam successfully.

It takes risks out of the equation

Vicarious learning helps you gain experience without actual participation, e.g. you can watch a
video of some dangerous situation and learn something from it, without the actual presence.

An opportunity like this allows you to get insights into certain situations without going through
a costly trial and error process.

Improvement in imitation and knowledge retention

 Vicarious learning offers the opportunity to watch and mimic a process and absorb the
information at your own pace. After understanding all the aspects of the task, it is committed to
long-term memory and can be performed when the need arises.

You can learn from the stories

There are millions of books, stories, and bibliographies about people’s lives in the world.

These documents are used to present their past experiences, actions, and real-life situations.

Defining Self-Concept

Social psychologist Roy Baumeister says that self-concept should be understood as a knowledge
structure. People pay attention to themselves, noticing both their internal states and responses
and their external behavior. Through such self-awareness, people collect information about
themselves. Self-concept is built from this information and continues to develop as people
expand their ideas about who they are.

Early research on self-concept suffered from the idea that self-concept is a single, stable,
unitary conception of the self. More recently, however, scholars have recognized it as a
dynamic, active structure that is impacted by both the individual’s motivations and the social
situation.

Carl Rogers’ Components of Self-Concept

Carl Rogers, one of the founders of humanistic psychology, suggested that self-concept includes
three components:

Self-Image

Self image is the way we see ourselves. Self-image includes what we know about ourselves
physically (e.g. brown hair, blue eyes, tall), our social roles (e.g. wife, brother, gardener), and
our personality traits (e.g. outgoing, serious, kind). Self-image doesn’t always match reality.
Some individuals hold an inflated perception of one or more of their characteristics. These
inflated perceptions may be positive or negative, and an individual may have a more positive
view of certain aspects of the self and a more negative view of others.
Self-Esteem

Self-esteem is the value we place upon ourselves. Individual levels of self-esteem are
dependent on the way we evaluate ourselves. Those evaluations incorporate our personal
comparisons to others as well as others’ responses to us.

When we compare ourselves to others and find that we are better at something than others
and/or that people respond favorably to what we do, our self-esteem in that area grows. On
the other hand, when we compare ourselves to others and find we’re not as successful in a
given area and/or people respond negatively to what we do, our self-esteem decreases. We can
have high self-esteem in some areas ("I am a good student") while simultaneously having
negative self-esteem in others ("I am not well-liked").

Ideal Self

The ideal self is the self we would like to be. There’s often a difference between one’s selfimage
and one's ideal self. This incongruity can negatively impact one’s self-esteem.

According to Carl Rogers, self-image and ideal self can be congruent or incongruent.
Congruence between the self-image and ideal self means that there is a fair amount of overlap
between the two. While it is difficult, if not impossible, to achieve perfect congruence, greater
congruence will enable self-actualization. Incongruence between the self-image and ideal self
means there’s a discrepancy between one’s self and one’s experiences, leading to internal
confusion (or cognitive dissonance) that prevents self-actualization.

Development of Self-Concept

Self-concept begins to develop in early childhood. This process continues throughout the
lifespan. However, it is between early childhood and adolescence that self-concept experiences
the most growth. By age 2, children begin to differentiate themselves from others. By the ages
of 3 and 4, children understand that they are separate and unique selves. At this stage, a child's
self-image is largely descriptive, based mostly on physical characteristics or concrete details.
Yet, children increasingly pay attention to their capabilities, and by about 6 years old, children
can communicate what they want and need. They are also starting to define themselves in
terms of social groups.

Between the ages of 7 and 11, children begin to make social comparisons and consider how
they’re perceived by others. At this stage, children’s descriptions of themselves become more
abstract. They begin to describe themselves in terms of abilities and not just concrete details,
and they realize that their characteristics exist on a continuum. For example, a child at this
stage will begin to see himself as more athletic than some and less athletic than others, rather
than simply athletic or not athletic. At this point, the ideal self and self-image start to develop.

Adolescence is a key period for self-concept. The self-concept established during adolescence is
usually the basis for the self-concept for the remainder of one’s life. During the adolescent
years, people experiment with different roles, personas, and selves. For adolescents,
selfconcept is influenced by success in areas they value and the responses of others valued to
them. Success and approval can contribute to greater self-esteem and a stronger self-concept
into adulthood.

8: Cognitive Behavioral interactions:

 Cognitive behavioural intervention :

Cognitive behavioural intervention is based on the belief that behavior is mediated
by cognitive processes. Learners are taught to examine their own thoughts and emotions,
recognize when negative thoughts and emotions are escalating in intensity, and then use
strategies to change their thinking and behaviour.

 Cognitive Behavioral Interventions (CBI) is an evidence-based treatment Which helps

offenders understand the thoughts and feelings which influence behaviours. CBI is
focused on helping offenders deal with a specific problem as identified by an assessment.
During the course of treatment, offenders learn how to identify and change destructive or
disturbing thought patterns which have a negative influence on behavior. CBI is an
overarching entity with pathways to treatment inclusive of the Integrated Substance Use
Disorder Treatment (ISUDT) and Life Skills programs managed under the authority of
the Division of Rehabilitative Programs.

 Offenders are placed into one of three program types based upon their clinical assessed
need or medical referral: CBI-Intensive Outpatient, CBI-Outpatient, or CBI-Life skills.

 CBI curriculum focuses on a goal-oriented treatment that takes a hands-on, practical

approach to problem solving that transforms thinking patterns and behaviours. CBI
modalities are offered in the following areas:

o Treatment Readiness
o S Parenting
 o Disorder (SUD)
o Anger Management
o Victim Impact

 Cognitive behavioral intervention (CBI) is a process by which patients learn to

become experts of their own behavior. Through CBI, patients learn to examine
their thoughts, recognize when negative thoughts are increasing, and then apply a
number of strategies to alter those negative thoughts and emotions.
The theory behind CBI is that if people can learn to better understand their thoughts and
emotions, then they can also alter them through a host off strategies or exercises. The
ultimate goal of CBI is to teach patients how to change undesirable emotions, such as
anxiety and anger, that result in maladaptive or destructive behaviours.

CBI strategies, all of which are focused on increasing positive behaviours,

 How does CBI look like?
The strategies of CBI are designed to be simple, straightforward, and actionable. Through CBI,
patients are taught to break down their feelings and emotions into easily identifiable parts. Doing
so enables them to better understand when they need to begin applying CBI strategies.
Some of the exercises/techniques used in CBI include:

 Cognitive restructuring: Involves helping patients better understand and track their
negative thinking patterns that lead to negative responses and then devise alternative
responses.

 Activity scheduling: Involves encouraging patients to gradually engage in

behaviours they would normally avoid due to anxiety, fear, etc. The behavior
analyst would help the patient schedule these behaviour’s throughout the week,
reducing undesirable or inappropriate behaviours, and promoting self-control.

 slowly at first and then increasing in frequency.

 Mindful meditation: Involves helping patients eliminate negative thoughts by

connecting in the moment through meditation.
 Problem solving: Involves helping patients become active participants in finding
solutions to their problems; focuses on implementing problem-solving strategies
to regain control of their lives.
 Graded Exposure: Involves repeatedly introducing something that is feared to
gradually reduce anxiety and fear.
 Successive Approximation: Involves helping patients break down overwhelming
or daunting goals into easily manageable steps.
  How CBI Used?
CBI is always actionable, goal-oriented, and engaging. The patient and behavior therapist work
together to:

 Identify the problem

 Define the specifics of the problem (how it occurs, when it occurs, etc.)
 Develop a plan for solving the problem
 Evaluate different strategies for implementing the plan
 Discuss the consequences of implementing the plan and discussing alternative plans
 Agree on a course of action

A behavior therapist may use CBI on a patient who is plagued with excessive worry. Using
cognitive restructuring, the behavior analyst would help the patient identify the thoughts that lead
to worry and then help her replace those thoughts with more grounded, positive thoughts, which
in turn would lessen her anxiety.
Or, the behavior analyst may implement the graded exposure strategy to help the patient achieve
the goal of grocery shopping, which she always avoided out of fear. Through graded exposure,
the patient would accomplish smaller goals that would eventually lead to completing a shopping
trip:

 Day 1: Drive to the shopping centre.

 Day 2: Drive to the shopping canter and park.
 Day 3: Drive to the shopping centre, park, and walk to the store entrance.
 Day 4: Drive to the shopping centre, park, and walk into the store.
 Day 5: Drive to the shopping centre, park, walk into the store, and walk through the store.
 Day 6: Drive to the shopping centre, park, walk into the store, and walk through the store
with a shopping cart.
 Day 7: Drive to the shopping centre, park, walk into the store, and put one item into the
shopping cart.
 Day 8: Drive to the shopping centre, park, walk into the store, put one item into the
shopping cart, and purchase that item.

 When is CBI used?

CBI has been used for decades on children, adolescents, and adults. Just some of the conditions
CBI is used to treat include depression, anxiety, post-traumatic stress disorder, obsessive-
compulsive disorders, eating disorders, and substance
Beh avior Therapy
techniques:

1-Introduction

The roots of behavioural therapy go back to the work of Ivan P. Pavlov (1849–1936) and his
principles of respondent conditioning. He discovered that the salivation response of dogs to the
sight of food could be induced by a neutral stimulus (such as ringing a bell) which had
accompanied the sight of food with sufficient frequency.

Another contribution was by Edward L. Thorndike (1874–1949) and his law of effect. This states
an action with beneficial consequences (effect) for the actor is more likely to be repeated. John
B. Watson (1878–1958) stated that the true subject of psychology is observable behaviour, and
developed the psychological theory of stimulus and response. This consists of experimentally-
established laws of observable responses triggered in living creatures by environmental stimuli.
His work launched the psychological school of behaviourism.B. F. Skinner (1904–1990) took the
behaviourist theory further, adding the principles of operant conditioning, an addition to
respondent conditioning which made use of Thorndike’s law of effect. Operant conditioning is
the influence of the consequences of behaviour on the subsequent frequency of that behaviour.
Skinner used the principles discovered in the laboratory to modify human behaviour, thus
making a major contribution to the development of behavioural therapy.

2- Principle of Behaviour Therapy:

Behaviorism conceptualize psychological disorders as the result of maladaptive learning, as

people are born tabula rasa (a blank slate). They do not assume that sets of symptoms reflect
single underlying causes.
Behavioral therapies (also called behavior modification) are based on the theories of classical
and operant conditioning.  The premise is that all behavior is learned; faulty learning (i.e.
conditioning) is the cause of abnormal behavior. Therefore the individual has to learn the correct
or acceptable behavior. 
An important feature of behavioral therapy is its focus on current problems and behavior, and on
attempts to remove behavior the patient finds troublesome. This contrasts greatly with
psychodynamic therapy (re: Freud), where the focus is much more on trying to uncover
unresolved conflicts from childhood (i.e. the cause of abnormal behavior).
3. Therapy

The purpose of behavioural therapy is to modify human behaviour, defined as what people do,
think, feel and say.

4.Behavioural diagnosis

Assessing somebody’s (e.g. a patient’s) behaviour involves the following considerations:

 Behavioural description concerns only the person’s observable actions and avoids the
use of abstract terms. For example, instead of saying, “Angela is anxious”, we say,
“Angela is sweating, her hand is trembling, her heart is beating intensely,” etc.
 Behaviour can be measured in dimensions: frequency, duration, intensity and latency.
For example, Angela suffers anxiety with a score of 5 on the anxiety scale for two hours
every day, and her anxiety occurs as soon as she goes out into the street.
  The person who makes the observations of a patient’s behaviour may be the therapist,
the patient or a relative.
 Behaviour has an effect on the physical or social environment. Sometimes the effect is
obvious: if we switch on the radio, we hear music (physical effect); if we call our friend,
he comes (social effect); we repeat a telephone number to ourselves so as to remember it
(effect on ourselves). Sometimes, however, the effects on the environment are not
obvious, but behaviour always has an effect on the physical, social or internal
environment even if we are not always conscious of these effects.
 Behaviour follows laws. Environmental and internal events systematically influence its
occurrence. The basic principles of learning determine the functional connection
between behaviour and environmental events. Realizing the environmental events
causing behaviour enables us to change the events and thus change our behaviour. For
example, if a patient starts shouting at the doctor and the doctor fulfils her wishes, she
will always shout at the doctor when she wants something.
 Behaviour may be visible or concealed (private). Behavioural therapy mostly aims to
change visible behaviours. A visible behaviour is one that another person can observe.
Some behaviours are concealed, however, and so not observable to another person:
cognitions (thoughts, expectations, figments of the imagination), feelings, physiological
responses (muscle tension, heart rhythm, blood pressure, breathing rate ). Changing
behaviour consists of two stages:
 Analysis and modification.
Analysing behaviour means identifying the functional relationship between environmental events
and behaviour so as to understand why the person acted as he or she did. Modifying behaviour
involves working out and applying interventions resulting in changes to the patient’s behaviour.
Its characteristics are:

 Focus on behaviour. Behaviour modification applies to behaviours and not personality

traits. When a person suffers from agoraphobia, what we attempt to change is not the
condition but the behaviours associated with agoraphobia: avoidance behaviour, its
rewarding effects, heightened vegetative response in the phobic situation, etc.
– Behavioural excess is undesirable behaviour which the person wants to decrease in frequency,
duration or intensity, such as bingeing or smoking.

– Behavioural deficit is a behaviour which the person wants to increase in frequency, duration or
intensity, such as exercise, healthy lifestyle or meeting people.

 Emphasis on current environmental events.

 Putting diagnostic labels on behaviours has little place in behavioural therapy. A label
may seem to imply a cause of behaviour, and this is erroneous in the behavioural view. It
is not the condition of agoraphobia that causes the behaviour but the environmental
reinforcers.
  Behaviour modification interventions require careful planning.
 Measuring behavioural change helps to check the effectiveness of the intervention and
permanence of the change.
 Past events as the causes of behaviour are of less interest than direct environmental
effects .
5. The process of behavioural therapy

1.Identifying the patient’s problem

Patients usually come with problems on several levels. The aim of the behaviour therapist is to
narrow the patient’s problems to a well-defined behaviour on which the work of therapy can
start. This has several benefits

 The patient can more easily concentrate on a task.

 Concentrating on one problem enables relatively quick achievement, motivating the
patient to solve other problems.
 The problems are usually interrelated, so that solving one problem behaviour can bring
about a change in another area. Treating one problem at a time is therefore efficient even
in the long term.
2. Formulating the initial goals of therapy and selecting the target behaviour to be modified

The therapist helps to select a clear, measurable and realistic goal. Such a goal could be to
increase the frequency of a deficient adaptive behaviour or to reduce the frequency of an
excessive or harmful behaviour. The treatment will be more effective in making a harmful
behaviour less frequent if at the same time it works to increase the frequency of an adaptive
behaviour. The four minimum criteria for choosing a target behaviour are that it be

1. well defined,

2. clearly formulated,

3. measurable in frequency, duration, intensity and number of consequences,

4. adaptive. Background: what situations does the target behaviour occur in?

5.Consequences: what are the short and long-term consequences of the target behaviour?

3.Planning interventions to modify the maintenance conditions

We look for the maintainers which exercise the greatest effect on behaviour and can most
effectively be modified. The therapist plans the interventions together with the patient, and
ensures that the patient knows

1. the point of the intervention,

2. what it involves,

3. exactly what the patient must do,

4. how long it will take for the therapy to take effect.

Behaviour therapy techniques:

Systematic Desensitisation – Systematic desensitisation was developed by Joseph Wolfe and was
designed for clients with phobias. This treatment follows a process of “counterconditioning”
meaning the association between the stimulus and the anxiety is weakened through the use of
relaxation techniques, anxiety hierarchies and desensitisation.

Exposure Therapies – Exposure therapies are designed to expose the client to feared situations
similar to that of systematic desensitisation (Corey, 2005). The therapies included are in vivo
desensitisation and flooding. In vivo desensitisation involves the client being exposed to real life
anxiety provoking situations.
The exposure is brief to begin with and eventually the client is exposed for longer periods of time
to the fearful situation. As with systematic desensitisation, the client is taught relaxation
techniques to cope with the anxiety produced by the situation. The example of the client with a
fear of spiders will be used to demonstrate in vivo desensitisation.

To begin with the client would be shown a spider in a container on the other side of the room for
one minute. This would gradually increase in time as well as the client getting closer to the
spider until eventually the client is able to be sitting near the spider for a prolonged period.

Flooding – Flooding involves the client being exposed to the actual or imagined fearful situation
for a prolonged period of time. The example of the client with the spider fear would be that the
client would be exposed to the spider or the thought of a spider for a prolonged period of time
and uses relaxation techniques to cope.

There may be ethical issues in using these techniques with certain fears or traumatic events and
the client should be provided with information on the techniques before utilising them so he or
she understands the process.

Aversion Therapy – The most controversial of the behavioural treatments, aversion therapy is
used by therapists as a last resort to an aversive behaviour. This treatment involves pairing the
aversive behaviour (such as drinking alcohol) with a stimulus with an undesirable response (such
as a medication that induces vomiting when taken with alcohol).
This is designed to reduce the targeted behaviour (drinking alcohol) even when the stimulus with
the undesirable response is not taken (medication).

Modelling – Modelling is used as a treatment that involves improving interpersonal skills such as
communication and how to act in a social setting. Techniques involved in modelling are live
modelling, symbolic modelling, role-playing, participant modelling and covert modelling.

Live modelling involves the client watching a “model” such as the counsellor perform a specific
behaviour, the client then copies this behaviour. Symbolic modelling involves the client
watching a behaviour indirectly such as a video. Role-playing is where the counsellor role-plays
a behaviour with the client in order for the client to practice the behaviour.

Participant modelling involves the counsellor modelling the behaviour and then getting the client
to practice the behaviour while the counsellor performs the behaviour. Covert modelling is where
the client cannot watch someone perform the behaviour but instead the counsellor gets the client
to imagine a model performing the behaviour

6.The role of the behavioural therapist

A good therapeutic relationship is a necessary but not sufficient condition for success in
behavioural therapy. It is by implementing behaviour therapeutic techniques that the therapy
seeks to change the patient’s behaviour, and the nature of the therapeutic relationship has a
supporting role. The therapist transfers expertise to the patient, and they work together in
planning behavioural change. Treatment of young children and people with severe learning
difficulties can be effective even without understanding the principles of behavioural therapy.
Behavioural therapy often takes place at the locations of the problem behaviour: public transport,
lifts, dog pens, etc. Behavioural therapists often take part in role plays to show the new
behaviour to be learned by the patient. A behavioural therapy session consists firstly of
discussing the homework and practising the behaviour modification method. Then, using
appropriate expertise, the therapist helps to identify the factors obstructing behaviour
modification. Another function is to provide a model when trying out new behaviours. The
therapist’s job is to encourage the patient and, when doing exposure therapy together, to lend
support to the patient through a reassuring and encouraging presence.

7. Evaluating the success of the treatment plan

The effectiveness of behavioural therapy is assessed by four main criteria:

1.The clinical significance of change:

 Change that meets the norms of the target behaviour.

 The target behaviour attains the generally-accepted level of adaptive and acceptable
Behaviour
 The change causes an improvement in the patient’s quality of life.
2. Generalization of the change and its adoption in other situations:

The patient uses the target behaviour learned in the therapeutic situation and employs it
elsewhere, or it becomes generalized to antecedents and consequences beyond those practised.
The permanence of change

8.Acceptability of the therapy:

The pleasantness of the intervention determines the extent it will be adopted in the patient’s life
and how much time and effort it requires from the patient. A high level of acceptability reduces
the likelihood of premature termination and enhances cooperation, thus increasing effectiveness.
Therapy ends when it has successfully modified the behaviour, unless there is a need to work on
another target behaviour. If it does not succeed, the therapist reconceptualises the target
behaviour.

9.Modalities of behavioural therapy

The behavioural therapy assessment takes place on an individual basis, but practising social skills
can be done effectively in couples, families and groups. There are also effective self-help and e-
therapeutic behavioural-therapy programmes.

10.Evidence for the effectiveness of behavioural therapy

Behavioural therapy has been found effective in the following areas of application.

o Common behavioural problems among individuals suffering from development

disorders.
o Treating forms of behaviour found in a large proportion of mental disorders (behaviour
disorders, and anxiety, depression and personality disorders).
o Developing self-support skills, social skills, cooperation skills and working skills for
people with chronic mental disorders, and for modifying aggressive and psychotic
behaviour.
o Patient education, such as teaching diabetes patients how to administer insulin.
o In rehabilitation, when lost skills have to be retaught after traumatic injuries or stroke, or
in the treatment chronic pain syndrome.
o Learning and reinforcing health promotion behaviours and skills for disease prevention.

Summary

The principles of learning psychology (respondent and operant conditioning and model learning)
form the basis of modifying behaviour. Behavioural therapy makes use of behaviour
modification techniques to change a target behaviour. Its scope of indication is very wide, and
extends to any medical and educational area requiring some kind of behavioural change.
Behavioural therapy interventions usually consist of only a few (1–10) sessions and often take
place in the field rather than the therapist’s office. The therapist’s tasks are functional analysis of
the problem behaviour, planning the behaviour modification protocol, teaching the model, and
tracking the change.

Anxiety reduction techniques:

Relax. You deserve it, it's good for you, and it takes less time than you think. You don't need a
spa weekend or a retreat. Each of these stress-relieving tips can get you from OMG to om innless
than 15 minutes.

Meditate:

Few minutes of practice per day can help ease anxiety. “Research suggests that daily meditation
may alter the brain’s neural pathways, making you more resilient to stress,” says psychologist
Robbie Miller Hartman, PhD, a Chicago health and wellness coach. It’s simple. Sit up straight
with both feet on the floor. Close your eyes. Focus your attention on reciting – out loud or
silently – a positive mantra such as “I feel at peace” or “I love myself.” Place one hand on your
belly to sync the mantra with your breaths. Let any distracting thoughts float by like clouds.

2.Breathe deeply:

Take a 5-minute break and focus on your breathing. Sit up straight, eyes closed, with a hand on
your belly. Slowly inhale through your nose, feeling the breath start in your abdomen and work
its way to the top of your head. Reverse the process as you exhale through your mouth. Deep
breathing counters the effects of stress by slowing the heart rate and lowering blood pressure,”
psychologist Judith Tustin, PhD, says. She’s a certified life coach in Rome, GA.

3.Be present slow down:

“Take 5 minutes and focus on only one behavior with awareness,” Turin says. Notice how the air
feels on your face when you’re walking and how your feet feel hitting the ground. Enjoy the
texture and taste of each bite of food. When you spend time in the moment and focus on your
senses, you should feel less tense.

4 Reach out:

Your social network is one of your best tools for handling stress. Talk to others –preferably face
to face, or at least on the phone. Share what’s going on. You can get a fresh perspective while
keeping your connection strong
5 Tune to in your body:

Mentally scan your body to get a sense of how stress affects it each day. Lie on your back, or sit
with your feet on the floor. Start at your toes and work your way up to your scalp, noticing how
your body feels. Simply be aware of places you feel tight or loose without trying to change
anything,” Tustin says. For 1 to 2 minutes, imagine each deep breath flowing to that body part.
Repeat this process as you move your focus up your body, paying close attention to sensations
you feel in each body parts

6 Decompress:

Place a warm heat wrap around your neck and shoulders for 10 minutes. Close your eyes and
relax your face, neck, upper chest, and back muscles. Remove the wrap, and use a tennis ball or
foam roller to massage away tension. “Place the ball between your back and the wall. Lean into
the ball, and hold gentle pressure for up to 15 seconds. Then move the ball to another spot, and
apply pressure,” says Cathy Benninger, a nurse practitioner and assistant professor at The Ohio
State University Werner Medical Centre in Columbus.

7 Laugh out loud:

A good belly laugh doesn’t just lighten the load mentally. It lowers cortisol, your body’s stress
hormone, and boosts brain chemicals called endorphins, which help your mood. Lighten up by
tuning in to your favourite sitcom or video, reading the comics, or chatting with someone who
makes you smile.

8 Crank up the tunes :

Research shows that listening to soothing music can lower blood pressure, heart rate, and
anxiety. “Create a playlist of songs or nature sounds (the ocean, a bubbling brook, birds
chirping), and allow your mind to focus on the different melodies, instruments, or singers in the
piece,” Benninger says. You also can blow off steam by rocking out to more upbeat tunes – or
singing at the top of your lungs!

9 Get moving:

You don’t have to run in order to get a runner’s high. All forms of exercise, including yoga and
walking, can ease depression and anxiety by helping the brain release feel-good chemicals and
by giving your body a chance to practice dealing with stress. You can go for a quick walk around
the block, take the stairs up and down a few flights, or do some stretching exercises like head
rolls and shoulder shrugs.
10 Be grateful :

Keep a gratitude journal or several (one by your bed, one in your purse, and one at work) to help
you remember all the things that are good in your life. “Being grateful for your blessings cancels
out negative thoughts and worries,” says Joni Emerging, a wellness coach in Greenville, NC. Use
these journals to savour good experiences like a child’s smile, a sunshine-filled day, and good
health. Don’t forget to celebrate accomplishments like mastering a new task at work or a new
hobby. When you start feeling stressed, spend a few minutes looking through your notes to
remind yourself what really matters.

Operant conditioning:

Operant conditioning, sometimes referred to as instrumental conditioning, is a method of

learning that employs rewards and punishments for behavior. Through operant conditioning, an
association is made between a behavior and a consequence (whether negative or positive) for that
behavior.

For example, when lab rats press a lever when a green light is on, they receive a food pellet as a
reward. When they press the lever when a red light is on, they receive a mild electric shock. As a
result, they learn to press the lever when the green light is on and avoid the red light.

The History of Operant Conditioning:

Operant conditioning was first described by behaviourist B.F. Skinner, which is why you may
occasionally hear it referred to as Skinnerian conditioning.1 As a behaviourist, Skinner believed
that it was not really necessary to look at internal thoughts and motivations in order to explain
behavior. Instead, he suggested, we should look only at the external, observable causes of human
behavior.

Through the first part of the 20th century, behaviorism became a major force within psychology.
The ideas of John B. Watson dominated this school of thought early on. Watson focused on the
principles of classical conditioning, once famously suggesting that he could take any person
regardless of their background and train them to be anything he chose.

Early behaviourists focused their interests on associative learning. Skinner was more interested
in how the consequences of people's actions influenced their behavior.

Operant conditioning relies on a fairly simple premise: Actions that are followed by
reinforcement will be strengthened and more likely to occur again in the future. If you tell a
funny story in class and everybody laughs, you will probably be more likely to tell that story
again in the future.
If you raise your hand to ask a question and your teacher praises your polite behavior, you will
be more likely to raise your hand the next time you have a question or comment. Because the
behavior was followed by reinforcement, or a desirable outcome, the preceding action is
strengthened.

Conversely, actions that result in punishment or undesirable consequences will be weakened and
less likely to occur again in the future. If you tell the same story again in another class but
nobody laughs this time, you will be less likely to repeat the story again in the future. If you
shout out an answer in class and your teacher scolds you, then you might be less likely to
interrupt the class again.

Types of Behaviors

Skinner distinguished between two different types of behaviors

 Respondent behaviors are those that occur automatically and reflexively, such as pulling
your hand back from a hot stove or jerking your leg when the doctor taps on your knee.
You don't have to learn these behaviors. They simply occur automatically and
involuntarily.
 Operant behaviors, on the other hand, are those under our conscious control. Some may
occur spontaneously and others purposely, but it is the consequences of these actions that
then influence whether or not they occur again in the future. Our actions on the
environment and the consequences of that action make up an important part of
the learning process.

While classical conditioning could account for respondent behavior, Skinner realized that it
could not account for a great deal of learning. Instead, Skinner suggested that operant
conditioning held far greater importance.

Skinner invented different devices during his boyhood and he put these skills to work during his
studies on operant conditioning. He created a device known as an operant conditioning chamber,
often referred to today as a Skinner box. The chamber could hold a small animal, such as a rat or
pigeon. The box also contained a bar or key that the animal could press in order to receive a
reward.

In order to track responses, Skinner also developed a device known as a cumulative recorder.
The device recorded responses as an upward movement of a line so that response rates could be
read by looking at the slope of the line.

Components of Operant Conditioning:

There are several key concepts in operant conditioning.

Reinforcement in Operant Conditioning

Reinforcement is any event that strengthens or increases the behavior it follows. There are two
kinds of reinforcers. In both of these cases of reinforcement, the behavior increases.

1. Positive reinforcers are favorable events or outcomes that are presented after the
behavior. In positive reinforcement situations, a response or behavior is strengthened by
the addition of praise or a direct reward. If you do a good job at work and your manager
gives you a bonus, that bonus is a positive reinforcer.
2. Negative reinforcers involve the removal of an unfavorable events or outcomes after the
display of a behavior. In these situations, a response is strengthened by the removal of
something considered unpleasant. For example, if your child starts to scream in the
middle of a restaurant, but stops once you hand them a treat, your action led to the
removal of the unpleasant condition, negatively reinforcing your behavior (not your
child's).
Punishment in Operant Conditioning:

Punishment is the presentation of an adverse event or outcome that causes a decrease in the
behavior it follows. There are two kinds of punishment. In both of these cases, the
behavior decreases.

1. Positive punishment, sometimes referred to as punishment by application, presents an

unfavourable event or outcome in order to weaken the response it follows. Spanking for
misbehavior is an example of punishment by application.

2. Negative punishment, also known as punishment by removal, occurs when a favorable

event or outcome is removed after a behavior occurs. Taking away a child's video game
following misbehaviour is an example of negative punishment.
Examples of operant conditioning:

We can find examples of operant conditioning at work all around us. Consider the case of
children completing homework to earn a reward from a parent or teacher, or employees finishing
projects to receive praise or promotions. More examples of operant conditioning in action
include:

 After performing in a community theatre play, you receive applause from the audience.
This acts as a positive reinforcer, inspiring you to try out for more performance roles.
  A professor tells students that if they have perfect attendance all semester, then they do
not have to take the final comprehensive exam. By removing an unpleasant stimulus (the
final test), students are negatively reinforced to attend class regularly.
Problem solving skills :

Traditional talk-therapy is devoted to discussing problems in detail, usually by focusing on their

antecedents in the distant past. This approach can be helpful for improving insight into the past,
but significant research shows it is not sufficient in making changes in the present. Problem-
solving therapy for depression in Los Angeles turns this traditional approach upside down:
Keeping the focus on the present, it’s much easier to make significant and lasting changes.
Problem-solving therapy is an action-oriented treatment aimed at helping people cope with
present challenges and teaching them skills to solve their own problems. It’s been found to be
helpful with reducing negative emotion states such as depression and anxiety, as well as
improving relationships, and obtaining difficult long-term goals. There’s even research showing
problem-solving therapy improves immune function and can be helpful during cancer treatment.

Problem solving treatment in Los Angeles is centred on the goal of teaching each person
the skills that are required for them to be more active in their lives and the decisions they need to
make to reach their goals. This type of treatment allows the client to use their influence to take
an active role in their decision-making processes. When used with a specific problem, the client
is able to use and apply the skills to other problems that they come across in life and to face
challenges in an independent way. Through repetition, confidence can be built for more agency
in every aspect of life.

Problem solving group therapy in Los Angeles focuses on the following components:

Agenda Item #1:

What is problem solving?

Agenda Item #2:

Develop a positive problem orientation.

Agenda Item #3:

Identify your client’s problems.

Agenda Item #4:

Brainstorm solutions.
Agenda Item #5:

Choose a solution.

Agenda Item#6:

develop coping thoughts.

What Is Problem Solving?

Problem-solving therapy was originally developed by D’Zurilla and Gold fried (1971), and
although it has been revised over the years,, the core process and principles have remained
essentially the same.

OVERVIEW OF THE PROBLEM-SOLVING PROCESS

Problem solving involves both an attitude that problems can be solved or at least improved, and
a process based on a specific set of skills. The process of problem solving has four distinct steps.
For many clients, you will want to go through the whole problem-solving process step by
step; however, for some clients, you may use only parts of the process. Below are the four
steps.

1. Identify the problem and set realistic goals.

2. Generate new solutions. This is often called brainstorming.

3. Evaluate the different solutions and decide which one to try.

4. Try one of the solutions: evaluate the consequences and decide whether the problem is solved
or whether you need to continue to problem solve

THE THEORY BEHIND PROBLEM SOLVING

The theory underlying problem solving is that clients’ emotional distress is due to poor
problem-solving skills which lead to dysfunctional ways of coping. Poor problem solving leads
to more problems, which in turn are poorly solved. Clients quickly find themselves dealing with
multiple problems and it becomes a vicious negative cycle. Problem solving stops the vicious
cycle and helps clients find better ways to cope.

Problem-Solving Theory Good Problem Solving = Better Coping = Improved Life and Better
Mood When you help your client find solutions to his problems, you are also saying, “You
matter, I care about your welfare, and together we can figure out how to address your
problems.” These are very powerful messages. For many clients the whole problem-solving
process feels new and empowering.

Individuals with a positive problem orientation see difficulties as normal life challenges and try
to find solutions to their problems. Individuals with a negative problem orientation tend to either
avoid their problems or approach them with an impulsive or careless problem-solving style.

Clearly, a positive orientation is better, but how do you help your clients develop one? Modeling
optimism and having faith in your client’s ability to problem solve is one of the most
effective ways to help your client develop a positive problem orientation. Here are some
phrases I use to encourage a positive problem-solving orientation:

• Let’s see if we can find a way to solve your problems.

• I wonder if there is something you can do that will help this situation.

• I know it feels hopeless, but I wonder if we could find a way to make things even a little better
for you.

• I’m not sure we’ve looked at all of the possible solutions. Would you be willing to try to
problem solve?

Such relatively simple interventions communicate that you believe in your client’s ability to find
a better solution, and that together you will be able to improve his life. You will also find that as
your client uses the problem-solving process successfully, his problem orientation will start to
automatically become more positive.

Let’s see how Shan’s therapist helps him develop a more positive problem orientation. Shan was
telling his therapist about his poor relationship with his boss, who gave him a poor work
evaluation.

Shan: I feel so depressed when I think of going to work. I used to like going to work, but I feel
so awkward and anxious with my boss since I received the poor work evaluation. I think we have
a terrible relationship. It just seems hopeless to do anything about it. I hear you’re thinking that it
is hopeless to try and change your relationship with your boss, is that right?

His therapist has identified a negative problem orientation: It is hopeless to try and change
the relationship with his boss. Therapist: Definitely, what can I do? I am wondering if you
would be willing to put aside the thought that it is hopeless to do anything and see if we could
find some better ways to cope with the situation, to help you feel better.
Shan: What do you mean?

Therapist: Well, when you tell yourself that it’s hopeless, how does that affect your behavior?

Shan: I just avoid him, and keep doing the same old thing.

Therapist: does avoiding help?

Shan: No, in fact, it is getting worse. I just feel more and more awkward.

Therapist : I am wondering if you would be willing to work with me to see if we could

problem solve some different ways of coping with your boss that might improve the situation.

Shan :I would be willing, but I don’t think we will find any.

Therapist: You may be right, but I want to see if we put our heads together if we could find a
better way for you to cope.

Notice how the therapist acknowledges that Shan’s might be right but asks him to try
problem solving. The therapist is Modeling a calm, thoughtful approach to the problem.

Agenda Item #3:

Identify Your Client’s Problems Before your client can solve his problems, he needs to
identify them. Defining the problem and setting realistic goals are the first components of a
problem-solving skill set. Problems can be a one-time event, such as a divorce or a serious
health problem. They can be situations that happen fairly regularly, such as disciplining a child
who refuses to do chores, fighting over finances with a partner, or dealing with constant daily
difficulties such as a long commute to work, chronic pain, or loneliness. Sometimes it is very
clear that a client needs help problem solving. A client may start therapy saying, “I don’t know
what to do about X,” or one of your client’s thoughts may be, What else can I do? Or I don’t
know how to handle this. In other cases, it can be more difficult to identify your client’s need to
problem solve. Clients with a negative problem orientation often avoid their problems but feel
anxious. It is helpful to teach a client who tends to avoid that if he is anxious, he should ask
himself whether there is a problem he is not looking at.

PROBLEM DEFINITION

The more specific and concrete the problem, the easier it will be to think of helpful solutions. For
example, “I don’t communicate well with my partner” is a very vague problem and hard to
start solving, whereas, “My partner and I don’t agree on how to discipline our children” is
much clearer and an easier problem to address. Raoul had started his therapy session by saying
in a low voice, “I feel so depressed when I think of going to work. I used to like work, but I
feel so awkward and anxious with my boss since I received the poor work evaluation. I
think we have a terrible relationship. It just seems hopeless to do anything about it.” At this
point, Shan’s problem is not very specific. His therapist uses the questions under “Questions to
Help Define the Problem” in the Problem-Solving Worksheet to help Raoul become more
specific and concrete. Sometimes you may want to use all of the questions, and sometimes only a
few may be relevant. You can find Shan’s answers in the below.

Questions to help define the problem:

1. Shan’s boss handed him his poor work evaluation, but his boss has never talked to him about
it.

2. tension between Shan’s and his boss

3. Presently, almost no casual contact with his boss

4. Boss never asks for his opinion, never chat together, boss often ignores him who is involved?
Where does the problem happen? When does the problem happen? The problem involves Shan
and his boss; it happens at work during the day. Why is this problem difficult for your client?

Shan’s answers :

1. feels ashamed about the poor work evaluation.

2. Shan’s feels judged, hates work, has trouble concentrating, and thinks everyone knows about
his problems with his boss.

3. Shan does not know what to do about the poor evaluation. What does your client currently do
to handle the problem? Is your client avoiding or acting in an impulsive manner? Shan’s tries to
avoid interacting with his boss. In the past, Shan used to drop by his boss’s office in the morning
for a five-minute chat; he used to ask his boss for his opinion on a project. Now Shan goes
straight to his desk. What does your client hope will happen as a consequence of his/her
behavior? Shan hopes “things will go back to normal.

SETTING GOALS

Both Shan and his therapist now have a much better sense of his problems. The next step is
setting goals. Goals need to be specific and concrete, realistic, and possible to accomplish. You
also want to articulate both short-term and long-term goals. For example, a short-term goal might
be becoming more assertive with your boss and asking for an extra two weeks of holiday time
during the Christmas season, but that might conflict with the long-term goal of being seen as a
team player and getting a promotion. Often after your client answers the questions to help define
the problem on the Problem-Solving Worksheet, his goals are clear.

If your client’s goals are not clear, the following questions may be helpful.

• How would your client like the situation to change or be different?

• How would your client like other people in the situation to change or be different?

• How would your client like to change or be different?

When Shan’s therapist asked how he would like the situation to change, Shan responded that he
wanted “everything to go back to normal.” This is not a very specific goal. His therapist then
asked how he would like his boss to change and if there were ways that he would like to
change. Shan explained that generally he wanted to have a good relationship with his boss again.
He wanted his boss to joke with him and talk to him easily. He also wanted to be
comfortable asking his boss for his opinion about projects. As shan articulated his goals, he
realized that he also wanted to understand his negative work evaluation better. When a client
slows down and examines his problems and goals, he often realizes aspects of the problem that
are important to him that he had not focused on before.

You can also identify goals by paying attention to what your client hopes will happen as a
consequence of his current behavior. As ineffective as their behavior may be, most people act in
a way that they hope will make their situation better. In Shan’s case his therapist could have
asked, “What are you hoping will happen when you avoid your boss?” Once you have identified
your client’s goals and explored what he hopes will happen as a consequence of his behavior, it
is important to examine the actual consequences of his behavior. Unless your client understands
that his behavior is ineffective, he will not be motivated to problem solve. In Shan’s case, he
hoped that by avoiding his boss everything would “go back to normal.” When his therapist
asked Shan what were the consequences of avoiding, Shan quietly acknowledged that it was
not helping, and was in fact making things worse.

EXPLAIN PROBLEM SOLVING TO YOUR CLIENT

Once you have established that what your client is currently doing is not working, it is a good
time to explain problem solving. You want to give your client an overview of the process and in
still hope that problem solving can help.

Agenda Item #4:

Brainstorm Solutions

The next phase involves helping your client find new solutions for his problem. Finding new
solutions to problems is difficult—if clients knew of better ways to manage their lives, they
would already be doing things differently. Problem solving involves asking your client to step
outside of his usual mind-set. You want to engage in a process called brainstorming, which
means coming up with as many varied solutions as you can. When brainstorming, it is helpful to
follow these three principles:

• Quantity: Try to generate as many solutions as possible.

• Variety: The greater the variety of solutions, the more chances that you will have a good idea.

• Deferred Judgment: Write down all solutions that come to mind, no matter how silly,
irrelevant, or outrageous.

Include a few far-fetched and seemingly impossible solutions; they can help your client think
outside the box. Sometimes combining a far-fetched solution with another solution can lead to
a good solution.

FINDING NEW SOLUTIONS

It can be very hard not to jump in and solve your client’s problems. Ideally, brainstorming new
solutions is a collaboration between therapist and client. The more your client can discover his
own solutions, the more empowering the process will be. I start with asking my client for his
suggestions. Often, all I need to say is, “I wonder if there are some other ways of handling this
situation.” If I think of a specific strategy that my client did not mention, I usually say, “I have an
idea that might help. Let’s see if you like it.” If my client likes the suggestion, I encourage him to
apply the strategy to his specific problem. For many of your clients, the process of stopping and
consciously looking at their problems will naturally lead to thinking of new, effective solutions.
However, some clients find it hard to think of alternative ways of handling their problems. Try
the “Questions to Help Find New Solutions” list on the Problem-Solving Worksheet.

Below are the questions.

• What are some different ways you could handle your problem?

• What would you suggest to someone who had this problem?

• What do you think a friend or someone who cared for you would suggest if he or she knew
that you had this problem?
• How have you handled similar situations in the past?

• How do you overcome obstacles in other areas of your life?

• Is there any positive information that you are ignoring that could be helpful in solving this
problem?

• Is there an aspect of the problem that cannot be changed and that you have to accept?

Agenda Item #5:

Choose a Solution For many clients, calmly evaluating different solutions is a new and
empowering experience. You want your client to evaluate the likelihood that the different
solutions will either resolve or improve the problem.

teach your clients to ask themselves the following questions from the Problem-Solving
Worksheet so that they can make an informed choice.

• What are the short-term and long-term benefits of each solution?

• What are the short-term and long-term drawbacks of each solution? If my client finds the
concept of benefits and drawbacks too abstract, I ask, “If you use this solution, what are
some of the good things that might happen and what are some of the bad things that might
happen?” We make a chart and write down the answers; clients can then take the chart home
and spend more time thinking about the decision. Below are some of the questions that I ask to
encourage clients to think about the short-term and long-term consequences of each solution.

• How will this solution affect me, other people, and the situation?

• How will I feel after implementing this solution?

• Is this solution consistent with my values? Will implementing this solution be important
to me in terms of acting on my values?

• Does the solution generally feel doable?

• Does the solution feel doable in terms of time and effort required?

MAKE A PLAN

Next, your client needs to develop a plan for implementing the solution he chose. Make sure
that the plan is specific and concrete. It is helpful to write out what your client will actually
do. Next, specify a first step to the plan and a time and date when your client will try the first
step to the solution. You also want to check if there are any obstacles to the plan, and try to
address them. Raoul decided he wanted to try dropping by his boss’s office the next day.

PREPARE FOR THE WORST

Sometimes your client wants to try a solution where there is a realistic possibility of a
negative outcome. For example, my client Julia decided to disclose to her partner that she had
been sexually abused as a child, even though she knew there was a realistic possibility her
partner would blame her for the abuse. Other clients have raised various difficult issues with
their bosses, partners, and friends, hoping to improve the relationship, but instead the
discussion resulted in increased tension. You want to be sure your client understands the
realistic risk of a negative reaction and is prepared for that should it occur.

USE IMAGERY TO PRACTICE

Rehearsing using imagery is an opportunity to practice the new solution and to check if there are
any obstacles. I ask my client to imagine doing the new solution in his mind. I encourage my
client to close his eyes, and I describe him carrying out the new solution. I ask him to see and
feel himself in the situation, and if the solution involves talking, to hear himself and the other
people. After he has imagined doing the solution once, I ask him to open his eyes and I ask if
there were any obstacles, or if he would like to change anything. We address the obstacles. I
then ask him to imagine doing the new solution two more times and incorporate any changes
he wanted. I ask my client to rate how doable the solution is before and after practicing in his
mind. When Raoul imagined dropping by his boss’s office to chat, he realized it would be
easier if he had a specific question about a file that he wanted to ask. His therapist
incorporated that into the next two imaginal rehearsals.

Clients solutions:

of your client’s new solution as an experiment that will provide additional data, rather than the
one right way to proceed. Often clients prematurely dismiss a solution because the outcome
wasn’t perfect. Results need to be evaluated on a continuum rather than a “perfect or else failure”
yardstick. It is helpful to decide ahead of time how your client will evaluate whether his new
solution is successful.

Agenda Item #6:

Develop Coping Thoughts Once your client has decided how he wants to handle the problem,
and has a plan, it can be useful to develop coping thoughts that help him focus on the task and
manage any negative feelings. Highly critical thoughts about ourselves or others not only make
us feel bad, but also distract us from the present moment, making it harder to handle a stressful
situation. In a coping thought model, you and your client actively develop thoughts that help
your client execute his plan and manage his negative emotions. Coping thoughts tend to be short
and provide directions as to what to do in a specific situation. Here is the general process that use
to develop coping thoughts:

1. Identify the behavior your client wants to accomplish and his plan.

2. Check if your client’s current thoughts are interfering with or sabotaging his plan.

3. Develop coping thoughts.

4. Use imagery to practice your client’s coping thoughts.

What is Social Skills Training (SST)? 

Social Skills Training (SST) refers to a wide range of interventions and instructional methods
used to help an individual understand and improve social skills. Sometimes referred to as social
skills groups, SST is often associated with the fields of applied behavior analysis, special
education, cognitive-behavioral therapy, and relationship-based therapies. A variety of
professionals implement SST, including teachers, behavior analysts, psychologists, therapists,
and autism support professionals. 
What skills can be taught with SST? Social skills training addresses a wide range of social skills.
While there are many different ways to define social skills, in general, SST focuses on the rules
and behaviors that help individuals interact with one another. Some examples of skills targeted in
SST programs include:

● Initiating conversations

● Greetings

● Appropriate eye contact

● How to behave in specific social and community settings

● Understanding emotions and facial expressions

● Gestures and body language

● Assertiveness

● Empathy
SST programs vary significantly based on the age and skill level of participants. Social skills for
toddlers might include fundamental play skills like turn-taking, waiting for others, and eye
contact. Social skills for adolescents and young adults with ASD might consist of expressing
opinions, workplace behavior, and maintaining friendships. One benefit of social skills programs
is that they are fully customizable for each individual’s strengths and needs.

Is SST evidence-based?

According to the National Clearinghouse on Autism Evidence and Practice (NCAPE), social
skills training is an evidence-based method for teaching social skills. To be considered evidence-
based, researchers and provider professionals have published sufficient and quality research
showing that social skills training results in improved outcomes for individuals with ASD.

Why is teaching social skills necessary?

Most therapy programs, including SST, recognize the critical need to address social skills for
individuals with autism. By tackling a wide range of social skills, SST addresses one of the core
symptoms of autism outlined in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5). Multiple studies show that developing social skills in children with autism can
increase appropriate peer interactions, reduce problem behavior, and increase academic
performance.

Different types of Social Skills Training

As mentioned above, there is no one-size-fits-all format for social skills programs. Individuals
with ASD have a wide range of skills, so finding an SST program that fits well for each child is
essential. To describe how SST programs can differ, here are four different types of SST:

Peer Mediated Instruction and Interventions – In peer-mediated instruction and intervention

(PMII), children without an associated diagnosis are trained to be ‘peer mentors’ or ‘peer tutors.’
The peer mentors are then assigned a series of tasks to work with classmates with ASD,
including how to facilitate social and play interactions. PMI programs also structure the physical
environment of a classroom or clinic to promote social interactions.

Social Stories and Scripts – Social stories and scripts are one SST method that involves
describing a particular social concept using written or visual materials. Social stories and scripts
can be customized to capture the strengths and motivations of a specific individual. There is
limited evidence that social stories alone assist children with ASD in learning social skills.
Instead, social stories work best when combined with role-playing, peer-intervention, or
rehearsal models where the individual practices and receives feedback on performance
Video Modeling – One of the most effective social skills training methods involves using video
as a tool to teach social concepts. In video Modeling, the individual watches a video
demonstration of a behavior and then attempts to perform the social skill immediately after.
Videos can be of other children or adults engaging with others, or videos of the individual can be
collected and watched later.

PEERS (UCLA Programmed for the Education and Enrichment of Relational Skills) – involves
weekly, 90-minute group sessions for 3-4 months for children with ASD aged preschool to
young adults. Sessions tackle a variety of different social skills taught through lessons, role-play,
and group activities designed to foster socialization. A parent or caregiver often attends, who
trains to help the learner practice the skills at home and in the community.

9: CBT-Spacific interventions

PANIC DISORDER:

Diagnostically, panic disorder is defined and characterized by the occurrence of panic attacks
that often seem to come “out of the blue.” According to the DSM-5 criteria for panic disorder,
the person must have experienced recurrent, unexpected attacks and must have been
persistently concerned about having another attack or worried about the consequences of
having an attack for at least a month.

Symptoms:

For such an event to qualify as a full-blown panic attack, there must be abrupt onset of at least
4 of 13 symptoms, most of which are physical, although three are cognitive:

Depersonalization (a feeling of being detached from one’s body) or derealization (a feeling that
the external world is strange or unreal).

Fear of dying

Fear of “going crazy” or “losing control”

Severe unexpected attacks

Palpitations of heart

Tingling in hands and foot

Shortness of breath
Trembling

Biological Causal Factors:

Genetic factors:

According to family and twin studies, panic disorder has a moderate heritable component. In a
large twin study, estimated that 33 to 43 percent of the variance in liability to panic disorder
was due to genetic factors. this genetic vulnerability is manifested at a psychological level at
least in part by the important personality trait called neuroticism (which is in turn related to the
temperamental construct of behavioral inhibition).

Panic and the brain:

Abnormal Norepinephrine activity

Amygdala, Hippocampus, Nuclei of hippocampus and central gray matter.

One relatively early prominent theory about the neurobiology of panic attacks implicated the
locus coeruleus in the brain stem and a particular neurotransmitter norepinephrine that is
centrally involved in brain activity in this area. However, today it is recognized that it is
increased activity in the amygdala that plays a more central role in panic attacks than does
activity in the locus coeruleus. The amygdala is a collection of nuclei in front of the
hippocampus in the limbic system of the brain that is critically involved in the emotion of fear.

Biochemical abnormalities:

Two primary neurotransmitter systems are most implicated in panic attacks the noradrenergic
and the serotonergic systems.

The inhibitory neurotransmitter GABA has also been implicated in the anticipatory anxiety that
many people with panic disorder have about experiencing another attack. GABA is known to
inhibit anxiety and has been shown to be abnormally low in certain parts of the cortex in people
with panic disorder.

Psychological Causal Factors:

Comprehensive learning theory of panic disorder:

According to this theory, initial panic attacks become associated with initially neutral internal
(interoceptive) and external (exteroceptive) cues through an interoceptive conditioning (or
exteroceptive conditioning) process

Cognitive theory of Panic disorder:

An earlier cognitive theory of panic disorder proposed that individuals with panic disorder are
hypersensitive to their bodily sensations and are very prone to giving them the direst possible
interpretation. For example, a person who develops panic disorder might notice that his heart is
racing and conclude that he is having a heart attack, or notice that he is dizzy, which may lead
to fainting or to the thought that he may have a brain tumor.

Treatments:

Medications:
Many people with panic disorder (with or without agoraphobia) are prescribed anxiolytics
(antianxiety medications) from the benzodiazepine category such as alprazolam (Xanax) or
clonazepam (Klonopin)

Behavioral and cognitive behavioral treatments:

Behavioral therapy (Interoceptive exposure)

CBT technique (cognitive restructuring techniques)

PCT (Panic Control Treatment)

One kind of integrative cognitive-behavioral treatment for panic disorder panic control treatment
targets both agoraphobic avoidance and panic attacks. There are several aspects to PCT. First,
clients are educated about the nature of anxiety and panic and how the capacity to experience
both is adaptive. A second part of the treatment involves teaching people with panic disorder to
control their breathing. Third, clients are taught about the logical errors that people who have
panic disorders are prone to making and learn to subject their own automatic thoughts to a
logical reanalysis. Finally, they are exposed to feared situations and feared bodily sensations to
build up a tolerance to the discomfort.

ANXIETY DISORDER:

Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of
potential danger ahead. Everyone feels anxious now and then. For example, you may worry
when faced with a problem at work, before taking a test, or before making an important
decision.

Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses
that cause constant and overwhelming anxiety and fear. The excessive anxiety can make you
avoid work, school, family get-togethers, and other social situations that might trigger or
worsen your symptoms.

With treatment, many people with anxiety disorders can manage their feelings. Anxiety
disorders are real, serious medical conditions - just as real and serious as physical disorders
such as heart disease or diabetes. Anxiety disorders are the most common and pervasive
mental disorders.

The term "anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or
worry, and includes generalized anxiety disorder (GAD), panic disorder and panic attacks,
agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.

WHO:

According to the World Health Organization (WHO), 1 in 13 globally suffers from anxiety.
The WHO reports that anxiety disorders are the most common mental disorders worldwide
with specific phobia, major depressive disorder and social phobia being the most common
anxiety disorders.

Example of anxiety disorder:

Sally is a 24-year-old sales associate in a highly prestigious pharmaceutical firm. She

constantly works under a great deal of pressure. She says it's "no big deal." She even believes
she thrives off this stress. However, she recently walked into her local grocery store and began
to sweat. Her heart began to race. She felt like she was losing control. This happened on several
occasions. She became so distressed she decided to order her groceries online to avoid another
repeat episode.

Bill is a 47-year-old hardware store owner. Bill is constantly "worrying" about (what seems to
him) just about everything. Whether he is concerned about his business not doing well. or,
what if that mole on his back is not just a beauty mark? or, how on earth is he ever going to
drive to Michigan all by himself to see his son (even with the brand-new navigation system)? Bill
just cannot seem to "control" his worry.
Kim is a 36-year-old, part-time, freelance web-designer. She is ordinarily calm and low-key. This
is true until she has to go over a bridge, or travel in an airplane. For Kim, she hates places where
she feels she cannot escape. She finds that she will often worry for days or even months in
advance of these situations. As a result, she makes it a habit to avoid these situations at all
costs; or, she "barely gets through them.

PHOBIAS TYPES:

Specific Phobia:
Phobias are excessive fears or anxieties about a specific situation or object that are considered
to be markedly disproportional to the actual threat involved. The feared object or situation
almost always provokes an immediate fear response or anxiety reaction.

The result of the fear or anxiety leads to a number of dysfunctional behaviors aimed at avoiding
the situation or object in question.

The person must display these behaviors as well as the excessive fear for at least six months.

Of course, there are a number of different phobias recognized, the majority of which actually
represent potentially threatening situations or objects, such as snakes, spiders, flying, being in
enclosed spaces, etc. It very rare to see phobic reactions to benign objects or events, such as
phobias directed at things like chairs.

Social Anxiety Disorder (Social Phobia):

Social anxiety disorder is characterized by having an excessive anxiety or fear concerning at
least one social situation where the person will be scrutinized by other people. These situations
can include things like being with unfamiliar people for the first time, being watched when one
is eating, and, of course, actually performing in front of others, such as speaking in public.
Individuals with social anxiety disorder most often feel that they will be humiliated as a result of
these interactions and will typically avoid these situations. If forced to perform, they will
generally do so under extreme duress.

The experience of anxiety in these cases must be well out of proportion to the actual threat
involved in the particular situation and also be markedly excessive when considered in terms of
how most people feel in the same situation. For instance, the majority of people become
anxious when having to give a speech in front of others; however, in order for a diagnosis of
social anxiety disorder to be made in this situation, the individual must display rather extreme
fearful or anxious behaviors as well as a number of dysfunctional behaviors associated with
avoiding or trying to cope with the situation.

Agoraphobia:
Agoraphobia is a condition that was previously most often associated with the development of
panic disorder; however, it has become a standalone diagnosis. Agoraphobia consists of a fear
or extreme anxiety about being in two or more different situations where one believes that
they cannot escape. These situations include:

Being in open spaces.

Being in a crowd.

Being outside of one’s home alone.

Being in some form of public transportation.

Being in some enclosed place, including stores, theaters, etc.

Often, the person experiences symptoms that are very similar to symptoms of a panic attack
when either thinking about or being in the situation.

GENERALIZED ANXIETY DISORDER (GAD):

Introduction:

Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a
number of different things. People with GAD may anticipate disaster and may be overly
concerned about money, health, family, work, or other issues. Individuals with GAD find it
difficult to control their worry. They may worry more than seems warranted about actual
events or may expect the worst even when there is no apparent reason for concern. GAD is
diagnosed when a person finds it difficult to control worry on more days than not for at least six
months and has three or more symptoms (/understandinganxiety/generalized-anxiety-disorder-
gad/symptoms).

This differentiates GAD from worry that may be specific to a set stressor or for a more limited
period of time. GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year.
Women are twice as likely to be affected. The disorder comes on gradually and can begin across
the life cycle, though the risk is highest between childhood and middle age. Although the exact
cause of GAD is unknown, there is evidence that biological factors, family background, and life
experiences, particularly stressful ones, play a role.

Sometimes just the thought of getting through the day produces anxiety. People with GAD
don’t know how to stop the worry cycle and feel it is beyond their control, even though they
usually realize that their anxiety is more intense than the situation warrants. All anxiety
disorders may relate to a difficulty tolerating uncertainty and therefore many people with GAD
try to plan or control situations. Many people believe worry prevents bad things from
happening so they view it is risky to give up worry. At times, people can struggle with physical
symptoms such as stomachaches and headaches. When their anxiety level is mild to moderate
or with treatment (understandinganxiety/generalized-anxiety-disorder-gad/treatment), people
with GAD can function socially, have full and meaningful lives, and be gainfully employed. Many
with GAD may avoid situations because they have the disorder or they may not take advantage
of opportunities due to their worry (social situations, travel, promotions, etc). Some people can
have difficulty carrying out the simplest daily activities when their anxiety is severe.

Diagnostic Criteria According to DSM-5:

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at
least 6 months, about a number of events or activities (such as work or school performance).

The individual finds it difficult to control the worry.

The anxiety and worry are associated with three (or more) of the following six symptoms (with
at least some symptoms having been present for more days than not for the past 6 months); Note:
Only one item is required in children. 1. Restlessness or feeling keyed up or on edge. 2. Being
easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition (e.g., hyperthyroidism).

The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about
having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social
phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from
attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic
stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom
disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in
illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional
disorder).

Diagnostic Features According to DSM-5:

The essential feature of generalized anxiety disorder is excessive anxiety and worry
(apprehensive expectation) about a number of events or activities. The intensity, duration,
or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact
of the anticipated event. The individual finds it difficult to control the worry and to keep
worrisome thoughts from interfering with attention to tasks at hand.

Adults with generalized anxiety disorder often worry about every day, routine life
circumstances, such as possible job responsibilities, health and finances, the health of family
members, misfortune to their children, or minor matters (e.g., doing household chores or
being late for appointments). Children with generalized anxiety disorder tend to worry
excessively about their competence or the quality of their performance. During the course
of the disorder, the focus of worry may shift from one concern to another. Several features
distinguish generalized anxiety disorder from nonpathological anxiety.

First, the worries associated with generalized anxiety disorder are excessive and typically
interfere significantly with psychosocial functioning, whereas the worries of everyday life
are not excessive and are perceived as more manageable and may be put off when more
pressing matters arise. Second, the worries associated with generalized anxiety disorder are
more pervasive, pronounced, and distressing; have longer duration; and frequently occur
without precipitants. The greater the range of life circumstances about which a person
worries (e.g., finances, children's safety, job performance), the more likely his or her
symptoms are to meet criteria for generalized anxiety disorder.

Third, everyday worries are much less likely to be accompanied by physical symptoms (e.g.,
restlessness or feeling keyed up or on edge). Individuals with generalized anxiety disorder
report subjective distress due to constant worry and related impairment in social,
occupational, or other important areas of functioning. The anxiety and worry are
accompanied by at least three of the following additional symptoms: restlessness or feeling
keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank,
irritability, muscle tension, and disturbed sleep, although only one additional symptom is
required in children.

Prevalence:
The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and
2.9% among adults in the general community of the United States. The 12-month
prevalence for the disorder in other countries ranges from 0.4% to 3.6%. The lifetime
morbid risk is 9.0%. Females are twice as likely as males to experience generalized anxiety
disorder. The prevalence of the diagnosis peaks in middle age and declines across the later
years of life. Individuals of European descent tend to experience generalized anxiety
disorder more frequently than do individuals of non-European descent (i.e., Asian, African,
Native American and Pacific Islander). Furthermore, individuals from developed countries
are more likely than individuals from non-developed countries to report that they have
experienced symptoms that meet criteria for generalized anxiety disorder in their lifetime.

Development and Course:

Individuals with generalized anxiety disorder report that they have felt anxious and nervous
all of their lives. The median age at onset for generalized anxiety disorder is 30 years;
however, age at onset is spread over a very broad range. The median age at onset is later
than that for the other anxiety disorders. The symptoms of excessive worry and anxiety may
occur early in life but are then manifested as an anxious temperament.

Onset of the disorder rarely occurs prior to adolescence. The symptoms of generalized
anxiety disorder tend to be chronic and wax and wane across the lifespan, fluctuating
between syndromal and subsyndromal forms of the disorder. Rates of full remission are very
low.

The clinical expression of generalized anxiety disorder is relatively consistent across the
lifespan. The primary difference across age groups is in the content of the individual's worry.
Children and adolescents tend to worry more about school and sporting performance,
whereas older adults report greater concern about the well-being of family or their own
physical heath. Thus, the content of an individual's worry tends to be age appropriate.
Younger adults experience greater severity of symptoms than do older adults.

The earlier in life individuals have symptoms that meet criteria for generalized anxiety
disorder, the more comorbidity they tend to have and the more impaired they are likely to be.
The advent of chronic physical disease can be a potent issue for excessive worry in the
elderly. In the frail elderly, worries about safety—and especially about falling—may limit
activities. In those with early cognitive impairment, what appears to be excessive worry
about, for example, the whereabouts of things is probably better regarded as realistic given
the cognitive impairment.
In children and adolescents with generalized anxiety disorder, the anxieties and worries often
concern the quality of their performance or competence at school or in sporting events, even
when their performance is not being evaluated by others. There may be excessive concerns
about punctuality. They may also worry about catastrophic events, such as earthquakes or
nuclear war. Children with the disorder may be overly conforming, perfectionist, and unsure
of themselves and tend to redo tasks because of excessive dissatisfaction with less-than-
perfect performance. They are typically overzealous in seeking reassurance and approval and
require excessive reassurance about their performance and other things they are worried
about.

Generalized anxiety disorder may be over-diagnosed in children. When this diagnosis is

being considered in children, a thorough evaluation for the presence of other childhood
anxiety disorders and other mental disorders should be done to determine whether the
worries may be better explained by one of these disorders. Separation anxiety disorder, social
anxiety disorder (social phobia), and obsessive-compulsive disorder are often accompanied
by worries that may mimic those described in generalized anxiety disorder. For example, a
child with social anxiety disorder may be concerned about school performance because of
fear of humiliation. Worries about illness may also be better explained by separation anxiety
disorder or obsessive-compulsive disorder.

Risk and Prognostic Factors:

Temperamental:
Behavioral inhibition, negative affectivity (neuroticism), and harm avoidance have been
associated with generalized anxiety disorder.

Environmental:
Although childhood adversities and parental overprotection have been associated with
generalized anxiety disorder, no environmental factors have been identified as specific to
generalized anxiety disorder or necessary or sufficient for making the diagnosis.

Genetic and physiological:

One-third of the risk of experiencing generalized anxiety disorder is genetic, and these
genetic factors overlap with the risk of neuroticism and are shared with other anxiety and
mood disorders, particularly major depressive disorder

Differential Diagnosis:
 Anxiety disorder due to another medical condition:

The diagnosis of anxiety disorder associated with another medical condition should be
assigned if the individual's anxiety and worry are judged, based on history, laboratory
findings, or physical examination, to be a physiological effect of another specific medical
condition (e.g., pheochromocytoma, hyperthyroidism).

Substance/medication-induced anxiety disorder:

A substance/medication-induced anxiety disorder is distinguished from generalized anxiety

disorder by the fact that a substance or medication (e.g., a drug of abuse, exposure to a toxin)
is judged to be etiologically related to the anxiety. For example, severe anxiety that occurs
only in the context of heavy coffee consumption would be diagnosed as caffeine-induced
anxiety disorder.

Social anxiety disorder:

Individuals with social anxiety disorder often have anticipatory anxiety that is focused on
upcoming social situations in which they must perform or be evaluated by others, whereas
individuals with generalized anxiety disorder worry, whether or not they are being evaluated.

Obsessive-compulsive disorder:

Several features distinguish the excessive worry of generalized anxiety disorder from the
obsessional thoughts of obsessive-compulsive disorder. In generalized anxiety disorder the
focus of the worry is about forthcoming problems, and it is the excessiveness of the worry
about future events that is abnormal. In obsessive-compulsive disorder, the obsessions are
inappropriate ideas that take the form of intrusive and unwanted thoughts, urges, or images.

Posttraumatic stress disorder and adjustment disorders:

Anxiety is invariably present in posttraumatic stress disorder. Generalized anxiety disorder is

not diagnosed if the anxiety and worry are better explained by symptoms of posttraumatic
stress disorder. Anxiety may also be present in adjustment disorder, but this residual category
should be used only when the criteria are not met for any other disorder (including
generalized anxiety disorder). Moreover, in adjustment disorders, the anxiety occurs in
response to an identifiable stressor within 3 months of the onset of the stressor and does not
persist for more than 6 months after the termination of the stressor or its consequences.

Depressive, bipolar, and psychotic disorders:

Generalized anxiety/worry is a common associated feature of depressive, bipolar, and
psychotic disorders and should not be diagnosed separately if the excessive worry has
occurred only during the course of these conditions.

Comorbidity:
Individuals whose presentation meets criteria for generalized anxiety disorder are likely to
have met, or currently meet, criteria for other anxiety and unipolar depressive disorders. The
neuroticism or emotional liability that underpins this pattern of comorbidity is associated
with temperamental antecedents and genetic and environmental risk factors shared between
these disorders, although independent pathways are also possible. Comorbidity with
substance use, conduct, psychotic, neurodevelopmental, and neurocognitive disorders is less
common.

Cognitive Behavioral Therapy (CBT) For Anxiety:

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders.
Research has shown it to be effective in the treatment of panic disorder, phobias, social
anxiety disorder, and generalized anxiety disorder, among many other conditions. CBT
addresses negative patterns and distortions in the way we look at the world and ourselves. As
the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.

Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel.
In other words, it’s not the situation you’re in that determines how you feel, but your
perception of the situation.

CBT Interventions for Generalized Anxiety Disorder (GAD):

The treatment of choice for generalized anxiety disorder (GAD) is cognitive behavioral
therapy (CBT). Research has shown CBT is significantly more effective than all other
psychological treatments for generalized anxiety disorder. CBT teaches different ways of
thinking, behaving, and reacting to situations that reduce anxiety and worry.
CBT treatment for GAD can last anywhere between 10 and 20 sessions, with most people
reporting significant symptom reduction after 10 sessions. CBT for GAD typically includes
several of the following CBT interventions.

Relaxation Training:

Teaching people who worry a great deal to relax can be an important part of treatment.
Because people who worry a lot usually have a great deal of muscle tension, it can be hard to
go through any of the other CBT interventions without first learning to relax. Physical
relaxation makes it easier for the mind to relax and let go of worries.

Cognitive Restructuring:

Cognitive restructuring involves examining unhelpful patterns of thinking, and learning new,
more effective ways to think about challenging situations. With generalized anxiety disorder,
cognitive restructuring focuses specifically on negative predictions about the future, and
unhelpful attitudes about one’s ability to cope with difficult situations.

Mindfulness Training:

Mindfulness is simply the art of learning to bring one’s attention to the present moment. This
can be a very important skill for someone whose mind tends to time-travel to worry about the
future.

Systematic Exposure:

Systematic exposure is an intervention that helps people to face their fears and test their
extreme predictions. Usually this involves imagining the worst-case scenario that is the
object of so much worry, and overtime making peace with it such that it no longer triggers
anxiety. Exposure can also involve behavioral experiments, testing what happens when
people act out of line with their worrisome thinking.

Problem-Solving Training:

Because people often feel anxious when crises arise, or are overwhelmed by their obligations,
problem-solving training can be a helpful way to reduce objective stressors. Through
learning skills to effectively manage stress, people can feel at ease even in difficult situations.

Practical Approaches or Interventions:

CBT as treatment for GAD includes the development of a functional analysis, providing
information through psychoeducation, experimentation with new behaviors and emotions
(exposition, relaxation), and a cognitive approach.
Functional Analysis:

Functional analysis makes it possible to specify where, when, with what frequency, with
what intensity, and under what circumstances the anxious response is triggered. It is
performed with the patient and integrates the factors maintaining the difficulties. This
functional analysis is crucial to the smooth running of therapy because it gradually introduces
important notions of psychology. It makes it possible to visualize the mental functioning
of the person, which is already therapeutic in and of itself.

Psychoeducation:

Psychoeducation can easily be the next step. It is generally crucial because it makes it
possible to understand what the future therapeutic tools will be and facilitates the
increase in motivation to change. Patients begin to think in a different way about which
behaviors could be the most useful.

The Emotional and Behavioral Approach:

The emotional and behavioral approach is generally favored. The therapist tries to teach
relaxation in order to instruct how to create positive emotions, not to manage negative
ones. There is a double effect as follows:

(i) the provision of a “psychological tool” to prepare for exposition exercises; relaxation
allows desensitization of anxiogenic situations; and (ii) a balancing of the general mood by
adding “cognitive break times” in thoughts and worries.

The behavioral dimension of CBT is the most important. Patients will be able to expose
themselves to their own emotions and so will be able to learn how to fight maintaining
factors and avoidance behaviors that perpetuate the disorder. The cognitive process that
is sought is habituation. It is the acceptance of thoughts as normal and nonblocking that
initiates cognitive work. An example of mental exposition is the instruction “think the
worst.”

This strategy allows a rapid and effective reduction in avoidance. Exposure to anxiety allows
patients to remain in the presence of images related to their possible concerns (disturbing
images that are usually avoided), in order to encourage emotional habituation. Patients can
learn to tolerate their fears, which will allow them to think less often and less intensely about
their worries.

The Cognitive Approach:

The cognitive approach often begins with a self-observation that patients will carry out
on their own thoughts. Can the thoughts be spotted? Can patients isolate them from
emotions? The aim of the cognitive work is to help patients take a step back from their
automatic thoughts and to be disjointed from those worries. The third wave in CBT
(mindfulness) adopted this principle to create its therapeutic program with a different
form. In a second step, therapy tends to modify the content of thoughts to reach a more
objective evaluation of situations.

The goal is to struggle against cognitive biases, such as overgeneralization or maximization

of danger. A second evaluation of situations is possible by looking for objective indicators
that allow relativizing. It is also possible to evaluate the consequences of worry and to
understand subtle avoidance. The therapist tries to help patients to fully treat anxious
anticipations, make them aware of danger patterns, and propose alternatives to catastrophism
(overestimation of risk).

Conclusion:
CBT as a treatment for GAD has been established as an excellent way to change pathological
worries into normal worries. A lot of research must still be done to improve therapeutic tools
that facilitate distancing oneself from anxious thoughts. Current science has achieved a good
understanding of psychological mechanisms in GAD, and further research in transdiagnostic
fields may provide new approaches to GAD treatment.

THEORIES & THERAPIES:

Our knowledge about successful treatment for anxiety disorders continues to advance at an
accelerated rate. This progress is due to the hundreds of past and ongoing research studies.
Many of these studies are dedicated to testing and developing effective treatment
approaches. In fact, anxiety disorders are one of the most treatable psychiatric conditions;
meaning, treatment is highly likely to produce a positive outcome (i.e., a reduction in
symptoms). Not only do we know what does work, but research has also identified what
does not work. Results consistently indicate that cognitive behavioral therapy (CBT) is the
most effective treatment strategy for treating a variety of conditions including anxiety
disorders (Deacon & Abramowitz, 2004; Norton & Price, 2007; Stewart & Chamblass, 2009).

Other therapeutic strategies tend to be ineffective for anxiety disorders. This includes
supportive psychotherapy (often thought of as "talk therapy") and psychodynamic/
psychoanalytic therapy. These approaches may be helpful for some issues. However,
research has not demonstrated effectiveness for the symptoms of anxiety.
 In psychology books Cognitive-behavioral therapy (CBT) differs from earlier therapies. Its
primary focus is the present "here and now," rather than on the past. It assumes that
people in recovery can make progress without having to unearth the past in order to
determine the origins of their symptoms. Instead, progress occurs by recognizing,
understanding, and changing dysfunctional thoughts, emotions, and behaviors. It is
assumed and accepted that these dysfunctional patterns have been "learned" and
reinforced during prior life experiences (the past). Nonetheless, the patterns can be
"unlearned" in the present by creating new experiences.

Here, in this assignment, we will discuss specific treatment techniques for each anxiety
disorder (Treatment for Anxiety Disorders Section).

Paired Association and Classical Conditioning:

Anxiety Disorders:
We now introduce a particular type of learning called classical conditioning. Specifically, we
will discuss the concept of paired association and its relationship to the development of
anxiety disorders. However, classical conditioning is discussed in more detail in the section
on Behavioral Learning Theories and Associated Therapies. Classical conditioning can be
applied to understand many learning experiences. For our purposes, we will limit our
discussion to classical conditioning as it relates to how anxiety disorders may be learned.

Upset woman anxiety can be learned through a type of learning called classical
conditioning. This occurs via a process called paired association. Paired association refers to
the pairing of anxiety symptoms with a neutral stimulus. A neutral stimulus can be any
situation, event, or object that is does not ordinarily elicit a fearful response. In the previous
example, the grocery store would be a neutral stimulus. By pairing the anxiety symptoms of
an uncured panic attack, with the neutral stimulus (the grocery story), anxiety now becomes
associated with the neutral stimulus. Thus, a previously neutral stimulus (the grocery store)
now evokes an anxious response. Because of this pairing, the "neutral" stimulus, which was
previously considered non-threatening, subsequently becomes capable of automatically
causing a fearful response. This is because the person has "learned" it was a cue to a threat.
The person has learned to be anxious via classical conditioning. Once this learning has
occurred, the previously neutral stimulus (the grocery store) becomes a conditioned
stimulus that spontaneously evokes a fear response. The grocery store now prompts a cued
panic attack due to the learning that took place. In other words, the grocery store now
serves as a cue for danger.
 In the example above, the grocery store became a conditioned stimulus that subsequently
prompted a cued panic attack. However, cued panic attacks may also begin to form when
people equate the physical symptoms of anxiety, with danger. It is important to remember
the symptoms themselves are not actually dangerous. Recall that a person sees initial
uncured panic attacks as "coming out of the blue" without any observable trigger. Because
the person experienced a significant amount of distress and discomfort when the attack first
occurred, the symptoms themselves now represent a threat. The symptoms become a cue
capable of triggering anxiety whenever the symptoms begin. In other words, the individual
has now "learned" to fear the symptoms themselves, as well as any situation that might
trigger the symptoms. This creates a vicious cycle: Anxiety triggers a panic attack. The
symptoms signal more danger. This is turn creates more anxiety and so on.

In order to illustrate these concepts, let's return to the previous example of the woman in
the grocery store who has an uncured, panic attack. Recall, these initial panic attacks
frequently occur in response to some life stressor. However, these stressors are often
outside her immediate awareness. Perhaps this woman is experiencing some overall
financial stress, maybe she recently lost their job. The need to shop for groceries triggers
this stress. While shopping for groceries she suddenly feels short of breath and dizzy. She
senses their heart is racing. These sensations are alarming because they just seem to "come
out of the blue" for no apparent reason. Because of the learning that occurs through
classical conditioning, future experiences of a racing heart with dizziness, and a grocery
store, may each elicit an anxious response.

In addition to setting the stage for future, cued panic attacks, classical conditioning (via
paired association) is often associated with the development of phobias. Phobias are highly
anxious responses to specific objects or situations. For example, imagine a child is happily
playing with her neighbor's dog. However, while playing, the child accidentally pulls on the
dog's tail a little too hard. As a result, the dog begins to bark and growl at her. At this point,
the reaction from the dog may startle the young child. She might experience some form of
distress. If this type of experience with a dog were repeated several times, the child would
come to associate dogs with her distress. As such, she may now wish to avoid all dogs, at all
cost. Because she avoids all dogs, the child has no chance to experience dogs that do not
bark or growl. Because she lacks any experience with kinder and gentler dogs, she has no
information to refute her belief that all dogs are dangerous. Thus, her fear is maintained. As
we will see in the next section, while paired association plays a role in the development of
anxiety disorders, avoidance plays a key role in maintaining those disorders.

Cognitive Therapy:
Cognitive therapy rests upon the assumption that problematic behaviors result from core
schemas (beliefs). It is assumed these core schemas developed in response to prior life
(past) experiences. Therapy participants are taught that these core schemas are not
necessarily "The Truth." Instead, they merely reflect beliefs that were developed over time.
The goal of treatment is to identify, challenge, and replace these automatic thoughts and
dysfunctional thinking patterns. Ultimately, the goal is to create a new core schema to
replace the old one that is at the root of dysfunctional thoughts.

Businessman thinking, these automatic, dysfunctional thinking patterns are called cognitive
distortions. Many cognitive distortions can result in anxious feelings. Here are some
examples of cognitive distortions:

(1) All or nothing thinking: Anxiety can result when things are seen in terms of extremes and
absolutes because most things have shades of grey. The thought, "If I am not perfect, then I
am worthless" can create anxiety because it is impossible to be perfectly perfect.

(2) Fortune telling: Anxiety can result when attempting to predict the future without
adequate information by assuming a negative outcome is certain to occur, such as "I'll never
find a boyfriend." A rather extreme version of fortune telling is often called
"catastrophizing." This occurs when the predicted future event is expected to result in some
catastrophe.

(3) Emotional reasoning: Anxiety may develop when feelings are considered an accurate and
factual reflection of a situation. For instance, the thought "My feelings are hurt, therefore
you must have done something unkind to me" could easily provoke an argument full of false
accusations. Clearly, there are many reasons someone's feelings may get hurt that may
have nothing to do with actions of another person. In fact, according to cognitive theory, it
is the thoughts about the actions of the other person that cause the hurt feelings.
Afterwards, when logic is applied (feelings do not depict facts), the person may feel guilty
and anxious about their unfounded accusations and hostile behavior.

4) Should statements: Anxiety is often created when evaluating and judging oneself based
upon what one "should" be doing, or should be feeling. For example, "I should be clean and
tidy at all times" can result in a standard that is impossible to achieve.

In addition to examining and evaluating cognitive distortions, cognitive therapy also assists
participants to examine and challenge their appraisal of an anxiety-provoking event. This
emphasis evolves from cognitive appraisal theory. This theory posits that our emotions are
determined, in part, by our cognitive appraisal (subjective evaluation) of a particular
circumstance. Thus, in any given situation a person must judge whether the situation poses
any danger or not. Then the person evaluates whether their resources for coping with the
situation are adequate. Clearly, the more dangerous a situation is judged, the more likely it
is for coping resources to be inadequate. For more information about cognitive appraisal
theory, refer to the Biopsychosocial Model.

Our core beliefs are strongly influenced by our cognitive appraisals. For instance, suppose
Jamal grew up in an environment where his parents did not adequately protect him. He may
develop a core belief, "The world is an unsafe place." Such a belief will likely cause Jamal to
over-estimate the threat of a particular situation. In addition, if Jamal's parents angrily and
impatiently corrected his mistakes, Jamal might develop another core schema, "I am
inadequate and incompetent." This core belief might lead Jamal to underestimate his ability
to cope with challenging situations. Indeed, the overestimation of threat, and
underestimation of coping resources are commonly associated with anxiety disorders. For
instance, when someone is having a panic attack, they may think, "Oh my gosh, I'm having a
heart attack. I'm going to die!" Such an appraisal is likely to increase anxiety. Next, the
person may become aware there is no one available to help them. Thus, they appraise their
resources for coping with this circumstance to be inadequate. This appraisal will further
increase anxiety. Cognitive therapy would assist such a person to more accurately appraise
their symptoms and to improve their coping skills. This will reduce the escalation of anxious
symptoms. Specific applications of this approach are discussed in the Treatment of Anxiety
Disorders Section.

Cognitive therapy is collaboration between the therapist and therapy participant. The
therapist helps participants to systematically examine and challenge the dysfunctional
thoughts and beliefs contributing to anxiety symptoms. Different anxiety disorders are
associated with certain characteristic types of dysfunctional thoughts. For example, people
with Social Phobia might believe that they are inadequate and inferior to others.

There are many specific techniques to challenge dysfunctional beliefs. First, the therapy
participant must identify their internal mental dialogue. This will reveal dysfunctional
beliefs. This is accomplished by asking therapy participants to record their internal dialog on
homework sheets. Many people are unaware that their mind is constantly evaluating and
judging their surrounding environment, and themselves. Next, the therapist guides the
participant to challenge their dysfunctional thoughts by questioning their validity. The
therapist and participant work to develop statements that are more accurate. When these
dysfunctional thoughts occur again, the therapy participant consciously replaces the
dysfunctional thought with a more accurate statement or belief. For example, Jamal might
learn to replace the belief, "I am a failure" with the thought, "I may have failed in the past,
but when I try my best, I often succeed." Cognitive therapy research has demonstrated that
when these dysfunctional thoughts are corrected, people feel better and their behavior
improves as well.

Cognitive therapy emphasizes the element of choice. This emphasis extends to the therapy
itself. The emphasis on choice is particularly important for anxiety disorder treatment. You
may recall that one of the psychological variables that increase anxiety is the lack of
perceived control. Therefore, a therapy participant would be asked to reframe the thought,
"I must do these therapy exercises because my therapist says I should." to "I choose to
recover from this disorder. Therefore, I choose to do these exercises." This slight shift in
perspective is very important. It empowers therapy participants to develop the willingness
to participate in some of the more uncomfortable behavioral exercises such as exposure
and response prevention.

Cognitive therapy has many applications. Oftentimes, people can benefit from this approach
in less than 10 sessions. Cognitive therapy is an evidenced-based treatment. This means
there are numerous studies to support its effectiveness. Studies have even demonstrated
that cognitive therapy can be as effective as anti-depressant medications for treating
depression (Derubeis et al., 2005). In fact, cognitive therapy significantly reduces relapse
rates when added to medication treatment (Bockting, et al., 2005). Cognitive therapy for
anxiety disorders is similarly effective (Abramowitz, Franklin, & Foa, 2002; Franklin, Foa, &
Kozak, 1998)

OPERANT CONDITIONING:

B.F. Skinner was one of the most prominent psychologists of the last century. He is credited
with the discovery of operant conditioning. Skinner attended Harvard University. His goal
was to study animal behavior in a scientific manner. He conducted many famous
experiments during his lifetime. These experiments demonstrated that behavior was
influenced not only by what occurred before it (as in classical conditioning, but also by what
occurred afterward. Skinner believed that human beings (and animals) learn a behavior
through a system of rewards and punishments. These rewards and punishment occur
naturally in the external environment. When psychologists use the word "environment,"
they are referring to all the external events that are going on around a person. Thus, my
boss smiling at me is an external event and part of my environment. In contrast, my
thoughts and ideas about my boss smiling at me are internal events. These internal
thoughts, called cognitions, are not considered part of my environment. It was not until
much later that it was discovered these cognitions also influence behavior. This subsequent
recognition resulted in the inclusion of the "cognitive" portion of the cognitive-behavioral
theory.

dice with reward written on its Skinner's focus on behavior and the environment was quite
unique at the time. Prior to Skinner's work, the newly emerging field of psychology was
heavily influenced by Freudian theory. According to Freud, psychopathology was a function
of "unconscious processes," "intra-psychic conflicts," and childhood fantasies. Because
these Freudian concepts cannot be observed nor measured, they were not suitable for
scientific study. Skinner, and many other behaviorists of his era, believed psychology should
be limited to the study of things that can be measured. Otherwise, psychology could not
advance as a legitimate science. This is because science can only study things that can be
measured. Thus, the focus shifted to studying observable and measurable events; namely,
behavior and the environment itself.

Skinner demonstrated that by manipulating the rewards and punishments in the

environment, a behavior can be learned (and unlearned). In behavioral terms, a
reinforcement (reward) refers to anything that causes a behavior to increase. In contrast, a
punishment is something that causes a behavior to decrease. If the environment rewards a
behavior, that behavior is reinforced. This increases the likelihood that a person will repeat
the same behavior in the future. Conversely, if the environment punishes a particular
behavior, this decreases the likelihood the behavior will be repeated. To illustrate, let's
imagine you smile every time you pass by your boss at work. Your boss responds by smiling
back at you, and greets you with a warm and hearty, "Hello!" This interaction leads to
pleasant emotions. These pleasant emotions serve as an environmental reward. Since the
response from your boss was rewarding by producing pleasant emotions, it was positively
reinforcing. Therefore, it is likely that you will continue to smile at her each morning
because smiling was reinforced by your environment.

Skinner's work resulted in many practical applications. These applications ranged from
teaching effective parenting skills to improving employee productivity and satisfaction in
the workplace. Because of Skinner and other influential researchers of his era, today's
cognitive-behavioral psychologists have systematic methods available to help people
change problematic behaviors. This is accomplished by evaluating and altering the
environmental influences that reward or punish a person's behavior.
Let's use an example to illustrate these concepts. Suppose a family wants their child's
temper tantrums to stop. So, they ask a behavioral psychologist to help them. First, the
psychologist will observe the child and his family in their natural environment. This is often
called a behavioral evaluation. The purpose of the behavioral evaluation is to identify, and
to understand, the environmental factors that may be reinforcing the tantrum. The
evaluation will record when, where, and with whom, the tantrum occurred. In other words,
the evaluation assesses the circumstances in which the tantrum occurred. These are
considered the antecedents to the tantrum. Antecedents are the things that happened
before the tantrum occurred. For example, do the tantrums occur more frequently in the
evenings, when the mother is busy cooking dinner, and unable to give the child her
undivided attention?

The behavioral evaluation will also record of the consequences of the tantrum to identify
the environmental factors that may be reinforcing the tantrum. The consequences are the
things that happened after the tantrum. When the child begins to cry, does the mother stop
her dinner preparation, and give the child her attention, thereby unwittingly rewarding the
tantrum? After identifying all of these important environmental variables, the psychologist
would coach the parents to alter the environment so as not to reward the tantrum. This
might involve asking the family to simply ignore the tantrum whenever it occurs. This would
serve to stop rewarding the tantrum. Likewise, they may be encouraged to reward the child
when the tantrum stops. The psychologist may also coach them to provide the child
attention for positive behavior during meal preparation. Perhaps finding the child could be
included in the meal preparation in some small way. When the tantrum is no longer
reinforced by the mother's attention, it will gradually fade away. In behavioral terms, this is
called extinction.

Operant Conditioning and Avoidance Learning:

The principles of operant conditioning have taught us to recognize how certain coping
techniques can reward, and therefore continue anxiety disorders. Two similar coping
strategies for dealing with anxiety symptoms are called avoidance and escape. For more
information about coping strategies, please review this section.

woman avoiding something as the name implies, avoidance refers to behaviors that attempt
to prevent exposure to a fear-provoking stimulus. Escape means to quickly exit a fear-
provoking situation. These coping strategies are considered maladaptive because they
ultimately serve to maintain the disorder and decrease functioning. Operant conditioning
enables us to understand the powerful impact of these two coping strategies. Both coping
strategies are highly reinforcing because they remove or diminish the unpleasant
symptoms. Unfortunately, they do nothing to prevent the symptoms from re-occurring
again and again in the future.

In 1947, O. Hobart Mowrer proposed his two-factor theory of avoidance learning to explain
the development and maintenance of phobias. Mowrer's two-factor theory combined the
learning principles of classical and operant conditioning. Based upon the principles of
classical conditioning, it was assumed that phobias develop as a result of a paired
association between a neutral stimulus and feared stimulus. However, classical learning
theory could not explain the continuation of avoidance and escape behaviors. These
behaviors often led to further distress and interference in a person's life such as: 1) the
avoidance of pleasurable activities; 2) the inability to engage in daily activities and
responsibilities; and 3) the inability to maintain interpersonal relationships.

The second stage of Mowrer's model attempted to explain why people felt so compelled to
avoid anxiety-provoking stimuli; or failing that, escape from the stimuli. The answer comes
from Skinner's theory of operant conditioning and the environmental rewards produced by
these coping strategies. Mowrer proposed that the avoidance of (or escape from) anxiety-
provoking stimuli resulted in the removal of unpleasant emotions. Thus, avoidance becomes
a reward and reinforces (increases) the behavior of avoidance. For example, an individual
with social anxiety will feel a significant decrease in anxiety once s/he decides to avoid
attending a large social event. This avoidance results in the removal of the unpleasant
anxiety symptoms thereby reinforcing avoidance behavior. As such, it becomes the person's
preferred method of coping with future social events. Similarly, suppose this same person
attempted to go to a party, despite his/her reservations, and experienced a panic attack
while there. If this person immediately exited the party, the panic will subside, and the
behavior of escape will be rewarded by the swift reduction in panic symptoms. Avoidance
and escape are called negative reinforcement. The removal of unpleasant symptoms
(negative) leads to an increase in that behavior (reinforcement).

The therapeutic implication of operant conditioning and its relationship to avoidance

learning was extremely important. When maladaptive copying strategies that serve to
maintain an anxiety disorder are discontinued, these maladaptive behaviors become
extinct. The research has demonstrated this to be correct. This understanding formed the
foundation for effective treatments.

Cognitive-Behavioral Therapy:
The marriage of cognitive therapy and behavioral therapy has been a significant change in
psychology. Each approach has somewhat different methods. Nonetheless, they both are
scientific methods that alter thoughts and behaviors interfering with someone's functioning,
and enjoyment of life. It is generally assumed there is a bi-directional causality between
behavior and cognition. This means behavioral change leads to cognitive change, and
cognitive change leads to behavioral change. Thus, nowadays few clinicians rely on a single
approach. Instead, they employ a blend of both cognitive and behavioral techniques. For
example, some therapy participants benefit from a few sessions of cognitive therapy before
jumping into the more challenging, behavioral method of exposure and response
prevention (ERP). By decreasing certain dysfunctional beliefs, the therapy participant can
more readily tolerate the initial discomfort of ERP. Many studies have found that the
combination of these techniques, along with the appropriate medication, can produce the
greatest treatment benefit for many of the anxiety disorders (Franklin & Foa, 2007).

group therapy session as you have already learned, cognitive-behavioral therapy (CBT) is
supported by a large body of research. In an attempt to standardize treatment, the
American Psychological Association (APA) formed a task force. The APA charged the task
force with the responsibility of developing a list of empirically supported treatments for
psychiatric disorders. The APA encouraged the development of treatment protocol
manuals. This would ensure that people received the best possible care using standardized,
efficacious treatment practices. The APA's task force had numerous requirements before a
therapy could be approved as an empirically supported treatment. One such requirement
was stringent, controlled, research studies consisting of standard scientific methods.
Cognitive-behavioral techniques are consistently identified as the most effective type of
treatment for anxiety disorders (Deacon & Abramowitz, 2004; Norton & Price, 2007;
Stewart & Chamblass, 2009).

Hybrid Therapies:

Overtime, the cognitive-behavioral model has been revised and further modified. One
modification was to integrate CBT with other theories. This integration resulted in several
effective hybrids of CBT. These hybrid therapies cannot be considered cognitive-behavioral
therapies (CBT) in the strictest sense. Nonetheless, they rest heavily on the CBT foundation.

Two such therapies have been successfully applied in the treatment of anxiety disorders:
Acceptance and Commitment Therapy (ACT), and Dialectical Behavioral Therapy (DBT). Both
of these therapies have modified the strong emphasis on change that is inherent in
conventional CBT.
Acceptance and Commitment Therapy (ACT):

For those people who are reluctant to enter exposure and response prevention therapy,
there is another approach that has recently attracted a lot of attention. It is called
Acceptance and Commitment Therapy (ACT). ACT is derived from functional contextualism
and relational frame theory. While these concepts are highly abstract and quite complex,
they can be distilled down to one essential feature. ACT recognizes that words (and the
thoughts formed with words) have individual and unique meanings. This unique meaning is
dependent upon the specific person and context in which the learning took place. The
overall message of ACT is that the meaning and importance we assign to our thoughts,
perpetuates our emotional suffering. While ACT is very similar to traditional cognitive-
behavioral therapy (CBT), it differs in that it accepts and embraces dysfunctional thoughts.
Instead of attempting to challenge and correct dysfunctional thoughts (as would
conventional CBT), therapy participants are encouraged to view these thoughts
dispassionately. So instead of attempting to challenge and correct the dysfunctional
thought, "Everyone thinks I'm ugly," the person detaches from the meaning of the thought.
This would become, "I'm simply having a thought that everyone thinks I'm ugly." This shift in
perspective places thoughts in their proper perspective. Thoughts are just that. They do not
represent facts. They have no particular meaning other than the meaning we assign to
them.

Because language allows us to attribute meaning to thoughts, it is possible for us to allow

thoughts to enter our minds without giving them importance. ACT teaches people how to
accept their emotional distress. Simultaneously, they are encouraged to build a meaningful
life that is anchored to their value system, rather than a life that is dictated by their
symptoms. For example, in the case of Social Anxiety Disorder (Social Phobia), therapy
participants might be asked to examine the enormous value they place on the opinions of
other people. They would be asked to consider other values that are important to them.
Having identified other important values, therapy participants commit to actively pursuing a
life that models these values. Therapy participants also learn to tolerate emotional pain
through mindfulness training and meditation exercises. These exercises aim to make people
aware of their thoughts, feelings, images, and memories without judgment or avoidance.
Incorporating ACT into cognitive-behavioral treatment for anxiety disorders may be a
valuable tool to decrease the poor quality of life, high suicide rates, depression, and
immense suffering reported by people with anxiety disorders (Eifert, Forsyth, & Hayes,
2005).
COGNITIVE BEHAVIORAL INTERVENTIONS:

Cognitive behavioral intervention (CBI) is based on the belief that behavior is mediated by
cognitive processes. Learners are taught to examine their own thoughts and emotions,
recognize when negative thoughts and emotions are escalating in intensity, and then use
strategies to change their thinking and behavior. These interventions tend to be used with
learners who display problem behavior related to specific emotions or feelings, such as
anger or anxiety. Cognitive behavioral interventions are often used in conjunction with
other evidence-based practices including social narratives, reinforcement, and parent-
implemented intervention.

Cognitive behavioral intervention (CBI) is a process by which patients learn to become

experts of their own behavior. Through CBI, patients learn to examine their thoughts,
recognize when negative thoughts are increasing, and then apply a number of strategies to
alter those negative thoughts and emotions.
The theory behind CBI is that if people can learn to better understand their thoughts and
emotions, then they can also alter them through a host of strategies or exercises. The
ultimate goal of CBI is to teach patients how to change undesirable emotions, such as
anxiety and anger, that result in maladaptive or destructive behaviors.
CBI strategies, all of which are focused on increasing positive behaviors, reducing
undesirable or inappropriate behaviors, and promoting self-control, include actionable goals
that promote problem-solving, communication, relaxation, and self-awareness.